The recipient entity's physical address:
           4950 Essen Lane
Baton Rouge, LA 70809

The recipient entity's mailing address (if different):
           4950 Essen Lane
Baton Rouge, LA 70809

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:  0520

What is the dollar amount of the request?  $350,000

What type of request is this?  Both

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:
           Board of Directors
Tom Adamek – Chair
Cordell Haymon – Vice Chair
Vanessa Graham – Secretary/Treasurer
Art Favre – Immediate Past Chair
Jonas Fontenot, PhD - President/CEO
Kate Castle, M.D. - Medical Director
Nathaniel Tannehill – MBPCCF Chair
Anthony O’Connor
Cathy Giering
Mark Dearman
Mawe Takyi
Laurie Lipsey
Eric Lane
John Boyce
Kyle France
David Hanson, M.D.
Cynthia Peterson
Hank Saurage
Tee Brown
Steven Moore
Sandra Brown
Danielle Mack - Chief Development Officer
Renea Duffin - Vice President (person responsible for program)
Dana Neucere - CFO
Jodi Conachen - COO

Provide a summary of the project or program:
           Our project goal is to purchase an additional mobile medical clinic to provide 5 types of cancer screenings in 31 parishes in the state focusing on disparate communities. We will also provide patient navigation for those with abnormal findings and community outreach.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $350,000
          Major Repairs . . . . . . . $0
          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?
          For 50 years, Mary Bird Perkins Cancer Center (MBPCC) has worked relentlessly on behalf of our patients and their loved ones to improve survivorship and lessen the burden of cancer (mission). We provide the highest quality treatment, educational programs, screenings and clinical trials to residents throughout a 30-parish service area in eastern Louisiana (LA) and four counties in southern Mississippi (MS). Through our collaborative work, we provide the critical resources necessary for the fight against cancer to all those in need. We serve all individuals diagnosed with cancer regardless of their ability to pay. Across our network, we see approximately 8,500 patients annually

What are the goals and objectives for achieving such purpose?
          Our goals and objectives are to purchase a custom built mobile mammogramp clinic, including all required equipment for operation of the unit

What is the proposed length of time estimated by the entity to accomplish the purpose?
           24 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:
                

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

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:
               

          What is the nature of the relationship? 

(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:  Renea Duffin 
                                       address:  4950 Essen Lane
Baton Rouge, LA 70809
                                       phone:  2252151227
                                       fax:  2252151387
                                       e-mail:  rduffin@marybird.com
                                       relationship to entity:  Vice President