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f ,* 7/9/08 <br />COUNTY OF HAWAII <br />CONTINGENCY RELIEF FUNDS REQUEST <br />TO: <br />Office of Aging DATE: <br />Department <br />FROM: Maile David, Council District 6 <br />Council Member <br />A. REQUEST (ATTACH BACKUP INFORMATION, IF AVAILABLE) <br />October 20, 2020 <br />PHONE/FAX: 323-4275 <br />1. AMOUNT: $1,000 2. To ACCOUNT # (i.e., 010.500.5503.02): <br />010.411.5411.02.115 <br />3. To ACCOUNT NAME (i.e., P&R Admin. OCE): Office o f Aging — OCE, Misc. Contract Services <br />4. PURPOSE(S) OF TRANSFER: To assist Hospice of Hilo with expenses for educational material, <br />graphic design, photography, supplies and printing related to Pohai Malama Care Center Brochure. <br />5. IF THE MONEY IS DESIGNATED FOR A NONPROFIT ORGANIZATION, NAME OF ORGANIZATION: <br />6. IS IT A 501(C)(3)? ® YES ❑ No <br />*If,YES,,,,the IRS determination letter,and,tlie Nonprox'C„onflict <br />Hospice of Hilo dba Hawai `i Care Choices Disclosure Form mustbe attached W this_request form <br />7. COUNTY -RELATED PROGRAM(S) OR ACTIVITY(IES) TO BE FUNDED: <br />Pohai Malama Care Center <br />Brochure by raising awareness & education of end of life choices. <br />8. DEPARTMENTAL GOALS AND OBJECTIVES TO BE ADDRESSED: Goal #4 Addresses providing long <br />term services and supports for the frail and those in need of end of life care. <br />9. FUNDING TO BENEFIT THE PUBLIC -AT -LARGE (AS OPPOSED TO PRIVATE BENEFIT)? ®YES ❑ NO <br />10. IS THE PROGRAM OR ACTIVITY FUNDED ESTABLISHED BY CHARTER, ORDINANCE, OR DIRECTION <br />OF THE MAYOR? [:]YES ® NO <br />B. DEPARTMENT'S RECOMMENDATION: <br />® APPROVE ❑ DENY ❑ DEFER: <br />RATIONALE: This program shares our mission of providing supports to the elderly, persons with <br />disabilities and caregivers. <br />p <br />DATE: 1012012020 <br />Department Head <br />C. MAYOR'S ACTION <br />N. <br />APPROVED F1 DENIED ❑ DEFERRED: <br />COMMENTS: <br />DATE: <br />a0� <br />3k'a7q_e� <br />