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Home My WebLink AboutContract Agency Disclosure Forms KAREN McLAUGHLIN Town Director of Human Services Town of South old 750 Pacific Street P.O. Box 85 Mattituck, NY 11952 Tel. (631) 298-4460 Fax (631) 298-4462 Nutrition Program Home Delivered Meals Case Management Essential Transportation Senior Adult Day Care Alzheimer's Day Care Telephone Reassurance Residential Repair RECEIVED RECElvm JUL 2 4 ZJ06 JUL 2 1 2006 SoufhoM Town ClerA: MEMO Soui\;oid Tc.v;n Clerk To: Elizabeth Neville, Town Clerk V' John Cushman, Town Comptroller Karen McLaughlin, Director of Human Services ~ From: Re: 2005/2006 Suffolk County Comptrollers Contract Agency Disclosure Forms Date: July 21, 2006 For your records, attached please find the above referenced forms submitted by this Department in accordance with Suffolk County Local Law No. 9- 2001, "A Charter Law to Require Annual Expenditure Disclosure for Contract Agency Funding". We currently have four contracts with Suffolk County, i.e. Supplemental Nutrition Assistance Program (SNAP), III-C Nutrition, Residential Repair and State Pharmaceutical Assistance Program (SP AP). COUNTY OF SUFFOLK (9 OFFICE OF THE COUNTY COMPTROLLER JOSEPH SAWICKI, JR. Comptroller June 2, 2006 Ms. Karen McLaughlin, Director Town of Southold 53095 Main Rd., PO Box 1179 Southold, NY 11971 Dear Ms. McLaughlin: In accordance with Suffolk County Local Law No. 9-2001, "A Charter Law To Require Annual Expenditure Disclosure For Contract Agency Funding," your agency is required to complete the attached Contract Agency Disclosure Form(s). Instructions for the completion of the form are attached for your convenience. Each form includes agency and program data that was entered based on information provided by the County department responsible for the oversight of your contract. A separate form should be completed for each of your contracts with Suffolk County. If you have any questions regarding completion of the form, please call either 631-852-2064 or 631-852-2062. Please complete and return the disclosure form(s), as well as a copy of your agency's audited 2005 financial statements to the following address, no later than July 31, 2006. Suffolk County ComptroUer's Office Contract Compliance Unit - Room 8-232 Evans K. Griffing Building 300 Center Drive Riverhead, NY 11901 Failure to comply with this request may result in a recommendation to eliminate funding for your program(s) in the County's 2007 operating budget. Thank you for your anticipated cooperation. v cry truly yours, ~~.:r~ Elizabeth Tesoriero, CPA Executive Director of Auditing Services H. LEE DENNISON BUILDING. 