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Community Development - Community Programs
CDBG FY 2023-2024
Deadline: 12/7/2022
Savie Health Corp.
Free Health Care for Uninsured Santa Maria Residents
Jump to: Pre-Application Application Questions Program Budget Tables Required Documents
USD$ 20,000.00 Requested
Submitted: 12/6/2022 11:38:23 AM (Pacific)
Project Contact
Eryn Shugart
[email protected]
Tel: 805.455.0165
Additional Contacts
[email protected]
Savie Health Corp.
1111 E Ocean Ave Ste 2
Lompoc, CA 93436
United States
Executive Director
Eryn Shugart
[email protected]
Telephone(805) 743-4776
Fax (805) 735-8540
Web saviehealth.org
Pre-Application top
1. What type of proposal is this?
Public service programs must answer this question and submit. Capital projects must continue.
2. What priority does this Capital project fall under?
-answer not presented because of the answer to #1-
3. Proposed Project Goal:
-answer not presented because of the answer to #1-
4. Project Description (Program Narrative):
-answer not presented because of the answer to #1-
5. Statement of Need: Provide a summary of the established need for the proposed project and the problems that will be solved as a result of the project.
-answer not presented because of the answer to #1-
Some answers will not be presented because they are not part of the selected group of questions based on the answer to #1.
Capital
Public Service
6. Proposed date of construction or project start:
-answer not presented because of the answer to #1-
7. Schedule:
-answer not presented because of the answer to #1-
8. Phasing:
-answer not presented because of the answer to #1-
9. Do Federal Labor Standards and Davis-Bacon prevailing wages apply? -answer not presented because of the answer to #1-
10. As a Public Service Applicant, indicate that you are aware that your Application deadline is not until Wednesday, December 7, 2022.
Yes
No
Documents Requested * Required?Attached Documents *
Budget for Proposed Capital Development Project
(Required for Capital project proposals)
download template
Agency Evaluation Worksheet (Required for Capital
project proposals)
download template
Application Questions top
Project Information
1. Please state the type of CDBG program / project you are applying for:
THIS IS A BRANCHING QUESTION. Different questions will apply based on your answer to this question. Please disregard any incorrect number sequencing.
2. Name of proposed program / project:
Free Health Care for Uninsured Santa Maria Residents
3. Location of proposed program / project:
(Street address, if applicable of proposed program / project):
1111 East Ocean Aven., #2, Lompoc, CA 93436
Problem / Need Statement
4. Proposed Program / Project Description: Describe in detail the services that will be provided to Santa Maria residents with the requested CDBG funding and explain the established need for this program/project. What problems will this program/project solve or alleviate?
Include quantitative data to support your position.
Savie Health free clinic already provides free medical services to residents of Santa Maria (SM) who are uninsured. We will also be enrolling residents who may not be aware that they are eligible into Medi-Cal, and will soon be contracted with the SB County Education Office to do so. We will be receiving funding in the next month to add telehealth to our services.
For this project, staff will attend community health fairs and work with the Santa Barbara County Promotores on specific outreach to Santa Maria residents. We will also inform other nonprofits in SM (that may be unaware of Savie) about our work, and advertise on Spanish language radio to best get the word out about our services.
Some answers will not be presented because they are not part of the selected group of questions based on the answer to #1.
Public Services
Capital Project
We will provide primary, preventive, and behavioral healthcare, health education, and care coordination to uninsured SM residents. We will pay for the cost of patients’ lab and imaging expenses and provide discounted medication cards so that usually patients will not be paying more than $4 per prescription. With telehealth, residents of Santa Maria will be able to have follow-up medical visits, care coordination visits, and initial and ongoing behavioral healthcare without needing to drive back to our Lompoc clinic.
