Cornerstone Community Health Clinic

Words in [brackets] are blanks you fill in with your own details when you adopt this sample in Supreme Plan AI.

Executive Summary

Cornerstone Community Health Clinic is a nonprofit primary care organization in Tennessee, serving uninsured, underinsured and Medicaid-enrolled residents in a federally designated health professional shortage area. Our mission is to make sure that every person in our community has access to a doctor, whatever their ability to pay. This proposal is for our Community Health Worker program, which sends trained workers into homes, churches and events to help the patients who need the most support.

The need is urgent. Our target area has one primary care physician for every 3,800 residents, more than double the national shortage threshold, and about 28 percent of adults have no health insurance. Many patients use the emergency room for care that a regular doctor could handle at lower cost.

With this grant we will enroll about 100 high-risk patients in Year 1. Our workers are not clinicians, do not diagnose or treat and always call 911 in an emergency. We promise respectful help, careful follow-up and honest records.

Our Year 1 budget is about $198,000, growing to about $269,500 by Year 5 as we add community health workers, patients and outreach sites. Each year's budget is planned to balance, with a small surplus each year. We have 4 staff in Year 1 (an Executive Director, two Community Health Workers and a part-time Nurse Supervisor) and 8 by Year 5.

We are asking the Appalachian Health Access Foundation for $75,000 for two Community Health Workers, bilingual outreach, health event supplies and a sliding-scale subsidy. Our other income and startup support cover the rest. These numbers are estimates based on the assumptions listed at the end of this proposal, and we do not promise any result beyond what we describe.

Company Description

Cornerstone Community Health Clinic is a nonprofit organization in Tennessee. We are a registered charity with a volunteer board of directors, a written conflict-of-interest policy and a yearly budget the board reviews.

Our mission. To make sure that every person in our community has access to a doctor, whatever their ability to pay.

What we do.
- Provide primary care on a sliding fee scale, with extended hours and care in English and Spanish.
- Run the Community Health Worker program, which pairs trained workers with high-risk patients.
- Make monthly home visits, go with patients to appointments when needed and follow up within 48 hours of any emergency room visit.
- Connect families with food, housing and benefits help.
- Hold community health events and health fairs in trusted places.
- Subsidize clinic visits for patients with no ability to pay.

What we do not do. Our community health workers are not clinicians. They do not diagnose, treat or give medical advice beyond what a doctor or nurse has already told the patient. They call 911 for any emergency. We follow all health privacy rules and share patient information only with permission or as the law requires. We do not promise any health outcome.

How we got here. A group of nurses, a physician and neighbors began hosting monthly health days in a church hall. Patients kept returning and kept asking for help between visits. We kept simple records of who came and what happened. This proposal asks for support to move from monthly health days to a steady worker program.

Problem & Opportunity

Many people in our community cannot get regular medical care.

Too few doctors. Our target area has one primary care physician for every 3,800 residents, more than double the national shortage threshold.

No insurance. About 28 percent of adults have no health insurance, and many with insurance cannot find a provider who is taking new patients.

Costs and distance. A visit may cost more than a household can spare. Without a car, the nearest clinic can be hard to reach.

Emergency rooms as a first stop. Patients delay care and arrive sicker. Preventable emergency room visits cost the regional health system over $4 million a year.

What we hear.
- A woman says she skipped her blood pressure pills for months because she could not afford the visit to refill them.
- A father says he took his child to the emergency room because it was the only place open at night.
- A nurse says many patients are lost between visits.
- A hospital social worker says she sees the same patients over and over.

We do not claim that a worker program can solve every challenge. We believe that a trusted person who knocks on the door can help patients reach the care that is available.

Products & Services

Our Community Health Worker program helps high-risk patients get and keep the care they need.

How the program works.
1. Referral. Patients are referred from the clinic, the hospital emergency room, churches and community groups.
2. Enrollment. A worker meets the patient, explains the program and writes a simple plan with the patient's goals.
3. Home visits. Each worker carries a caseload of about 50 patients and makes monthly home visits.
4. Appointments. Workers help patients schedule visits, arrange rides and go with them when needed.
5. Follow-up. A worker contacts each patient within 48 hours of any emergency room visit.
6. Support services. Workers connect families with food, housing and benefits help.
7. Community events. Workers hold health fairs and screening events in churches and community centers.