100 VETERANS MEMORIAL mGHWAY . P.O. BOX 8100 . HAUPPAUGE, NY 117_ (831) 8li3-fi04O Fax (831) 8lI3__7 J ," KAREN McLAUGHLIN Town Director of Human Services Town of South old 750 Pacific Street P.O. Box 85 Mattituck, NY 11952 Tel. (631) 298-4460 Fax (631) 298-4462 Nutrition Program Home Delivered Meals Case Management Essential Transportation Senior Adult Day Care Alzheimer's Day Care Telephone Reassurance Residential Repair July 19,2006 Elizabeth Tesoriero, CPA Executive Director of Auditing Services Contract Compliance Unit Room S-232 Evans K. Griffing Building 300 Center Drive Riverhead, NY 11901 Dear Ms. Tesoriero: Enclosed please find the completed Contract Agency Disclosure Forms for the CSE Residential Repair, III-C Nutrition, Supplemental Nutrition Assistance (SNAP) and SPAP Programs for the Town of Southold. I have not included the Town's audited financial statements for 2005 as they are not yet completed. Our Town Comptroller, John Cushman, informed me that once the statements are completed we would gladly forward them to you. In closing, if you have any questions or need further information regarding the enclosed disclosure forms, please contact me at 298-4460 or call John Cushman, Town Comptroller at 765-4333. We would be happy to assist you. Sincerely yours, ~ghH"" U Director of Human Services cc: John Cushman, Town Comptroller Elizabeth Neville, Town Clerk ~ CONTRACT AGJj3NCf' DISCLOS~'Jj10RM ',;", .. - .' - ',- - - - -<::i-'::< ", _ ",' /, --//?";"(:i _:\:-,3:::";'-j'_,;,_.,_,,(; - (,;: '_'''''''.'''>.'c, i,:/->:-:,> -', _ - -- _-': ,',fih4"- ,.(FQrzwr:' ,4" , Conti1:ict~A/'"^" "r: ' ,Pllgel <>f4" , --,',-?'.:-"',-' ,'.,. > fore c01l1pleq,ng this fo~, please telldJ:hel ,~uic; ~~, ~evant and sistent inforrnation is PWvided. Ifr~;l1p"v~, ""~g:~".,':,:'.,.,ep,'O, I.J,~,thi,',' .,"s,'follll. refer to the contact infoimati,op, jn~ ',+.., :~",.~,'~;~",_. ',...., rJ1i93 ; , ',k~.j'" ~~,'2r.,'e.!:,7~,:',l;lseB:Y"~' I' 11 7 J Entered BY:' ' (I ' "-"VI ...ou I Date Received ,j /EXECUTIVE IOffice for the Aging .... -,,'0 __,', #6,:,/-':, .~;_<':';J::'.. ' ""'1r"tri .,(",",-:.;" JOOI .. '-'.. -'," "~'- :'!" Agency JEXE .,,'.Qit .,,' )6790 ,.:." ,;.....,: ";-'<_~:I'-,,: -'~'"~"'-'--' Objt1lrt ,14980 2006Iisti.mate ' $67,275 '. ,'{:'" :$;1' ~1";~~~ , Co~~ AmOlJ11t J" $65,288 I 'i:' <'\ (;':'-~' " .. ITown of South old jmc Nutrition ,(j, ,~,' ..... ntractor J.>hone Number f 1(631) 298-4460 I ""-',. , !'r~ ;.':,"~'(/'f".;.' '_~" 'c_ _''''''>'' ., -::i:ift'.'- ., , ,.' . ,., ',~'~'.;, ~~2"'.