Grant Application

SECTION ONE

Funder to which this application is directed

Date of Application

ORGANIZATION NAME
Applicant Organization (Full Legal Name)

The Order of Love Peace Truth tolerance and Cooperation

Doing Business As Tomorrow’s Bread Today (TBT)
Previous Name, if changed

IRS letter date 3-10-1997

Tax Exempt ID # (EIN) 76-0446925
Name of Executive Director Donald Harold McCormick

Name of Attorney (if applicable)

Name of Accountant (if applicable)

Name of Contract Fundraiser (if applicable)

Name of Fiscal Sponsor (if applicable)

CONTACT INFORMATION
Proposal Contact Name Donald Harold McCormick

Title Trustee
Phone 832-202-9922
Fax 1866-324-8707

E-mail [email protected]

Street Address 843 CR3704B

City Splendora

State TX

Zip Code 77372

Organization Website tbt.org

Mailing Address (if different than street address) P.O. Box 1838

City Splendora

State TX

Zip Code 77372

ORGANIZATION FINANCIAL INFORMATION
Organization’s Budgeted Expenses for Current Year (give fiscal year end mm/dd/yy)

$1,500,000

Endowment Size (market value as of fiscal year mm/dd/yy) $

Organization’s Major Funding Sources
(e.g., United Way, local community foundation, county board of health, etc.) by percentage Individual Donations

ORGANIZATION’S AFFILIATION
United Way: Yes No Other (specify): Gateway to Care

Chapter of national or regional organization (specify):

REQUEST DATA
Program/Project Title Establish a local base for Patient and Physician Medical Cooperative

Total Budget for this Program/Project $1,010,000

Amount of this request $200,000

Grant Duration (e.g., one-year grant, etc.) 1 Year

Anticipated Project Start Date March 2017

Community/Counties served by this
Program/Project Splendora,Texas and Albuquerque, New Mexico

Total Number of people to be served during grant period 5,000

Brief demographic description of population served by this Program/Project

The uninsured population having less than 300% of the poverty level income

TYPE OF REQUEST (check all that apply and see glossary for definitions)
Capital 0 Technical assistance X Operating 0 Endowment
X Program/Project Start-up 0Other (specify)

SIGNATURES (both are required unless otherwise specified by funder)
Signature of Executive Director
Signature of Board President Don McCormick

SECTION TWO – ORGANIZATIONAL BACKGROUND

The following section should not exceed 2 pages in total (please confirm any page limits with each foundation to which you are submitting the application). Responses should be typed, single-spaced, single-sided and use 11 or 12-point type. At the funder’s discretion, you may answer questions individually or group them into one narrative for this section.

1. Brief summary of organization’s history and statement of organization’s mission

We began in 1997 as a lay religious organization with the intent of doing the corporal and spiritual works of mercy for those people in need in our community. There have been about 5 to 10 of us who have been the members of TBT who have contributed their labor and the money they have earned from their labor to help needy people get health care, food, and shelter. Our members have been and are still either medical care administrators or direct health care providers.

2. Brief description of current programs/projects and activities.

In the last five years we have operated a health care cooperative located in the Greater Houston Area and Portland Oregon that includes 250 physicians and 3,500 patients We have seen over 5,000 patients for free outside of the cooperative ranging in age from newborns to people in their 90s. The patients have been treated people for a very wide range of injuries and sicknesses. Most of the free patients have been seen by contracted primary care physicians and nurse practitioners. We have been helped by specialists in the areas that we know from the administrative work we do for them in order to earn money for support of the clinics. We joined the Gateway for Care Organization in 2007 to get more access to care for our patients. They also make referrals to us for patients with primary care needs. Our only source of funding has been donations from the people working for us and members of TBT and from patients who join the co-op and pay monthly fees that average $30 per month for medical services. Members who cannot pay the fees are seen at the expense of TBT.

3. Evidence of organization’s overall effectiveness (please list achievement of specific organizational or program goals).

We care for many people who would not have health care without any barriers to care and in a strictly confidential way. Our cost of care is less than 1/2 of the usual cost in the commercial and government systems, yet the health care workers can earn as much as they do in other clinics that do not serve the uninsured population.

4. Description of population and geographic region (community/counties) served by this organization.
Our service areas are Greater Houston, Albuquerque, NM and Portland, OR for the development of this Cooperative. Based on our surveys of patients we have found that forty percent of these people who come to our clinics are either uninsured or lack primary health care coverage in their health plans. They are mostly employed, but are paid low wages and work for small businesses. Many of the areas in are medically under-served and the poor patients do not have access to providers because of lack of money and insurance.

