The recipient entity's physical address:
           3111 Florida St.
Baton Rouge, LA 70806

The recipient entity's mailing address (if different):
           PO 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?  $550,000

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:
           Matthew Valliere, CEO
2441 Creek Hollow Ave
Zachary, LA 70791

Edmond Jordan
Natalie Cooley
Ruth Franklin
Debra Butler
Richard Andrus
Kerry Auzenne
Dalton Honore
Shirley Lolis
Elaine Patin
Edwin Walker
Kenneth Wright

Provide a summary of the project or program:
           This project will be to construct a state-of-the-art healthcare facility in north Baton Rouge that will offer primary care, dental and behavioral health services. The primary targeted patient population will be low-income, uninsured and underinsured individuals.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $0
          Professional Services. . . $550,000
          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?
          The organization's mission is to provide affordable healthcare services with compassion and respect for all. The purpose is to provide a facility which offers outstanding medical care to the most vulnerable populations.

What are the goals and objectives for achieving such purpose?
          The goals and objectives are to build a state-of-the-art healthcare facility that will be beneficial to improving healthcare access and health care outcomes to individuals in the 70805 and contiguous zip codes.

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:
               The contracts that will be executed for the purpose of this project will be for architectural design, planning and construction of the facility.


Contact Information
name:  Matthew Valliere 
                                       address:  3111 Florida St.
Baton Rouge, LA 70806
                                       phone:  2253011585
                                       fax: 
                                       e-mail:  mvalliere@caresouth.org
                                       relationship to entity:  Chief Executive Officer