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Health and WellnessTrust Fund Commission <br />ELI6tINA'I INC HEALTH DISPARIT IFS <br />Applicant Agency: Lee Counly Public Health <br />Contact Person for Budget: Carol Kvell <br />Contact Phone: (919)719-4640 exl 5350 <br />Fax: (919)718AG32 <br />e-mail c4ier,11 leecounlynccom <br />Federal Tax I.D. or 501(c)(3): 566000313 <br />1. Year 1 sbsrtln0 on OF about 71112006 and ending 613012007 <br />2. Pedmmanre Penod E denslan start[, 71112008 <br />YEAR ONE APPROVED <br />HWTFC USE ONLY,.; <br />Appru ed_ Rlrhard Clark <br />EY,eCive Oalea/1101_;_:',.- _ <br />uv renLC 2.-' t <br />7012007-613MOD0 $ +r 7112o0B'c'J: Pre ect Total <br />Budget CateOones - _QmPosntl r 7 <br />11 . Proposed amount In-Kind t r A I I P Vo d n u 71 I KI .nun d <br />~I <br />a.Uaurd staff <br />50 <br />NCr Llaril fn Juslihcolivn) <br />7 143 <br /> <br />- <br />- <br />- <br />. <br />se <br />$7, <br />ublolaL <br />so <br />57443 <br />-50 <br />1 SO <br />~i s0 <br />r~EO <br />- -:SO <br />50 <br />S7, <br />ether Than Pmsnnnel Support <br />- <br />- <br />3TP51: <br />Ys k <br />Upponsl Material <br />51 000 <br />- <br />$1000 <br />of t 4 I <br />ommuncalion Costs <br />I <br />d1whrare. oslage trvphfJ <br />t <br />oanq Gusts (rent, v061les, <br />s, raferanfe) <br />50 <br />.a <br />' <br />0 <br />` <br />I I <br />7 <br />dvenlsing and Promotion (Paid <br />. I <br />r <br />I. t t <br />. <br />/ <br />I <br />'ediu Placemenf and Produftfon <br />c <br />h;. <br />.r <br />asfs <br />5500 <br />$WO <br />.Pit.[ 0.11.y (runlllnre, <br />7uipmenl, date pmcess(ng epolp <br />- <br />far and msfe of at least 5500 <br />- <br />t <br />50 <br />afet (Glad[ In Justilc. fion) <br /> <br />$0 <br />obinlal <br />S150D <br />30 <br />-<.SO <br />1 ` 50 <br /> <br />SD <br />51,500 <br />avel Ex apses: <br />'avel (mteage, fmnspnrfallon, <br />- <br />eats. haler <br />51,160 <br />- I <br />-'.`t <br />E1,160 <br />eehn s <br />S11040 <br />S81)40 <br />! <br />Iher Clanl is Justification) <br />50050 <br />- <br /> <br />=1' <br /> <br /> <br />58,050 <br />Ihtotal <br />S17 250 <br />SO <br />-s0 <br />s0 <br />~so <br />- -'DSO <br />517.250 <br />otal Direct Expanses <br />S111,750 <br />57,443 <br />- so <br />SD <br />S0 <br />- So <br />- ~ so <br />548.750 <br />S7,4 <br />direct Costs <br />- <br />- <br />SO <br />opmved Larry Forward <br />- <br />- <br />- <br />- <br />IW FC use on1Y1 <br />'SO <br />nal Request <br />S111,750 <br />57,443 <br />SO <br />5 D <br />.S0 <br />- SO <br />50 <br />$18.750, <br />Sl,a <br />OTES: IH•ARFC use only[ <br />" <br />