Lantern Community Counseling Center

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Executive Summary

Lantern Community Counseling Center is a nonprofit in Georgia that opens a neighborhood counseling center where people can see a licensed therapist within about a week, in a warm, private space, at a fee they can afford. We serve children age 13 and older, teens and adults, with a focus on people who are covered by Medicaid, people with no insurance and working families whose insurance does not cover enough.

Many people who need counseling never get it. Some wait months for an appointment. Many therapists do not take Medicaid. Others are too far away, have no evening hours or charge more than a family can pay. When a person does not get help early, the problem often grows: a rough few months turns into a lost job, a crisis or a family in pain. We want the first call to lead to a real appointment, not a waiting list.

With this grant we will open the center and see about 200 people in Year 1 for about 1,300 counseling sessions, growing to about 720 people and 5,200 sessions a year by Year 5. We offer individual, family and group counseling in English and Spanish, same-week first appointments, evening and some Saturday hours, and telehealth for people who cannot travel. A Care Coordinator helps each person with insurance, referrals and follow-up. Graduate students in counseling and social work, supervised by licensed clinicians, expand how many people we can see starting in Year 2.

Our Year 1 budget is about $299,000, growing to about $505,000 by Year 5. Each year's budget is planned to balance, with a small surplus each year. We have 4 paid staff in Year 1 and 7 by Year 4. Over time, client fees and Medicaid and insurance payments grow from about 20% of our income in Year 1 to about 48% in Year 5, so grants become a smaller share of the budget each year.

We are asking the Meadowbrook Health Foundation for $80,000 for our first Licensed Therapist, clinical supervision for our graduate interns, language access and outreach, and our health records and telehealth system. Other grants, client fees and local donors cover the rest, so this grant is one part of a shared funding plan.

I am Renee Okafor, a Licensed Clinical Social Worker and the Executive Director. The numbers in this proposal are estimates based on the assumptions listed at the end, not promises.

Company Description

Lantern Community Counseling Center is a nonprofit organization in Georgia. We are a 501(c)(3) public charity (or a program of one, through a fiscal sponsor), governed by a volunteer board of directors. We will provide our IRS determination letter, board list and most recent financial statements with this proposal.

Our mission. To make good counseling easy to reach for every person in our community, no matter their income, insurance or language.

What we believe. Asking for help takes courage, and the system should meet that courage with a quick, kind response. People are the experts on their own lives, and good therapy works with them, not on them. Counseling works best when it is close to home, when it fits around a work schedule and when the therapist understands the client's culture and language. Mental health care is health care, and it should be part of how a community looks after itself.

How we started. Lantern began as a monthly wellness night at a neighborhood church, where Renee Okafor and two other licensed clinicians volunteered to talk with neighbors and answer questions. Every month, people asked how they could see a counselor and not wait. Local doctors, school counselors and a hospital social worker began sending us people they could not place anywhere else. We kept a list of those who asked for help: more than 140 names in the last year. This proposal asks for support to open a permanent center with a full-time clinical team.

What we offer:
- Same-week first appointments. A short intake call within one business day and a first appointment within about seven days, with a goal of seeing urgent requests sooner.
- Individual, family and group counseling. Evidence-based approaches such as cognitive behavioral therapy (CBT), trauma-focused therapy and family therapy, delivered by licensed clinicians and supervised graduate interns.
- Evening and Saturday hours, and telehealth. Sessions after work and school, plus video and phone sessions for people who cannot travel or are caring for children or older relatives.
- Care coordination. A Care Coordinator who helps clients enroll in Medicaid or other coverage, find a psychiatrist or primary care doctor for medication or medical needs, and connect to housing, food and legal help.
- Language access. Counseling in English and Spanish, and professional interpreters for other languages.
- Community education. Free workshops at churches, libraries and workplaces about stress, grief, parenting and when to ask for help.

What we do not do. We are not an emergency room or a crisis line. We do not prescribe medication, but we work with clients' doctors and refer to psychiatric providers. We do not treat people in immediate danger. We connect them to emergency care.

How we are run. A seven-member volunteer board of directors oversees the organization and approves the budget each year. The board includes a psychiatrist, a pastor, a school counselor, a hospital social worker, a small business owner, a person who has used counseling, and a certified public accountant. The Executive Director, who is also our Clinical Director, supervises clinical work and manages the organization, and an outside accountant reviews our books every year.