Savie’s services address the healthcare provider shortage that exists in the City of Santa Maria per HRSA (in zip codes 93454,93455, and 93458). Furthermore, the 93454-zip code region in Santa Maria has been designated as medically underserved. In addition to these communities being both medically underserved and healthcare provider shortage areas, there is a substantial population of Santa Maria residents who are uninsured (approximately 10,000 individuals, per the Santa Barbara Foundation website). According to the National Immigration Law Center, access to health care coverage improves well-being and saves lives. Compared to people with health insurance, people who are uninsured are more likely to: receive an initial diagnosis in the advanced stages of a disease, die or suffer permanent impairment after a sudden-onset condition, and to live with a chronic condition that could be managed if diagnosed.
Savie Health addresses patient’s social determinants of health, which are conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide variety of health, functioning, and quality of life outcomes and risks. We do this through the administration of a SDOH survey, and our bilingual, bicultural, Promotore Clinic Manager provides care consultations with patients based upon their outcomes on these measures to provide appropriate community referrals.
Finally, Savie Health will be enrolling individuals who are eligible into Medi-Cal. Our Promotore is certified to do so, and many of those that we serve are unaware that they are eligible, due to recent changes in California law such that immigrants who are under 26 and over 49 are automatically eligible, regardless of their immigration statu
5. Based on the City of Santa Maria's Community Development Block Grant priorities for Fiscal Year 2023-24, which PRIMARY priority do you feel your program / project falls under? The priorities are not listed in order of importance. They are numbered for referencing purposes only. Priorities #1 and #2 will only be considered for CDBG public services funding.
6. Explain why you believe your program / project best fits the PRIMARY priority selected.
Refer to NOFA packet for the detailed description of each priority and choose only one subcategory under one of the four priorities.
Savie Health’s work assists low income persons in need of food, shelter, clothing, health care and/or safety. We specifically assist individuals in this population who do not have health insurance by providing them with preventative and behavioral healthcare, medication management, nutrition counseling and care coordination. The majority of residents who come from Santa Maria are farmworkers or other individuals who have recently arrived from Mexico. Nearly all of our patients speak only Spanish.
We have patients complete an intake form that asks their income, and whether the patient is an agricultural worker. What is unique about Savie Health is that patients are willing to come to our clinic regardless of their immigration status because we do not require documentation including pay stubs, which deters these patients from seeking care elsewhere, as other health centers do require this documentation. Our bilingual, bicultural, Promotore (who is also our Clinic Manager), Medical Assistant, and office volunteers are able to communicate with and translate for these patients when needed. In reviewing the stated income of our Santa Maria patients, all fall in the low-income category, with many individuals reporting income levels of $20,000 or less for their family, and some reporting no income at all.
Furthermore, by enrolling eligible SM patients who seek care at Savie into Medi-Cal, these individuals (many of whom are not aware they are eligible due to being newly eligible on account of the recent Medi-Cal expansion to those aged 50 and over and 26 and under regardless of immigration status, and those who have recently come to this country from Mexico) these individuals will have access to full scope healthcare and well as dental care. These individuals will be able to receive healthcare from specialists such as cardiologists, endocrinologists, urologists, and others that will best be able to care for acute or chronic healthcare conditions that these individuals may have.
Without access to healthcare, individuals who are uninsured are more likely to experience chronic conditions such as diabetes, and acute conditions such as a stroke, resulting in these individuals having a decreased likelihood of being able to maintain their jobs, purchase food, and maintain their housing.
Prevent homelessness and address critical emergency, at-risk youth, elderly and underserved populations
Expand educational and development opportunities
Provide affordable housing
Revitalize existing neighborhoods
Target Population
7. At least 70 percent of the CDBG funding used must serve low- to moderate-income persons. How does your program / project benefit low- to moderate-income Santa Maria residents? Provide the income guidelines and requirements used to qualify participants for the proposed program/project.
Note: CDBG income limits can found on the City's webpage under General Subrecipient Resources www.cityofsantamaria.org/city-government/departments/community-development/special-projects-division/community- development-block-grant-cdbg-program
Savie Health’s work assists low income Santa Maria residents in need of healthcare due to being uninsured, primarily due to immigration status. We estimate that 80-85% of our patients are undocumented. We specifically assist individuals in this population who do not have health insurance by providing them with preventative and behavioral healthcare, medication management, nutrition counseling and care coordination. The majority of residents who come from Santa Maria are farmworkers or other individuals who have recently arrived from Mexico. Nearly all of our patients speak only Spanish, and are English illiterate.
