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For the Period January 1, 2020 - December 31, 2022Submitted October 1, 2019

TEMPLATE AND INSTRUCTIONS

SENIOR CONNECTION CENTER, INC.

PSA: 6

2020-2022 Area Plan Contract Module

Section Item Page

Section C.I.A. Allocation to the Planning and Service Area (PSA) 3

Section C.I.B. OAA Title IIIB Services Expenditures 5

Section C.I.C. Service Units and Costs Projections - Provider Summary 6

Section C.I.E. Service Units and Cost Projections - PSA Summary 32

Section C.I.F.AAA. Areawide Funding Profile 37

Section C.I.F. County Funding Profile 38

Section C.I.G. Areawide Funding Summary 43

Section C.II.A. AAA Administration Budget 44

Section C.II.B. OAA Budget Summary 54

Section C.II.C. Financial and Compliance Audit Schedule 55

Section C.III AAA Monitoring Schedule 56

Section C.IV Contract Providers 57

Section C.V Contract Module Review Checklist 69

Attachments Contract Module Attachments 72

Contract Module Table of Contents

PSA: 6 Original Submission Date: 10/01/19

C.I.A. - Allocation to the Planning and Service Area

OAA FEDERAL FUNDING AAA TITLE TITLE TITLE TRANSFER TITLE TITLE TITLE TOTAL OAACOMPOSITION ADMIN IIIB IIIC1 IIIC2 AMOUNT IIID IIIE NSIP VII Minus VII

Original AllocationFFY 2019-20 $1,012,531.00 $2,771,892.00 $3,549,861.00 $1,782,688.00 $167,680.00 $1,230,648.00 $634,477.00 $21,266.91 $11,149,777.00Revised AllocationFFY 2019-20 $0.00Less (-)Transfer Amount ($1,006,435.00) ($1,006,435.00) ($1,006,435.00)Plus (+)Transfer Amount $387,916.00 $618,519.00 $1,006,435.00 $1,006,435.00Adjusted AmountFFY 2019-20 $1,012,531.00 $3,159,808.00 $2,543,426.00 $2,401,207.00 $167,680.00 $1,230,648.00 $634,477.00 $21,266.91 $11,149,777.00Carry Forward FundsFFY 2018-19 $0.00

TOTAL FUNDS $1,012,531.00 $3,159,808.00 $2,543,426.00 $2,401,207.00 $0.00 $167,680.00 $1,230,648.00 $634,477.00 $21,266.91 $11,149,777.00

Title III B Total Funds include $ 120,868.00 in set aside funds (included in the Title III B column).Disaster Recovery Reserves include $ 5,531.00 $8,296.00 $8,296.00 in set-aside funds (included in IIIB, C1, and C2 columns).

This worksheet documents all funds allocated to the PSA. The “Original Allocation” row contains the continuation budget amount issued in the original contract for the year. The amount on this line does not change. The “Revised Allocation” line is the amount of the allocations after the actual federal grant award for the year is received. It is also where subsequent changes in allocations via contract amendments are reflected.

Less (-) Transfer Amount and Plus (+) Transfer Amount contain transfers between titles. The amounts must be within allowable percentages: B to C or C to B can be no more than 30 percent (i.e., B ↔ [C1+C2]); amounts transferred between C1 and C2 can be no more than 40 percent of the source title (not the combined amount of [C1+C2]. Adjusted Amount is the total after the transfers. Carry Forward Funds must be exact amounts and allocated to the titles in which they were awarded. Total Funds equals the total after all adjustments have been made. Total OAA plus the GR AAA admin will equal the contract amount. State General Revenue Allocations and Supplemental Resource Activities (State, Federal, and Private) should match current contract amounts and the amounts detailed in CIRTS. Transfer Amount sums up transfers recorded in previous four columns.

C.1.A - FEDERAL ALLOCATION TO THE PLANNING AND SERVICE AREA

SFY 2019-20 AMOUNTGR AMOUNTS OF FUNDING

$37,016.00 $349,083.00

$68,071.00 $40,384.00

$5,886,689.00 $61,603.00

$77,955.00 $141,629.00

$845,073.00 $317,773.92

$0.00 $0.00

$2,171,591.00 $467,231.00

$3,648.00

$259,352.00 $125,789.00

$52,577.00

LSP SERVICES

LSP ADMINISTRATION

ADI SERVICES

ADI ADMINISTRATION

HCE SUBSIDY & CASE MANAGEMENT

AAA ADMINISTRATION

CCE ADMINISTRATION

STATE GENERAL REVENUE ALLOCATION TO THE PLANNING AND SERVICE AREA

FUNDING COMPOSITION

STATE GENERAL REVENUE ALLOCATIONS

The State General Revenue Allocations and Supplemental Resource Activities (State, Federal, and Private) below should match current contract amounts.

SUPPLEMENTAL RESOURCE ACTIVITIES (STATE, FEDERAL & PRIVATE)

SOURCE OF FUNDING

EHEAP SERVICES

CCE SERVICES

HCE ADMINISTRATION

EHEAP ADMINISTRATION

EHEAP OUTREACH

MED WAIVER SPECIALIST

SHINE

RELIEF

ADRC (MAC)

OTHERS (LIST BELOW):

MIPPA (SCC PSA-WIDE SERVICE, NOT SUBCONTRACTED)

SMP (SCC PSA-WIDE SERVICE, NOT SUBCONTRACTED)


C.I.B. - OAA TITLE IIIB Services Expenditures

Title IIIB Expenditures

Funds Allocated

% of Total IIIB Allocation

# Units of Services Provided

# of Unduplicated Consumers

Served

% of Total 60+ Population*

LAN Set-Aside 120,868.00$ 3.83%Disaster Recovery

Reserve 5,531.00$ 0.18%

IIIB Priority Services

Information $204,368.99 6.47% 9,206.00 8,285 1.32%Referral $61,197.01 1.94% 2,757.00 2,757 0.44%Outreach $39,150.00 1.24% 435.00 435 0.07%Transportation $743,429.00 23.53% 54,037.00 384 0.06%Subtotal $1,048,145.00

33% = amount allocated for Access Services (must be equal to or greater than 20%)

Homemaker $310,722.00 9.83% 15,773.00 207 0.03%Personal Care $0.00 0.00% 0.00 0 0.00%In-Home Respite $45,851.00 1.45% 1,955.00 27 0.00%Chore $0.00 0.00% 0.00 0 0.00%Companionship $0.00 0.00% 0.00 0 0.00%Telephone Reass. $2,757.00 0.09% 414.00 414 0.07%Subtotal $359,330.00

11% = amount allocated for In-Home Services (must be equal to or greater than 8%)

Legal Assistance $449,970.00 14.24% 3,973.00 920 0.15%14% = amount allocated for Legal Services (must be equal to or greater than 1%)

IIIB Non-Priority Services $1,175,964.00 37.22% 58,916.00 3,376Total IIIB $3,159,808.00 100.00% 147,466 16,805

* To have % total 60+ population computed, enter 60+ population: 626,700

Legal Assistance

Access Services

In-Home Services

This worksheet documents OAA Title IIIB expenditures by service, with services categorized as priority services or non-priority services.


C.I.C. - Service Units and Costs Projections - PSA Summary

This worksheet lists the actual unit rate (what providers report as their actual costs to provide a unit of service) and the adjusted unit rate (the negotiated unit rate/what the Area Agency on Aging agrees to pay for a unit of service) for each service provider under direct contract with the AAA.

Services provided directly by the AAA must also be included and reflect county allocations.

Service and client count projections must be included for each service and substantiate the funds allocated for each service.


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: OA3B Start Date: 01/01/2020 End Date: 12/31/2020

PSA COUNTY PROVIDER SERVICETOTAL STATE/

FEDERAL SHARE

PROJ.

SERVICE UNITS

REIMB.

UNIT RATE

PROV.

COST PER UNIT

PROJ.

CLIENT COUNT

6 HARDEE FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $5,572.00 41 $137.54 $153.87 7Provider Total: $5,572.00

6 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE EDUCATION/TRAINING - GROUP $305.00 6 $50.83 $54.44 486 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE EMERGENCY ALERT RESPONSE $323.00 311 $1.04 $1.35 26 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HEALTH SUPPORT $4,456.00 100 $44.56 $53.52 106 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOMEMAKER $20,090.00 920 $21.84 $26.77 206 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE MATERIAL AID $82.00 1 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE RESPITE IN-HOME $5,249.00 250 $21.00 $24.57 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE TRANSPORTATION $858.00 156 $5.50 $14.46 26 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE TRANSPORTATION FOR LTC CLIENTS $22.00 4 $5.50 $14.46 1

Provider Total: $31,385.006 HARDEE SENIOR CONNECTION CENTER, INC. INFORMATION $2,431.99 110 $22.20 $22.20 996 HARDEE SENIOR CONNECTION CENTER, INC. INTAKE $1,582.70 23 $68.75 $68.75 236 HARDEE SENIOR CONNECTION CENTER, INC. OUTREACH $540.27 6 $90.00 $90.00 66 HARDEE SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $728.24 33 $22.20 $22.20 33

Provider Total: $5,283.20County Total: $42,240.20

6 HIGHLANDS FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $30,761.00 224 $137.54 $153.87 41Provider Total: $30,761.00

6 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS EDUCATION/TRAINING - GROUP $610.00 12 $50.83 $54.44 966 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS EMERGENCY ALERT RESPONSE $445.00 428 $1.04 $1.35 36 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HEALTH SUPPORT $5,381.00 113 $47.62 $53.52 106 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOMEMAKER $97,943.00 4,046 $24.21 $26.77 606 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS MATERIAL AID $3,875.00 5 56 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS RECREATION $1,562.00 24 $65.08 $66.96 166 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS RESPITE IN-HOME $37,332.00 1,552 $24.05 $24.57 86 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS TRANSPORTATION $28,965.00 3,284 $8.82 $14.46 326 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS TRANSPORTATION FOR LTC CLIENTS $953.00 108 $8.82 $14.46 1

Provider Total: $177,066.006 HIGHLANDS SENIOR CONNECTION CENTER, INC. INFORMATION $13,427.04 605 $22.20 $22.20 5446 HIGHLANDS SENIOR CONNECTION CENTER, INC. INTAKE $8,738.10 127 $68.75 $68.75 1276 HIGHLANDS SENIOR CONNECTION CENTER, INC. OUTREACH $4,588.38 51 $90.00 $90.00 516 HIGHLANDS SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $4,020.64 181 $22.20 $22.20 181


6 HILLSBOROUGH BAY AREA LEGAL SERVICES, INC. LEGAL ASSISTANCE $199,440.00 1,840 $108.38 $191.36 300Provider Total: $199,440.00

6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. ADULT DAY CARE $452,482.00 30,971 $14.61 $15.42 70




FEDERAL SHARE

PROJ.

SERVICE UNITS

REIMB.

UNIT RATE

PROV.

COST PER UNIT

PROJ.

CLIENT COUNT

6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $1,172.00 15 26 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. TRANSPORTATION $297,487.00 18,535 $16.05 $19.29 1116 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. TRANSPORTATION FOR LTC CLIENTS $12,840.00 800 $16.05 $19.29 4

Provider Total: $763,981.006 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. INFORMATION $99,139.40 4,465 $22.20 $22.20 4,0196 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. INTAKE $64,518.30 939 $68.75 $68.75 9396 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. OUTREACH $12,958.65 144 $90.00 $90.00 1446 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $29,686.67 1,337 $22.20 $22.20 1,337

Provider Total: $206,303.026 HILLSBOROUGH THE CENTRE FOR WOMEN, INC. HOUSING IMPROVEMENT $219,424.00 90 906 HILLSBOROUGH THE CENTRE FOR WOMEN, INC. MATERIAL AID $37,534.00 20 20

Provider Total: $256,958.00County Total: $1,426,682.02

6 MANATEE GULFCOAST LEGAL SERVICES, INC. LEGAL ASSISTANCE $84,504.00 926 $91.25 $216.55 400Provider Total: $84,504.00

6 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. ADULT DAY CARE $246,533.00 21,550 $11.44 $16.34 956 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. TRANSPORTATION $181,067.00 11,081 $16.34 $29.82 1306 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. TRANSPORTATION FOR LTC CLIENTS $6,863.00 420 $16.34 $29.82 3

Provider Total: $434,463.006 MANATEE SENIOR CONNECTION CENTER, INC. INFORMATION $32,760.35 1,476 $22.20 $22.20 1,3286 MANATEE SENIOR CONNECTION CENTER, INC. INTAKE $21,319.90 310 $68.75 $68.75 3106 MANATEE SENIOR CONNECTION CENTER, INC. OUTREACH $6,209.19 69 $90.00 $90.00 696 MANATEE SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $9,809.88 442 $22.20 $22.20 442


6 POLK FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $129,693.00 942 $137.54 $153.87 172Provider Total: $129,693.00

6 POLK MID FLORIDA COMMUNITY SERVICES, INC. ADULT DAY CARE $44,850.00 2,368 $18.94 $20.97 66 POLK MID FLORIDA COMMUNITY SERVICES, INC. EDUCATION/TRAINING - GROUP $4,247.00 154 $27.58 $27.58 1546 POLK MID FLORIDA COMMUNITY SERVICES, INC. HOMEMAKER $192,689.00 10,807 $17.83 $20.17 1276 POLK MID FLORIDA COMMUNITY SERVICES, INC. RESPITE IN-HOME $3,270.00 153 $21.37 $23.49 186 POLK MID FLORIDA COMMUNITY SERVICES, INC. SCREENING & ASSESSMENT $19,683.00 813 $24.21 $24.21 8136 POLK MID FLORIDA COMMUNITY SERVICES, INC. TELEPHONE REASSURANCE $2,757.00 414 $6.66 $6.66 4146 POLK MID FLORIDA COMMUNITY SERVICES, INC. TRANSPORTATION $207,828.00 19,049 $10.91 $12.03 986 POLK MID FLORIDA COMMUNITY SERVICES, INC. TRANSPORTATION FOR LTC CLIENTS $6,546.00 600 $10.91 $12.03 2

Provider Total: $481,870.006 POLK SENIOR CONNECTION CENTER, INC. INFORMATION $56,610.21 2,550 $22.20 $22.20 2,2956 POLK SENIOR CONNECTION CENTER, INC. INTAKE $36,841.00 536 $68.75 $68.75 536




FEDERAL SHARE

PROJ.

SERVICE UNITS

REIMB.

UNIT RATE

PROV.

COST PER UNIT

PROJ.

CLIENT COUNT

6 POLK SENIOR CONNECTION CENTER, INC. OUTREACH $14,853.51 165 $90.00 $90.00 1656 POLK SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $16,951.58 764 $22.20 $22.20 764


PSA Total: $3,033,409.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: O3C1 Start Date: 01/01/2020 End Date: 12/31/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS

REIMB.

UNIT RATE

PROV.

COST PER UNIT

PROJ.