Where things stand today. We have signed a letter of intent for a 2,400 square foot suite on a bus line, with four counseling rooms, a waiting area and an office. Before we sign the lease, an attorney will review it and our privacy policies. We have letters of support from two clinics, a hospital social work department, a school district counseling office and two churches. We have started the application to enroll as a Medicaid provider and to be credentialed with the main insurers, which can take several months, so our first-year fee income is planned low.

Problem & Opportunity

Why this center is needed.

Mental health conditions are common, and most are treatable. Anxiety, depression, trauma, grief, stress at work and at home, and the strain of caring for others touch nearly every family. Counseling can help people understand what they are feeling, build skills and stay connected to work, school and family. But access is uneven, and many of our neighbors cannot get it.

The gaps we see:
1. Long waits. Many practices and clinics have waiting lists of weeks or months. By the time an appointment is available, a problem may have grown, or the person may have given up.
2. Not enough providers who take Medicaid. Many therapists work only with clients who pay out of pocket or have certain private insurance. People who have Medicaid, or no insurance, have far fewer choices.
3. Cost. Even with insurance, copays and deductibles can make weekly counseling impossible for a family on a tight budget.
4. Hours and travel. Most appointments are offered during the workday. A person who cannot leave work, or who relies on a bus, may not be able to attend. Nearby counties may have no provider at all.
5. Language and culture. Many people want to speak with someone who speaks their language and understands their background, and few practices can offer that.
6. The path is confusing. Families often do not know whether to start with a doctor, a school, a clinic or a counselor, or how to sign up for coverage. People in distress give up when they hit the first barrier.
7. Providers are stretched. Primary care doctors, school counselors and emergency departments see many people who need counseling and have few places to send them.

Why now. Many communities have too few mental health professionals for the number of people who need them. The federal government identifies these places as Mental Health Professional Shortage Areas. Before we submit, we will check whether our service area is one using the federal Health Resources and Services Administration's shortage area finder, and add what we find.

How we know people want this. In the last year, more than 140 people asked our volunteer team how to see a counselor, and our referral partners told us they had nowhere to send about 60 more. Two school counselors told us they refer students and families to us every week even without a formal program.

How we will show the need. Before we submit this proposal, we will add the county's population, the share of residents with Medicaid or no insurance, the number of licensed mental health providers per resident from the state licensing board and the county health rankings, the share of adults and teens who report frequent mental distress from the county health department or the state survey, and the average wait time for a first appointment, which we will check by calling local providers. We will also add the number of people on our own waiting list.

Who benefits first. Children age 13 and older, teens and adults in our service area who have Medicaid, no insurance, or insurance that does not cover enough, and who want to see a counselor but cannot get a timely appointment.

Products & Services

What the grant will pay for and what we will do.

1. Open the center. We lease and prepare a suite with four counseling rooms, a calm waiting area and a private entrance, and open our doors with a licensed Clinical Director, a Licensed Therapist, an Intake and Care Coordinator and a part-time Office and Billing Coordinator.

2. Make the first step easy. A person can call, text or use our website to ask for an appointment. The Intake and Care Coordinator calls back within one business day, asks a few questions about needs and safety, explains fees and coverage and offers a first appointment within about seven days. A person who describes an urgent need or immediate risk is connected the same day to a clinician and, if needed, to emergency help.

3. Provide counseling that fits the person.
- A first visit where the therapist listens, explains privacy and its limits, asks about what brought the person in, checks for safety and agrees on goals.
- Individual, family and group counseling, usually weekly or every other week at first, with a plan for how long we expect to work together.
- Evidence-based approaches, such as CBT, trauma-focused therapy and family therapy, chosen by the clinician with the client.
- Evening hours until 8 p.m. two nights a week, Saturday morning hours once a month, and telehealth by secure video or phone.
- Services in English and Spanish, and professional interpreters for other languages.

4. Track progress with the client. At the start and at regular points, clients complete short, standard questionnaires, such as the PHQ-9 for depression and the GAD-7 for anxiety. These are used to see change over time and to talk with the client about progress. They are not used to diagnose and are not shared outside the clinical team and the client.

5. Coordinate care. The Care Coordinator helps clients apply for Medicaid or other coverage, find a psychiatrist or primary care doctor, and connect to housing, food, legal and employment help. With the client's written permission, we share information with their other providers.