We have patients complete an intake form that asks their income, and whether the patient is an agricultural worker. What is unique about Savie Health is that patients are willing to come to our clinic regardless of their immigration status because we do not require documentation including pay stubs, which deters these patients from seeking care elsewhere, as other health centers do require this documentation. We are filling a previously unmet need in doing this, and our clinic has been incredibly busy treating patients from this population since the day we opened. In reviewing the stated income of our Santa Maria patients, almost every patient falls in the low-income category, with many individuals reporting income levels of $20,000 or less for their family, and some reporting no income at all.
Furthermore, by enrolling eligible patients who seek care at Savie into Medi-Cal, these individuals (many of whom are not aware they are eligible due to being newly eligible on account of the recent Medi-Cal expansion to those aged 50 and over and 26 and under regardless of immigration status, and those who have recently come to this country from Mexico) these individuals will have access to full scope healthcare and well as dental care. These individuals will be able to receive healthcare from specialists such as cardiologists, endocrinologists, urologists, and others that will best be able to care for acute or chronic healthcare conditions that these individuals may have.
Without access to healthcare, individuals who are uninsured are more likely to experience chronic conditions such as diabetes, and acute conditions such as a stroke, resulting in these individuals having a decreased likelihood of being able to maintain their jobs, purchasing food, and maintaining their housing. Our work is helping to ensure a healthier Santa Maria community through filling this previously unmet need, and addresses health equity.
8. Check box or boxes of population category to be served by the proposed program / project:
9. Out of all the boxes checked above, which population category will primarily be served by the proposed program / project?
The primary population that Savie Health serves is families living in poverty. We inquire about patient’s household size on our
Homeless
At Risk of Homelessness
Homeless Youth, 18-24 Years Old
Elderly
Victims of Crime
Persons with Mental Illness
Physically Disabled
Developmentally Disabled
Persons with AIDS/HIV
Unemployed
Language Barriers
Youth, 0-5 Year Olds
Youth, 6-12 Year Olds
Youth, 13-17 Year Olds
Families Living in Poverty
Families w/ Housing Burden
Substance Abuse Problems
At-Risk Youth
Other: Youth who do not have health insurance, primarily because their parents are not aware that they qualify for Medi- Cal
intake form, and nearly every person that we have thus far provided services for who is a Santa Maria resident lives with family.
Frequently, adult children bring their older parent to our clinic to receive care. As previously stated, in reviewing the reported income of our Santa Maria patients, just about all fall in the low-income category. Many patients individuals report income levels of $20,000 or less for their family, and some reporting no income at all. Savie serves many individuals who come to the clinic with their partner, and often, children are brought along to the visit. Savie is able to, but has not as of yet, served residents of Santa Maria who are children. We are able to provide healthcare services to children who do not have health insurance. Our comprehensive health, behavioral health, and care coordination services all benefit entire families.
Unit of Service
10. What is the total number of unduplicated persons OR households to be served OVERALL by the proposed SANTA MARIA program / project?
Please enter only for persons OR households (not both).
11. A.) Define the unit of service, other than persons or households, to be provided by the proposed program. A unit of service is the service that is being provided to the client under CDBG. B.) Provide the estimated units of service each person OR household will receive.
Example: A.) The unit of service can be defined as a bed night, meal, counseling session, etc.; B.) 1 person OR household equals (X amount) units of service; 1 person equals approx. 30 shelter bed nights.
A. Units of service: healthcare visit, care coordination, labs/imaging, Medi-Cal enrollment. B. Units of services that each person will receive is estimated to be 3: a visit, care coordination & labs, or a visit, care coordination & Medi-Cal enrollment.