Supervision. A nurse supervisor reviews every care plan and meets with workers weekly.

Workers. Our workers are trained, pass a background check and complete our training in health privacy and boundaries. They are paid, with benefits.

Access and fairness. The program is free to patients. We welcome every patient who qualifies and provide materials and visits in English and Spanish.

Market Analysis

Who we serve. Uninsured, underinsured and Medicaid-enrolled residents of our area who have a long-term condition, have recently used the emergency room or have no regular source of care. Eligibility is based on where a person lives and need, and no one is turned away for lack of insurance.

How we estimate need. We cannot count every patient who could benefit, so we plan from what we can see. In our monthly health days we served a full hall each time and kept a waiting list. The hospital emergency room and local churches told us they know many more patients than we can serve. For Year 1 we plan to enroll about 100 high-risk patients. By Year 5, with more workers, we plan to enroll about 220.

Where patients come from.
- The clinic and the hospital emergency room.
- Churches and community centers.
- Food pantries and social service offices.
- Patients who tell a neighbor.

Who else benefits. Families gain support and continuity. The hospital gains fewer avoidable visits. The community gains a stronger link between patients and care.

What the numbers mean. Every number here is a person and a family. We keep our early counts modest and honest so we can do the work well.

Competitive Landscape

What patients can find today, and how we are different.

1. Hospital emergency rooms. They treat anyone, at high cost, and cannot follow up. We help patients avoid repeat visits.

2. Other clinics and health centers. Some are far away, have waiting lists or have limited hours. We work with them and send patients on when they are ready.

3. Health department programs. They provide screenings and education. Few have home visits or follow-up. We fill that gap.

4. Insurance care coordinators. They help patients who are insured and are not always available to people on the edge of coverage.

5. Faith communities. They care for members and want a trained partner for health matters. We provide one.

What makes us different.
- Free to patients.
- Trained community health workers with nurse supervision.
- Home visits and a 48-hour follow-up after an emergency room visit.
- Materials and visits in English and Spanish.
- A sliding fee scale for clinic visits.

We have spoken with the hospital, the health department and other clinics to make sure we are filling a gap and not duplicating services. Their letters of support are in the attachments.

Marketing & Sales Strategy

How patients and partners will find us.

Reaching patients.
- The clinic and the hospital emergency room. We will give staff a short referral form and a named contact.
- Churches and community centers. We will hold health events and share a one-page flyer in English and Spanish.
- Food pantries and social service offices. We will leave information and give short talks.
- Word of mouth. Patients tell neighbors.
- A simple website and a phone line with a text option.

Reaching workers and partners.
- Recruit community members who are trusted in their neighborhoods and are interested in health work.
- Offer a training course, a background check and weekly supervision.
- Give partners a short report each quarter with counts of patients and what they said.

How we decide who joins. We use a simple intake form and enroll patients in the order received, with priority for patients with a recent emergency room visit or a long-term condition and no regular care. We keep a waiting list when caseloads are full.

What we watch. Referrals, enrollment, visits, appointments kept and how many patients stay in the program.

Operations Plan

How the program will be carried out.

Timeline for Year 1:
- Months 1 and 2 (July and August): Hire the community health workers and nurse supervisor, buy equipment, finalize the consent form and privacy policy with our attorney and train the team.
- Month 3 (September): Open referrals and begin enrolling patients.
- Months 4 to 10: Enroll patients up to the caseload, make monthly home visits, hold health events and follow up within 48 hours of emergency room visits.
- Months 11 and 12: Survey patients and partners, report to funders and plan Year 2.

Space. Workers use the clinic as a base, with visits in homes and at community sites. Health events are held in churches and community centers.