CLIENT COUNT

6 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CONGREGATE HOLIDAY/EMERGENCY SHELF $18.00 4 $4.50 $10.24 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CONGREGATE MEALS $17,340.00 3,853 $4.50 $10.24 276 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CONGREGATE MEALS BREAKFAST $18.00 4 $4.50 $10.24 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CONGREGATE MEALS FOR LTC CLIENTS $18.00 4 $4.50 $10.24 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CONGREGATE MEALS GUEST $18.00 4 $4.50 $10.24 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CONGREGATE MEALS VOLUNTEERS $18.00 4 $4.50 $10.24 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE NUTRITION COUNSELING - INDIVIDUAL $86.00 1 $86.00 $93.77 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE NUTRITION EDUCATION $125.00 184 $0.68 $1.26 276 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE OUTREACH $765.00 14 $54.64 $143.60 14


6 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CONGREGATE HOLIDAY/EMERGENCY $1,441.00 186 $7.75 $10.24 406 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CONGREGATE MEALS $88,540.00 11,425 $7.75 $10.24 756 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CONGREGATE MEALS BREAKFAST $8,724.00 1,126 $7.75 $10.24 26 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CONGREGATE MEALS FOR LTC CLIENTS $395.00 51 $7.75 $10.24 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CONGREGATE MEALS GUEST $721.00 93 $7.75 $10.24 56 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CONGREGATE MEALS VOLUNTEERS $1,163.00 150 $7.75 $10.24 66 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS NUTRITION COUNSELING - INDIVIDUAL $339.00 4 $84.75 $93.77 46 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS NUTRITION EDUCATION $492.00 794 $0.62 $1.26 756 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS OUTREACH $1,310.00 24 $54.58 $143.60 24


6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CONGREGATE HOLIDAY/EMERGENCY $1,971.00 300 $6.57 $8.23 1006 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CONGREGATE MEALS $1,175,841.00 178,971 $6.57 $8.23 1,7996 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CONGREGATE MEALS BREAKFAST $39,420.00 6,000 $6.57 $8.23 1306 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CONGREGATE MEALS FOR LTC CLIENTS $26,280.00 4,000 $6.57 $8.23 406 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CONGREGATE MEALS GUEST $657.00 100 $6.57 $8.23 106 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CONGREGATE MEALS VOLUNTEERS $2,628.00 400 $6.57 $8.23 206 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. NUTRITION COUNSELING - INDIVIDUAL $9,464.00 160 $59.15 $59.15 120

Provider Total: $1,256,261.00County Total: $1,256,261.00

6 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. CONGREGATE HOLIDAY/EMERGENCY $89.00 10 $8.90 $21.79 26 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. CONGREGATE MEALS $139,584.00 15,684 $8.90 $21.79 356 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. CONGREGATE MEALS BREAKFAST $89.00 10 $8.90 $21.79 26 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. CONGREGATE MEALS FOR LTC CLIENTS $1,958.00 220 $8.90 $21.79 56 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. CONGREGATE MEALS GUEST $89.00 10 $8.90 $21.79 26 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. CONGREGATE MEALS VOLUNTEERS $89.00 10 $8.90 $21.79 26 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. NUTRITION COUNSELING - INDIVIDUAL $3,638.00 48 $75.79 $75.79 48




FEDERAL SHARE

PROJ.

SERVICE UNITS

REIMB.

UNIT RATE

PROV.

COST PER UNIT

PROJ.

CLIENT COUNT

6 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. OUTREACH $30,776.00 800 $38.47 $38.47 800Provider Total: $176,312.00County Total: $176,312.00

6 POLK MID FLORIDA COMMUNITY SERVICES, INC. CONGREGATE HOLIDAY/EMERGENCY $19,824.00 2,400 $8.26 $9.91 3506 POLK MID FLORIDA COMMUNITY SERVICES, INC. CONGREGATE MEALS $852,851.00 103,251 $8.26 $9.91 6856 POLK MID FLORIDA COMMUNITY SERVICES, INC. CONGREGATE MEALS BREAKFAST $82,600.00 10,000 $8.26 $9.91 5006 POLK MID FLORIDA COMMUNITY SERVICES, INC. CONGREGATE MEALS FOR LTC CLIENTS $11,564.00 1,400 $8.26 $9.91 56 POLK MID FLORIDA COMMUNITY SERVICES, INC. CONGREGATE MEALS GUEST $826.00 100 $8.26 $9.91 506 POLK MID FLORIDA COMMUNITY SERVICES, INC. CONGREGATE MEALS VOLUNTEERS $4,130.00 500 $8.26 $9.91 56 POLK MID FLORIDA COMMUNITY SERVICES, INC. NUTRITION EDUCATION $5,168.00 3,022 $1.71 $1.95 6856 POLK MID FLORIDA COMMUNITY SERVICES, INC. OUTREACH $4,063.00 125 $32.50 $38.19 125


PSA Total: $2,535,130.00




FEDERAL SHARE

PROJ.

SERVICE UNITS

REIMB.

UNIT RATE

PROV.

COST PER UNIT

PROJ.

CLIENT COUNT

6 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOME DELIVERED MEAL GUEST $18.00 4 $4.50 $7.98 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOME DELIVERED MEALS $32,981.00 7,329 $4.50 $7.98 246 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOME DELIVERED MEALS - FROZEN $18.00 4 $4.50 $7.98 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOME DELIVERED MEALS - HOT $18.00 4 $4.50 $7.98 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE NUTRITION COUNSELING - INDIVIDUAL $166.00 2 $83.00 $93.77 26 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE NUTRITION EDUCATION $240.00 300 $0.80 $1.26 246 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE OUTREACH $636.00 12 $53.00 $143.60 12


6 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOME DELIVERED MEAL GUEST $122.00 20 $6.10 $7.98 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOME DELIVERED MEALS $180,526.00 29,594 $6.10 $7.98 1086 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOME DELIVERED MEALS - FROZEN $122.00 20 $6.10 $7.98 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOME DELIVERED MEALS - HOT $122.00 20 $6.10 $7.98 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS NUTRITION COUNSELING - INDIVIDUAL $498.00 6 $83.00 $93.77 66 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS NUTRITION EDUCATION $645.00 949 $0.68 $1.26 1086 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS OUTREACH $1,166.00 22 $53.00 $143.60 22


6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOME DELIVERED MEAL GUEST $445.00 100 $4.45 $5.67 106 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOME DELIVERED MEALS $1,157,660.00 260,148 $4.45 $5.67 1,2526 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOME DELIVERED MEALS - FROZEN $445.00 100 $4.45 $5.67 106 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOME DELIVERED MEALS - HOT $445.00 100 $4.45 $5.67 106 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. NUTRITION COUNSELING - INDIVIDUAL $14,453.00 244 $59.15 $59.15 150


6 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. HOME DELIVERED MEAL GUEST $57.00 10 $5.62 $13.08 26 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. HOME DELIVERED MEALS $507,892.00 90,372 $5.62 $13.08 1,1556 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. HOME DELIVERED MEALS - FROZEN $57.00 10 $5.62 $13.08 26 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. HOME DELIVERED MEALS - HOT $57.00 10 $5.62 $13.08 26 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. NUTRITION COUNSELING - INDIVIDUAL $2,609.00 35 $74.53 $75.96 34


6 POLK MID FLORIDA COMMUNITY SERVICES, INC. HOME DELIVERED MEAL GUEST $621.00 100 $6.21 $7.61 106 POLK MID FLORIDA COMMUNITY SERVICES, INC. HOME DELIVERED MEALS $483,644.00 77,881 $6.21 $7.61 3406 POLK MID FLORIDA COMMUNITY SERVICES, INC. HOME DELIVERED MEALS - FROZEN $621.00 100 $6.21 $7.61 106 POLK MID FLORIDA COMMUNITY SERVICES, INC. HOME DELIVERED MEALS - HOT $621.00 100 $6.21 $7.61 106 POLK MID FLORIDA COMMUNITY SERVICES, INC. NUTRITION EDUCATION $2,132.00 1,247 $1.71 $1.95 3406 POLK MID FLORIDA COMMUNITY SERVICES, INC. OUTREACH $3,874.00 125 $30.99 $38.19 125




FEDERAL SHARE

PROJ.

SERVICE UNITS

REIMB.

UNIT RATE

PROV.

COST PER UNIT

PROJ.

CLIENT COUNT


PSA Total: $2,392,911.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: OA3D Start Date: 01/01/2020 End Date: 12/31/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS

AVG REIMB. UNIT RATE

MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE SENIOR CONNECTION CENTER, INC. A MATTER OF BALANCE (EBP) - GROUP $2,429.17 1 $2,429.17 $2,429.17 106 HARDEE SENIOR CONNECTION CENTER, INC. ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $2,953.99 1 $2,953.99 $2,953.99 106 HARDEE SENIOR CONNECTION CENTER, INC. CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10


6 HIGHLANDS SENIOR CONNECTION CENTER, INC. A MATTER OF BALANCE (EBP) - GROUP $7,287.51 3 $2,429.17 $2,429.17 306 HIGHLANDS SENIOR CONNECTION CENTER, INC. ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $2,953.99 1 $2,953.99 $2,953.99 106 HIGHLANDS SENIOR CONNECTION CENTER, INC. CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10


6 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. A MATTER OF BALANCE (EBP) - GROUP $25,814.98 11 $2,429.17 $2,429.17 1106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. ACTIVE LIVING EVERYDAY (EBP) - GROUP $6,762.48 1 $6,762.48 $6,762.48 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $14,769.95 5 $2,953.99 $2,953.99 506 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. DIABETES EMPOWER EDUC (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. DIABETES SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. ENHANCE WELLNESS (EBP) - INDIVIDUAL $1,018.20 5 $203.64 $203.64 56 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. HEALTHY EATING EVERY DAY (EBP) - GROUP $6,261.38 1 $6,261.38 $6,261.38 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. POWERFUL TOOLS FOR CAREGIVERS (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. PROG. DE MANEJO PERS. DE LA DIAB. (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. TOMANDO CONTROL DE SU SALUD (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. UN ASUNTO DE EQUILIBRIO (EBP) - GROUP $2,429.17 1 $2,429.17 $2,429.17 10


6 MANATEE SENIOR CONNECTION CENTER, INC. A MATTER OF BALANCE (EBP) - GROUP $17,004.19 7 $2,429.17 $2,429.17 706 MANATEE SENIOR CONNECTION CENTER, INC. ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $5,907.98 2 $2,953.99 $2,953.99 206 MANATEE SENIOR CONNECTION CENTER, INC. CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10


6 POLK SENIOR CONNECTION CENTER, INC. A MATTER OF BALANCE (EBP) - GROUP $26,720.87 11 $2,429.17 $2,429.17 1106 POLK SENIOR CONNECTION CENTER, INC. ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $17,723.94 6 $2,953.99 $2,953.99 606 POLK SENIOR CONNECTION CENTER, INC. CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10


PSA Total: $167,680.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: OA3E Start Date: 01/01/2020 End Date: 12/31/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE ALZHEIMER'S ASSOCIATION CAREGIVER TRAIN/SUPPORT (GRP) $884.00 7 $134.16 $148.89 37Provider Total: $884.00

6 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE RESPITE IN-HOME $7,095.00 322 $22.03 $24.57 1Provider Total: $7,095.00

6 HARDEE SENIOR CONNECTION CENTER, INC. INFORMATION $2,394.65 108 $22.20 $22.20 976 HARDEE SENIOR CONNECTION CENTER, INC. INTAKE $719.95 10 $68.75 $68.75 106 HARDEE SENIOR CONNECTION CENTER, INC. OUTREACH $360.18 4 $90.00 $90.00 46 HARDEE SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $717.06 32 $22.20 $22.20 32


6 HIGHLANDS ALZHEIMER'S ASSOCIATION CAREGIVER TRAIN/SUPPORT (GRP) $4,880.00 36 $134.16 $148.89 206Provider Total: $4,880.00

6 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS RESPITE IN-HOME $39,226.00 1,778 $22.06 $24.57 3Provider Total: $39,226.00

6 HIGHLANDS SENIOR CONNECTION CENTER, INC. INFORMATION $13,220.91 596 $22.20 $22.20 5366 HIGHLANDS SENIOR CONNECTION CENTER, INC. INTAKE $3,974.85 58 $68.75 $68.75 586 HIGHLANDS SENIOR CONNECTION CENTER, INC. OUTREACH $3,058.92 34 $90.00 $90.00 346 HIGHLANDS SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $3,958.92 178 $22.20 $22.20 178


6 HILLSBOROUGH ALZHEIMER'S ASSOCIATION CAREGIVER TRAIN/SUPPORT (GRP) $36,028.00 269 $134.16 $148.89 1,518Provider Total: $36,028.00

6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. RESPITE IN-FACILITY $70,138.00 5,003 $14.02 $14.85 96 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. RESPITE IN-HOME $136,202.00 8,002 $17.02 $20.62 25

Provider Total: $206,340.006 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. INFORMATION $97,617.40 4,396 $22.20 $22.20 3,9576 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. INTAKE $29,348.55 427 $68.75 $68.75 4276 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. OUTREACH $8,639.10 96 $90.00 $90.00 966 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $29,230.91 1,317 $22.20 $22.20 1,317


6 MANATEE ALZHEIMER'S ASSOCIATION CAREGIVER TRAIN/SUPPORT (GRP) $11,905.00 89 $134.16 $148.89 501Provider Total: $11,905.00

6 MANATEE MEALS ON WHEELS PLUS OF MANATEE, INC. RESPITE IN-FACILITY $86,342.00 7,751 $11.14 $15.52 21Provider Total: $86,342.00

6 MANATEE SENIOR CONNECTION CENTER, INC. INFORMATION $32,257.41 1,453 $22.20 $22.20 1,3016 MANATEE SENIOR CONNECTION CENTER, INC. INTAKE $9,698.15 141 $68.75 $68.75 1416 MANATEE SENIOR CONNECTION CENTER, INC. OUTREACH $4,139.46 46 $90.00 $90.00 46


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: OA3E Start Date: 01/01/2020 End Date: 12/31/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 MANATEE SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $9,659.28 435 $22.20 $22.20 435Provider Total: $55,754.30County Total: $154,001.30

6 POLK ALZHEIMER'S ASSOCIATION CAREGIVER TRAIN/SUPPORT (GRP) $20,573.00 153 $134.16 $148.89 866Provider Total: $20,573.00

6 POLK MID FLORIDA COMMUNITY SERVICES, INC. RESPITE IN-FACILITY $76,267.00 4,481 $17.02 $19.44 106 POLK MID FLORIDA COMMUNITY SERVICES, INC. RESPITE IN-HOME $89,223.00 4,175 $21.37 $23.49 25

Provider Total: $165,490.006 POLK SENIOR CONNECTION CENTER, INC. INFORMATION $55,741.13 2,511 $22.20 $22.20 2,2606 POLK SENIOR CONNECTION CENTER, INC. INTAKE $16,758.50 244 $68.75 $68.75 2446 POLK SENIOR CONNECTION CENTER, INC. OUTREACH $9,902.34 110 $90.00 $90.00 1106 POLK SENIOR CONNECTION CENTER, INC. REFERRAL/ASSISTANCE $16,691.33 752 $22.20 $22.20 752