Outcomes
12. Describe your short- and long-term goals and performance targets.
A.) Describe the intended outcomes for the program participants / beneficiaries; B.) What measures, tools and / or indicators will be used to demonstrate the outcomes?
The intended outcomes (and outcome measures) will be as follows:
Short Term:
First, The Promotores will provide outreach in the Santa Maria community at a variety of locations and provide Savie with intake documents for individuals interested in being seen for a healthcare visit at our clinic. Based upon this outreach, 25 residents will receive an in-person healthcare visit/ and a care plan at the conclusion of their visit, and 25 more will receive a telehealth behavioral healthcare visit or care coordination with a corresponding care or action plan. This number will be tracked through our electronic health record.
Second, Savie Health will continue to provide healthcare services to residents of Santa Maria at our clinic and soon, by telehealth.
Long Term (entire grant period and beyond):
100 additional Santa Maria residents without health insurance (who learned about us via the radio, community partners, word of mouth, etc.) will receive an initial in person healthcare/behavioral health visit at Savie Health, including a plan of care. We will track this number through our electronic health record.
Of the 125 residents receiving an initial visit at Savie, 100 will also receive lab and/or imaging tests and have a follow-up appointment in person or by telehealth to learn the outcomes of these tests and the corresponding care/medication management plan. We will track this number through our electronic health record as well.
Of the 150 Santa Maria residents served through items 1-3 above, 80% will report feeling healthier and better overall 6 months after their initial visit at Savie Health. We will track this through our electronic health record, and our bilingual office staff will make these calls or inquire of these residents as they make a return visit to Savie or via a telehealth visit.
We will enroll 30 Santa Maria residents who are eligible into Med-Cal during the grant period. These individuals most likely will have received a healthcare visit prior to enrollment, given that the Medi-Cal approval process takes time. This number will be tracked through our electronic health record as well as on reports that we provide to the Santa Barbara County Education Office.
150Persons
Households
150.00150.00TOTAL
Collaboration
13. Will you collaborate with other partners in implementing the proposed program / project? If so, identify the collaborative partners and describe how the proposed program / project will be designed and implemented.
How will funding be distributed to each collaborative partner and what percentage of the requested CDBG funding will be provided to each partner?
Savie will continue to collaborate with other organizations on this project, and our funding partner will be the Promotores (through the Santa Barbara County Education Office). Lompoc Valley Medical Center (LVMC) is a collaborative partner, as the hospital provides our clinic space to us free of charge and provides highly discounted rates on labs and imaging. We refer female patients in need of women’s healthcare (cervical and breast cancer screening) to the Santa Barbara County Public Health Department to participate in their Every Woman Counts project. We will be collaborating with Family Services Agency through a separate grant, and consequently their therapists will likely provide some behavioral healthcare services to Santa Maria patients. We refer patients to CALM, CADA, Good Samaritan, and other nonprofits depending upon their circumstances and needs. We are collaborating with the Santa Barbara County Education Office through a contract in which will receive reimbursement for enrolling eligible individuals into Medi-Cal.
Savie collaborated with the Promotores prior to opening our clinic in the beginning of 2022. They were highly effective in Spanish language outreach and in getting the word out about the new clinic to those likely to be uninsured. We will once again collaborate with them for this project. Promotores (who will be trusted members of the Latina community in Santa Maria) will go to multiple locations throughout the city where those likely to utilize Savie’s services would likely go, including food distribution sites, churches, money transfer stations, outdoor markets, etc. The Promotores will receive $5,000, or 25% of grant funds for this outreach. For this sum of funds, they will perform the following work:
Promotora Coordinator and Lead Promotoras – will assist in developing a community needs assessment, create an outreach plan, assist in developing material for outreach. Recruit additional promotores to conduct surveys (regarding whether residents are insured, eligible for Medi-Cal, whether they would be interested in receiving behavioral healthcare services, etc.) in the community. The Promotores will also plan an open house type of event to introduce these Santa Maria residents to the clinic.