6. Train the next generation of counselors. Starting in Year 2, graduate students in counseling and social work complete part of their required supervised hours at the center, under a written agreement with their university and the supervision of a licensed clinician. Interns see clients only within the limits set by their program and the law, and every case is reviewed by a licensed supervisor. This adds capacity and builds a pipeline of local, bilingual clinicians.

7. Bring education to the community. About 12 free workshops a year at churches, libraries, schools and workplaces, each followed by information on how to reach us.

How we will measure results. We count people served, sessions, wait time from call to first appointment, appointments kept, and how many people stop counseling early. We track average change on the PHQ-9 and GAD-7 for people who stay in care, client satisfaction and the number of referrals to other services that result in a connection. With permission, we follow clients for 6 months after counseling ends.

Our Year 1 goals:
- About 200 people served and about 1,300 sessions.
- At least 80% of new clients offered a first appointment within 7 days of their first contact.
- At least 70% of clients who attend four or more sessions show improvement on their PHQ-9 or GAD-7 scores.
- At least 80% of clients say they felt respected and heard.
- At least 70% of clients who need help with coverage or other services are connected.
- Our Medicaid and main insurer credentialing completed by the end of Year 1.
These are goals, and we will report our real results to the Foundation, including where we fall short. We do not promise that counseling will work for every person.

Market Analysis

Who we serve and how many.

The people. Children age 13 and older, teens and adults in our service area. Rules about the age at which a young person can agree to counseling on their own differ by state, so we confirm Georgia's rules with an attorney, and we ask for a parent or guardian's consent where it is required. We welcome people of every background. We reach out especially to people covered by Medicaid, people with no insurance, working families whose coverage does not go far enough, new parents, caregivers, people in grief or transition, and people who want counseling in Spanish.

Where we work. A leased suite on a bus line in the neighborhood where most of our early requests came from. Telehealth extends our reach to nearby areas with few providers. In Year 3 we begin offering counseling at a school-based site, depending on a partnership agreement with the district.

How many we will reach:
- Year 1: about 200 people and about 1,300 sessions, with one Licensed Therapist and our Clinical Director.
- Year 2: about 340 people and about 2,400 sessions, with a second Licensed Therapist and the first graduate interns.
- Year 3: about 480 people and about 3,400 sessions, with a third Licensed Therapist.
- Year 4: about 650 people and about 4,600 sessions, with a fourth Licensed Therapist.
- Year 5: about 720 people and about 5,200 sessions.
Over five years we expect to serve about 2,400 people and about 16,900 sessions. Some people return for a second round of counseling, so they are counted more than once.

Who else benefits:
- Families. When a parent, partner or teenager gets help, the whole household benefits.
- Primary care providers, schools and clinics. They gain a place to send patients and students, and care coordination that closes the loop.
- Employers. People who get support are better able to keep their jobs.
- Emergency departments. Early counseling can mean fewer crises that end in an emergency room visit, though we do not promise this.
- Future counselors. Graduate interns get real training, and many will stay and work in our region.

How we will size the need before we submit. We will add the population, Medicaid enrollment, number of licensed providers and share reporting frequent mental distress for our service area, along with the number of people on our own waiting list and the number of referral requests we cannot place. These come from the Georgia Department of Community Health, the Georgia licensing board, the county health department and the County Health Rankings.

Competitive Landscape

Other places people can go, and how we fit.

- Private practice therapists. Many are excellent, but most do not take Medicaid, and few have openings or evening hours. We are not competing with them, and we refer clients who prefer a private practice.
- Community mental health centers and clinics. Publicly funded centers serve people with serious mental illness and often have long waits and limited routine counseling. We serve people who need regular counseling and may not meet the criteria of the larger system, and we refer clients who need higher levels of care.
- Primary care and school counselors. They are our closest partners. They see many people who need counseling and do not have time to provide it. We accept their referrals and send back a short note, with the client's permission.
- Hospital emergency departments and crisis services. They are essential for emergencies. They are not a place for ongoing counseling. We coordinate with them and the 988 Suicide and Crisis Lifeline so people who need urgent care get it.
- Employee assistance programs and telehealth companies. Helpful for people who have them, but limited sessions and no local relationships. We accept some of these clients and keep the rest of our capacity for people who have no other option.
- Faith communities and peer support groups. Valuable sources of support. We partner with them and do not replace them.