SECTION THREE – STATEMENT OF NEED OR COMMUNITY BENEFIT

1. What is the problem, challenge or need that is unaddressed or unmet? Or what is the community benefit that this program or project will impart?

The problem in providing care in these communities is that only private or public insurance programs are available to support the labor and material costs and neither system is practically available to the patients we serve and could serve. Even under the current new health care law, most of the patients we are to serve will remain either uninsured or under-insured because of lack of adequate income and inadequate funds from the public sector programs for primary health care services. Medicaid eligibility is difficult to maintain by many patients and the reimbursement for physician services is at Medicare rates and through a limited number of contracted HMOs that pay less than 70% of the filed claims for a host of reasons. Therefore, patients must pay for health care as best they can, yet the specialist physicians and hospitals do not want to care for them unless they have insurance or proof of wealth.

We know that primary health care is not expensive and that even the poor can afford it if there is a systematic and routine way to fund it. We have discovered that monthly fees of about $30.00 per month per person from 2,000 people will provide complete primary care services for 3,000 people. We know that most of the patients we see could make that kind of regular donation and that others in the community would also make these small monthly donations. The challenge for TBT and the community is to organize the patients and clinics into a local cooperatives so that the clinics will be sustained indefinitely and all of the people in need will be served. We can only address the specialty needs and hospital needs of this group by help from the physicians and hospitals and by guiding the patients through the programs these groups have available.

2. What is the research, statistic(s) or evidence that shows this need or benefit exists?

We have seen and treated thousands of these kinds of patients and can report the contact information and we know that there is no universal health care available and not likely to come in the near future because of political conflicts, lack of community organization, and the dominance of the profit and business motives in the system.

SECTION FOUR – PROGRAM/PROJECT DESCRIPTION & METHODOLOGY

IMPORTANT: Review the funder’s program guidelines and restrictions before responding to this section.

1. Description of program/project, including:
a. Summary description of overall program/project to be funded under this grant

We intend to enroll 2,500 patients who will contribute at least $30 per month to support the primary care clinics. The members will be individuals who live in the service areas and may or may not use the services of the clinics. In order to do this within the projected one-year time frame we will need at least five community organizers who will each enroll about two households per day. We expect that some of the people enrolled will not keep their pledges of support so our organizers will have to sign-up twice as many as the minimum 2,500 we need. Assuming a minimum number of two people per household and the loss of fifty percent of those who fail to maintain their membership status then the 2,500 required can be met. We must pay the cost of supporting these organizers in addition to the cost of operating the medical clinic network. This cost is projected to be $350,000 per each location over the year of development.

b. Brief description of goals and objectives for program/project

2,500 donors or members who contribute $30 each on a monthly basis.

c. Timetable for implementation and duration of program/project

One year.

d. Evidence of use of best practices (For example, is this program/project based on a program that has been shown to be effective in other settings? Is it based on national standards?). If the initiative is a pilot project and has not been done before, please list assumptions on why new approach will succeed.

It is a new approach for funding health care that is from the grass roots. It is simple to understand and its benefits are apparent to the people who are directly involved in the support and use of the clinic.

2. How and with whom will the organization collaborate on this particular program/project?

We are going to pay the community organizer’s salaries and expenses and office overhead. The fees they bring in will pay the cost of operating the clinic network for an indefinite time into the future.

3. Why is your organization positioned to address this need or benefit (e.g., skills, location, etc.)?

We have been organizing physician practices to take care of patients in need since 1995 and have about 250 physicians who help the organization and the clinic in Splendora. Splendora and Portland were our pilots to discover how to do and to price a Cooperative. The provider in that Clinic, Lee Attema, whom we recruited worked for two years without pay to provide care in our sponsored facilities in Splendora. With his help we were able to prove the Co-op concept would work for the poor and medically underserved. Our staff is expert at getting workable physician and hospital agreements. The medical staff is especially good at providing access to quality medical care.

4. How is your project different from similar existing projects at other organizations?

The usual clinics who support the poor are mostly dependent of continuous grant money and Medicaid to operate. We will become self-sustaining and reproductive in the first year in each area we target.

SECTION FIVE – EVALUATION AND RESULTS

Please see glossary for definition of “Outcomes,” as well as the funder’s guidelines before completing this section.

