The recipient entity's physical address:
           1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

The recipient entity's mailing address (if different):
           1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

Type of Entity (for instance, a nonprofit corporation):  Corporation

If the entity is a corporation, list the names of the incorporators:
          MATTHEW D KLEIN SECRETARY
367 S GULPH ROAD
KING OF PRUSSIA PA 19406

CHERYL K RAMAGANO TREASURER
367 S GULPH ROAD
KING OF PRUSSIA PA 19406

STEVE FILTON DIRECTOR, VICE-PRESIDENT
367 S GULPH ROAD
KING OF PRUSSIA PA 19406

MATT PETERSON PRESIDENT
367 S GULPH ROAD
KING OF PRUSSIA PA 19406

The last four digits of the entity's taxpayer ID number:  4854

What is the dollar amount of the request?  $370,000

What type of request is this?  General 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:
           WILLIAM WEAVER CHIEF EXECUTIVE OFFICER
1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

RAVON DOMINIQUE CHIEF NURSING OFFICER
1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

RICHARD BENNETT CHIEF OPERATIONS OFFICER
1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

NARAYANA SABBENAHALLI MD INTERIM CHIEF MEDICAL OFFICER
1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

MARY KATHERINE BELL CHIEF FINANCIAL OFFICER
1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

CYNTHIE VINEYARD, LEAD EDUCATOR
1006 HIGHLAND AVENUE
SHREVEPORT LA 71101

Provide a summary of the project or program:
           To provide appropriate educational services to Louisiana residents between the ages of 5 and 17 years who are hospitalized for acute psychiatric disorders at Brentwood Hospital.

What is the budget relative to the project for which funding is requested?:
          Salaries. . . . . . . . . . . . . $370,000
          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 appropriate educational services to Louisiana residents between the ages of 5 and 17 years who are hospitalized for acute psychiatric disorders at Brentwood Hospital.

What are the goals and objectives for achieving such purpose?
          To provide daily (excluding weekends and holidays) comprehensive lessons tailored to the individual patient’s educational needs. These lessons are to be aligned with Louisiana state standards while providing no interruption of the patient’s treatment plan.

Relevant activities are instruction, guided practice, and independent practice. All activities will be completed over a two hour period per day.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           AVERAGE LENGTH OF STAY FOR EACH PATIENT IS 9 DAYS

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:
                 LOUISIANA SPECIAL SCHOOL DISTRICT
LOUISIANA DEPARTMENT OF EDUCATION
1201 N 3RD ST
BATON ROUGE LA 70802

(d) The nature of the contract, including a description of the goods or services provided or to be provided pursuant to the contract:
               To provide appropriate educational services to Louisiana residents between the ages of 5 and 17 years who are hospitalized for acute psychiatric disorders at Brentwood Hospital.
Funding requested will supplement educator salaries.
Facility will continue to absorb remaining salary, benefit, supply & equipment expenses.


Contact Information
name:  Mary Brooks 
                                       address:  1006 Highland Avenue
Shreveport LA 71101
                                       phone:  318-678-7557
                                       fax:  318-227-9296
                                       e-mail:  mary.brooks@uhsinc.com
                                       relationship to entity:  Executive Administrative Assistant