The gap we fill. In our service area, no program offers same-week first appointments, evening hours, Spanish-language counseling, care coordination and a sliding fee in one place, for people on Medicaid, uninsured or underinsured.

Our partners:
- Two community health clinics and a hospital social work department, which refer patients and take our referrals.
- A school district counseling office, which refers students and families.
- Two universities with counseling and social work programs, which place graduate interns with us.
- Three churches, which host workshops and share our flyers.
- A local psychiatrist on our board, who advises on referrals for medication.
- The county's mental health coalition and the 988 Lifeline center, which we coordinate with on crisis follow-up.

Marketing & Sales Strategy

How people will find us and how we keep them engaged.

Reaching people who need us:
- Referrals from doctors, clinics, schools, hospitals, pastors, probation and community agencies, using a one-page referral form and a direct phone line for professionals.
- Word of mouth. The best advertising for counseling is a neighbor who says it helped.
- Free community workshops at churches, libraries, schools and workplaces, followed by information on how to book.
- A simple website with an online request form, and a text number, both in English and Spanish.
- A free Google business listing with accurate hours and photos of the center.
- Flyers and posters in laundromats, grocery stores, clinics and community centers.
- Local radio and newspaper features in English and Spanish, with a trained clinician speaking on topics such as stress and grief.

Making it easy to say yes:
- The first call goes to a person, not a voicemail, during business hours, and every message is returned within one business day.
- Fees are explained up front in plain words, with a written estimate before the first visit.
- Clients can choose a day, time, a clinician and in person or by telehealth when possible.
- Text reminders, with the client's permission, before each visit. We never include any detail about the visit in a text.

Keeping people engaged:
- The same therapist sees the client from the start, whenever possible.
- When a client misses a visit, the Care Coordinator reaches out kindly, and we make it easy to reschedule.
- Group counseling and workshops add connection with peers.
- We ask clients for feedback after every few sessions and use it to improve.

Reaching supporters. Local doctors, businesses and faith communities are invited to sponsor workshops or the fee support fund. We share results twice a year with funders and partners. We never use a client's name or story without written permission.

Outreach budget. Language access and community outreach together are about $9,000 a year in Year 1, growing about 4% a year. Exterior sign, brochures and the website are paid for once from startup money ($2,500).

Operations Plan

How the center will operate.

Timeline for Year 1:
- Months 1 to 3: Attorney review of the lease and privacy policies, sign the lease, build out the suite, hire the Licensed Therapist and Intake and Care Coordinator, set up the secure health records and telehealth system, and complete Medicaid enrollment and insurer credentialing applications.
- Month 4: Staff training on our crisis plan, privacy rules, intake and care coordination. Soft opening for referral partners.
- Months 5 to 8: Open to clients with same-week first appointments, evening hours and the first workshops. Begin telehealth.
- Months 9 to 12: First Medicaid and insurance payments arrive. Review wait times, no-shows and client feedback and adjust hours. Plan for the second Licensed Therapist and university internship agreements.

Space. A leased suite of about 2,400 square feet on a bus line with four counseling rooms, a waiting area, an office and an accessible restroom. Rent and utilities are about $36,000 a year in Year 1. Rooms are soundproofed and have white noise machines so conversations cannot be heard in the hallway.

Equipment. We buy about $13,000 of equipment once at the start: furniture for four counseling rooms and the waiting area ($5,600), six laptops with secure telehealth cameras and headsets ($5,200), and white noise machines, lockable file cabinets and a secure printer and scanner ($2,200). After Year 1, we set aside about $2,000 to $3,000 a year to replace and add equipment. Soundproofing, paint and flooring are a one-time cost of $10,000.

Staffing. In Year 1: an Executive Director who is also our Clinical Director (a licensed clinician who carries a small caseload), one Licensed Therapist, one full-time Intake and Care Coordinator and one part-time Office and Billing Coordinator. A second Licensed Therapist joins in Year 2, a third in Year 3 and a fourth in Year 4.

Clinical supervision and quality. Licensed clinicians receive regular consultation and take part in ongoing training. Graduate interns receive weekly individual supervision from a licensed supervisor, and their university also provides supervision. We review cases and outcomes monthly. Clinical supervision and training cost about $12,000 a year in Year 1.