Second Scope of Work: The Lead Promotoras and promotores will begin conducting community surveys and begin distribution of outreach material. They will assist in promoting the open house event and assist at the event.
14. How do you cooperate or network with other existing related programs, organizations or community resources?
Savie works closely with community partners. Lompoc Valley Medical Center (LVMC) is a collaborative partner, as the hospital provides our clinic space to us free of charge and provides highly discounted rates on labs and imaging. We refer female patients in need of women’s healthcare (cervical and breast cancer screening) to the Santa Barbara County Public Health Department (in this case, to the Santa Maria location) to participate in their Every Woman Counts project. We will be collaborating with Family Services Agency through a separate grant starting in January, and consequently their therapists will likely provide some behavioral healthcare services to Santa Maria patients. We refer patients to CALM, CADA, Good Samaritan, Catholic Charities, the Food Bank, and Route 1 Farmer's Market for food, Servicios de Immigracion, and other nonprofit and governmental agencies depending upon their needs.
Individuals who come to Savie seeking healthcare who have Medi-Cal are referred to Community Health Centers of the Central Coast. People who have emergency needs are referred to the hospital, and we inform them that emergency Medi-Cal will cover the cost of their visit.
15. Does the proposed program require parental participation or family involvement? If so, please describe in detail.
We require parental consent to treat anyone under the age of 18 years.
16. Do you utilize volunteers for direct services?
17. If answered "yes" to previous question, explain and indicate the total number of hours of volunteer labor used per year and for what purpose.
If you do not utilize volunteers for direct services because the circumstances do not allow for them or the situation is not appropriate, you may wish to make a comment to clarify your reasoning or answer "N/A".
Several of Savie Health’s medical providers are volunteers and they provide primary, preventive healthcare. Our volunteer medical providers include our Medical Director, Dr. Ahmad Nooristani, who is an Internist, Dr. Lee Silkman, Dr. Lawrence Li, and Dr. Hafez Nasr, all of whom are whom are Family Practice Physicians, and Dr. James Trettin, who is an Emergency Room Physician. Our physicians average a total of 40 hours monthly, or 480 hours annually of donated direct medical care.
Yes
No
Our Medical Assistant volunteer is Kim Garcia, who averages 30 hours monthly, or 360 hours annually of direct medical assisting care including taking patient’s health history, vitals, and assisting with minor medical procedures. Our Licensed Clinical Social Workers are volunteers Michael Dixon and Art Dossey, who average 9 hours monthly or 108 hours annually of donated behavioral healthcare services. These hours total to 948 annual hours of direct medical or behavioral healthcare services.
Non-medical office volunteer includes scribes and bilingual individuals who can help patients with paperwork and scheduling for a total of approximately 480 hours of donated services. We have interns who work remotely and help with marketing, development, and volunteer recruitment for a total of approximately 480 hours of donated services as well.
Total hours of donated volunteer labor per year averages 1908 hours.
Description of Agency Services
18. Describe in detail the services your agency provides and how they are unique from the services provided by other agencies.
Savie provides primary, preventive, and urgent care, as well as behavioral healthcare to people without health insurance When patients arrive at our clinic, they are given an intake form to complete that requests that they self-certify that they do not have health insurance and that asks other questions. They are also given the Social Determinants of Health form which asks questions about environmental factors which are related to health, and the Patient Health Questionnaire (PHQ) which assesses depression and anxiety. Most patients come to our clinic to receive primary care, and many have not seen a physician for years. Patients are asked questions related to their health history and given a physical exam after having their vitals taken. Most patients are ordered labs, ultrasounds, or X-rays as part of their health screening. We pay for these tests, and patients go to LVMC (which is one quarter of a mile away) to receive them. We provide patients with medication discount cards so that patients are not paying more than $4 per prescription. We are able to treat patients for urgent care visits when they are ill and need to be tested for strep throat, a urinary infection, need stitches out after an ER visit, or other reasons. All patients are informed of their care plan after their visit and provided with health education should their health concern warrant (for instance, information on a healthy diet for those with hypertension or high blood sugar). Based upon a patient’s PHQ score, self-reports or reported history of any depression or anxiety, those patients are referred to our Licensed Clinical Social Worker for an assessment and referral to appropriate community resources. We will soon be working with Family Services Agency (FSA), and by the time that this grant period begins, we will have FSA therapists to provide ongoing counseling to those patients who desire this.