PSA Total: $926,852.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: OA3EG Start Date: 01/01/2020 End Date: 12/31/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $884.00 6 $137.84 $153.87 3Provider Total: $884.00County Total: $884.00

6 HIGHLANDS FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $4,880.00 35 $137.84 $153.87 17Provider Total: $4,880.00County Total: $4,880.00

6 HILLSBOROUGH BAY AREA LEGAL SERVICES, INC. LEGAL ASSISTANCE $62,132.00 573 $108.36 $191.36 40Provider Total: $62,132.00County Total: $62,132.00

6 MANATEE GULFCOAST LEGAL SERVICES, INC. LEGAL ASSISTANCE $11,905.00 130 $91.25 $216.55 45Provider Total: $11,905.00County Total: $11,905.00

6 POLK FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $20,573.00 150 $137.84 $153.87 70Provider Total: $20,573.00County Total: $20,573.00

PSA Total: $100,374.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: OA3ES Start Date: 01/01/2020 End Date: 12/31/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $1,626.00 12 $137.68 $153.87 3Provider Total: $1,626.00County Total: $1,626.00

6 HIGHLANDS FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $8,975.00 65 $137.68 $153.87 17Provider Total: $8,975.00County Total: $8,975.00

6 HILLSBOROUGH BAY AREA LEGAL SERVICES, INC. LEGAL ASSISTANCE $58,725.00 378 $155.26 $191.36 20Provider Total: $58,725.00

6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $1,172.00 15 2Provider Total: $1,172.00

6 HILLSBOROUGH THE CENTRE FOR WOMEN, INC. HOUSING IMPROVEMENT $63,781.00 18 18Provider Total: $63,781.00County Total: $123,678.00

6 MANATEE GULFCOAST LEGAL SERVICES, INC. LEGAL ASSISTANCE $31,306.00 343 $91.25 $216.55 120Provider Total: $31,306.00County Total: $31,306.00

6 POLK FLORIDA RURAL LEGAL SERVICES, INC. LEGAL ASSISTANCE $37,837.00 275 $137.68 $153.87 70Provider Total: $37,837.00County Total: $37,837.00

PSA Total: $203,422.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: OAA7 Start Date: 01/01/2020 End Date: 12/31/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE SENIOR CONNECTION CENTER, INC. EDUCATION/TRAINING - GROUP $253.08 1 4Provider Total: $253.08County Total: $253.08

6 HIGHLANDS SENIOR CONNECTION CENTER, INC. EDUCATION/TRAINING - GROUP $1,397.24 3 24Provider Total: $1,397.24County Total: $1,397.24

6 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. EDUCATION/TRAINING - GROUP $10,316.57 19 174Provider Total: $10,316.57County Total: $10,316.57

6 MANATEE SENIOR CONNECTION CENTER, INC. EDUCATION/TRAINING - GROUP $3,409.09 6 57Provider Total: $3,409.09County Total: $3,409.09

6 POLK SENIOR CONNECTION CENTER, INC. EDUCATION/TRAINING - GROUP $5,890.93 11 99Provider Total: $5,890.93County Total: $5,890.93

PSA Total: $21,266.91 40 358


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: ADI Start Date: 07/01/2019 End Date: 06/30/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CASE AIDE $57.00 2 $28.50 $118.26 26 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CASE MANAGEMENT $88.00 2 $44.00 $89.09 26 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE RESPITE IN-HOME $15,709.00 665 $23.61 $23.63 26 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE SPECIALIZED MEDICAL EQUIP/SERV/SUPP $125.00 1 1

Provider Total: $15,979.006 HARDEE SENIOR CONNECTION CENTER, INC. INTAKE $445.00 6 $68.75 $68.75 6

Provider Total: $445.00County Total: $16,424.00

6 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CASE AIDE $423.00 15 $28.20 $118.26 86 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CASE MANAGEMENT $2,754.00 50 $55.08 $89.09 86 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS RESPITE IN-FACILITY $45,096.00 4,199 $10.74 $10.74 26 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS RESPITE IN-HOME $118,996.00 5,038 $23.62 $23.63 66 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS SPECIALIZED MEDICAL EQUIP/SERV/SUPP $530.00 1 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS TRANSPORTATION $689.00 80 $8.61 $14.37 1

Provider Total: $168,488.006 HIGHLANDS SENIOR CONNECTION CENTER, INC. INTAKE $4,693.00 68 $68.75 $68.75 68


6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CASE AIDE $589.00 20 $29.44 $56.94 346 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CASE MANAGEMENT $27,677.00 496 $55.80 $58.22 626 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. RESPITE IN-FACILITY $40,882.00 2,755 $14.84 $14.86 86 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. RESPITE IN-FACILITY - SPEC. ALZ. SRVS. $147,364.00 7,639 $9.65 $19.29 196 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. RESPITE IN-HOME $674,398.00 34,817 $19.37 $20.63 1186 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $29,236.00 384 576 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. TRANSPORTATION $15,061.00 969 $15.54 $33.50 7

Provider Total: $935,207.006 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. INTAKE $21,945.00 320 $68.75 $68.75 320


6 MANATEE MANATEE COUNTY B.O.C.C. CASE MANAGEMENT $22,618.00 366 $61.85 $70.40 406 MANATEE MANATEE COUNTY B.O.C.C. RESPITE IN-HOME $402,922.00 16,866 $23.89 $24.48 44

Provider Total: $425,540.006 MANATEE SENIOR CONNECTION CENTER, INC. INTAKE $11,853.00 172 $68.75 $68.75 172


6 POLK SENIOR CONNECTION CENTER, INC. INTAKE $15,919.00 232 $68.75 $68.75 232Provider Total: $15,919.00

6 POLK SENIORS FIRST CASE AIDE $3,156.00 120 $26.30 $27.97 5


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: ADI Start Date: 07/01/2019 End Date: 06/30/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 POLK SENIORS FIRST CASE MANAGEMENT $37,140.00 600 $61.90 $74.04 256 POLK SENIORS FIRST RESPITE IN-FACILITY $96,604.00 6,253 $15.45 $15.95 156 POLK SENIORS FIRST RESPITE IN-HOME $386,416.00 18,032 $21.43 $21.43 506 POLK SENIORS FIRST SPECIALIZED MEDICAL EQUIP/SERV/SUPP $48,206.00 144 25


PSA Total: $2,171,591.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: CCE Start Date: 07/01/2019 End Date: 06/30/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CASE AIDE $887.00 36 $24.64 $118.26 126 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CASE MANAGEMENT $10,547.00 200 $52.74 $89.09 126 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE EMERGENCY ALERT RESPONSE $2,333.00 2,287 $1.02 $1.38 76 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOME DELIVERED MEALS $910.00 140 $6.50 $7.96 46 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOMEMAKER $7,270.00 313 $23.21 $24.90 106 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE HOUSING IMPROVEMENT $500.00 1 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE MATERIAL AID $770.00 1 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE PERSONAL CARE $16,199.00 680 $23.82 $24.74 66 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE PEST CONTROL (RODENT CONTROL) $46.00 1 $46.00 $335.88 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE PEST CONTROL INITIATION $71.00 1 $71.00 $201.53 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE PEST CONTROL MAINTENANCE $37.00 1 $37.00 $87.33 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE RESPITE IN-HOME $2,058.00 88 $23.39 $23.63 16 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE SPECIALIZED MEDICAL EQUIP/SERV/SUPP $532.00 1 1

Provider Total: $42,160.006 HARDEE SENIOR CONNECTION CENTER, INC. INTAKE $2,521.00 37 $68.75 $68.75 37


6 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS ADULT DAY CARE $43,020.00 3,998 $10.76 $10.87 46 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CASE AIDE $3,657.00 151 $24.22 $118.26 846 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CASE MANAGEMENT $49,532.00 874 $56.67 $89.09 846 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS EMERGENCY ALERT RESPONSE $8,299.00 7,980 $1.04 $1.37 366 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOME DELIVERED MEALS $26,280.00 4,043 $6.50 $7.96 346 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOMEMAKER $104,000.00 4,245 $24.50 $24.90 546 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOUSING IMPROVEMENT $3,350.00 1 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS MATERIAL AID $770.00 1 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS PERSONAL CARE $66,094.00 2,676 $24.70 $24.74 306 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS PEST CONTROL (RODENT CONTROL) $45.00 1 $45.00 $335.88 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS PEST CONTROL INITIATION $71.00 1 $71.00 $201.53 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS PEST CONTROL MAINTENANCE $37.00 1 $37.00 $87.33 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS RESPITE IN-HOME $128,244.00 5,429 $23.62 $23.63 266 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS SPECIALIZED MEDICAL EQUIP/SERV/SUPP $900.00 3 36 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS TRANSPORTATION $927.00 100 $9.27 $14.37 1

Provider Total: $435,226.006 HIGHLANDS SENIOR CONNECTION CENTER, INC. INTAKE $26,028.00 379 $68.75 $68.75 379


6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. ADULT DAY CARE $313,165.00 20,283 $15.44 $15.44 476 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CASE AIDE $1,556.00 67 $23.22 $56.94 80




FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CASE MANAGEMENT $328,550.00 6,337 $51.85 $58.22 7996 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CHORE $3,682.00 207 $17.79 $22.83 266 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CHORE (ENHANCED) $43,082.00 1,768 $24.37 $33.02 316 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. COMPANIONSHIP $49,807.00 3,000 $16.60 $22.02 296 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. EMERGENCY ALERT RESPONSE $25,301.00 38,335 $0.66 $0.66 2236 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOME DELIVERED MEALS $42,043.00 9,100 $4.62 $6.07 866 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOMEMAKER $418,330.00 23,087 $18.12 $19.17 2596 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOUSING IMPROVEMENT $500.00 1 16 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. MATERIAL AID $500.00 1 16 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. PERSONAL CARE $465,447.00 22,007 $21.15 $25.40 1996 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. PEST CONTROL (ENHANCED INITIATION) $750.00 5 $150.00 $150.00 56 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. PEST CONTROL (RODENT CONTROL) $460.00 10 $46.00 $46.00 106 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. PEST CONTROL INITIATION $1,101.00 17 $64.77 $76.20 176 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. PEST CONTROL MAINTENANCE $12,079.00 307 $39.34 $50.80 596 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. RESPITE IN-HOME $553,793.00 28,739 $19.27 $20.63 1116 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $79,001.00 1,278 2556 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. TRANSPORTATION $18,936.00 1,219 $15.53 $33.50 8

Provider Total: $2,358,083.006 HILLSBOROUGH SENIOR CONNECTION CENTER, INC. INTAKE $141,021.00 2,051 $68.75 $68.75 2,051


6 MANATEE MANATEE COUNTY B.O.C.C. ADULT DAY CARE $17,149.00 1,268 $13.52 $16.88 26 MANATEE MANATEE COUNTY B.O.C.C. CASE AIDE $353.00 14 $25.19 $26.41 56 MANATEE MANATEE COUNTY B.O.C.C. CASE MANAGEMENT $88,197.00 1,750 $50.40 $70.40 1456 MANATEE MANATEE COUNTY B.O.C.C. EMERGENCY ALERT RESPONSE $6,434.00 7,481 $0.86 $1.06 256 MANATEE MANATEE COUNTY B.O.C.C. HOME DELIVERED MEALS $76,642.00 14,796 $5.18 $6.19 706 MANATEE MANATEE COUNTY B.O.C.C. HOMEMAKER $377,935.00 19,997 $18.90 $20.86 1356 MANATEE MANATEE COUNTY B.O.C.C. PERSONAL CARE $215,363.00 10,017 $21.50 $24.32 1006 MANATEE MANATEE COUNTY B.O.C.C. RESPITE IN-HOME $361,238.00 16,548 $21.83 $24.48 406 MANATEE MANATEE COUNTY B.O.C.C. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $6,400.00 2,133 36 MANATEE MANATEE COUNTY B.O.C.C. TRANSPORTATION $7,254.00 863 $8.41 $10.15 20

Provider Total: $1,156,965.006 MANATEE SENIOR CONNECTION CENTER, INC. INTAKE $69,191.00 1,006 $68.75 $68.75 1,006


6 POLK SENIOR CONNECTION CENTER, INC. INTAKE $93,418.00 1,359 $68.75 $68.75 1,359Provider Total: $93,418.00

6 POLK SENIORS FIRST ADULT DAY CARE $63,515.00 4,035 $15.74 $46.46 10




FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 POLK SENIORS FIRST CASE AIDE $3,629.00 150 $24.19 $27.97 3006 POLK SENIORS FIRST CASE MANAGEMENT $282,620.00 4,827 $58.55 $74.04 3506 POLK SENIORS FIRST CHORE $5,763.00 250 $23.05 $23.05 106 POLK SENIORS FIRST CHORE (ENHANCED) $3,266.00 100 $32.66 $32.66 36 POLK SENIORS FIRST COMPANIONSHIP $178,001.00 10,367 $17.17 $17.17 306 POLK SENIORS FIRST EMERGENCY ALERT RESPONSE $16,500.00 15,000 $1.10 $1.10 1006 POLK SENIORS FIRST HOME DELIVERED MEALS $130,376.00 20,089 $6.49 $6.76 1556 POLK SENIORS FIRST HOMEMAKER $297,677.00 16,161 $18.42 $18.42 1506 POLK SENIORS FIRST MATERIAL AID $1,156.00 200 46 POLK SENIORS FIRST PERSONAL CARE $239,030.00 11,000 $21.73 $21.73 1006 POLK SENIORS FIRST PEST CONTROL (ENHANCED INITIATION) $750.00 5 $150.00 $150.00 56 POLK SENIORS FIRST PEST CONTROL INITIATION $766.00 10 $76.57 $76.57 106 POLK SENIORS FIRST PEST CONTROL MAINTENANCE $1,378.00 30 $45.94 $45.94 156 POLK SENIORS FIRST RESPITE IN-HOME $163,425.00 7,626 $21.43 $21.43 446 POLK SENIORS FIRST SPECIALIZED MEDICAL EQUIP/SERV/SUPP $174,224.00 521 150


PSA Total: $5,886,689.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: HCE Start Date: 07/01/2019 End Date: 06/30/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE BASIC SUBSIDY $15,360.00 96 86 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CASE AIDE VENDOR $1,123.00 48 $23.40 $118.26 86 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE CASE MANAGEMENT-VENDOR PAYMENT $4,522.00 102 $44.33 $89.09 86 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE MATERIAL AID-VENDOR $2,378.00 6 56 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE SPECIALIZED MEDICAL EQUIP/SERV/SUPP $3,727.00 52 86 HARDEE NU-HOPE ELDER CARE SERVICES - HARDEE SPEC.MED.EQUIP/SERV/SUPP-VENDOR $1,116.00 2 1


