The recipient entity's physical address:
           5000 Hennessy Blvd. Baton Rouge, La 70802

The recipient entity's mailing address (if different):
           5000 Hennessy Blvd. Baton Rouge, La 70802

Type of Entity (for instance, a nonprofit corporation):  Non-Profit Religious Corp.

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

The last four digits of the entity's taxpayer ID number:  6617

What is the dollar amount of the request?  $7,763,900

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:
           Mr. John M. Selser, Chair
Tightline Capital
619 Jefferson Highway Suite 2F
Baton Rouge, LA 70806

Mr. William E. Balhoff, Vice Chair
Postlethwaite and Netterville 8550 United Plaza Blvd
Ste 1001
Baton Rouge, LA 70809

Ms. Yolanda Dixon, Secretary
Louisiana Senate PO Box 94183
Baton Rouge, LA 70804-9183

Louis Barfield, MD
BR Colon Rectal Associates
7777 Hennessy Blvd, Ste 206
Baton Rouge, LA 70808

Mr. Greg Bowser
Louisiana Chemical Association One American Place
Suite 2040
Baton Rouge, LA 70825

Sr. Helen Cahill, FMOL
FMOL
4200 Essen Lane
Baton Rouge, LA 70809

Michael Crapanzano, MD
Pediatric Cardiology Associates
7777 Hennessy Blvd, Ste 103
Baton Rouge, LA 70808

James Craven, MD
CVT Surgical Center
7777 Hennessy Blvd, Ste 1008
Baton Rouge, LA 70808

Henry L. Eiserloh, MD
Baton Rouge Orthopedic Clinic
8080 Bluebonnet Boulevard
Suite 1000
Baton Rouge, LA 70801

Mr. John M. Engquist
H&E Equipment Services
7500 Pecue Lane
Baton Rouge, LA 70809

Mr. Scott N. Hensgens
Breazeale Sachse & Wilson, LLP
PO Box 3197
Baton Rouge, LA 70821-3197

Mr. Julio Melara
Louisiana Business, Inc.
9029 Jefferson Hwy, Suite 300
Baton Rouge, LA 70808

Benton Oubre, MD
Gastroenterology Associates
9103 Jefferson Highway
Baton Rouge, LA 70809

Mr. Harry J. “Skip” Philips, Jr.
Taylor, Porter, Brooks & Phillips, LLP
451 Florida Street, Suite 800
Baton Rouge, LA 70801

Sr. Eileen Rowe, FMOL
FMOL
4200 Essen Lane
Baton Rouge, LA 70809

Mr. K. Scott Wester
OLOL Regional Medical Center
5000 Hennessy Boulevard
Baton Rouge, LA 70808

Provide a summary of the project or program:
           Construct 130-bed, free-standing Children's Hospital facility to provide specialized inpatient and outpatient care for Louisiana's pediatric population.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $28,700,325
          Professional Services. . . $12,532,000
          Contracts . . . . . . . . . . . $0
          Acquisitions . . . . . . . . . $0
          Major Repairs . . . . . . . $0
          Operating Services. . . . $0
          Other Charges. . . . . . . $8,931,000

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 construct 130-bed, free-standing Children's Hospital facility to provide specialized inpatient and outpatient care for Louisiana's pediatric population.

What are the goals and objectives for achieving such purpose?
          Program is currently housed within floors 2 and 3 of Our Lady of the Lake Regional Medical Center. In order to accommodate expansion and specialized needs of pediatric patients and families, a new facility is needed.

The new Children's Hospital facility will include space for comprehensive pediatric medical services across the inpatient and outpatient continuum's of care. The distribution of patient care, diagnostic and treatment, and shell space to public, administrative, and support space is represented. The ratio for the patient
care/diagnostic and treatment/shell space to public/administrative/support space is approximately 74% to
26%. Shell space will be used for future expansion for patient care services to total the 130-bed capacity.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           03/31/2020

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:
                
    
     (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:
                

     (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: 
               

(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:
              

          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:
                

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


Contact Information
name:  Angie Brown 
                                       address:  9032 Perkins Road
Baton Rouge, La 70810
                                       phone:  225-768-5791
                                       fax: 
                                       e-mail:  angelee.brown@fmolhs.org
                                       relationship to entity:  Director of Community Health Sciences Programs