All patients receive a follow up call by our Clinic Manager after visiting our clinic. She discusses with those patients whose scores on the Social Determinants measure indicate that they are experiencing challenges these concerns, and works with them to find appropriate resources that could help to alleviate these issues.
Patients who are 26 & under and 50 & over will be contacted by our Clinic Manager or Medical Assistant after the first of 2023 to be told they are eligible for Medi-Cal. These patients will be invited back to Savie Health or enrolled via telehealth.
Savie is the only clinic in this county that does not require patients to provide documentation at visits. The Community Health Centers are a non-profit, but they serve patients who have Medi-Cal and have a sliding fee scale for others. The public health department charges a fee for patients. SLO NOOR is also free but is located 20 miles further away (in another county) for residents of Southern Santa Maria. They do not address social determinants, do care consultation, and they do not do Medi- Cal enrollment
19. How long have you been in existence and provided services to the community? Savie has been open for close to one year. We received our 501c3 in September of 2021 and provided some limited services in early 2022. We opened two days weekly in June of 2022 and added a third day in early November. We are adding a 4th day at the first of 2023.
It is important to note that Savie was founded by the founder of the SLO NOOR Foundation, and consequently our clinic model has a proven history of success.
CDBG Experience
20. Has your agency received CDBG funding in the past from the City of Santa Maria?
21. If YES, explain when your agency received funding and how your agency did in managing these funds. This
Yes
No
includes providing information obtained during your most recent monitoring review by the Special Projects Team.
If NO, explain how your agency is prepared to manage these additional CDBG funds and confirm that you are aware of the various reporting requirements imposed by this federal funding.
Not applicable.
Funding Sources
22. List the annual funding sources and amounts for the entire Agency or organization in the table below.
These figures should agree with the figures in the financial statements for your most recent prior fiscal year.
23. How do you offer a service that is both cost-efficient and effective? Savie Health relies heavily upon volunteers to reduce our costs. Our volunteer physicians donate approximately 480 hours annually of their services, valued at close to $100,000 (at an hourly rate of $200/hour). Our social workers donate approximately 108 hours annually, valued at $5,400 (based upon a rate of $50/hour). Our Medical Assistant volunteers approximately 360 hours annually, which is valued at $8,640 (based upon an hourly rate of $24/hourly). Our scribed and other officer volunteers likely save us thousands of dollars per year annually as well. Furthermore, we receive a 90% discount on the cost of labs and imaging. These in-kind services and highly discounted rate result in Savie being able to provide services to our patients that are cost-efficient to our grantors and donors, and of course, free of charge for our patients. Our preventative healthcare services to those who would otherwise go without healthcare will result in fewer premature deaths and hospitalizations from chronic conditions from individuals in this population residing in our community, and will result in a healthier, and more productive community overall.