6 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS BASIC SUBSIDY $17,280.00 108 156 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CASE AIDE VENDOR $1,123.00 48 $23.40 $118.26 156 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS CASE MANAGEMENT-VENDOR PAYMENT $4,864.00 92 $52.87 $89.09 156 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS HOUSING IMPROVEMENT-VENDOR PAYMENT $160.00 1 16 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS MATERIAL AID-VENDOR $1,495.00 3 36 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS RESPITE-VENDOR PAYMENT $2,073.00 88 $23.63 $23.63 26 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS SPECIALIZED MEDICAL EQUIP/SERV/SUPP $1,995.00 10 36 HIGHLANDS NU-HOPE ELDER CARE SERVICES - HIGHLANDS SPEC.MED.EQUIP/SERV/SUPP-VENDOR $947.00 2 2


6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. BASIC SUBSIDY $172,800.00 1,080 906 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. BASIC SUBSIDY - LEGACY $35,520.00 96 86 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. CASE MANAGEMENT-VENDOR PAYMENT $70,100.00 1,205 $58.17 $58.22 1106 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOMEMAKER-VENDOR PAYMENT $5,868.00 306 $19.17 $19.17 96 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. PERSONAL CARE-VENDOR PAYMENT $5,330.00 210 $25.40 $25.40 96 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. RESPITE-VENDOR PAYMENT $66,314.00 3,214 $20.63 $20.63 316 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $13,466.00 172 386 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. SPEC.MED.EQUIP/SERV/SUPP-VENDOR $30,044.00 384 73


6 MANATEE MANATEE COUNTY B.O.C.C. BASIC SUBSIDY $49,920.00 312 266 MANATEE MANATEE COUNTY B.O.C.C. CASE MANAGEMENT-VENDOR PAYMENT $15,567.00 262 $59.43 $70.40 306 MANATEE MANATEE COUNTY B.O.C.C. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $12,349.00 61 11


6 POLK SENIORS FIRST BASIC SUBSIDY $126,720.00 792 666 POLK SENIORS FIRST CASE AIDE VENDOR $2,577.00 110 $23.42 $27.97 1506 POLK SENIORS FIRST CASE MANAGEMENT-VENDOR PAYMENT $39,705.00 700 $56.72 $74.04 606 POLK SENIORS FIRST CHORE (ENHANCED)-VENDOR PAYMENT $1,621.00 50 $32.66 $32.66 16 POLK SENIORS FIRST HOME DELIVERED MEALS-VENDOR PAYMENT $18,503.00 2,737 $6.76 $6.76 21


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: HCE Start Date: 07/01/2019 End Date: 06/30/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 POLK SENIORS FIRST HOMEMAKER-VENDOR PAYMENT $2,508.00 136 $18.42 $18.42 46 POLK SENIORS FIRST MATERIAL AID-VENDOR $1,819.00 1 16 POLK SENIORS FIRST PERSONAL CARE-VENDOR PAYMENT $3,491.00 161 $21.73 $21.73 46 POLK SENIORS FIRST RESPITE-VENDOR PAYMENT $34,053.00 1,589 $21.43 $21.43 116 POLK SENIORS FIRST SPEC.MED.EQUIP/SERV/SUPP-VENDOR $78,635.00 235 72


PSA Total: $845,073.00


C.I.C. - Service Units and Costs Projections - PSA SummaryProgram: LSP Start Date: 07/01/2019 End Date: 06/30/2020


FEDERAL SHARE

PROJ.

SERVICE UNITS


MAX. PROV. COST PER

UNIT

PROJ.

CLIENT COUNT

6 HILLSBOROUGH HILLSBOROUGH COUNTY B.O.C.C. HOMEMAKER $109,352.00 5,704 $19.17 $19.17 51Provider Total: $109,352.00

6 HILLSBOROUGH SELF RELIANCE, INC. HOUSING IMPROVEMENT $60,580.00 5 56 HILLSBOROUGH SELF RELIANCE, INC. MATERIAL AID $55,920.00 5 56 HILLSBOROUGH SELF RELIANCE, INC. OTHER SERVICES $31,500.00 5 56 HILLSBOROUGH SELF RELIANCE, INC. SPECIALIZED MEDICAL EQUIP/SERV/SUPP $2,000.00 4 4


PSA Total: $259,352.00


Section C.I.C. Service Units and Costs Projections - Provider Summary for AAA (FED)PSA: 06

PSA COUNTY Program SERVICETOTAL STATE/

FEDERAL SHARE

TOTAL PROJ. SERVICE

UNITSAVG REIMB. UNIT RATE

MAX. PROV. COST PER

UNIT

TOTAL PROJ. CLIENT COUNT

6 HARDEE OA3B INFORMATION $2,431.99 110 $22.20 $22.20 996 HARDEE OA3B INTAKE $1,582.70 23 $68.75 $68.75 236 HARDEE OA3B OUTREACH $540.27 6 $90.00 $90.00 66 HARDEE OA3B REFERRAL/ASSISTANCE $728.24 33 $22.20 $22.20 33

Program Total: $5,283.206 HARDEE OA3D A MATTER OF BALANCE (EBP) - GROUP $2,429.17 1 $2,429.17 $2,429.17 106 HARDEE OA3D ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $2,953.99 1 $2,953.99 $2,953.99 106 HARDEE OA3D CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10

Program Total: $8,147.386 HARDEE OA3E INFORMATION $2,394.65 108 $22.20 $22.20 976 HARDEE OA3E INTAKE $719.95 10 $68.75 $68.75 106 HARDEE OA3E OUTREACH $360.18 4 $90.00 $90.00 46 HARDEE OA3E REFERRAL/ASSISTANCE $717.06 32 $22.20 $22.20 32

Program Total: $4,191.846 HARDEE OAA7 EDUCATION/TRAINING - GROUP $253.08 1 4

Program Total: $253.08County Total: $17,875.50

6 HIGHLANDS OA3B INFORMATION $13,427.04 605 $22.20 $22.20 5446 HIGHLANDS OA3B INTAKE $8,738.10 127 $68.75 $68.75 1276 HIGHLANDS OA3B OUTREACH $4,588.38 51 $90.00 $90.00 516 HIGHLANDS OA3B REFERRAL/ASSISTANCE $4,020.64 181 $22.20 $22.20 181

Program Total: $30,774.166 HIGHLANDS OA3D A MATTER OF BALANCE (EBP) - GROUP $7,287.51 3 $2,429.17 $2,429.17 306 HIGHLANDS OA3D ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $2,953.99 1 $2,953.99 $2,953.99 106 HIGHLANDS OA3D CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10

Program Total: $13,005.726 HIGHLANDS OA3E INFORMATION $13,220.91 596 $22.20 $22.20 5366 HIGHLANDS OA3E INTAKE $3,974.85 58 $68.75 $68.75 586 HIGHLANDS OA3E OUTREACH $3,058.92 34 $90.00 $90.00 346 HIGHLANDS OA3E REFERRAL/ASSISTANCE $3,958.92 178 $22.20 $22.20 178

Program Total: $24,213.606 HIGHLANDS OAA7 EDUCATION/TRAINING - GROUP $1,397.24 3 24

Program Total: $1,397.24County Total: $69,390.72

6 HILLSBOROUGH OA3B INFORMATION $99,139.40 4,465 $22.20 $22.20 4,0196 HILLSBOROUGH OA3B INTAKE $64,518.30 939 $68.75 $68.75 939

Provider: 69999 - SENIOR CONNECTION CENTER, INC.Program: FEDERALLY FUNDED (01/01 TO 12/31) Year: 2019 From 01/01/2020 To 12/31/2020




FEDERAL SHARE

TOTAL PROJ. SERVICE


MAX. PROV. COST PER

UNIT



6 HILLSBOROUGH OA3B OUTREACH $12,958.65 144 $90.00 $90.00 1446 HILLSBOROUGH OA3B REFERRAL/ASSISTANCE $29,686.67 1,337 $22.20 $22.20 1,337

Program Total: $206,303.026 HILLSBOROUGH OA3D A MATTER OF BALANCE (EBP) - GROUP $25,814.98 11 $2,429.17 $2,429.17 1106 HILLSBOROUGH OA3D ACTIVE LIVING EVERYDAY (EBP) - GROUP $6,762.48 1 $6,762.48 $6,762.48 106 HILLSBOROUGH OA3D ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $14,769.95 5 $2,953.99 $2,953.99 506 HILLSBOROUGH OA3D CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH OA3D DIABETES EMPOWER EDUC (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH OA3D DIABETES SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH OA3D ENHANCE WELLNESS (EBP) - INDIVIDUAL $1,018.20 5 $203.64 $203.64 56 HILLSBOROUGH OA3D HEALTHY EATING EVERY DAY - GROUP $6,261.38 1 $6,261.38 $6,261.38 106 HILLSBOROUGH OA3D POWERFUL TOOLS FOR CAREGIVERS (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH OA3D PROG. DE MANEJO PERS. DE LA DIAB. (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH OA3D TOMANDO CONTROL DE SU SALUD (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 106 HILLSBOROUGH OA3D UN ASUNTO DE EQUILIBRIO (EBP) - GROUP $2,429.17 1 $2,429.17 $2,429.17 10

Program Total: $73,641.486 HILLSBOROUGH OA3E INFORMATION $97,617.40 4,396 $22.20 $22.20 3,9576 HILLSBOROUGH OA3E INTAKE $29,348.55 427 $68.75 $68.75 4276 HILLSBOROUGH OA3E OUTREACH $8,639.10 96 $90.00 $90.00 966 HILLSBOROUGH OA3E REFERRAL/ASSISTANCE $29,230.91 1,317 $22.20 $22.20 1,317

Program Total: $164,835.966 HILLSBOROUGH OAA7 EDUCATION/TRAINING - GROUP $10,316.57 19 174


6 MANATEE OA3B INFORMATION $32,760.35 1,476 $22.20 $22.20 1,3286 MANATEE OA3B INTAKE $21,319.90 310 $68.75 $68.75 3106 MANATEE OA3B OUTREACH $6,209.19 69 $90.00 $90.00 696 MANATEE OA3B REFERRAL/ASSISTANCE $9,809.88 442 $22.20 $22.20 442

Program Total: $70,099.326 MANATEE OA3D A MATTER OF BALANCE (EBP) - GROUP $17,004.19 7 $2,429.17 $2,429.17 706 MANATEE OA3D ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $5,907.98 2 $2,953.99 $2,953.99 206 MANATEE OA3D CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10

Program Total: $25,676.396 MANATEE OA3E INFORMATION $32,257.41 1,453 $22.20 $22.20 1,3086 MANATEE OA3E INTAKE $9,698.15 141 $68.75 $68.75 1416 MANATEE OA3E OUTREACH $4,139.46 46 $90.00 $90.00 46




FEDERAL SHARE

TOTAL PROJ. SERVICE


MAX. PROV. COST PER

UNIT



6 MANATEE OA3E REFERRAL/ASSISTANCE $9,659.28 435 $22.20 $22.20 435Program Total: $55,754.30

6 MANATEE OAA7 EDUCATION/TRAINING - GROUP $3,409.09 6 57Program Total: $3,409.09County Total: $154,939.10

6 POLK OA3B INFORMATION $56,610.21 2,550 $22.20 $22.20 2,2956 POLK OA3B INTAKE $36,841.00 536 $68.75 $68.75 5366 POLK OA3B OUTREACH $14,853.51 165 $90.00 $90.00 1656 POLK OA3B REFERRAL/ASSISTANCE $16,951.58 764 $22.20 $22.20 764

Program Total: $125,256.306 POLK OA3D A MATTER OF BALANCE (EBP) - GROUP $26,720.87 11 $2,429.17 $2,429.17 110

ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $17,723.94 6 $2,953.99 $2,953.99 60CHRONIC DISEASE SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 10

Program Total: $47,209.036 POLK OA3E INFORMATION $55,741.13 2,511 $22.20 $22.20 2,2606 POLK OA3E INTAKE $16,758.50 244 $68.75 $68.75 2446 POLK OA3E OUTREACH $9,902.34 110 $90.00 $90.00 1106 POLK OA3E REFERRAL/ASSISTANCE $16,691.33 752 $22.20 $22.20 752

Program Total: $99,093.306 POLK OAA7 EDUCATION/TRAINING - GROUP $5,890.93 11 99


PSA Total: $974,751.91


Section C.I.C. Service Units and Costs Projections - Provider Summary for AAA (SGR)PSA: 06


FEDERAL SHARE

TOTAL PROJ. SERVICE


MAX. PROV. COST PER

UNIT


6 HARDEE ADI INTAKE $445.00 6 $68.75 $68.75 6Program Total: $445.00

6 HARDEE CCE INTAKE $2,521.00 37 $68.75 $68.75 37Program Total: $2,521.00County Total: $2,966.00

6 HIGHLANDS ADI INTAKE $4,693.00 68 $68.75 $68.75 68Program Total: $4,693.00

6 HIGHLANDS CCE INTAKE $26,028.00 379 $68.75 $68.75 379Program Total: $26,028.00County Total: $30,721.00

6 HILLSBOROUGH ADI INTAKE $21,945.00 320 $68.75 $68.75 320Program Total: $21,945.00

6 HILLSBOROUGH CCE INTAKE $141,021.00 2,051 $68.75 $68.75 2,051Program Total: $141,021.00County Total: $162,966.00

6 MANATEE ADI INTAKE $11,853.00 172 $68.75 $68.75 172Program Total: $11,853.00

6 MANATEE CCE INTAKE $69,191.00 1,006 $68.75 $68.75 1,006Program Total: $69,191.00County Total: $81,044.00

6 POLK ADI INTAKE $15,919.00 232 $68.75 $68.75 232Program Total: $15,919.00

6 POLK CCE INTAKE $93,418.00 1,359 $68.75 $68.75 1,359Program Total: $93,418.00County Total: $109,337.00

PSA Total: $387,034.00

Provider: 69999 - SENIOR CONNECTION CENTER, INC.Program: STATE FUNDED (07/01 TO 06/30) Year: 2020 From 07/01/2019 To 06/30/2020


C.I.E.- Service Units and Cost Projections — PSA Summary — All Programs

This worksheet displays for each program (except Medicaid waivers) the services provided and for each service the projected cost; number of units to be served; average unit rate; highest and lowest unit rate; and average, highest, and lowest contracted unit rate.


PSA: 06Program: FEDERALLY FUNDED (01/01 to 12/31) Year: 2020 From 01/01/2020 to 12/31/2020

PROGRAM SERVICE

TOTAL STATE/

FEDERAL SHARE

TOTAL PROJ.

SERVICE UNITS

AVG. REIMB.

UNIT RATE

HIGH REIMB.

UNIT RATE

LOW REIMB.