-f:r",~- ;.,~ ..,' ,< . ntractor Street Address JI<are~McLaUghlin, Dir~ctor :{0,' 153095 Main Rd., PO Bo~ '1179 ISouthold i'\.' ,','" ".-, h_;-,:,:/~;\~; INY jl197l ""\.,, '; ~ te: In addition to c~mpleting this :forDl,'.p~3,~e:.'e sUre to provid~lludited " ncial statements for the 2005 fIScal perio'<t, . . ~~ ' ',.';,~;q:; .. '. .. .. .. .. .. .. .. .. t:~;~ ( <,I . ~" ,. ~ Ti;':,:l.'>~~ ,",'0 .,..>,' '''V,,','''''_,,"''Vi;.v;i'. {:"""-"'/!"";,-"".L~- ;;<r..,,,~~,,,, "'_~'f" .,',r.,..",,, ''If'>'''''~'''' ',_, ,., .',;" ._1 ~ .j'?f-~if':'!":~~fl')~<:!i?~~0~~q~~*!<';,f~ ,.\.,_,p,,,,,,",,:,,)'<."":,:.,."":,~"',,>c, .. .. ;ri{~~; ,,- '~,{" -Z:h ;~:}'::'';'~~ '~'. : ,',- ,- ;,..' ;:~i ,,~;;:;;;f>'i;L '~l~ ;:;~~~; ^', ,.,!, ,<~~~;~:;;, ~.~ .>:f' .. .. .. .. ""F'!.~""":" -"""',,,."'."">:';>;';"""_.W" .-c.:......o,,~. ~""..,. , "~ . <'"",-(<'If!:""p<,,,,,..p~.:--!,,;;....If<.~t", ,i";,,,,,,,~,,,,,,,,,::I,,,,: 0;1')"""'''',' ",",,'v .. .. "",~':' ~;'::-~- .A"k, ';f~\k~:9'il\~J>, 1';' t. .,,,,ji "v ~~ ^ t < ",., "" ",,,, , " '( " 11' ~d,~y bYilhe :tlo1in" , .~,."""." ""<li',~'" ~<.;>!" ~ a ~bOUittd;Prtiz"":;.:~t,:~~:,~;<t . 't, ~'i;: :"'J' ",1'" '. ,';>-, ~ . No :.~~rd!:~t;;ec.'~ ti:~ ~.<i>i~t Saiaries)~e~ ...~ J; <<,"'4:Lbil~JiMaiUonllu ; iflln IIMOunt is ente 'in. J,' ':tciP"S IDtiIY'iaJal~jl\llJ:iJ must be enter~ on'~'~ L. .\ Il r\J~ , Suffolk County Agency Contract Disclosure CONTRACTOR NAME: Town of Southold CONTRACT: III -C Nutrition Reference: Page 3, questions 21 through 37. Program expenses are recorded pursuant to rules and regulations promulgated by GASB and the New York State Comptroller and are not segregated by county program. Therefore, this program specific information is not available. 4 , . CONTRACT AGENCV DISCLOSURE FORM ;.',.. .'.. .,", .. .......:. .. :.,. ......."...'...,.... -.--" ....,.'.:..<:..,... :/:...."-~;_.-.,.,,......... '. ., -,- ....-, ........ .. .-,.. '... ,/... ". C6ntract AgenCy Iflf~tion . " .. ":-,': ..:>"..........: ...'....,...'.,.......'.......::..::.: .....:..7:':.;.;......::..:;:..:-.........'.'.;.,.'.'... (f<lr.2007 Budgot~) ',)4,-,',' - .'",,-',' ',"~ 'Page lQf 4 . ''7,:\;::': .. .." ..',.. ...... ,,' .. _:_, ........', >'>:'__,': , :' .. ......;' '>":"0,,",'::::::,, _"_'_::"",:",":"_' ,:','.__;' " fore completing thisf9J.m, please ma~.~e iji~(;1jQ~m~4~ toe~Ure(~t.~~, relev~tand .2nsistent information is proVided. IfY,Ou have'anY.liuestiOti(regardi~ ~J;11pletion1:Jf:this forill' ,. '.i, ' easerefertothecontaciiriformationinthe~~Mter.0 ,'" . < " "<::-.. .. .... .. .. ", .. ':)"-::'i" ' .;;~;._L::L:::,_,.:,:_:')ij::~:;::~:~~:~' :__1~J~...":,,~~-;if~:__;~~_.