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

The recipient entity's mailing address (if different):
           3111 Florida Street
Baton Rouge, LA
70806

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:  0

What is the dollar amount of the request?  $150,000

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:
           1. Ruth Franklin, Secretary/Treasurer
704 Vatican Dr.
Donaldsonville, LA 70346

2. Linda Cannon
14475 Summerset Dr.
Gonzales, LA 70737

3. Andrus Richard
3912 Gus Young Dr.
Baton Rouge, 70802

4. Dianna Payton
3338 Pine Grove, Dr.
Baton Rouge, LA 70816

5. Kenneth Wright, President
643 WoodCliff Dr.
Baton Rouge, LA 70815

6. Tasha Dennis
8636 Cullen Avenue
Baton Rouge, LA 70809

7. Edmond Jordan
425 LeJeune St.
Brusly, LA 70719

8. Shirley Lolis, V. President
3156 Anita Dr.
Baton Rouge, LA 70805

Provide a summary of the project or program:
           If approved,CareSouth will expand to provide medical, dental, and medical support services to residents living in North Baton Rouge and surrounding communities. North Baton Rouge has been designated by the
Federal Bureau of Primary Health Care Services and the Louisiana Department of Health as medically
underserved areas. This means that there are not enough doctors and dentists in the area to provide health care services to those living in the area. CareSouth will apply to the Bureau of Primary Health Care for a federal grant to help defray the cost of the health services it will provide in the area. Establishing another Federally Qualified Health Center (FQHC) in Louisiana is supported by the President of the U.S. and Governor Edwards who both have endorsed expansions of these types of clinics to help provide low cost primary medical and dental services to the growing number of uninsured residents living in the United States and particularly in Louisiana where the uninsured is now approximately 20% of the total population. In addition, the Louisiana Department of Health has a Legislative Mandate in Act 162 of the First Extraordinary Session of 2002 "to maintain, enhance, and expand primary health services currently offered by private and public providers." One of major objectives of LDH Strategic Plan is "to support the sustainability of existing community health centers." Approval of this Capital Outlay request will lend State support to these goals and commitments.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $0
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          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?
          To provide primary heath care service delivery site to a medically underserved population in North Baton Rouge, LA.

What are the goals and objectives for achieving such purpose?
          Establishing another Federally Qualified Health Center (FQHC) in Louisiana is supported by The President and Governor Edwards who both have endorsed expansions of these types of clinics to help provide low cost primary medical and dental services to the growing number of uninsured residents living in the United States and particularly in Louisiana where the uninsured is now approximately 20% of the total population. In addition, the Louisiana Department of Health has a Legislative Mandate in Act 162 of the First Extraordinary Session of 2002 "to maintain, enhance, and expand primary health services currently offered by private and public providers."

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

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:  3111 Florida Street
Baton Rouge, LA 70806
                                       phone:  (225)301-1585
                                       fax: 
                                       e-mail:  mvalliere@caresouth.org
                                       relationship to entity:  CEO