UNIT RATE

AVG. PROV.COST

PER UNIT

HIGH PROV.COST

PER UNIT

LOW PROV.COST

PER UNIT

O3C1 CONGREGATE HOLIDAY/EMERGENCY $23,343.00 2,900 $7.20 $8.90 $4.50 $12.08 $21.79 $8.23O3C1 CONGREGATE MEALS $2,274,156.00 313,184 $7.20 $8.90 $4.50 $12.08 $21.79 $8.23O3C1 CONGREGATE MEALS BREAKFAST $130,851.00 17,140 $7.20 $8.90 $4.50 $12.08 $21.79 $8.23O3C1 CONGREGATE MEALS FOR LTC CLIENTS $40,215.00 5,675 $7.20 $8.90 $4.50 $12.08 $21.79 $8.23O3C1 CONGREGATE MEALS GUEST $2,311.00 307 $7.20 $8.90 $4.50 $12.08 $21.79 $8.23O3C1 CONGREGATE MEALS VOLUNTEERS $8,028.00 1,064 $7.20 $8.90 $4.50 $12.08 $21.79 $8.23O3C1 NUTRITION COUNSELING - INDIVIDUAL $13,527.00 213 $76.42 $86.00 $59.15 $80.62 $93.77 $59.15O3C1 NUTRITION EDUCATION $5,785.00 4,000 $1.00 $1.71 $0.62 $1.49 $1.95 $1.26O3C1 OUTREACH $36,914.00 963 $45.05 $54.64 $32.50 $90.97 $143.60 $38.19

Program Total: $2,535,130.00 345,446O3C2 HOME DELIVERED MEAL GUEST $1,263.00 234 $5.38 $6.21 $4.45 $8.46 $13.08 $5.67O3C2 HOME DELIVERED MEALS $2,362,703.00 465,324 $5.38 $6.21 $4.45 $8.46 $13.08 $5.67O3C2 HOME DELIVERED MEALS - FROZEN $1,263.00 234 $5.38 $6.21 $4.45 $8.46 $13.08 $5.67O3C2 HOME DELIVERED MEALS - HOT $1,263.00 234 $5.38 $6.21 $4.45 $8.46 $13.08 $5.67O3C2 NUTRITION COUNSELING - INDIVIDUAL $17,726.00 287 $74.92 $83.00 $59.15 $80.66 $93.77 $59.15O3C2 NUTRITION EDUCATION $3,017.00 2,496 $1.06 $1.71 $0.68 $1.49 $1.95 $1.26O3C2 OUTREACH $5,676.00 159 $45.66 $53.00 $30.99 $108.46 $143.60 $38.19

Program Total: $2,392,911.00 468,968OA3B ADULT DAY CARE $743,865.00 54,889 $15.00 $18.94 $11.44 $17.58 $20.97 $15.42OA3B EDUCATION/TRAINING - GROUP $5,162.00 172 $43.08 $50.83 $27.58 $45.49 $54.44 $27.58OA3B EMERGENCY ALERT RESPONSE $768.00 739 $1.04 $1.04 $1.04 $1.35 $1.35 $1.35OA3B HEALTH SUPPORT $9,837.00 213 $46.09 $47.62 $44.56 $53.52 $53.52 $53.52OA3B HOMEMAKER $310,722.00 15,773 $21.29 $24.21 $17.83 $24.57 $26.77 $20.17OA3B HOUSING IMPROVEMENT $219,424.00 90OA3B INFORMATION $204,368.99 9,206 $22.20 $22.20 $22.20 $22.20 $22.20 $22.20OA3B INTAKE $133,000.00 1,935 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75OA3B LEGAL ASSISTANCE $449,970.00 3,973 $122.45 $137.54 $91.25 $173.90 $216.55 $153.87OA3B MATERIAL AID $41,491.00 26OA3B OUTREACH $39,150.00 435 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00OA3B RECREATION $1,562.00 24 $65.08 $65.08 $65.08 $66.96 $66.96 $66.96OA3B REFERRAL/ASSISTANCE $61,197.01 2,757 $22.20 $22.20 $22.20 $22.20 $22.20 $22.20OA3B RESPITE IN-HOME $45,851.00 1,955 $22.14 $24.05 $21.00 $24.21 $24.57 $23.49OA3B SCREENING & ASSESSMENT $19,683.00 813 $24.21 $24.21 $24.21 $24.21 $24.21 $24.21OA3B SPECIALIZED MEDICAL EQUIP/SERV/SUPP $1,172.00 15OA3B TELEPHONE REASSURANCE $2,757.00 414 $6.66 $6.66 $6.66 $6.66 $6.66 $6.66OA3B TRANSPORTATION $716,205.00 52,105 $11.52 $16.34 $5.50 $18.01 $29.82 $12.03

C.I.E. Service Units and Cost Projections - PSA Summary - All Programs


PSA: 06Program: FEDERALLY FUNDED (01/01 to 12/31) Year: 2020 From 01/01/2020 to 12/31/2020

PROGRAM SERVICE

TOTAL STATE/

FEDERAL SHARE

TOTAL PROJ.

SERVICE UNITS

AVG. REIMB.

UNIT RATE

HIGH REIMB.

UNIT RATE

LOW REIMB.

UNIT RATE

AVG. PROV.COST

PER UNIT

HIGH PROV.COST

PER UNIT

LOW PROV.COST

PER UNIT


OA3B TRANSPORTATION TO MEAL SITE FOR LTC $27,224.00 1,932 $11.52 $16.34 $5.50 $18.01 $29.82 $12.03Program Total: $3,033,409.00 147,466

OA3D A MATTER OF BALANCE (EBP) - GROUP $79,256.72 33 $2,429.17 $2,429.17 $2,429.17 $2,429.17 $2,429.17 $2,429.17OA3D ACTIVE LIVING EVERYDAY (EBP) - GROUP $6,762.48 1 $6,762.48 $6,762.48 $6,762.48 $6,762.48 $6,762.48 $6,762.48OA3D ARTHRITIS FOUNDATION TAI CHI (EBP) - GROUP $44,309.85 15 $2,953.99 $2,953.99 $2,953.99 $2,953.99 $2,953.99 $2,953.99OA3D CHRONIC DISEASE SELF MGT (EBP) - GROUP $13,821.10 5 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22OA3D DIABETES EMPOWER EDUC (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22OA3D DIABETES SELF MGT (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22OA3D ENHANCE WELLNESS (EBP) - INDIVIDUAL $1,018.20 5 $203.64 $203.64 $203.64 $203.64 $203.64 $203.64OA3D HEALTHY EATING EVERY DAY (EBP) - GROUP $6,261.38 1 $6,261.38 $6,261.38 $6,261.38 $6,261.38 $6,261.38 $6,261.38OA3D POWERFUL TOOLS FOR CAREGIVERS (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22OA3D PROG. DE MANEJO PERS. DE LA DIAB. (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22OA3D TOMANDO CONTROL DE SU SALUD (EBP) - GROUP $2,764.22 1 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22 $2,764.22OA3D UN ASUNTO DE EQUILIBRIO (EBP) - GROUP $2,429.17 1 $2,429.17 $2,429.17 $2,429.17 $2,429.17 $2,429.17 $2,429.17

Program Total: $167,680.00 66OA3E CAREGIVER TRAIN/SUPPORT (GRP) $74,270.00 554 $134.16 $134.16 $134.16 $148.89 $148.89 $148.89OA3E INFORMATION $201,231.50 9,064 $22.20 $22.20 $22.20 $22.20 $22.20 $22.20OA3E INTAKE $60,500.00 880 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75OA3E OUTREACH $26,100.00 290 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00OA3E REFERRAL/ASSISTANCE $60,257.50 2,714 $22.20 $22.20 $22.20 $22.20 $22.20 $22.20OA3E RESPITE IN-FACILITY $232,747.00 17,235 $14.06 $17.02 $11.14 $16.60 $19.44 $14.85OA3E RESPITE IN-HOME $271,746.00 14,277 $20.62 $22.06 $17.02 $23.31 $24.57 $20.62

Program Total: $926,852.00 45,014OA3EG LEGAL ASSISTANCE $100,374.00 894 $122.63 $137.84 $91.25 $173.90 $216.55 $153.87

Program Total: $100,374.00 894OA3ES HOUSING IMPROVEMENT $63,781.00 18OA3ES LEGAL ASSISTANCE $138,469.00 1,073 $131.91 $155.26 $91.25 $173.90 $216.55 $153.87OA3ES SPECIALIZED MEDICAL EQUIP/SERV/SUPP $1,172.00 15

Program Total: $203,422.00 1,106OAA7 EDUCATION/TRAINING - GROUP $21,266.91 40

Program Total: $21,266.91 40PSA Total: $9,381,044.91 1,009,000


PSA: 06Program: STATE FUNDED (07/01 to 06/30) Year: 2020 From 07/01/2019 to 06/30/2020

PROGRAM SERVICE

TOTAL STATE/

FEDERAL SHARE

TOTAL PROJ.

SERVICE UNITS

AVG. REIMB.

UNIT RATE

HIGH REIMB.

UNIT RATE

LOW REIMB.

UNIT RATE

AVG. PROV.COST

PER UNIT

HIGH PROV.COST

PER UNIT

LOW PROV.COST

PER UNIT

ADI CASE AIDE $4,225.00 157 $28.11 $29.44 $26.30 $80.36 $118.26 $27.97ADI CASE MANAGEMENT $90,277.00 1,514 $55.73 $61.90 $44.00 $76.17 $89.09 $58.22ADI INTAKE $54,855.00 798 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75ADI RESPITE IN-FACILITY $182,582.00 13,207 $13.68 $15.45 $10.74 $13.85 $15.95 $10.74ADI RESPITE IN-FACILITY - SPEC. ALZ. SRVS. $147,364.00 7,639 $9.65 $14.84 $4.45 $19.29 $19.29 $19.29ADI RESPITE IN-HOME $1,598,441.00 75,418 $20.31 $23.89 $19.37 $21.30 $24.48 $20.63ADI SPECIALIZED MEDICAL EQUIP/SERV/SUPP $78,097.00 530ADI TRANSPORTATION $15,750.00 1,049 $13.81 $15.54 $8.61 $28.72 $33.50 $14.37

Program Total: $2,171,591.00 100,312CCE ADULT DAY CARE $436,849.00 29,584 $14.74 $15.74 $10.76 $18.54 $46.46 $10.87CCE CASE AIDE $10,082.00 418 $24.29 $25.19 $23.22 $69.57 $118.26 $26.41CCE CASE MANAGEMENT $759,446.00 13,988 $54.04 $58.55 $50.40 $76.17 $89.09 $58.22CCE CHORE $9,445.00 457 $19.54 $23.05 $17.79 $22.92 $23.05 $22.86CCE CHORE (ENHANCED) $46,348.00 1,868 $27.13 $32.66 $24.37 $32.90 $33.02 $32.66CCE COMPANIONSHIP $227,808.00 13,367 $16.65 $17.17 $16.60 $21.62 $22.02 $17.17CCE EMERGENCY ALERT RESPONSE $58,867.00 71,083 $0.86 $1.10 $0.66 $0.98 $1.37 $0.66CCE HOME DELIVERED MEALS $276,251.00 48,168 $5.50 $6.50 $4.62 $6.73 $7.96 $6.07CCE HOMEMAKER $1,205,212.00 63,803 $18.86 $24.50 $18.12 $19.95 $24.90 $18.42CCE HOUSING IMPROVEMENT $4,350.00 3CCE INTAKE $332,179.00 4,832 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75CCE MATERIAL AID $3,196.00 203CCE PERSONAL CARE $1,002,133.00 46,380 $21.59 $24.70 $21.15 $24.98 $25.40 $21.73CCE PEST CONTROL (ENHANCED INITIATION) $1,500.00 10 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00CCE PEST CONTROL (RODENT CONTROL) $551.00 12 $45.80 $46.00 $45.00 $161.95 $335.88 $46.00CCE PEST CONTROL INITIATION $2,009.00 29 $68.81 $76.57 $64.77 $118.04 $201.53 $76.20CCE PEST CONTROL MAINTENANCE $13,531.00 339 $39.66 $45.94 $37.00 $62.17 $87.33 $45.94CCE RESPITE IN-HOME $1,208,758.00 58,430 $20.09 $23.62 $19.27 $21.30 $24.48 $20.63CCE SPECIALIZED MEDICAL EQUIP/SERV/SUPP $261,057.00 3,936CCE TRANSPORTATION $27,117.00 2,182 $12.85 $15.53 $8.41 $25.00 $33.50 $10.15

Program Total: $5,886,689.00 359,092HCE BASIC SUBSIDY $382,080.00 2,388HCE BASIC SUBSIDY - LEGACY $35,520.00 96HCE CASE AIDE VENDOR $4,823.00 206 $23.41 $23.42 $23.40 $88.16 $118.26 $27.97HCE CASE MANAGEMENT-VENDOR PAYMENT $134,758.00 2,361 $54.30 $59.43 $44.33 $76.17 $89.09 $58.22HCE CHORE (ENHANCED)-VENDOR PAYMENT $1,621.00 50 $32.66 $32.66 $32.66 $32.66 $32.66 $32.66HCE HOME DELIVERED MEALS-VENDOR PAYMENT $18,503.00 2,737 $6.76 $6.76 $6.76 $6.76 $6.76 $6.76



PSA: 06Program: STATE FUNDED (07/01 to 06/30) Year: 2020 From 07/01/2019 to 06/30/2020

PROGRAM SERVICE

TOTAL STATE/

FEDERAL SHARE

TOTAL PROJ.

SERVICE UNITS

AVG. REIMB.

UNIT RATE

HIGH REIMB.

UNIT RATE

LOW REIMB.

