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HCCBG Budget <br />NAME AND ADDRESS <br />Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER <br />DAAS-732 (Rev. 2/16) <br />Cabarrus County- Combined <br />County Funding Plan <br />County <br />Cabarrus <br />1303 S. Cannon Blvd <br />July 1, 2017 through <br />June 30, 2018 <br />Kannapolis, NC 28083 <br />Provider Services Summary <br />Revision# <br />1 <br />Rev Date: <br />r I /,, 1,—r <br />�' - <br />A B C <br />D <br />E <br />F <br />G <br />H�4�� <br />I <br />Ser. Delivery <br />Projected <br />Projected <br />Projected <br />Projected <br />(Check One) Block Grant Funding Required Net' <br />USDA <br />Total <br />HCCBG <br />Reimburse. <br />HCCBG <br />Total <br />Services Direct Purch. Access In -Home <br />Other Total Local Match Sew Cost <br />Subsidy Funding <br />Units <br />Rate <br />Clients <br />Units <br />Trans 250 x 81464 <br />\\\1\\1\\\1\\\ 9052 90516 <br />0 <br />90516 <br />5396 <br />16.3087 <br />4664 <br />48500 <br />Medical Transp 033 x 66652 <br />\\\\\\\1\1\\\\ 7406 74058 <br />0 <br />74,058 <br />4040 <br />17.8233 <br />3816 <br />36004 <br />Ir Home II - Personal Care 042 145123 <br />\1\\\1\\V\\\\1 16125 161248 <br />0 <br />161248 <br />8610 <br />18.2091 <br />24 <br />8610 <br />l nHome III Personal Care 045 47697 <br />\\\1\\\%\\\\ 5300 52997 <br />0 <br />52997 <br />2500 <br />20.6116 <br />6 <br />2500 <br />Congregate 180 <br />107488 \\\\A\\\\\\\\ 11943 119431 <br />28628 <br />148059 <br />11406 <br />10.1808 <br />1 250 <br />41310 <br />Home Delivered 020 z 72643 <br />\\\\\1\\\\\\\1 8071 80714 <br />36000 <br />116714 <br />15872 <br />4.9443 <br />80 <br />116999 <br />Housing/ Home Repair 140 x <br />48158 \\\\\\\\\\\\1\ 5351 53509 <br />0 <br />53509 <br />#DIV/0! <br />#DIV/0! <br />70 <br />#DIV/0! <br />Adult Day Care 030 <br />20675 \%\\\\\\\\\\ 2297 22972 <br />0 <br />22972 <br />650 <br />34.3631 <br />6 <br />650 <br />Adult Day Health 155 <br />119119 \1\\1\I\\\\\\\ 13235 132354 <br />0 <br />132354 <br />3100 <br />41.5119 <br />20 <br />3100 <br />Senior Cameroperatlon170 <br />89789 1\%A\\\1\\\ 9977 99766 <br />0 <br />99766 <br />#DIV/01 <br />ilDIV/0! <br />4500 <br />#DIV/0! <br />\\\\1\1\\\\\1\ 0 0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />\\\\\\\\\\\\\1 0 0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />\1\1\\1\\1\\\\ 0 0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />\\\11\11\\\1\1 0 0 <br />0 <br />00 <br />0 <br />0 <br />\I\\1\1\1\\\\\ 0 0 <br />0 <br />0 <br />051 <br />0 <br />0 <br />Total 1\\1\1\ W%\ 148116 265463 <br />1 385,2291 798,808 88757 1 887565 1 <br />64628 <br />1 952193 \\1\\\1\\\11\1 <br />1111\\1\11111\ <br />13436 <br />#DIV/0! <br />"Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Care <br />Certification of required minimum local match <br />Transportation <br />availability. Required local match MI be expended <br />Authorized <br />Signature, Title <br />Date <br />Administrative <br />simultaneously with Block Grant Funding. <br />Community Service Lead Provider <br />Net Ser. Cost Total <br />Signature, County Finance Officer Date <br />Signature, Chairman, Board of Commissioners Date <br />F-4 Page 71 <br />