Privacy and records. Every client record is kept in a secure, password-protected electronic health records system that follows HIPAA, the federal health privacy law. Telehealth sessions use a secure video platform that is approved for health care. We share information only with the client's written permission or when the law requires it, and we report results to funders only as totals, never with a client's name. The health records, telehealth and billing system costs about $14,000 a year in Year 1.

Confidentiality and its limits. At the first visit, each client is told that what they share is private, with limits set by law. A therapist must act when a person is at serious risk of harming themselves or someone else, and must report suspected abuse or neglect of a child or an older or vulnerable adult as the law requires. Rules for minors and for reporting differ by state, so an attorney reviews our policies.

Crisis plan. We are not a crisis service, but we are ready. Every staff member is trained in a written crisis plan. If a client or caller may be in immediate danger, staff stay with the person, call 911 or the 988 Suicide and Crisis Lifeline when appropriate and notify the Clinical Director. Our after-hours voicemail gives the 988 number and says to call 911 in an emergency. Therapists complete safety planning with clients who are at risk, and we follow up after any crisis contact.

Fees. A sliding fee scale is based on income and family size and is posted at the front desk. No one is turned away because they cannot pay. We bill Medicaid and insurers for covered clients, once our enrollment and credentialing are complete. Medicaid and insurance rules differ and change, so our Office and Billing Coordinator checks each payer's current rules and an outside accountant reviews our billing practices.

Licensing and insurance. Clinicians hold the licenses required in Georgia and are not allowed to practice without them. We confirm with the state whether the center itself needs a license or registration. We carry professional liability, general liability, property and cyber insurance, and workers' compensation once we hire. Insurance is about $8,000 a year in Year 1.

Records and reporting. Grant money is tracked separately so we can show each funder how their money was spent, and an outside accountant reviews our books every year.

Management & Organization

Who leads the organization.

Renee Okafor, LCSW, Executive Director and Clinical Director. Renee leads the organization, raises money, manages grants and partnerships, supervises clinical staff and reports to the board. She is a Licensed Clinical Social Worker who has worked 12 years in community mental health and school-based counseling, and she carries a small caseload. Planned salary: $72,000 a year.

Licensed Therapist. Provides individual, family and group counseling, takes part in case review and supervises interns once experienced. Must hold a current Georgia license, such as Licensed Professional Counselor, Licensed Clinical Social Worker or Licensed Marriage and Family Therapist, and complete a background check. Bilingual in English and Spanish is a plus. One in Year 1, two in Year 2, three in Year 3 and four from Year 4, at a planned salary of $62,000 each. The Meadowbrook Health Foundation grant would support the first Licensed Therapist.

Intake and Care Coordinator. Answers calls, completes intake, schedules appointments, helps clients with coverage and referrals, and follows up after missed visits. Planned salary: $38,000 a year.

Office and Billing Coordinator (part-time). Handles billing, insurance and Medicaid claims, scheduling and records, about 25 hours a week. Planned pay: $24,000 a year.

Pay figures include payroll taxes and workers' compensation insurance.

Staff in each year: 4 paid staff in Year 1, 5 in Year 2, 6 in Year 3 and 7 from Year 4 on.

Graduate interns. From Year 2, two to four interns a year, supervised by licensed clinicians. Interns are not paid by the center and are not counted as staff.

The board. A seven-member volunteer board approves the budget, reviews results twice a year and helps raise money. Board members serve three-year terms. The board's certified public accountant chairs the finance committee. The board's psychiatrist advises on referrals and clinical policies.

People who help us. An outside accountant who reviews our books every year, an attorney who reviews our lease, privacy policies and agreements, an insurance agent who understands health care, a billing consultant for payer enrollment, and an advisory group of three people who have used counseling, a school counselor and a pastor, who meet each semester to tell us what is working.

Training. Every staff member completes training in crisis response, privacy, cultural humility and trauma-informed care before seeing clients, and again each year.

Money management. Grant money is tracked separately for each funder. The Executive Director and a board member must both approve any payment over $2,500.

Milestones Narrative

Our goals for each year and how we will measure them.