UNIT RATE

AVG. PROV.COST

PER UNIT

HIGH PROV.COST

PER UNIT

LOW PROV.COST

PER UNIT


HCE HOMEMAKER-VENDOR PAYMENT $8,376.00 442 $19.11 $19.17 $18.42 $19.11 $19.17 $18.42HCE HOUSING IMPROVEMENT-VENDOR PAYMENT $160.00 1HCE MATERIAL AID-VENDOR $5,692.00 10HCE PERSONAL CARE-VENDOR PAYMENT $8,821.00 371 $25.07 $25.40 $21.73 $25.07 $25.40 $21.73HCE RESPITE-VENDOR PAYMENT $102,440.00 4,891 $20.95 $23.63 $20.63 $20.95 $23.63 $20.63HCE SPECIALIZED MEDICAL EQUIP/SERV/SUPP $31,537.00 295HCE SPEC.MED.EQUIP/SERV/SUPP-VENDOR $110,742.00 623

Program Total: $845,073.00 14,471LSP HOMEMAKER $109,352.00 5,704 $19.17 $19.17 $19.17 $19.17 $19.17 $19.17LSP HOUSING IMPROVEMENT $60,580.00 5LSP MATERIAL AID $55,920.00 5LSP OTHER SERVICES $31,500.00 5LSP SPECIALIZED MEDICAL EQUIP/SERV/SUPP $2,000.00 4

Program Total: $259,352.00 5,723PSA Total: $9,162,705.00 479,598


AREAWIDEPROGRAM FEDERAL STATE TOTAL

SHARE SHARE BUDGETEDOAA IIIB $437,716.00 $437,716.00OAA IIIB Set Aside $120,868.00 $120,868.00OAA IIIB Disaster Recovery Reserve $5,531.00 $5,531.00OAA C1 $0.00 $0.00OAA C1 Disaster Recovery Reserve $8,296.00 $8,296.00OAA C2 $0.00 $0.00OAA C2 Disaster Recovery Reserve $8,296.00 $8,296.00OAA IIID $167,680.00 $167,680.00OAA IIIE $348,089.00 $348,089.00OAA VII $21,266.91 $21,266.91OAA ADMINISTRATION $1,012,531.00 $37,016.00 $1,049,547.00OAA TOTAL $2,130,273.91 $37,016.00 $2,167,289.91MED. WAIVER SPECIALIST $70,814.50 $70,814.50 $141,629.00EHEAP SERVICES $0.00 $0.00EHEAP ADMINISTRATION $34,326.00 $34,326.00EHEAP OUTREACH $0.00 $0.00NSIP $0.00 $0.00CCE $0.00 $0.00CCE ADMINISTRATION $68,071.00 $68,071.00CCE INTAKE $332,179.00 $332,179.00ADI INTAKE $54,855.00 $54,855.00ADI ADMINISTRATION $0.00 $0.00HCE $0.00 $0.00HCE ADMINISTRATION $77,955.00 $77,955.00LSP $0.00 $0.00LSP ADMINISTRATION $3,648.00 $3,648.00SHINE $317,773.92 $317,773.92RELIEF $0.00ADRC (MAC) $233,615.50 $233,615.50 $467,231.00TOTAL ALL FEDERAL AND STATE FUNDING SOURCES $2,786,803.83 $878,154.00 $3,664,957.83

OTHERS (List Below):MIPPA (SCC PSA-WIDE SERVICE, NOT SUBCONTRACTED) $125,789.00


$52,577.00

0

0

0

0

0

TOTAL ALL FUNDING SOURCES $3,843,323.83

C.I.F. - AAA AREAWIDE FUNDING PROFILE

This worksheet lists the amount retained at the AAA for areawide use including both administrative, direct service funding, LAN Set-Aside, and Disaster Recovery Reserves. Service funding included on this sheet must reflect the C.I.C. Service Units and Cost Projections - Provider Summary for AAA as provider of direct services.

Amounts are separated out by program and by state and/or federal share. Sixteen C.I.F. tabs have also been included in this workbook to capture county-level budgets. Direct services provided by the AAA entered on this form must be apportioned to each county on the C.I.F. tabs, by recording in the "County Share" and as "AAA Spending". Cells in the county C.I.F. and the areawide C.I.G. tabs do not include formulae to calculate values entered on this form. "OAA IIIB" does not include LAN Set-Aside or Disaster Recovery Reserves. "OAA Administration", "OAA IIIB LAN Set Aside", "OAA IIIB, OAA C1, and OAA C2 Disaster Recovery Reserves", "State General Revenue Administration", "Supplemental Resource Activities", and "Others" automatically populate in the respective line item, from the values entered in the C.I.A.


COUNTY:

OAA IIIB $42,240.20 $42,240.20 $5,283.20OAA C1 $18,406.00 $18,406.00 $0.00OAA C2 $34,077.00 $34,077.00 $0.00OAA IIID $8,147.38 $8,147.38 $8,147.38OAA IIIE $14,680.84 $14,680.84 $4,191.84OAA VII $253.08 $253.08 $253.08OAA TOTAL $117,804.50 $117,804.50 $17,875.50EHEAP SERVICES $15,249.00 $15,249.00 $0.00EHEAP ADMINISTRATION $629.00 $629.00 $529.00EHEAP OUTREACH $949.00 $949.00 $0.00NSIP $12,683.45 $12,683.45 $0.00CCE $44,681.00 $44,681.00 $2,521.00ADI $16,424.00 $16,424.00 $445.00HCE $28,226.00 $28,226.00 $0.00LSP $0.00 $0.00 $0.00RELIEF $0.00 $0.00 $0.00TOTAL ALL FEDERAL AND STATE FUNDING SOURCES $147,314.95 $89,331.00 $236,645.95 $18,404.50 $2,966.00

OTHERS (List Below):

$236,645.95

C.I.F.1 - COUNTY FUNDING PROFILE

AAA SPENDING

PROGRAM FEDERAL SHARE STATE SHARE TOTAL

BUDGETED FEDERAL

(N/A, SEE C.I.F. AAA)



This worksheet lists for one county the amount budgeted to each program separated out by state and/or federal share. Service funding include on this sheet must reflect the county total in the C.I.C. Service Units and Cost Projections - PSA Summary.

Sixteen C.I.F. tabs have been included in this workbook to allow for the maximum number of counties in a PSA. The funds identified on the C.I.F.AAA form must be apportioned to each county on the C.I.F. tabs.

HARDEE

STATE

COUNTY'S SHARE OF FUNDING LISTED BELOW AAA SPENDING(N/A, SEE C.I.F. AAA)

0

0

0

TOTAL ALL FUNDING SOURCES $21,370.50

0

0


COUNTY:

OAA IIIB $238,601.16 $238,601.16 $30,774.16OAA C1 $103,125.00 $103,125.00 $0.00OAA C2 $183,201.00 $183,201.00 $0.00OAA IIID $13,005.72 $13,005.72 $13,005.72OAA IIIE $82,174.60 $82,174.60 $24,213.60OAA VII $1,397.24 $1,397.24 $1,397.24OAA TOTAL $621,504.72 $621,504.72 $69,390.72EHEAP SERVICES $27,959.00 $27,959.00 $0.00EHEAP ADMINISTRATION $3,218.00 $3,218.00 $2,597.00EHEAP OUTREACH $4,661.00 $4,661.00 $0.00NSIP $33,874.81 $33,874.81 $0.00CCE $461,254.00 $461,254.00 $26,028.00ADI $173,181.00 $173,181.00 $4,693.00HCE $29,937.00 $29,937.00 $0.00LSP $0.00 $0.00 $0.00RELIEF $0.00 $0.00 $0.00TOTAL ALL FEDERAL AND STATE FUNDING SOURCES $691,217.53 $664,372.00 $1,355,589.53 $71,987.72 $30,721.00


$1,355,589.53


AAA SPENDING

FEDERAL STATEPROGRAM FEDERAL SHARE STATE SHARE






HIGHLANDSTOTAL

BUDGETED


0

0

0


0

0


COUNTY:

OAA IIIB $1,426,682.02 $1,426,682.02 $206,303.02OAA C1 $1,256,261.00 $1,256,261.00 $0.00OAA C2 $1,173,448.00 $1,173,448.00 $0.00OAA IIID $73,641.48 $73,641.48 $73,641.48OAA IIIE $593,013.96 $593,013.96 $164,835.96OAA VII $10,316.57 $10,316.57 $10,316.57OAA TOTAL $4,533,363.03 $4,533,363.03 $455,097.03EHEAP SERVICES $153,534.00 $153,534.00 $0.00EHEAP ADMINISTRATION $18,353.00 $18,353.00 $15,731.00EHEAP OUTREACH $28,231.00 $28,231.00 $0.00NSIP $339,424.96 $339,424.96 $0.00CCE $2,499,104.00 $2,499,104.00 $141,021.00ADI $957,152.00 $957,152.00 $21,945.00HCE $399,442.00 $399,442.00 $0.00LSP $259,352.00 $259,352.00 $0.00RELIEF $0.00 $0.00 $0.00TOTAL ALL FEDERAL AND STATE FUNDING SOURCES $5,072,905.99 $4,115,050.00 $9,187,955.99 $470,828.03 $162,966.00


$9,187,955.99


AAA SPENDING







HILLSBOROUGHTOTAL

BUDGETED


0

0

0


0

0


COUNTY:

OAA IIIB $589,066.32 $589,066.32 $70,099.32OAA C1 $176,312.00 $176,312.00 $0.00OAA C2 $510,672.00 $510,672.00 $0.00OAA IIID $25,676.39 $25,676.39 $25,676.39OAA IIIE $197,212.30 $197,212.30 $55,754.30OAA VII $3,409.09 $3,409.09 $3,409.09OAA TOTAL $1,502,348.10 $1,502,348.10 $154,939.10EHEAP SERVICES $53,093.00 $53,093.00 $0.00EHEAP ADMINISTRATION $6,358.00 $6,358.00 $5,502.00EHEAP OUTREACH $9,873.00 $9,873.00 $0.00NSIP $110,894.04 $110,894.04 $0.00CCE $1,226,156.00 $1,226,156.00 $69,191.00ADI $437,393.00 $437,393.00 $11,853.00HCE $77,836.00 $77,836.00 $0.00LSP $0.00 $0.00 $0.00RELIEF $0.00 $0.00 $0.00TOTAL ALL FEDERAL AND STATE FUNDING SOURCES $1,682,566.14 $1,741,385.00 $3,423,951.14 $160,441.10 $81,044.00


$3,423,951.14


AAA SPENDING







MANATEETOTAL

BUDGETED


0

0

0


0

0


COUNTY:

OAA IIIB $736,819.30 $736,819.30 $125,256.30OAA C1 $981,026.00 $981,026.00 $0.00OAA C2 $491,513.00 $491,513.00 $0.00OAA IIID $47,209.03 $47,209.03 $47,209.03OAA IIIE $343,566.30 $343,566.30 $99,093.30OAA VII $5,890.93 $5,890.93 $5,890.93OAA TOTAL $2,606,024.56 $2,606,024.56 $277,449.56EHEAP SERVICES $99,248.00 $99,248.00 $0.00EHEAP ADMINISTRATION $11,826.00 $11,826.00 $9,967.00EHEAP OUTREACH $17,889.00 $17,889.00 $0.00NSIP $137,599.74 $137,599.74 $0.00CCE $1,655,494.00 $1,655,494.00 $93,418.00ADI $587,441.00 $587,441.00 $15,919.00HCE $309,632.00 $309,632.00 $0.00LSP $0.00 $0.00 $0.00RELIEF $0.00 $0.00 $0.00TOTAL ALL FEDERAL AND STATE FUNDING SOURCES $2,872,587.30 $2,552,567.00 $5,425,154.30 $287,416.56 $109,337.00


$5,425,154.30


AAA SPENDING







POLKTOTAL

BUDGETED


0

0

0


0

0


C.I.G. - Areawide Funding Summary

FEDERAL STATE TOTALSHARE SHARE BUDGETED

OAA IIIB $3,033,409.00 $3,033,409.00OAA IIIB Set Aside $120,868.00 $120,868.00OAA IIIB Disaster Recovery Reserve $5,531.00 $5,531.00OAA C1 $2,535,130.00 $2,535,130.00OAA C1 Disaster Recovery Reserve $8,296.00 $8,296.00OAA C2 $2,392,911.00 $2,392,911.00OAA C2 Disaster Recovery Reserve $8,296.00 $8,296.00OAA IIID $167,680.00 $167,680.00OAA IIIE $1,230,648.00 $1,230,648.00OAA VII $21,266.91 $21,266.91OAA ADMINISTRATION $1,012,531.00 $37,016.00 $1,049,547.00OAA TOTAL $10,536,566.91 $37,016.00 $10,573,582.91MED. WAIVER SPECIALIST $70,814.50 $70,814.50 $141,629.00EHEAP SERVICES $349,083.00 $349,083.00EHEAP ADMINISTRATION $40,384.00 $40,384.00EHEAP OUTREACH $61,603.00 $61,603.00NSIP $634,477.00 $634,477.00CCE $5,886,689.00 $5,886,689.00CCE ADMINISTRATION $68,071.00 $68,071.00ADI $2,171,591.00 $2,171,591.00ADI ADMINISTRATION $0.00 $0.00HCE $845,073.00 $845,073.00HCE ADMINISTRATION $77,955.00 $77,955.00LSP $259,352.00 $259,352.00LSP ADMINISTRATION $3,648.00 $3,648.00SHINE $317,773.92 $317,773.92RELIEF $0.00 $0.00ADRC (MAC) $233,615.50 $233,615.50 $467,231.00TOTAL ALL FEDERAL AND STATE FUNDING SOURCES $12,244,317.83 $9,653,825.00 $21,898,142.83OTHERS (LIST):

MIPPA (SCC PSA-WIDE SERVICE, NOT SUBCONTRACTED) $125,789.00

SMP (SCC PSA-WIDE SERVICE, NOT SUBCONTRACTED) $52,577.00

0 $0.00

0 $0.00

$0.00

$0.00

$0.00FEDERAL STATE TOTAL

SHARE SHARE BUDGETED$12,244,317.83 $9,653,825.00 $22,076,508.83

0

0

TOTAL ALL FUNDING SOURCES

This worksheet contains the federal and state share allocations for each program for the AAA. Amounts are calculated from values entered on the C.I.F. tabs and C.I.A. The amounts are not calculated from the values entered on the C.I.F.AAA tab. "OAA IIIB, OAA C1, and OAA C2" do not include LAN Set-Aside or Disaster Recovery Reserves. "OAA IIIB LAN Set Aside and OAA IIIB, OAA C1, OAA C2 Disaster Recovery Reserves" automatically populate in the respective line item, from each value in the C.I.A.

