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INDIAN RIVER COUNTY NONPROFIT/ QUASI AGENCY REQUEST FOR FUNDING <br />A. Program Cover Page <br />Agency: New Horizons of The Treasure <br />Coast, Inc. <br />Contact Person: William Wims <br />Title: President/CEO <br />Address: 4500 W Midway Road <br />Telephone: 772-672-8350 <br />Fax: 772-468-5606 <br />E -Mail: wwims(a)nhtcinc.onmlcrosoft.com <br />Website nhtcinc.org k(tl' i] 7 20%1 <br />Address: <br />Mental Health and Substance <br />Program Title:}<�>t <br />Abuse Services <br />ovl, <br />. `'.. <br />i Agree - By checking the "I Agree" box and entering your name below, you certify that information M <br />contained In this application accurately reflects the activities of this agency and that the expenditures or <br />porflons thereof for which County funds are being requested are not reimbursed by any other source. <br />Name: William Wims Title: William Wims, President CEO <br />Brief description of the Program for which tunding is requested: <br />The purpose of this application Is to secure match funding necessary to leverage funding from the Department <br />of Children and Families through their contract with Southeast Florida Behavioral Health Network (SEFBHN). <br />The funds requested will be used to provide services to Indian River County residents ranging from <br />emergency stabilization provided 24/7 to Intensive community based programs for children and adults. (A <br />Program Description of all services, locations and service time Is attached.) The attached report "Units of <br />Service Report with State Rate" shows the specific services provided and number of residents accessing <br />these services for the period 10/1/2019 to 09/30/2020. <br />Summary Re ort <br />Amount requested from Indian River County for 2021/2022: <br />Total Proposed Program budget for 2021/2022: <br />Percent of total Program budget: <br />Current Funding (2020/2021) <br />Dollar Increase / (decrease) in request: <br />Percent increase / decrease In request: <br />Iain <br />$329,490.00 <br />$26,617,270.00 <br />1,29% <br />The Organization's Board of Directors has approved this application on (date): 05/01/21 <br />Name of Presideni/Chair of the Board: Greg Pickett <br />Name of Exec. Director/CEO: William Wims <br />3 <br />