NGO Funding Request


The recipient entity's full legal name:  CHRISTUS Health Central Louisiana d/b/a CHRISTUS Coushatta Health Care Center

The recipient entity's physical address:
           1635 Marvel Street
Coushatta, LA 71019


The recipient entity's mailing address (if different):
           1635 Marvel Street
Coushatta, LA 71019


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

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

The last four digits of the entity's taxpayer ID number:  8984

What is the dollar amount of the request?  $0

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:
           Abdel-Raouf F. Abu Shamat The Kidney Clinic
Michael DeBakey Drive, Suite 140
Lake Charles, LA 70601
Robert T. “Bob” Chandler Polaris Engineering
P.O. Box 125
Lake Charles, LA 70601
Gavin F. Chico, MD CHRISTUS Coushatta Health Care Center
1635 Marvel Street
Coushatta, LA 71019
Johnnie L. Clark, Jr., MD Premier Pediatrics
1405 Metro Dr., Bldg. L
Alexandria, LA 71301
Moselle A. Dearbone, PhD 2201 Donahue Ferry Road
Pineville, LA 71360
Aloysia C. Ducote Ducote & Company, Certified Public Accts
P.O. Box 70
Hamburg, LA 71339
Dallas L. Hixson
(Board Chair)
Hixson Automotive Group
2506 MacArthur
Alexandria, LA 71301
Ronald S. “Ronnie” Johns 3701 Maplewood Drive
Sulphur, LA 60663
Bernard S. Johnson Cook, Yancey, King & Galloway
333 Texas, Suite 1700
Shreveport, LA 71101
Martin W. Johnson Green Solar Louisiana
2211 North Macarthur Drive
Alexandria, LA 71303
Sister Theresa McGrath 536 W. Kings Hwy., Apt. 1
San Antonio, TX 78212-2813
Sister Miriam T. Miller Villa de Matel
6510 Lawndale
Houston, TX 77023
Nancy Stich Capital One
P.O. Box 3597
Baton Rouge, LA 70821
Thomas “Steen” Trawick, MD CHRISTUS Health Shreveport/Bossier
1453 East Bert Kouns Ind. Lp.
Shreveport, LA 71115
Willie C. White, III David Raines Community Health Center
3041 Dr. MartinLuther King, Jr. Drive
Shreveport, LA 71107
Nancy R. Hellyer, CEO CHRISTUS Health Central Louisiana
3330 Masonic
Alexandria, LA 71301


Provide a summary of the project or program:
           CHRISTUS Coushatta Health Care Center would like the opportunity to establish a Rural Health Clinic located at your location addressed 160 Stonecreek Drive, Stonewall, LA 71078. Our interest is in a five year agreement at no cost. We will provide equipment, staff, supplies, utilities, etc. Our intent is to provide outpatient services to the local community to include laboratory services, radiological services, pharmacy, and family medical services by licensed physicians and practitioners.

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?
          The purpose and intent of interest is in the physical building located at 160 Stonecreek Drive, Stonewall, LA 71078 rather than monies.

What are the goals and objectives for achieving such purpose?
          CHRISTUS Coushatta Health Care Center has one goal: to provide excellent and easily accessible healthcare to meet the needs of the Stonewall community and surrounding rural areas.

What is the proposed length of time estimated by the entity to accomplish the purpose?
           90 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:
                
    
     (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:  Justin McKnight 
                                       address:  1635 Marvel Street
Coushatta, LA 71019

                                       phone:  318-932-2191
                                       fax:  318-932-2211
                                       e-mail:  justin.mcknight@christushealth.org
                                       relationship to entity:  Director of Ambulatory Services & Finance