PROGRAM

0


(1) (2) (3) (4)

Federal GeneralLocal

Match/ TOTALFunding Revenue CCE/HCE FUNDS

1. Area Agency Admin A. Current Year $1,012,531.00 $37,016.00 $0.00 $1,049,547.00 B. Prior Year CF* (2018) $0.00 $0.00 CONTRACT TOTAL $1,012,531.00 $37,016.00 $0.00 $1,049,547.00 D. CCE GR Administration $68,071.00 $68,071.00 E. HCE GR Administration $77,955.00 $77,955.00 F. LSP Admin $3,648.00 $3,648.00 G. LSP Services $150,820.33 $150,820.33 H. Local Match $0.00 TOTAL ADMIN $1,012,531.00 $37,016.00 $300,494.33 $1,350,041.332. Title IIIB A. Supportive Services (1) Current Year $3,159,808.00 $351,089.78 $3,510,897.78

(2) Prior Year CF* (2018) $0.00 $0.00 $0.00 TOTAL $3,159,808.00 $351,089.78 $3,510,897.78 B. IIIB Set-Aside (also included in Total) $120,868.00 $120,868.00 C. IIIB Disaster Recovery Reserve (also included in Total) $5,531.00 $5,531.003. Title IIIC1 Nutrition Services A. Current Year $2,543,426.00 $282,602.89 $2,826,028.89 B. Prior Year CF* (2018) $0.00 $0.00 $0.00 TOTAL $2,543,426.00 $282,602.89 $2,826,028.89 D. IIIC1 Disaster Recovery Reserve (also included in Total) $8,296.00 $8,296.004. Title IIIC2 Nutrition Services A. Current Year $2,401,207.00 $266,800.78 $2,668,007.78 B. Prior Year CF* (2018) $0.00 $0.00 $0.00 TOTAL $2,401,207.00 $266,800.78 $2,668,007.78 D. IIIC2 Disaster Recovery Reserve (also included in Total) $8,296.00 $8,296.005. Title IIID Preventive Health A. Current Year $167,680.00 $167,680.00 B. Prior Year CF* (2018) $0.00 $0.00 TOTAL $167,680.00 $167,680.006. Title IIIE Caregiver Support Services A. Current Year $1,230,648.00 $136,738.67 $1,367,386.67 B. Prior Year CF* (2018) $0.00 $0.00 $0.00 TOTAL $1,230,648.00 $136,738.67 $1,367,386.677. NSIP A. Current Year $634,477.00 $634,477.00 B. Prior Year CF* (2018) $0.00 $0.00 TOTAL $634,477.00 $634,477.007. Total Federal Current Year Funds Awarded(Sum of 1.A, 2.A(1), 3.A, 4.A, 5.A., 6.A, 7.A) $11,149,777.008. Total CF Funds Awarded

$0.009. Total GR Awarded(Total of column (2)) $37,016.0010.Total of All Funds to be Received(Sum of 8, 9, 10) $11,186,793.00* Carry Forward

(Sum of 1.B, 1.C, 2.A(2), 2.A.(3), 3.B, 3.C, 4.B, 4.C, 5.B, 5.C, 6.B, 6.C, 7B)

C.II.B. - OAA Budget Summary


Sub-Contractor Agency

Sub-Contractor Fiscal Year

Last Audit Period End

Date

Status of Action on Audit Findings and Recommendations

Date Due to Contract Manager

Estimated Date of

Next Report

Agricultural & Labor Program, Inc. 7/1 - 6/30 6/30/2018 Approved 3/31/2019 3/31/2020Alzheimer's Association 7/1 - 6/30 6/30/2018 Approved 3/31/2019 3/31/2020Bay Area Legal Services, Inc. 1/1 - 12/31 12/31/2018 Approved 9/30/2019 9/30/2020The Centre for Women, Inc. 10/1 - 9/30 9/30/2018 Approved 6/30/2019 6/30/2020Florida Rural Legal Services, Inc. 1/1 - 12/31 12/31/2018 Approved 9/30/2019 9/30/2020Gulfcoast Legal Services, Inc. 1/1 - 12/31 9/30/2018 Approved 6/30/2019 9/30/2020Hillsborough County B.O.C.C. 10/1 - 9/30 9/30/2018 Approved 6/30/2019 6/30/2020Manatee County B.O.C.C. 10/1 - 9/30 9/30/2018 Approved 6/30/2019 6/30/2020Meals on Wheels PLUS of Manatee, Inc. 1/1 - 12/31 12/31/2018 Approved 9/30/2019 9/30/2020Mid Florida Community Services, Inc. 10/1 - 9/30 9/30/2018 Approved 6/30/2019 6/30/2020NU-HOPE Elder Care Services, Inc. 1/1 - 12/31 12/31/2018 Approved 9/30/2019 9/30/2020Self Reliance, Inc. 10/1 - 9/30 9/30/2018 Approved 6/30/2019 6/30/2020Seniors First, Inc. 1/1 - 12/31 12/31/2018 Approved 9/30/2019 9/30/2020

C.II.C. - Financial and Compliance Audit Schedule


C.III - AAA MONITORING SCHEDULE

Provider Date of Visit

Program /Service

Fiscal Admin/Programmatic

OAA/NSIP/EHEAP/ADI/CCE/HCE/LSPAgricultural & Labor Program, Inc. November, 2020 EHEAP (Polk) Program/Fiscal

Alzheimer's Association August, 2020 OAA Title III-E: CTSG Program/Fiscal

Bay Area Legal Services, Inc. October, 2020 OAA Title III-B/EG/ES: LEG Program/Fiscal

The Centre for Women, Inc. September, 2020 OAA Title III-B/ES: HOIM, MATE Program/Fiscal

Florida Rural Legal Services, Inc. August, 2020OAA Title III-B/EG/ES: LEG (Hardee/Highlands/Polk) Program/Fiscal

Gulfcoast Legal Services, Inc. September, 2020 OAA Title III-B/EG/ES: LEG Program/Fiscal

Hillsborough County B.O.C.C. December, 2020 OAA Title III-B/C1/C2/E, NSIP: ADC, CNML, HDM, NUCOI, RESF, RESP, TRS

Program/Fiscal

December, 2020 EHEAP Program/FiscalDecember, 2020 ADI/CCE/HCE/LSP: ADC, BASI, CM, ECHO, EAR,

HDM, HMK, MDC, PECA, PECI, PECM, RESP, SCSM

Program/Fiscal

Manatee County B.O.C.C. December, 2020 ADI/CCE/HCE: ADC, BASI, CM, EAR, HDM, HMK, PECA, RESF, RESP, SCSM, TRS

Program/Fiscal

December, 2020 EHEAP Program/Fiscal

Meals on Wheels PLUS of Manatee, Inc. August, 2020 OAA Title III-B/C1/C2/E, NSIP: ADC, CNML, HDM, NUCOI, OTR, RESF, TRS

Program/Fiscal

Mid Florida Community Services, Inc. - Polk

September, 2020 OAA Title III-B/C1/C2/E, NSIP: ADC, CNML, EDUCG, HDM, HMK, NUCOI, NTED, OTR, RESF, RESP, SCAS, TERA, TRS

Program/Fiscal

NU-HOPE Elder Care Services - Hardee/ Highlands

Decemebr, 2020 OAA Title III-B/C1/C2/E, NSIP: CHO, CNML, HDM, HMK, HSU, NUCOI, NTED, OTR, RESP, TRS

Program/Fiscal

December, 2020 EHEAP Program/FiscalDecember, 2020 ADI/CCE/HCE: BASI, CA, CM, EAR, HDM, HMK,

PECA, RESPProgram/Fiscal

Self Reliance, Inc. - Hillsborough December, 2020 LSP: HOIM/MATE/OTH/SCSM Program/Fiscal

Seniors First, Inc. - Polk November, 2020 ADI/CCE/HCE: ADC, BASI, CM, EAR, HDM, HMK, PECA, RESF, RESP

Program/Fiscal

This worksheet contains a description of the AAA fiscal and programmatic monitoring schedule, to include all DOEA-funded service providers.


A B C D E F G H I J K L M N O P

Row # PSA Agency Name Street Address City County Zip Code Street Address City County County Served

(One row per county)

Zip Code

Phone Number Fax Director NameContact Person

Name

1 6

Alzheimer's Disease and Related Disorders Association, Inc.

14010 Roosevelt Blvd., Suite 709 Clearwater Pinellas 33762

14010 Roosevelt Blvd., Suite 709 Clearwater Pinellas Hardee 33762 800-772-8672 727-578-2286 Angela McAuley Angela McAuley

2 6



14010 Roosevelt Blvd., Suite 709 Clearwater Pinellas Highlands 33762 800-772-8672 727-578-2286 Angela McAuley Angela McAuley

3 6



14010 Roosevelt Blvd., Suite 709 Clearwater Pinellas Hillsborough 33762 800-772-8672 727-578-2286 Angela McAuley Angela McAuley

4 6



14010 Roosevelt Blvd., Suite 709 Clearwater Pinellas Manatee 33762 800-772-8672 727-578-2286 Angela McAuley Angela McAuley

5 6



14010 Roosevelt Blvd., Suite 709 Clearwater Pinellas Polk 33762 800-772-8672 727-578-2286 Angela McAuley Angela McAuley

6 6Agricultural & Labor Program, Inc. P.O. Box 3126 Winter Haven Polk 33885 300 Lynchburg Road Lake Alfred Polk Polk 33850 863-956-3491 863-956-3357 Arlene Dobison Cheryl Burnham

7 6

Avon Park Multipurpose Senior Center

6414 U.S. Highway 27 South Sebring Highlands 33876 114 East Main Street Avon Park Highlands Highlands 33825 863-382-2134 863-382-4546 Ingra Gardner Debbie Slade

8 6Bay Area Legal Services, Inc.

1302 North 19th St., Suite 400 Tampa Hillsborough 33605

1302 North 19th St., Suite 400 Tampa Hillsborough Hillsborough 33605 813-232-1343 813-248-9922 Richard Woltmann Carol Moody

9 6 Bayshore Meal Site P.O. Box 1110 Tampa Hillsborough 33601 2909 W. Bacelona Street Tampa Hillsborough Hillsborough 33629 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

10 6Bethune Neighborhood Center P.O. Box 896 Brooksville Hernando 34605 915 Avenue East Haines City Polk Polk 33844 352-796-1425 352-796-9952 Michael Georgini Steve Homan

11 6 Bloomingdale ADC P.O. Box 1110 Tampa Hillsborough 33601 3940 Canoga Park Dr. Brandon Hillsborough Hillsborough 33511 813-635-8064 813-272-7145 Traci Gogichaishvili Mary Jo McKay

12 6Brandon Senior Center P.O. Box 1110 Tampa Hillsborough 33601 612 N. Parsons Avenue Brandon Hillsborough Hillsborough 33510 813-635-8064 813-272-7145 Traci Gogichaishvili Mary Jo McKay

13 6Cathryn McDonald Senior Center

6414 U.S. Highway 27 South Sebring Highlands 33876 310 North 8th Avenue Wauchula Hardee Hardee 33873 863-773-2022 863-773-3017 Ingra Gardner Ruth Long

14 6Auburndale Senior Center P.O. Box 896 Brooksville Hernando 34605 109 West Park Street Auburndale Polk Polk 33823 352-796-1425 352-796-9952 Michael Georgini Steve Homan

Mailing Address Physical Address

C.IV - CONTRACT PROVIDERS

Contact Information

This worksheet contains contact information for each contract agency including Community Focal Points, Senior Centers, Lead Agencies, and Aging and Disability Resource Center Access Points.





Zip Code


Name



Contact Information


15 6 Agua Apartments P.O. Box 1110 Tampa Hillsborough 33601 4505 N. Rome Avenue Tampa Hillsborough Hillsborough 33603 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

16 6Daybreak Adult Day Center 811 23rd Avenue East Bradenton Manatee 34208 10920 East SR 70

Lakewood Ranch Manatee Manatee 34202 941-747-4655 941-747-9871 Maribeth Phillips Haskell Gates

17 6

Diamond Meal Café (Emmanuel Church of Christ)

6414 U.S. Highway 27 South Sebring Highlands 33876 3115 Hope Street Sebring Highlands Highlands 33875 863-382-2134 863-382-4546 Ingra Gardner Debbie Slade

18 6Eagle Lake Senior Center P.O. Box 896 Brooksville Hernando 34605 665 Eagle Lake Avenue Eagle Lake Polk Polk 33839 352-796-1425 352-796-9952 Michael Georgini Steve Homan

19 6Eloise Resource Center P.O. Box 896 Brooksville Hernando 34605 710 Snively Avenue Winter Haven Polk Polk 33880 352-796-1425 352-796-9952 Michael Georgini Steve Homan

20 6 Fairhavens Meal Site6414 U.S. Highway 27 South Sebring Highlands 33876 3015 Spinks Road Sebring Highlands Highlands 33870 863-382-2134 863-382-4546 Ingra Gardner Debbie Slade

21 6Florida Rural Legal Services, Inc.

1321 East Memorial Blvd., Suite 101 Lakeland Polk 33801

1321 East Memorial Blvd., Suite 101 Lakeland Polk Hardee 33801 863-688-7376 863-683-7969 Jaffe Pickett Phil Short



1321 East Memorial Blvd., Suite 101 Lakeland Polk Highlands 33801 863-688-7376 863-683-7969 Jaffe Pickett Phil Short



1321 East Memorial Blvd., Suite 101 Lakeland Polk Polk 33801 863-688-7376 863-683-7969 Jaffe Pickett Phil Short

24 6Fort Meade Community Center P.O. Box 896 Brooksville Hernando 34605 10 SW 3rd Street Fort Meade Polk Polk 33842 352-796-1425 352-796-9952 Michael Georgini Steve Homan

25 6Gardenville Senior Center P.O. Box 1110 Tampa Hillsborough 33601 6215 Symmes Road Gibsonton Hillsborough Hillsborough 33534 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

26 6Gulfcoast Legal Services, Inc. P.O. Box 358 St. Petersburg Pinellas 33731

501 First Avenue North, Suite 420 St. Petersburg Pinellas Manatee 33731 727-821-0726 727-821-3340 Tammy Greer James Kushner

27 6Haines City Adult Day Care Center P.O. Box 896 Brooksville Hernando 34605 751 Scenic Hwy Haines City Polk Polk 33844 352-796-1425 352-796-9952 Michael Georgini Steve Homan

28 6

Hillsborough County B.O.C.C. - Aging Services P.O. Box 1110 Tampa Hillsborough 33601

601 E. Kennedy Blvd. 16th Floor Tampa Hillsborough Hillsborough 33602 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay





Zip Code


Name



Contact Information


29 6Jewish Towers Meal Site P.O. Box 1110 Tampa Hillsborough 33601 3001 W. DeLeon Street Tampa Hillsborough Hillsborough 33609 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

30 6James P Austin Jr Community Center P.O. Box 896 Brooksville Hernando 34605 315 Dr. MLK Blvd Lake Wales Polk Polk 33853 352-796-1425 352-796-9952 Michael Georgini Steve Homan

31 6 JL Young Meal Site P.O. Box 1110 Tampa Hillsborough 33601 8220 N. Florida Avenue Tampa Hillsborough Hillsborough 33604 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

32 6Journey Friendship Dining Center 811 23rd Avenue East Bradenton Manatee 34208 3855 Pro Am Avenue Bradenton Manatee Manatee 34208 941-747-4655 941-747-9871 Maribeth Phillips Haskell Gates

33 6Kings Manor Meal Site P.O. Box 1110 Tampa Hillsborough 33601 2946 W. Columbus Drive Tampa Hillsborough Hillsborough 33607 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

34 6Lake Maude NBHD Service Center P.O. Box 896 Brooksville Hernando 34605 608 Avenue S NE Winter Haven Polk Polk 33880 352-796-1425 352-796-9952 Michael Georgini Steve Homan

35 6Lake Placid Diamond Bistro

6414 U.S. Highway 27 South Sebring Highlands 33876 212 N. Main Avenue Lake Placid Highlands Highlands 33582 863-382-2134 863-382-4546 Ingra Gardner Debbie Slade

36 6Lake Silver Senior Center P.O. Box 896 Brooksville Hernando 34605 250 S. Lake Silver Drive Winter Haven Polk Polk 33880 352-796-1425 352-796-9952 Michael Georgini Steve Homan

37 6Lakeland Activity Center for Seniors P.O. Box 896 Brooksville Hernando 34605

1510 Commercial Park Drive Lakeland Polk Polk 33801 352-796-1425 352-796-9952 Michael Georgini Steve Homan

38 6Lakeland Adult Day Care Center P.O. Box 896 Brooksville Hernando 34605 1200 Southern Avenue Lakeland Polk Polk 33815 352-796-1425 352-796-9952 Michael Georgini Steve Homan