Safety, privacy and limits.
- Every worker and volunteer passes a background check and completes training in health privacy, boundaries and safety.
- Workers travel in pairs for the first visits and follow a check-in plan.
- Workers are not clinicians, and any clinical question goes to the nurse supervisor.
- Workers call 911 for any emergency.
- Patient information is kept private, shared only with permission or as the law requires and handled under a written policy.

Equipment. We buy about $10,000 of equipment once at the start: tablets and laptops for fieldwork ($4,000), blood pressure monitors, scales and demonstration kits ($3,000), an outreach table, tent and banners ($1,500) and a printer and locking file storage ($1,500). Later years replace or add a few items.

Staffing. In Year 1 I serve as Executive Director. Two Community Health Workers, each paid $29,000 a year including benefits, carry caseloads and make home visits. A part-time Nurse Supervisor, paid $26,000, oversees the program and reviews care plans. We add a third worker in Year 3 and a fourth in Year 5.

Management & Organization

Dr. Marcus Reid, Executive Director and Medical Director. I lead the organization, report to the board and am responsible for budgets, partnerships and reporting. I came to this work as a family physician who watched patients return sicker because they could not reach care between visits. I will complete the training we require of our workers so I understand the program from the inside. (Replace this paragraph with your own background.)

Community Health Workers. Workers carry caseloads, make home visits and connect patients to care. We will hire neighbors who are trusted and bilingual where possible. These positions are part of our grant request.

Nurse Supervisor. A part-time nurse who reviews care plans, supervises workers and handles clinical questions.

Board of directors. Our volunteer board includes a nurse, a pastor, a hospital social worker, a patient, a banker who serves as treasurer, an attorney and a county health department staff member. The board meets every other month, approves our budget and reviews our privacy and safety plans. No board member is paid, and members with a conflict of interest step out of related decisions.

Advisory partners. A hospital community health director, a Medicaid care coordinator and a county health officer give guidance twice a year.

Staffing and pay in this plan: Executive Director, paid $60,000 a year; community Health Worker, paid $29,000 a year; nurse Supervisor (part-time), paid $26,000 a year.

Milestones Narrative

Our goals, how we will measure them and when we plan to reach them.

Year 1 outcomes (July 2027 through June 2028):
- Enroll about 100 high-risk patients who have no regular source of care.
- Complete at least 90 percent of the monthly home visits we plan.
- Help at least 70 percent of enrolled patients complete a visit with a primary care provider.
- Help at least 60 percent of patients with a long-term condition keep their follow-up appointments.
- Receive positive feedback from at least 90 percent of patients who answer our short survey.

What we count and how.
- Patients enrolled, visits made and follow-up within 48 hours of an emergency room visit, from our records.
- Appointments scheduled and kept, from clinic confirmations with patient permission.
- Referrals to food, housing and benefits help and what happened, from our referral log.
- Patient feedback, from a short, confidential form.
We report what we find, including what did not work, and use it to improve.

Growth over five years.
- Year 2: About 130 patients and a second outreach location.
- Year 3: About 160 patients and a third community health worker.
- Year 4: About 190 patients and a partnership with a managed care plan.
- Year 5: About 220 patients at 3 outreach sites and a fourth worker.

Learning along the way. At the end of each quarter, the director and the board review the numbers and decide whether we are on track. If we are behind, we will adjust our outreach, our sites or our schedule before asking for more money.

After the grant. By Year 5, grants make up about 41 percent of our budget, down from about 57 percent in Year 1, as partners and donors give more. We will keep building those relationships every year.

Funding Request

What we are asking for, and how the money will be used. Our request: $75,000 from the Appalachian Health Access Foundation for two Community Health Workers, bilingual outreach, health event supplies and a sliding-scale subsidy, for July 2027 through June 2028.

The request is spread across these budget lines:
- Personnel: Community Health Worker 1: salary, benefits and mileage, $29,000.
- Personnel: Community Health Worker 2: salary, benefits and mileage, $29,000.
- Other: Bilingual outreach materials, printing and translation, $6,000.
- Supplies: Community health event and health fair supplies, $4,000.
- Other: Sliding-scale subsidy for patients with no ability to pay, $7,000 (other funds add $3,000).