1. Provide specific short-term, intermediate and/or long-term outcomes of this program/project and the time frame within which they will occur.

We expect to enroll 2,500 patients in the Coop and that they will become financially self-sustaining, have much better health outcomes because of access to both primary and specialty care and to mutual support that is a part of a patient/physician cooperative.

2. How will outcomes be measured and who (e.g. staff, consultant, etc.) will measure them?

We keep comprehensive medical records on each patient using electronic medical records and we measure what we do against the standards of care for both preventive and acute care medical practice. On the administrative side, we survey each member and determine exactly what their needs and wants are with regard to medical and social issues and develop and care coordination plan. We use a “Pathways to Care” system to effect positive changes that benefit the patients and providers in the medical outcomes. We have expert in-house staff in these areas.

3. How will the results be used and disseminated by your organization and/or others?

We use the results to improve the way in which we get patients into the Coop, the way they are treated, and the coordination of their care. We use “Basecamp” to disseminate information among our providers and staff and to do project communications and milestones. We use “Scrum” to plan and carry our goals and to keep our teams organized and in communication with each other.

4. How will the project’s constituents and/or clients be actively involved in evaluating the project?

The providers and staff talk to them regularly about their health and the business of the Coop. The patients are equal members of the Coop with the providers and staff and they empower the organization through their talk and their votes.

5. If this is an ongoing program/project or if its purpose is to provide direct support to an ongoing program/project, summarize past quantitative and qualitative outcomes of that program/project.

The regular fees gained from the organizer’s work will create some surplus in the clinic network operations which can be used to start another round of co-op development. This will expand the clinical provider base and facilities and we can go from caring for 2,500 people to 5,000 and so on. Each round will reduce the grant need by about 20% so that in five years no additional grants will be required and we will be able to spin off new clinic networks from within our co-op resources each year. It is likely that the self-sustaining nature of this program will grow faster than we are projecting and the spirit of it appeals to most of the people in our community.

SECTION SIX – PROGRAM/PROJECT FUNDING PLANS

1. List of other funders to whom this current proposal has been and will be submitted. For each funder, indicate amount requested and status of request (e.g. “to be submitted,” “pending,” “funded,” or “declined”). If funded, specify amount of grant and date received.

2. Other anticipated funding for this current proposal including:
a. Earned revenue
Earned revenue
$610,000

b. In-kind support
$200,000

c. Special events

d. Fundraisers, etc.

3. If this will be an ongoing program/project, describe plans and specific sources for future/long-term funding.

The regular fees gained from the organizer’s work will create some surplus in the clinic network operations which can be used to start another round of co-op development. This will expand the clinical provider base and facilities and we can go from caring for 2,500 people to 5,000 and so on. Each round will reduce the grant need by about 20% so that in five years no additional grants will be required and we will be able to spin off new clinic networks from within our co-op resources each year. It is likely that the self-sustaining nature of this program will grow faster than we are projecting and the spirit of it appeals to most of the people in our community.

SECTION SEVEN – REQUIRED FINANCIAL ATTACHMENTS

1. List of grants greater than $5,000 (including funder name, amount, and brief description) received during your organization’s two most recently completed fiscal years.

None

2. Total organizational budget for current fiscal year* including a column showing the organization’s year-to-date status (budget vs. actual).
Attached #1

3. Project request budget* for your entire project.
Attached #2

4. Two most recently completed Form 990s.
Attached #3

5. If your organization has an endowment greater than $100,000, please provide your endowment spending policy.
N/A
6. Additional financial forms including:
a. Most recently completed audit if available, including auditor’s notes and management letter if issued. Not Audited
b. Statement of Revenue/Support and Expenses* for your organization’s most recently completed fiscal year. Attached #4
c. Current Balance Sheet. Attached #5

*Available as common form

SECTION EIGHT – OTHER REQUIRED ATTACHMENTS

1. IRS letter of determination 501(c)(3), or if such a letter does not exist see specific funder requirements. Attached #6
2. Names and organizations of board members, plus a brief narrative on the board’s operations that answers the following questions:
a. What are the term limits of board members? Annual
b. What are the standing committees of the board? Committee of Trustees and Co-op Committee
c. What is the fundraising responsibility of the board? Help get members through community contacts and promotion programs
d. How frequently does the full board receive financial reports? Monthly
e. How frequently does the full board meet and what percentage attend on average? Monthly and all members
f. What (if any) long-range or strategic plan has the board adopted? Improve the contracts with providers and get members into the coop through education and budget commitments.
3. List of key staff members and qualifications, or an organizational chart
Attached *7
4. One example of each of the following (if available): Attached #8
a. Annual reports
b. Organizational brochure
c. Sample newsletter
d. Program brochure
These items can be mailed to the funder if they are not available electronically.
5. Letters of commitment from collaborating organizations, if appropriate. N/A

Before using the Common Grant Application, please visit the funder’s website or call to learn additional information about the funder and how it uses the Application

The Common Grant Application is a collaborative effort of funder and nonprofit organizations working to build the performance capability of the nonprofit sector in Ohio.