~:"~~~~.~,'~,c:_,.__._::.~~:..::::,:";o.::,:.____,, ._~______~'~"_,,-_ .' sUffolk Codnly,~.lJSe Only .' ntrol Number 112000 ; Entewt:B?:':l ';ReVi~ B; I _])~te~ec~~~~_J.. , . __... __ ... ,~,_ IEXECUTIVE IOffice for the Aging IOOl Agency JEXE' Qrg 16804 . .Obj~ct 14980 ~5 Actu3l " 2006 EstUnate Contract AUlountl $5,0001 $0 ~" '''Contractor Nl!11le jT own of Southold /SPAP "c.__,,'.-" .. '. Phone Extension 'pontractorContact 1(631) 298-4460 I 'jeontractor Phone Number.. \- 'Contractor Street Address l'contractor City Addres~ t IKaren McLaughlin, Di;ector 153095 Main Rd., PO Box 1179 ISouthald ':Contractor State Address INY ~:Contractor Zip Code /11971 ;Y, ,'" ' , , ' " " ,__c, _ _:' '. ," , ,"',' ,',-' , ,','"" ,__i,:':'ci~,:::, ,: ,": ," _".;-:'::',,",,~}~::,:c.'F::_,.,.._~':~:.:,;r:._.:~,";"'-:'.:i:, ""'" -,. ~,",f",: -"-,','.-- ",:'>~ :te: In addition to c()mpletiQ;.~biHorm.'P,i~e.b~~lIireto)mjiide'Q..dit~d ancial statements for the 2005 faS(:31period. :' , , ' . n or;-o/.', ~")' ~\< ~', .- \:,-r:,':::, ;.~ 0 J 0 . (;\",A'o>, "~"'."):>"!': - , 0 0 ",.',- ,9 1 0 -~ , -'~. ,'. 0 'I 0 0 :1 0 ~,; 'Ii(;,-'" 'j.1t~', " . "'-,"- n ;" , " .:' 'OfU% '~pr;-;% @"~i~~~; ';~.~i :: O?\'.Dr;- r. <;: :t'iiQl;~ ~:~' , . *'''. !;" -~- , '__',.- ,._'~/~{.i~.;~::> ,)1(";!-)>:.:i",' '- -;,'.' >~" " -, :'~:::~ '\," , ~r't <. ' '!'" ~ ( " *~l: ~~'~r ;~ 1'~0 ~;\~ '1;"t.':~{'~~~~~:1J:~~:,_1r~i;;~}h~f~{::~_: :1 $29,321, 619~;29, 802, 998 .;;:t~' ,h',: .'.- ,~., " .,", " .. .. .. .. .. 'i;\~ijl ''',' '~""'.''':''',~i,'''.~ '>'-'i<'iJ':, __ ......~'"'. ',.", J ,,'g''''''''>,,'~:f':;;' ;-.,...;.c, "",:'~,,,",,,,,", -'i I i."h')~'t~~i'7):,'?'-:->t>iti~;:'\:" r;;:';< \!{," ,. c~"" ,~"",] ~ . '"-....,.:.;""\1'f',.'.~t!?4:':>-.': ":P;;'~...'''':''. ~',',e"'v" - .. .. .. .. 'F,' ~,i.. .., )I> ~. '~,,- ".,,',< .. .. ."-..-;.",....<-'. .. .. ~f " " .' " Suffolk County Agency Contract Disclosure CONTRACTOR NAME: Town of Southold CONTRACT: SPAP Reference: Page 3, questions 21 through 37. Program expenses are recorded pursuant to rules and regulations promulgated by GASB and the New York State Comptroller and are not segregated by county program. Therefore, this program specific information is not available. , , CONTRACT AGENCy'J) ~, ,-- '-' " ,',,-,,&: ,',' ,',- -'-:> --,-< -' " , - -, 'f.;~" '-- ~- <, , (l'or20\l1'~: Contr~tA ~tlO SUREFORM ' -,~]~';{:- f;.f~t:~_ '-,_ "_d _' <,' - "'. ' ,':+>J~~_f" ,^ > P{lge 1 of 4 ':!;'" , ;::.' ," "It ~""'-'/, .: 'lo,re:C9mpletiqgthi~ fo~ pl~ ~1h~ ., istent infonnationi~ provided. fffoU . ." ' refer to the contact infomiationln the,' .