Timeline
24. What is the proposed start date of construction / project? -answer not presented because of the answer to #1-
25. Phasing
-answer not presented because of the answer to #1-
0 Federal Government
0 State Government
0 County Government
0 Local Government
0 United Way
195479.64Contributions
Fundraising
0 Program Service Fees
113573Private Foundations
Other
309,052.64309,052.64TOTAL
Program Budget top
Revenue
Total Prior Year's
Budget for SM
Program
Total Annual Budget
for Proposed SM
Program
CDBG Portion of
Budget for Proposed
SM Program
Percent of
CDBG
Investment
CDBG Grant/City of Santa Maria
(same as amount requested)) USD$ 0.00 USD$ 20,000.00 USD$ 20,000.00 USD$ 1.00 CDBG Funding from another subsidiary USD$ 0.00 USD$ 0.00 USD$ 0.00 Grants from other Gov't Agencies USD$ 0.00 USD$ 2,000.00 USD$ 0.00 United Way USD$ 0.00 USD$ 0.00 USD$ 0.00
Contributions USD$ 0.00 USD$ 43,000.00 USD$ 0.00
Special Events/Fundraising USD$ 0.00 USD$ 2,000.00 USD$ 0.00 Legacies & Bequests (Unrestricted) USD$ 0.00 USD$ 0.00
Membership Dues USD$ 0.00 USD$ 0.00
Program Service Fees USD$ 0.00 USD$ 0.00
Other (Specify in Narrative) USD$ 0.00 USD$ 0.00 USD$ 0.00 Total USD$ 0.00USD$ 67,000.00USD$ 20,000.00USD$ 0.30
Expenses
Total Prior Year's
Budget for SM
Program
Total Annual Budget
for SM Program
CDBG Portion of
Budget for SM Program
Direct Assistance to Individuals USD$ 0.00 USD$ 0.00
Salaries USD$ 45,833.00 USD$ 13,000.00
Professional Fees USD$ 5,000.00 USD$ 5,000.00
Supplies/Publication/Printing USD$ 3,000.00 USD$ 0.00
Occupancy/Utilities USD$ 3,000.00 USD$ 0.00
Travel/Mileage USD$ 500.00 USD$ 0.00
Other (Specify in Narrative) USD$ 9,667.00 USD$ 2,000.00 Capital - Design & Engineering
Capital - Property Acquisition
Capital - Construction
Capital - Financing/Legal
Capital - Relocation
Capital - Demolition/Clearance
Capital - Site Improvements
Capital - Admin/Activity Delivery
Capital - Off site Improvements
Capital - Other (Specify in Narrative)
Total USD$ 0.00USD$ 67,000.00USD$ 20,000.00
Program Budget Narrative
Salaries are for all 4 of our staff, executive director, clinic manager, medical assistant, and nurse practitioner.
Professional services are for funds that will be paid to the Promotores for outreach.
Other fees are for costs of lab and imaging tests.
Tables top
% of Annual budget
Households or
Individuals
(Indicate one)
CDBG
Portion of
Budget
Annual Budget
for Santa Maria
Program (must
match the
budget tab)
Percent of
CDBG
Investment
OVERALL Annual
Number of Persons /
Households served
by Santa Maria
Program
REQUIRED Minimum
number of CDBG
Persons/Households
served
150 individuals $ 20,000 $ 67,000 30 % 150 45
Total $ 20,000 $ 67,000 30 % 150 45
Required Documents top
Documents Requested * Required?Attached Documents *
List of board of directors and local advisory board, if applicable. If N/A, please submit a written statement
in lieu of the required attachments.
Board List
Copy of board authorization to apply for this grant.
Board Authorization-City of SM
Agency's organizational chart
Organizational Chart
Certificates of insurance covering Worker's
Compensation and General Liability (it is not
necessary to name City of Santa Maria as additional
insured at this time)
Certificate of Insurance
Application ID: 423248
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Current and prior year's financial statements
Savie Health Balance Sheet 2021
Profit and Loss 2021
Most recent annual audit report (if your agency does
not perform an annual audit because it is not required
to, please submit a written statement in lieu of the
required attachments.)
Statement in lieu of audit
Most recent Form 990 and Schedule A Federal Tax
Return
Statement in lieu of tax return
Budget information for the current fiscal year and
next fiscal year (if budget for next fiscal year is not yet available, please submit a written statement in
lieu of the required attachments.)
Statement in lieu of 2023-2024 budget
Savie Health Budget 2022-2023
Capital Projects ONLY: Three (3) bids required, with
at least one (1) bid coming from a local contractor.
Failure to submit may result in an incomplete
application.
Organizational structure: List the total number of
employees for your agency by job title/classification
and salary/wage range for each job/classification.
download template
Organizational Structure