HomeMy WebLinkAboutGrant Request - Volunteers in Medicine1/5
Economic Development Fund
Discretionary Grant Program
Organization: Volunteers in Medicine
Organization Description: Volunteers in Medicine Clinic of the Cascades is a non-
profit medical clinic on the St. Charles hospital campus. The organization's goal is to
serve the health care needs of uninsured Deschutes County residents who don't qualify
for Oregon Health Plan or Medicare and have no access to medical care.
Project Name: Equipment, Supplies and Software
Project Description: The funds from this grant will be used to pay for a portion of the
following three items:
• Data Net Solutions ($1,200) — annual subscription for software used in filling
prescriptions
• Pharmaceuticals ($3,000, grant to cover $2,500) — basic medications, such as
antibiotics, purchased at a discount through St. Charles Medical Center. Long
term medications are provided through prescription assistance programs
• Lab Services ($1,200, grant to cover $300) — Most lab tests are provided for free
through LabCorp. This would fund tests not provided by LabCorp.
Project Period: Dec. 1, 2008 — March 31, 2009
Amount of Request: $4,000 (Total cost = $5,400)
Previous Grants:
• June 2004: $5,500 Equipment ($5,500 Luke)
• Jan. 2006: $4,500 Tech Hardware ($2,250 Daly; $2,250 Clarno)
• Dec. 2006: $4,944 Equipment.($1,500 Clarno; $1,000 Daly; $500 Luke)
• Sep. 2007: Equipment & Dental Supplies ($3,000 Baney; $2,500 Luke,
$2,000 Daly)
• FY2009 Community Grant: Internship Program $11,500
Deschutes County Board of Commissioners
1300 NW Wall St., Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
DESCHUTES COUNTY ECONOMIC DEVELOPMENT FUND
DISCRETIONARY GRANT PROGRAM APPLICATION
Direct Application to:
Commissioner Tammy Baney
Commissioner Dermis R. Luke
Date:
Nov 2S, D$
Project Name:
Project Beginning Date:
Commissioner Michael M. Daly
All Three Commissioners
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Amount of Request: I-4 Li. 000.1:
Applicant/Organization:
Address:
Project End Date:
Date Funds Needed:
Tax ID #•
City & Zip:
Telephone:
Email:
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On a separate sheet, please briefly answer the following questions:
1. Describe the applicant organization, including its purpose, leadership structure, and activities.
2. Describe the proposed project or activity.
3. Provide a timeline for completing the proposed project or activity.
4. Explain how the proposed project or activity will impact the community's economic health.
5. Identify the specific communities or groups that will benefit.
6. Itemize anticipated expenditures*. Describe how grant funds will be used and include the
source and amounts of matching funds or in-kind contributions, if any. If the grant will
support an ongoing activity, explain how it will be funded in the future.
Attach:
Proof of the applicant organization's non-profit status.
* Applicant may be contacted during the review process and asked to provide a complete line item budget.
Amount Approved:
By: Date:
Declined: By: Date:
Volunteers in Medicine Clinic of the Cascades
Deschutes County Economic Development Fund
Grant Request
Volunteers in Medicine Clinic of the Cascades (VIM) is a 501 (c) 3 non-
profit medical clinic providing healthcare to low-income, uninsured residents of
Deschutes County Oregon. Patients must live or work in Deschutes County, have
no health care coverage and have a household income below 2000/0 of the
federal Poverty Threshold. Care at VIM is coordinated and provided by out more
than 260 volunteers. These members of our local community — doctors, nurses,
interpreters, schedulers, counselors, dentists and others — complete more than
7,000 patient visits annually. The care at VIM is provided free of charge to the
patient. Our services include primary outpatient care, chronic disease education
and management, specialty care and referral, mental health assessment and
treatment, limited dental services and prescription medication assistance.
VIM is governed by a Board of Directors comprised of local business and
community members. The Board of Directors provides guidance to our Executive
Director and staff of 12 responsible for fundraising and overseeing volunteer
efforts.
We are seeking support from the Deschutes County Economic
Development Fund to support our volunteers by providing funding for essential
equipment and supplies and software. These would be used in the current fiscal
year — ending March 31, 2009. Please see the attached budget for a description
of the specific items we are seeking funding for.
Through the access provided by VIM, thousands of members of our
community are able to improve their health so that they can work or care for
their families. Having access to affordable healthcare benefits to not only these
individuals and their families but the community as a whole.
Our clinic also has a small dispensary with a limited formulary of
medications provided free of charge to patients. Having access to these
medications and assistance with submitting applications for prescription
assistance programs has proven to keep people healthier. For example, patients
with previously uncontrolled diabetes, blood pressure or substantial mental
health conditions having access to medications that help manage these
conditions can mean the difference between being too sick to work or being able
to go back to work and supporting their family.
Volunteers in Medicine Clinic of the Cascades
Deschutes County Economic Development Fund
Grant Request — Proposed Budget
Item
Annual Cost
Requested Amount
Comments
Data Net Solutions
$1,200
$1,200
Annual subscription for
software used by our
volunteers in the
Dispensary to fill drug
prescriptions free of
charge to patients.
Pharmaceuticals
$3,000
$2,500
Basic medications kept
on -hand such as
antibiotics — purchased
at a discount through
SCMC. Most long term
medications are provided
through prescription
assistance programs.
Lab Services
$1,200
$300
The majority of lab tests
are provided free of
charge through LabCorp.
These funds would be
used to access necessary
tests that are not
provided by LabCorp.
Total Request
$4,000
INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
Date: MAY 21 2006
VOLUNTEERS IN MEDICINE CLINIC OF
THE CASCADES
2300 NE NEFF
BEND, OR 97701
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
93-1327847
DLN:
17053091945106
Contact Person:
THOMAS C KOESTER ID# 31116
Contact Telephone Number:
(877) 829-5500
Public Charity Status:
170(b) (1) (A) (vi)
Our letter dated November 2001, stated you would be exempt from Federal
income tax under section 501(c)(3) of the Internal Revenue Code, and you would
be treated as a public charity, rather than as a private foundation, during
an advance ruling period.
Based on the information you submitted, you are classified as a public charity
under the Code section listed in the heading of this letter. Since your
exempt status was not under consideration, you continue to be classified as
an organization exempt from Federal income tax under section 501(c)(3) of the
Code.
Publication 557, Tax -Exempt Status for Your Organization, provides detailed
information about your rights and responsibilities as an exempt organization.
You may request a copy by calling the toll-free number for forms,
(800) 829-3676. Information is also available on our Internet Web Site a:
www.irs.gov.
If you have general questions about exempt organizations, please call our
toll-free number shown in the heading.
Please keep this letter in your permanent records.
Sincerely yours,
ct5;520 te_t-.-t
Lois G. Lerner
Director, Exempt Organizations
Rulings and Agreements
Letter 1050 ()0/CG)