~ 11l~07' . Entered'B; ':"i~Z::;~:~!5;i~ ',. , D~e Rece~ved I IEXECUlWE .J/ "J "i:~ ~ '_i,;--' IOffice for the Aging I u, cO '" .', , lEXE ....;;~fh\:t6774';~~{:.;~d~'~t~~80. .' , .~. .~2006~te Co~~~OW\t I . " . $13:3,l~9 I $147,037 ',fOOl Agen<,":y' . - - - -." . - " ~ , ITown of Southold ;"t. ' ,',',"- Supplemental Nutrition Assistance Program ,,'? - -,,'-' .;.':." -,~f",f.j,,;.___:, ,',lit">'-'/ -,' - ,-~- i~~:}~?'~~~~'-_~:_->>:" -,,:_/t::~f )~":_-: 1(631) 298-4460 I ': ':.,.;,<<",,' , ,-, --.'" $%i&;'" ,', ~\;:J~{~~~-~:_:~,,~~~i- :;-, IKaren McLaughlin, Director , ,ontractor Contact ;'" ntractor Street Address 153095 Main Rd., PO B~x 1179 "<;~ V-:",. 'lSouthold ,f, INY 11197l ;'te: .In addition to completin,ll th~f!rm. .It~~~~ sure #0 provide~udited anclal statements for the 20~rlSca''per404, ~'.;;~ ,;, '. .' " - , - ~ - '-,' .:' ,;,,' :<~-; ,,'-,-: (i"~.'~~:I:~W~s~~~e ,- . " Page 2 of 4 (-,;1 /",. ,-~\- Retained Transmitted' Percentage by In FuU to Transmitted Agency'? Suffolk to Suffolk :2005 ActUal 2006 Estimated County? County? .j$ 133,189. l$ 147,037. j'- I 0 I 0 0 0 Uro% I o o O. o ora- % o I o o o O~% .' I 0 0 0 0 Oro% I 0 0 0 0 Of" % I 0 0 0 0 Oro% 1$ 63,738. $ 70,000. IRl 0 O~% I 0 0 0 0 Oro% I 0 0 0 0 Oro% ~r,":":' ,_' I:' urces,ofRevenue; .: .' ;""., &~~~'~~rit~:~C;::. . ;",;,,;: '. -I(,~ , ",W'<::;\' ',~.' 9) Total Program Revenue (Add Lines 9.18) }>',;'::".-,", 1$196,927. l 217,037. 1$29,321,619,1 $29,802,998. ,.-', ,- ",,; .,' . ofl'oW Agency Revenue ~:k~~"-~':::::::;"""~'- . . . t.;:t;,;.,,:ti?i;:<'€-'J~\ i 'A:d~tbcth6;':'~i "" .,.:;',. t~~,';~ ,-,-",~~;~ty'":,.~t',,.t:l,:,_-_'9~~..7~;,:, ,j;;>';:~~"I;" c ,- il_,,:;;i"~"'Tt'-tJ;~,,:j rw'il1i~,;!i'~"':t", ~1f~-":O:":':Y_"'\ -',".N ,",,',",'" i~J1l:ilf#~a,1:?y~iiiitY,fi,' ,/' ,';"" ,~~~~~Yf~;~~~~~~~~~:~~:e;:~:;a r~'~~~~.-~1~'C'{'~~~~_I~~r~~i~;~b' . . Suffolk County Agency Contract Disclosure CONTRACTOR NAME: Town of Southold CONTRACT: Supplemental Nutrition Assistance Program (SNAP) Reference: Page 3, questions 21 through 37. Program expenses are recorded pursuant to rules and regulations promulgated by GASH and the New York State Comptroller and are not segregated by county program. Therefore, this program specific information is not available. , CONTRACl' A-GE.N~;'f -~ - - - , -, -,' - -- - , ';'~"" l" - >", 8~'FORM ., ,,'- ." - - ,'-' - -," .,/ "", - - . - ~.- '-> " -' .," - ,,:".,' '~ ~",~ " . - - '. a ,,-,', > '" j , - ,.,' ) -,~- . '-'-'," .. ~- 1 d "evlll,lt~, f~i:ni ',' '1 ' ;,':j;;'" , , 1 Number .-:..:...."J-=.,' ..., ::'_>:~_;,~.__ .,. J . 111202 ,"" "I;:':)~<t9~!,\,~1Jl;e OJilyl '; " ,i1titerixlBy,' , ,~'ro;~~~ By ~ , i i~ate:R~~~~:,~~L.