- Year 1: Open the center, serve about 200 people and about 1,300 sessions, complete Medicaid enrollment and insurer credentialing, and offer first appointments within about 7 days. A balanced budget of about $299,000, with a small surplus of about $8,400. 4 paid staff.
- Year 2: Add a second Licensed Therapist and the first graduate interns, serving about 340 people and about 2,400 sessions. A balanced budget of about $366,000, with a small surplus of about $9,200. 5 paid staff.
- Year 3: Add a third Licensed Therapist and begin offering counseling at a school-based site, serving about 480 people and about 3,400 sessions. A balanced budget of about $433,000, with a small surplus of about $9,700. 6 paid staff.
- Year 4: Add a fourth Licensed Therapist, serving about 650 people and about 4,600 sessions. A balanced budget of about $500,500, with a small surplus of about $10,700. 7 paid staff.
- Year 5: Serve about 720 people and about 5,200 sessions, with fees and insurance payments covering about 48% of our budget. A balanced budget of about $505,000, with a small surplus of about $10,300. 7 paid staff.

What we measure:
- People served, sessions, and new requests each month.
- Days from first contact to first appointment.
- Appointments kept, missed and canceled, and how many people leave counseling early.
- Change on the PHQ-9 and GAD-7 for people who stay in care.
- Client satisfaction and whether clients felt respected.
- Referrals made and connections completed.
- Fee income, Medicaid and insurance payments, and the amount of care we provide at a reduced fee.

How we review results. The Clinical Director reviews wait times and caseloads every week, and the whole team reviews cases and outcomes every month. Twice a year, the board reviews results and we share them with funders and partners. We report results as totals, and we change what is not working. Every number in this plan is a goal, and we will report what really happens.

Funding Request

What we are asking for, and how the money will be used. Our request: $80,000 from the Meadowbrook Health Foundation for our first Licensed Therapist, clinical supervision for graduate interns, language access and outreach, and the health records and telehealth system, for July 2027 through June 2028.

The request is spread across these budget lines:
- Personnel: Licensed Therapist salary, $62,000.
- Contractual: Clinical supervision and training, $8,000 (other funds add $4,000).
- Other: Language access and community outreach, $6,000 (other funds add $3,000).
- Other: Health records, telehealth and billing system, $4,000 (other funds add $10,000).

Other money in the program. Other grants, client fees and Medicaid and insurance payments, and local donors pay the other $17,000 of those lines, plus the Executive Director and Clinical Director's salary ($72,000), the Intake and Care Coordinator ($38,000), the part-time Office and Billing Coordinator ($24,000), rent and utilities ($36,000), insurance ($8,000) and evaluation, accounting and administration ($13,000).

Year 1 budget: about $299,000, planned to balance with a small surplus (about $8,400 after the yearly wear on equipment). Year 1 money coming in: grants $209,000 (this request plus other grants we are applying for), client fees and insurance payments $60,000 (about 1,300 sessions at about $46) and donations and community sponsors $30,000. Year 1 costs: Executive Director and Clinical Director $72,000; Licensed Therapist $62,000; Intake and Care Coordinator $38,000; Office and Billing Coordinator $24,000; rent and utilities about $36,000; clinical supervision and training about $12,000; language access and community outreach about $9,000; health records, telehealth and billing system about $14,000; insurance about $8,000; evaluation, accounting and administration about $13,000; and about $4,700 a year for the wear on equipment.

How we planned fee income. Some clients pay a reduced fee, some pay nothing and some are covered by Medicaid or insurance. We expect to average about $46 per session across all clients in Year 1 and about $47 in Year 5, after payments from Medicaid and insurers, and after our reduced fees. Credentialing with Medicaid and insurers takes time, so Year 1 is planned low. Payments often arrive weeks after we bill, so we plan for about $17,940 owed to us at the end of Year 1.

One-time startup costs. Startup costs of $40,500 are paid once from startup money, not from the yearly budget: $13,000 of equipment (counseling room furniture, laptops and telehealth equipment, white noise machines and secure storage), $10,000 for soundproofing, paint and flooring, $6,000 for the lease deposit and first month of rent, $1,200 for the business license and permits, $4,500 for an attorney's review of the lease and privacy policies and for accounting setup, $2,500 for the sign, brochures and website, and $3,300 for background checks, insurer enrollment fees and the first insurance payment.