GLOSSARY

Capital Request – A planned undertaking to purchase, build or renovate a space or building, or to acquire equipment.
In-Kind Support – A contribution of equipment/materials, time, and or services that the donor has placed a monetary value on for tax purposes.
Methodology – A sequence of activities needed to accomplish the program objectives.
Operational Support – A grant given to cover an organization’s day-to-day expenses such as salaries, utilities, office supplies, etc.
Outcomes – The changes in (or benefits achieved by) individuals or communities due to their participation in program/project activities. This may include changes to participants’ knowledge, skills, values, behavior, condition or status. In general, outcomes are described in quantitative or qualitative terms.

Quantitative (or Measurable) outcomes are changes or benefits that can be measured or counted and expressed with a numerical value. For example, 30 of the 40 third-grade students participating in the literacy program will increase their reading level by one grade level.

Qualitative outcomes are changes or benefits that refer only to the characteristics of something being described, rather than exact numerical measurement. Qualitative changes can be observed (or detected through the senses) and are generally described in a narrative form. For example, the mother of a student participating in the literacy program stated that her daughter no longer feared reading aloud in class now that she could read at the same level as her classmates.
Program – An organized set of services designed to achieve specific outcomes for a specified population that will continue beyond the grant period.

Project – A planned undertaking or organized set of services designed to achieve specific outcomes that begins and ends within a specified time period. (A successful project may become an ongoing program.)

Technical Assistance – Operational or managerial assistance given to a nonprofit organization. It may include fundraising assistance, budgeting or financial planning, program planning, legal advice, marketing or other aids to management. Assistance may be offered directly by a foundation or corporate staff member or in the form of a grant to pay for the services of a consultant.

Attachment #1

Ohio Common Grant Form
TOTAL ORGANIZATIONAL BUDGET FOR CURRENT FISCAL YEAR

Name of Organization:

The Order of Love Peace Truth Tolerance and Cooperation

Time Period (mm/dd/yy to mm/dd/yy): 3-1-2011 to 2-28-2012

REVENUE/SUPPORT Budget for Year Year–to-Date
(specify date – mm/dd/yy )
Corporate grants
Foundation grants
Govt. grants/contracts/per diem (describe in narrative)

Contributions
$490,000
Affiliate orgs./non-govt. contracts (describe in narrative)
Federated campaigns (describe in narrative)
Membership dues $810,000
Special events, fundraisers
Sponsorships
Admissions
Sales, rent
Revenue, tuition
Endowment funds
Interest, dividends, non-endowments investments
Other (if more than 20% of total revenues, describe in narrative)
Total Revenue/Support $1,300,000 $0

Ohio Common Grant Form
TOTAL ORGANIZATIONAL BUDGET FOR CURRENT FISCAL YEAR

Name of Organization:

Time Period (mm/dd/yy to mm/dd/yy):

EXPENSES Budget for Year Year–to-Date
(specify date – mm/dd/yy )
Salaries $922,200
Employee benefits, taxes $92,220
Affiliate orgs. or contracts (describe in narrative)
Professional fees $60,000
Equipment, supplies, materials $130,000
Telephone, utilities $38,800
Postage, mailing $25,000
Occupancy $70,000
Insurance $8,500
Training, staff development $40,000
Travel $4,500
Conferences $3,000
Evaluations $10,000
Other $95,780
TOTAL EXPENSES $1,500,000
Revenue less Expenses -$200,000