~,' ' , ""'H' IEXECUTrVE ' .,.;, . "-',- " IOfficefortheAgi~g, ,_,;., .'" " '[001 :AgencylExE ; ~,\~6;7;:0)r Object (4980 , '".imM, '.i';~,""~_,1 ' 2,OO61:istimafu ~" _ :, -;,_,_:",' >, _',;; :'; ,~~;~'il;l,\q.1 ,_,~ '_' IN/A coritr~t~ounil $20,000 I $20,400 .'1' ',7.' ITOwn ofSouthhold ''-.-'".,,' ,~'\. "-" ~~.\ _~}f;i-",~;",<i, '~,.. ~.- jCSE - Residential Repair '\;':.-;c' {"i:~,."~i'-'..;.,/ " 'or,. ~'. < ",> , ,,",-,~:.,'--::~~~' - . /" ; _ - <,,'--',;;'. lKaren McLaughlin, Director -,;-#r~ " Ip.O. Box 1179,53095 Main Road ISouthold , ontractor State Address " ~tractor Zip Code INY 111971 ',,' '; 'te: In addition to comllletint;~ts~.l~ Pt. .neial statements for the200SrlS~I'p~J.i~~. . ..t.: Page 2 of4 ..,L'",;j: * \~ ,k~,' "Revenue ~005 Actlla1 Retained Transmitted Percel1tage by In Full to Transmitted Agency'? Suffolk to Suffolk , County? County? " 2006 Estimlrted >..', \ip~~~~~ .J $ ;;A~~~~y:~ ' , , -"I 20,000 I I $ 20,4000 (l o o o OlO% I o o o o - Or; % ;-}~-,;~_,~~:.;:,)?' _ '-,:<,: __" _ .. ,'- , -', _ ~,':'__ i'.' e_ ,_,' - __ ~C; }~<V~ts from Other MuniCiPalities/Agencies I ~"k'{" .. .>. . '. ..,. '. ~2a'TdentffY Other Aid SoUrces'" , o o o o olO% ".' ;-, ", ,.' I 0 I 0 0 0 orD% I 0 I 0 0 0 ofl'% " I I 0 0 OrD% 0 0 I $ 2,485. I $ 2,000. I~ 0 010% I I 0 0 0 or;% 0 I 0 I 0 0 0 010% ',--' , . :)iii;[~, ... .. . " ',- .:::;<':,~':::' ~;:.t'<,::l:::::_,_.", . " " , t~!~~ :?tal PrOgram Reven~ (Add Lines 9 -18) ~~:~}?'/~~::-..;j~<-~,?~-,~; "~ ,~:,: - ..,::<"': - ~9):TotaI Agency Revenue "C'-".",.', b 22,485. $ 22,400. ~29,321,619. I $29,802,998. " ';>:~~l~J~~f~~~:~:%~; :ff:::,?;,.J~,';Y;~,~lt.,;}:;~:t';i:':?,.",' ,','., i' :.;)i:;:~';: >:7:' ,:::,/>:";.:: _,',' ,::,' ~',>: ." :\" ",,:":>:OS'~.J~::7:--:' \-:':'~':,,:;;~ n amoilDt is ~~~"red iI! Line2l (Dlreet SalariesHhen the '''Age 4 Lbi~40.~.dditionaUv, if aD' amount Is ente@! iii .'~~ing Top 5 IDdividulll s;.lariJ must be -enlered 0'; Page:' [,~::I$:X,,;':,i0;):';;,';;;:;;;';:,: \::J:::',:\J;~;,,;/;;:;~?~:!-j(-":; '. ii lnai~cluiil - Iaries, DiUIt be . ~-~..}; . ";,-,':',:;,,.:'.. "'~. "':f.":~'.,~' - """-" " <\">",';' :\"~ 'SaIaries) then the...".! /. ! ~~~~~~{f?'~~;.;,t1JS.:~::: I): t:"~;:~~0'\};;,~;')':;~~tc :-; , " " Suffolk County Agency Contract Disclosure CONTRACTOR NAME: Town of Southold CONTRACT: CSE Residential Repair Reference: Page 3, questions 21 through 37. Program expenses are recorded pursuant to rules and regulations promulgated by GASB and the New York State Comptroller and are not segregated by county program. Therefore, this program specific information is not available.