39 6Lee Davis Dining Center P.O. Box 1110 Tampa Hillsborough 33601 3402 N. 22nd Street Tampa Hillsborough Hillsborough 33605 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

40 6 Sterling Heights P.O. Box 1110 Tampa Hillsborough 33601 11706 Williams Road Thonotasassa Hillsborough Hillsborough 33592 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

41 6 Lutz Senior Center P.O. Box 1110 Tampa Hillsborough 33601 112 First Avenue, NW Lutz Hillsborough Hillsborough 33549 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay





Zip Code


Name



Contact Information


42 6

Manatee County B.O.C.C. - Community Services Department P.O. Box 1000 Bradenton Manatee 34206

1112 Manatee Avenue West Bradenton Manatee Manatee 34206 941-749-3030 941-749-3040 Ava Ehde Tracie Adams

43 6Mary Walker Meal Site P.O. Box 1110 Tampa Hillsborough 33601

4912 E. Linebaugh Avenue Tampa Hillsborough Hillsborough 33617 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

44 6

Meals on Wheels PLUS of Manatee, Inc. 811 23rd Avenue East Bradenton Manatee 34208 811 23rd Avenue East Bradenton Manatee Manatee 34208 941-747-4655 941-747-9871 Maribeth Phillips Haskell Gates

45 6Medulla Community Center P.O. Box 896 Brooksville Hernando 34605 1049 Parker Road Lakeland Polk Polk 33811 352-796-1425 352-796-9952 Michael Georgini Steve Homan

46 6

Mid Florida Community Services, Inc. P.O. Box 896 Brooksville Hernando 34605

820 Kenndey Avenue East Brooksville Hernando Polk 34601 352-796-1425 352-796-9952 Michael Georgini Steve Homan

47 6MulberryCommunity Center P.O. Box 896 Brooksville Hernando 34605 304 NW 8th Street Mulberry Polk Polk 33860 352-796-1425 352-796-9952 Michael Georgini Steve Homan

48 6 North Lakes ADC P.O. Box 1110 Tampa Hillsborough 33601 2640 N. Lakeview Drive Tampa Hillsborough Hillsborough 33618 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

49 6 Silver Tree Meal Site P.O. Box 1110 Tampa Hillsborough 3360111113 N. Nebraska Avenue Tampa Hillsborough Hillsborough 33612 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

50 6NU-HOPE Elder Care Services, Inc.

6414 U.S. Highway 27 South Sebring Highlands 33876 310 North 8th Avenue Wauchula Hardee Hardee 33873 863-773-2022 863-773-3017 Ingra Gardner Ruth Long

51 6NU-HOPE Elder Care Services, Inc.

6414 U.S. Highway 27 South Sebring Highlands 33876

6414 U.S. Highway 27 South Sebring Highlands Highlands 33876 863-382-2134 863-382-4546 Ingra Gardner Debbie Slade

52 6Omar K. Lightfoot Senior Center 10901 North 56th Street Temple Terrace Hillsborough 33617 10901 North 56th Street Temple Terrace Hillsborough Hillsborough 33617 813-989-7183 813-989-7059 Kelly Ahern Kelly Ahern

53 6Phyllis Busansky Senior Center P.O. Box 1110 Tampa Hillsborough 33601 4102 West Spruce Street Tampa Hillsborough Hillsborough 33607 813-554-5158 813-272-7145 Traci Gogichaishvili Mary Jo McKay

54 6Plant City Dining Center P.O. Box 1110 Tampa Hillsborough 33601 307 N. Michigan Avenue Tampa Hillsborough Hillsborough 33563 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay





Zip Code


Name



Contact Information


55 6Plant City Multipurpose Center P.O. Box 1110 Tampa Hillsborough 33601 1205 South Waller Street Plant City Hillsborough Hillsborough 33566 813-757-3824 813-272-7145 Traci Gogichaishvili Mary Jo McKay

56 6Progress Village Meal Site P.O. Box 1110 Tampa Hillsborough 33601

8701 Progress Village Blvd Tampa Hillsborough Hillsborough 33619 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

57 6Friendship Dining at Renaissance on 9th 811 23rd Avenue East Bradenton Manatee 34208 1816 9th Street West Bradenton Manatee Manatee 34205 941-747-4655 941-747-9871 Maribeth Phillips Haskell Gates

58 6 River Pines P.O. Box 1110 Tampa Hillsborough 33601 7517 N. 40th Street Tampa Hillsborough Hillsborough 33604 813-272-7108 813-272-7145 Traci Gogichaishvili Mary Jo McKay

59 6 Ruskin Senior Center P.O. Box 1110 Tampa Hillsborough 33601 905 6th Street SE Ruskin Hillsborough Hillsborough 33570 813-672-1106 813-272-7145 Traci Gogichaishvili Mary Jo McKay

60 6 San Clemente Villas P.O. Box 1110 Tampa Hillsborough 33601 1102 N. Alexander Street Plant City Hillsborough Hillsborough 33563 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

61 6San Lorenzo Terrace II P.O. Box 1110 Tampa Hillsborough 33601 4820 N. Gomez Avenue Tampa Hillsborough Hillsborough 33614 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

62 6 Self Reliance, Inc. 8901 N. Armenia Avenue Tampa Hillsborough 33604 8901 N. Armenia Avenue Tampa Hillsborough Hillsborough 33604 813-375-3965 813-375-3970 Finn Kavanagh Finn Kavanagh

63 6 Seniors First, Inc.1290 Golfview Ave., Suite 202 Bartow Polk 33830

1290 Golfview Ave., Suite 202 Bartow Polk Polk 33830 863-534-5320 407-292-2773 Marsha Lorenz Maura Hassey

64 6Tampa Baptist Manor Meal Site P.O. Box 1110 Tampa Hillsborough 33601

215 W. Grand Central Avenue Tampa Hillsborough Hillsborough 33606 813-272-6630 813-272-6862 Traci Gogichaishvili Mary Jo McKay

65 6The Centre for Women Inc.

305 South Hyde Park Avenue Tampa Hillsborough 33606

305 South Hyde Park Avenue Tampa Hillsborough Hillsborough 33606 813-251-8437 813-253-2081 Ann Madsen Ann Madsen

66 6The Manor at W. Bartow Meal Site P.O. Box 896 Brooksville Hernando 34605 850 Gordon Avenue Bartow Polk Polk 33830 352-796-1425 352-796-9952 Michael Georgini Steve Homan

67 6

The Oaks at Riverview Senior Center P.O. Box 1110 Tampa Hillsborough 33601 101 E. Kirby Street Tampa Hillsborough Hillsborough 33604 813-272-6827 813-272-7145 Traci Gogichaishvili Mary Jo McKay

68 6Town N' Country Senior Center P.O. Box 1110 Tampa Hillsborough 33601 7606 Paula Drive Tampa Hillsborough Hillsborough 33615 813-272-7008 813-272-7145 Traci Gogichaishvili Mary Jo McKay





Zip Code


Name



Contact Information


69 6Wabash Community Center P.O. Box 896 Brooksville Hernando 34605 1230 Southern Avenue Lakeland Polk Polk 33815 352-796-1425 352-796-9952 Michael Georgini Steve Homan

70 6Washington Oaks Meal Site P.O. Box 896 Brooksville Hernando 34605 150 W. 14th Street Lakeland Polk Polk 33805 352-796-1425 352-796-9952 Michael Georgini Steve Homan

71 6Wimauma Senior Center P.O. Box 1110 Tampa Hillsborough 33601 5714 North Street Wimauma Hillsborough Hillsborough 33598 813-671-7672 813-272-7145 Traci Gogichaishvili Mary Jo McKay

1 If an entity is a Primary Contractor and also a Sub-Contractor for DOEA services, complete a row for the Contractor, and additional rows for each entity for which the provider is a sub-contractor.

PSA: 6

A

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1

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C.IV - C

This work

Q R S T Y Z AA AB AC AD AE AF AG AH AI AJ AK AL AM AN AO AP AQ

CCELead

AgencyGovt. Non-Profit

Profit- Making

ADI CCE EHEAP HCE LSP NSIP OAA RELIEF Other(Please List)

Other(Please List)

Access Point

Focal Point

Senior Center

Cong

rega

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Heal

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Recr

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Clas

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Lear

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Opp

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s

X X X XAlzheimer's Association





X X X X

Agricultural & Labor Program, Inc.

X X X X

NU-HOPE Elder Care Services, Inc. X X X X X

X X X XBay Area Legal Services, Inc.

X X X

Hillsborough County B.O.C.C. - Aging Services

X X X

Mid Florida Community Services

X X X X X X


X X X X X X

Hillsborough County B.O.C.C. - Aging Services X X X X X X

X X X X X X X X


X X X X

Mid Florida Community Services X X X X X

Programmatic Information

Type of Organization

Sponsoring Organization

Name(if Sr. Center or Focal Point is

checked)

Check each box that applies to the Sr. Center operations

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Profit- Making


Other(Please List)

Access Point

Focal Point

Senior Center

Cong

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Recr

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Clas

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checked)


X X X


X X X X

Meals on Wheels PLUS of Manatee, Inc.

X X X

NU-HOPE Elder Care Services, Inc.

X X X X


X X X


X X X


X X X X

Florida Rural Legal Services, Inc.

X X X X


X X X X


X X X


X X X X


X X X XGulfcoast Legal Services, Inc.

X X X


X X X X X X X X X X X


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Profit- Making


Other(Please List)

Access Point

Focal Point

Senior Center

Cong

rega

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Recr

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Clas

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checked)


X X X


X X X


X X X


X X X X


X X X


X X X X


X X X


X X X X

Mid Florida Community Services X X X X X X

X X X X

Mid Florida Community Services X X X

X X X


X X X


X X X


X X X X X X


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Profit- Making


Other(Please List)

Access Point

Focal Point

Senior Center

Cong

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Clas

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Lear

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checked)


X X X X X X X X

Manatee County B.O.C.C. - Community Services

X X X


X X X X X


X X X X

Mid Florida Community Services X X X X X X

X X X X X


X X X X

Mid Florida Community Services X X X X

X X X X X X


X X X


X X X X X X X X X X


X X X X X X X X X X


X X X X

Omar K. Lightfoot Senior Center X X X X X

X X X X X X


X X X


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68


CCELead


Profit- Making


Other(Please List)

Access Point

Focal Point

Senior Center

Cong

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Recr

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X X X X X X


X X X


X X

Meals on Wheels PLUS of Manatee, Inc. X X X X X

X X X X


X X X X


X X X


X X X


X X X XSelf Reliance, Inc.

X X X X X X XSeniors First, Inc.

X X X


X X X XThe Centre for Women, Inc.

X X X


X X X X


X X X X


PSA: 6

A

Row #

C.IV - C

This work

69

70

71

1 If an enti


CCELead


Profit- Making


Other(Please List)

Access Point

Focal Point

Senior Center

Cong

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ning

Heal

thSc

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Recr

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Clas

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checked)


X X X


X X X


X X X X



C.V - CONTRACT MODULE REVIEW CHECKLIST

ITEM INCLUDEDContract Module YES NO N/A PAGE

The location of each section of the contract module is accurately reflected. X 2

The form is properly completed. X PMThe form is signed by Board President (or Designee) and dated. X PMThe form is signed by Advisory Council Chair and dated. X PMThe form is signed by Executive Director and dated. X PM

The OAA funding amounts are correct. X 3-4Transfers between titles are within allowable percentages (IIIB to IIIC or IIIC to IIIB - no more than 30 percent; IIIC1 to IIIC2 or IIIC2 to IIIC1 - no more than 40 percent). X 3-4The Title IIIB total includes the set aside amount and includes a footnote that indicates the amount set aside. X 3-4The Title IIIB set aside amount currently approved by the Department did not increase. X 3-4General revenue amounts are correct. X 3-4Amounts for supplemental resource activities are reflected. X 3-4

Title III B funds allocated to OAA Access Services meet or exceed 20 percent. X 5Title III B funds allocated to OAA In-Home Services meet or exceed eight percent. X 5Title III B funds allocated to OAA Legal Assistance Services meet or exceed one percent. X 5

Provider summary information from the PSA-Summary Service Units and Costs Projections CIRTS report has been entered correctly for each provider. X 6-31Provider summary information from the PSA-Summary Service Units and Costs Projections CIRTS report has been entered correctly for the AAA as the provider of direct services. X 6-31Services provided directly by the AAA are reflected. X 6-31Funds are allocated only to allowable services. X 6-31The actual and negotiated unit rates are provided. X 6-31

Table of Contents

Contract Module Certification Page (See Program Module)

Section C.I.A. Allocation to the Planning and Service Area

Section C.I.B. OAA Title III Priority Services Expenditures

Section C.I.C. Service Units and Costs Projections Provider Summary


PSA summary information from CIRTS has been entered correctly. X 32-36Data in CIRTS reconciles to the contract amounts. X 32-36

Accurate areawide information for the PSA is displayed on a separate form. X 37

Accurate information for each county in the PSA is displayed on a separate form. X 38-42

p g allocated to services provided directly by the AAA is accurately reflected. X 43

All pages (1-6) were submitted as a separate attachment. X 44-53Pages 1-6 of the detailed operating budget and cost allocation plan accurately display the breakout of salaries and expenses by positions and funding sources. X 44-53Includes narrative justification for the planned purchase/expenditures in the equipment and other categories in the III B set aside funds. X 44-53Includes written explanation of planned expenditures in the communications category. X 44-53All expenses of the Agency are reflected in the budget. Non-DOEA column is completed with the portion not funded through DOEA. X 44-53

The minimum match requirement of 25 percent is met for administration. X 54The minimum match requirement of 10 percent is met for services. X 54The III B set aside amount was not increased. X 54

The form is completed in its entirety. X 55

The form displays the schedule for conducting fiscal and programmatic monitoring of service providers. X 56

The form includes the name, address, phone number, and fax number for each contract and subcontract provider. X 57-68The form includes a contact person for each contract and subcontract provider. X 57-68

Section C.I.F.AAA. Areawide Funding Profile

Section C.III AAA Monitoring Schedule

Section C.IV Contract Providers

Section C.I.F. County Funding Profiles

Section C.I.E. Service Units and Costs Projections - Planning and Service Area Summary

Section C.I.G. Areawide Funding Summary

Section C.II.A. AAA Operating Budget Allocation

Section C.II.B. OAA Budget Summary

Section C.II.C. Financial and Compliance Audit Schedule


The form identifies the type of organization (government, non-profit, profit-making) for each contract and subcontract provider. X 57-68

The form indicates whether each item is included in the Contract Module. X 69-71The form identifies the page location(s) of each item. X 69-71

Section C.V Contract Module Review Checklist


Contract Module Attachments

This worksheet lists the names of all Contract Module attachments.

Attachment Name AttachmentFile Type

Not Applicable

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