How we got our startup number. The Funding Need Calculator in this plan adds the startup costs ($40,500), the cash we need to cover the wait for the first payments (about $6,900) and a cash cushion of about $72,000, which is about three months of Year 1 costs. That comes to $119,500. We start with $25,000 of our own savings and $100,000 in startup support from a local health foundation and our board, $125,000 in all, which covers that amount with room to spare.

The next five years. Our budget grows from about $299,000 in Year 1 to about $505,000 in Year 5. Grants are planned at $209,000, $222,000, $233,000, $236,500 and $201,000 in Years 1 to 5. Client fees and insurance payments grow from $60,000 to $244,000 as we add therapists and interns. Donations and community sponsors grow from $30,000 to $60,000. Grants fall from about 70% of our income in Year 1 to about 40% in Year 5.

Savings. We plan to keep several months of costs in savings. The lowest year-end balance in the plan is about $105,100, at the end of Year 1.

After the grant. Our plan is that client fees and Medicaid and insurance payments carry a growing share of the budget each year, and that we are paid for the work we do rather than depending only on grants. We will also grow local donors, ask hospitals and clinics that refer patients to support the center, and apply to state and county behavioral health funds. A center that is paid for the care it provides can last.

Risks and how we will handle them:
- Medicaid or insurer credentialing takes longer than planned. We apply early, plan low fee income in Year 1 and keep a cash cushion.
- We cannot hire a licensed therapist quickly. We start recruiting early, offer flexible hours and telehealth, and the Clinical Director can carry more clients for a time.
- A client is in crisis. Every staff member is trained in our written crisis plan, and we coordinate with 911 and the 988 Lifeline.
- Clients leave counseling early. We follow up kindly, offer flexible times and track why people leave so we can improve.
- A grant ends. We keep savings, grow fee income and diversify donors.

If you are just starting. A new organization can begin before it has its own 501(c)(3) status through a fiscal sponsor: an established nonprofit that receives grants for you and passes them to your program, usually for a fee (commonly around 5% to 10% of the grant, sometimes more; ask before you agree). Another way is to start smaller: a few days a week in donated space at a church or clinic, with a part-time licensed clinician and telehealth, tracked carefully. Strong results from a small start make larger grants easier to win.

Appendix Notes

Documents to attach with this proposal:

- Your IRS 501(c)(3) determination letter, or your fiscal sponsor agreement.
- Your most recent financial statements and your current year budget.
- A list of your board members and what each one does.
- Licenses and resumes for your Clinical Director and Licensed Therapist.
- The letter of intent for the lease, or a letter from the landlord.
- Letters of support and referral agreements from clinics, hospitals, schools and churches.
- Agreements with universities for graduate interns, once they exist.
- Your crisis plan, privacy policy, confidentiality notice and sliding fee scale.
- Your Medicaid enrollment and insurer credentialing applications, or proof they were submitted.
- Proof of professional liability insurance, or a quote.
If you don't have any of this yet, no worries - let's continue.

The assumptions behind our numbers (change them in the Financials section to match your own):
- Grant Revenue: $209,000 in Year 1, then $222,000, $233,000, $236,500 and $201,000.
- Client Fees and Insurance Payments: $60,000 in Year 1 (about 1,300 sessions at about $46), then $108,000, $156,000, $212,000 and $244,000 (about 5,200 sessions at about $47 in Year 5).
- Donations and Community Sponsors: $30,000 in Year 1, growing to $60,000.
- Pay (a full year, per person, including payroll taxes and workers' compensation): Executive Director and Clinical Director $72,000, Licensed Therapist $62,000 (one in Year 1, two in Year 2, three in Year 3, four from Year 4), Intake and Care Coordinator $38,000, Office and Billing Coordinator (part-time) $24,000.
- Other yearly costs in Year 1: Rent and Utilities $36,000, Clinical Supervision and Training $12,000, Language Access and Community Outreach $9,000, Health Records, Telehealth and Billing System $14,000, Professional Liability and Property Insurance $8,000, Evaluation, Accounting and Administration $13,000. These grow between 4% and 5% a year.
- Equipment: $13,000 at the start, then $2,000 to $3,000 a year.
- Startup costs: $40,500, paid once from $125,000 in startup money.
- About 6% of each year's income is still owed to us at year end.
- Tax: none, as a nonprofit.
- Every dollar amount is an estimate. Replace them with your own quotes and real budget.

Startup Costs