Attachment #2

Ohio Common Grant Form
TOTAL ORGANIZATIONAL BUDGET FOR CURRENT FISCAL YEAR

Name of Organization: The Order of Love Peace Truth Tolerance and Cooperation

Time Period (mm/dd/yy to mm/dd/yy): 3-1-2011 to 2-28-2012

REVENUE/SUPPORT Budget for Year Year–to-Date
(specify date – mm/dd/yy )
Corporate grants
Foundation grants
Govt. grants/contracts/per diem (describe in narrative)
Contributions
Affiliate orgs./non-govt. contracts (describe in narrative)
Federated campaigns (describe in narrative)
Membership dues $810,000
Special events, fundraisers
Sponsorships
Admissions
Sales, rent
Revenue, tuition
Endowment funds
Interest, dividends, non-endowments investments
Other (if more than 20% of total revenues, describe in narrative)
Total Revenue/Support $810,000 $0

Ohio Common Grant Form
TOTAL ORGANIZATIONAL BUDGET FOR CURRENT FISCAL YEAR

Name of Organization:

Time Period (mm/dd/yy to mm/dd/yy):

EXPENSES Budget for Year Year–to-Date
(specify date – mm/dd/yy )
Salaries $622,200
Employee benefits, taxes $62,220
Affiliate orgs. or contracts (describe in narrative)
Professional fees $40,000
Equipment, supplies, materials $120,000
Telephone, utilities $28,800
Postage, mailing $15,000
Occupancy $60,000
Insurance $6,500
Training, staff development $30,000
Travel $2,500
Conferences $2,000
Evaluations $20,000
Other (if more than 20% of total expenses, describe in narrative) $780
TOTAL EXPENSES $1,010,000 $0

Revenue less Expenses -$200,000 $0

Attachment #3 : See PDF File, “TBT Tax Returns 2014 and 2015”
Attachments #4 and #5

The Order of Love Peace Truth Tolerance and Cooperation DBA -Tomorrow’s Bread Today (TBT)
Statement of Assets, Liabilities and Equity — Income Tax Basis
As of December 31, 2016

ASSETS
Current Assets
Checking/Savings
TBT Coop $ 1,240
TBT Main Checking $ 9,012
TBT Trustee $ 108
Petty Cash $ 400
Total Checking/Savings $ 10,760

Long Term Assets
MRSB Note Receivable $ 94,500
Investment in MRSB $ 180,534
Total Long Term Assets $ 275,034

TOTAL ASSETS $ 285,794
LIABILITIES & EQUITY
Current Liabilities
Due to Freeport Co-Op Clinic $ 3,444
Total Current Liabilities $ 3,444

Long Term Liabilities
Compass Note $ 48,000
Wachovia Note $ 46,500
Total Long Term Liabilities $ 94,500

Total Liabilities $ 97,944
Equity
Unrestricted Net Assets $ 206,383
Net Income $ (18,533)
Total Equity $ 187,850
TOTAL LIABILITIES & EQUITY $ 285,794

The Order of Love Peace Truth Tolerance and Cooperation DBA -Tomorrow’s Bread Today (TBT)
Statement of Revenues and Expense — Income Tax Basis
For The Period Ended December 31, 2016

Income
Membership Fees $ 122,061 74.03%
Medical Services $ 72 0.04%
NPSS Claims $ 21,956 13.32%
Nursing Services $ 29,915 18.14%
Less: Refunds and Chargebacks $ (9,132) -5.54%
Total Income $ 164,872 100.00%

Operating Expenses
Capitation Costs $ 61,715 37.43%
Commission and Bonus Expenses $ 8,965 5.44%
Consulting $ 16,800 10.19%
Equipment Rental

$ 3,618 2.19%
Lab Fees $ 6,000 3.64%
Medical Directors $ 6,287 3.81%
Medical Supplies $ 1,155 0.70%
Nurse Practitioners $ 43,440 26.35%
Premiums $ 19,922 12.08%
Scheduling and Appointment Services $ 11,506 6.98%
Sterling Payment Charges $ 3,998 2.43%
Total Operating Expenses $ 183,405 111.24%

Net Income/(Loss) $ (18,533) -11.24%

Attachment #6 IRS Determination letter: PDF File 501 c 3 for The Order of Love…

Attachment # 7

Organizational Chart

Board of Trustees
Don McCormick
Ken McCormick
Arnold Valenson, MD
Malcolm Roy

Coop Committee
Don McCormick
Dru White
Jennifer Ramos-McCormick, MPH

General Administration:
Don McCormick, CEO
Greg Neuman, JD – Accounting and Legal
Jennifer Ramos-McCormick, MPH – Directory of Training and Community
Organizing

Attachment # 8 : PDF of Program Materials
Attachment # 9: PDF of Organizational Documents