The recipient entity's physical address:
           3140 Florida St.
Baton Rouge, LA 70806

The recipient entity's mailing address (if different):
           P.O. Box 66156
Baton Rouge, LA 70896

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:  5500

What is the dollar amount of the request?  $1,277,265

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:
           Governing Board:
Edmond Jordan (President) 425 Lejeune St Brusly, LA 70719
Elaine Patin (Vice President) 1662 Harding Blvd. Baton Rouge, LA 70807
Debra Butler (Treasurer) 1138 Columbus Dunn Dr. Baton Rouge, LA 70802
Ruth Franklin (Secretary) 704 Vatican Dr. Donaldsonville, LA 70346
Richard Andrus 3912 Gus Young Blvd. Baton Rouge, LA 70802
Kerry Auzenne 680 Sharp Lane Apt. 416 Baton Rouge, LA 70815
Dalton Honore Jr. 6655 Van Gogh Ave. Baton Rouge, LA 70806
Shirley Lolis 3156 Anita Ave Baton Rouge, LA 70805
Edwin Walker P.O. BOX 12566 Baton Rouge, LA 70813
Kenneth Wright 653 Woodcliff Drive Baton Rouge, LA 70815
Matthew Valliere (Chief Executive Officer) 2441 Creek Hollow Ave. Zachary, LA 70791

Provide a summary of the project or program:
           The proposed project is designed to redevelop the previous location of Earl K. Long hospital and to have a CareSouth clinic as one of the anchor sites of the location. This clinic will provide primary care, behavioral health and specialty services to the patient population of this underserved area.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $152,265
          Acquisitions . . . . . . . . . $850,000
          Major Repairs . . . . . . . $275,000
          Operating Services. . . . $0
          Other Charges. . . . . . . $0

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?
          The public purpose of CareSouth is to provide quality, affordable health care to residents of the Baton Rouge metropolitan area regardless of their ability to pay. The entity will offer comprehensive medical, behavioral health and specialty services to residents of this underserved area with a focus on the uninsured, underinsured and Medicaid populations. These state monies will allow for the revitalization of the property where a prominent teaching hospital focused on service to the indigent once existed.

What are the goals and objectives for achieving such purpose?
          The goals and objectives are to do the following:

- improve access to primary care and specialty services in the 70805 and surrounding zip codes
- improve healthcare outcomes related to cardiovascular disease and diabetes of residents in the 70805 and surrounding zip codes
- create economic development opportunities within the 70805 zip code through the revitalization of this property

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:  Matthew Valliere 
                                       address:  P.O. Box 66156
Baton Rouge, LA 70896
                                       phone:  12253011585
                                       fax: 
                                       e-mail:  mvalliere@caresouth.org
                                       relationship to entity:  Chief Executive Officer