NGO Funding Request


The recipient entity's full legal name:  University Hospital & Clinics, Inc.

The recipient entity's physical address:
           2390 West Congress Street, Lafayette, LA 70506

The recipient entity's mailing address (if different):
           2390 West Congress Street, Lafayette, LA 70506

Type of Entity (for instance, a nonprofit corporation):  Non-Profit Corporation

If the entity is a corporation, list the names of the incorporators:
          

The last four digits of the entity's taxpayer ID number:  5366

What is the dollar amount of the request?  $7,255,000

What type of request is this?  Capital Outlay Appropriation

Is this entity in good standing with the Secretary of State?  Yes

Provide the name of each member of the recipient entity's governing board and officers:
           David Callecod, Chairman - 213 Biltmore Way, Lafayette, LA 70508; Jared Stark, CEO - 229 Laken Lane, Lafayette, LA 70508; James Falterman, Jr., MD, Medical Director - 109 Higdon, New Iberia, LA 70563; Betty Duhon Brown, Board Member - 216 Noah Street, Lafayette, LA 70501; Allen J. Celestine, Board Member - 109 Northern Avenue, Lafayette, LA. 70501; Joby John, Board Member - 115 Canterbury, Lafayette, LA 70503; Rosemary St. Clergy, Board Member - 420 E. Bellevue, Opelousas, LA 70570; Katie Hebert, COO - 109 Stephanie, Lafayette, LA 70503; Laurence Vincent, CNO - 202 Stonehill Road, Lafayette, LA 70508; Brian Kirk, CFO - 100 Troon Drive, Broussard, LA 70508

Provide a summary of the project or program:
           A 40,000 SF building will be constructed on property adjacent to the current main facility of University Hospital & Clinics. The building space will be utilized for outpatient and support services such as pediatric and women's health care, primary and specialty care medical clinics for children and adults and other ancillary services. Medical skills lab and other educational space, will be utilized by medical residents, other healthcare professionals and hospital and clinic employees to gain proficiency in the new and latest medical procedures and technology, will also be provided in the new building.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $52,639,864
          Professional Services. . . $37,769,779
          Contracts . . . . . . . . . . . $418,607
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $36,024,350
          Other Charges. . . . . . . $18,529,713

Does your organization have any outstanding audit issues or findings?  No

If 'Yes' is your organization working with the appropriate governmental agencies to resolve those issues or findings?
          

What is the entity's public purpose, sought to be achieved through the use of state monies?
          University Hospital & Clinics serves as the primary health care facility for the people residing in the Acadiana region who are uninsured or under-insured. University Hospital & Clinics also serves as the primary health care facility for this region's medical residency program and currently trains approximately 200 students and medical residents each year. This project will help to ensure that the region will have adequate clinic facilities to serve the people within the region - especially the indigent and uninsured population - and will also help to ensure that the region can continue to provide the necessary facilities and technology to maintain a medical residency program for the region.

What are the goals and objectives for achieving such purpose?
          The primary goals and objectives for achieving this purpose is to develop and build a facility that will provide adequate clinic space for providing services that include pediatric and women's health care, and other primary and specialty care clinics. This project will also help to achieve the goal of ensuring that the region will be able to maintain a medical residency program that will help to attract and recruit physicians to provide medical care within the region.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           30 Months

If any elected or appointed state official or an immediate family member of such an official is an officer, director, trustee, or employee of the recipient entity who receives compensation or holds any ownership interest therein:
     (a) If an elected or appointed state official, the name and address of the official and the office held by such person:
                 N/A
    
     (b) If an immediate family member of an elected or appointed state official, the name and address of such person; the name, address, and office of the official to whom the person is related; and the nature of the relationship:
                 N/A

     (c) The percentage of the official's or immediate family member's ownership interest in the recipient entity, if any:
                 N/A

     (d) The position, if any, held by the official or immediate family member in the recipient entity:
                  N/A

If the recipient entity has a contract with any elected or appointed state official or an immediate family member of such an official or with the state or any political subdivision of the state:
(a) If the contract is with an elected or appointed state official, provide the name and address of the official and the office held by such person: 
               N/A

(b) If the contract is with an immediate family member of an elected or appointed state official:
          Provide the name and address of such person:
               N/A

          Provide the name, address, and office of the official to whom the person is related:
                N/A

          What is the nature of the relationship?  N/A

(c) If the contract is with the state or a political subdivision of the state, provide the name and address of the state entity or political subdivision of the state:
                 N/A

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               N/A


Contact Information
name:  Brian T. Kirk 
                                       address:  2390 West Congress Street, Lafayette, LA 70506
                                       phone:  337-261-6011
                                       fax:  337-261-6003
                                       e-mail:  btkirk@lgh.org
                                       relationship to entity:  CFO