Other money in the program. This request is about 66% of our Year 1 grant income. Other grants and the income lines below pay for everything it does not cover.

Year 1 budget: about $198,000, planned to balance with a small surplus (about $10,000 after the yearly wear on equipment). Year 1 money coming in: Grant Revenue $113,000; state Community Health Access Grant $50,000; hospital Community Benefit Funding $25,000; individual Donors $10,000. Year 1 costs: executive Director $60,000; community Health Worker $29,000; nurse Supervisor (part-time) $26,000; bilingual Outreach and Translation about $6,000; community Health Events and Supplies about $4,000; sliding-Scale Patient Subsidy about $7,000; mileage and Home Visit Supplies about $6,000; training and Certification about $4,000; data System and Reporting about $5,000; administration and Insurance about $10,000; about $4,000 a year for the wear on equipment.

One-time startup costs. Startup costs of $19,500 are paid once from startup money, not from the yearly budget: $4,000 for tablets and laptops for community health worker fieldwork; $3,000 for blood pressure monitors, scales and demonstration kits; $1,500 for outreach table, tent and banners for events; $1,500 for printer and locking file storage; $2,500 for attorney review of the consent form and privacy policy; $1,800 for bilingual flyers and a simple website; $2,200 for community health worker training and background checks; $3,000 for first insurance payment.

How we got our startup number. The Funding Need Calculator in this plan adds the startup costs ($19,500), the cash the program uses before it balances (about $0) and a cash cushion of about $46,500, which is about three months of Year 1 costs. In all, that comes to $66,000. We start with $8,000 from our founding board and $60,000 in startup support from a community foundation and a regional hospital, $68,000 in all, which covers that amount with room to spare.

The next five years. Our budget grows from about $198,000 in Year 1 to about $269,500 in Year 5. Grants are planned at $113,000, $96,500, $111,500, $96,000 and $111,500 in Years 1 to 5. Other income grows: state Community Health Access Grant from $50,000 to $82,000; hospital Community Benefit Funding from $25,000 to $50,000; individual Donors from $10,000 to $26,000. Our surplus is planned at about $10,000 in Year 1, about $10,200 in Year 2, about $11,600 in Year 3, about $11,500 in Year 4 and about $13,200 in Year 5. We add a third community health worker in Year 3 and a fourth in Year 5, and grow from one outreach site to three.

Savings. We plan to keep several months of costs in savings. The lowest year-end balance in the plan is about $62,100, at the end of Year 1. Some grant payments and partner payments arrive after we bill, so we plan for about $7,920 owed to us at the end of Year 1.

Cost per patient. In Year 1, our total costs are about $1,900 per patient served, which includes setting up the program. By Year 5, with more patient served and a trained team in place, that falls to about $1,165 per patient.

After the grant. State health access funding, hospital community benefit funding and individual donors grow every year, so grants become a smaller share of our budget. Patients share their stories with permission, and employers and businesses can sponsor a worker or a health fair by name. We will look for partnerships with the state Medicaid program and managed care plans that pay for community health worker services.

Risks and how we will handle them:
- A patient emergency. Community health workers call 911 for any emergency, follow a written plan and tell the nurse supervisor the same day.
- A worker leaves. We keep a list of trained backup workers and share care plans.
- Low enrollment. We hold events at trusted places and partner with churches and clinics.
- A privacy problem. A written policy, secure systems, and training for every worker in patient confidentiality and health privacy rules.
- A grant ends. We keep savings and grow partner and donor support each year.

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: one neighborhood, a handful of patients and a small team, 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.
- Signed letters of support from partner schools, agencies and sites.
- Your site agreements and your insurance certificate.
- Your consent, waiver and privacy policy.
- Your safety plan and background check policy.
- Your program outline and schedule.
- Quotes for equipment and materials.
- Resumes for your Executive Director and key staff.
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: $113,000 in Year 1, growing to $111,500 in Year 5.
- State Community Health Access Grant: $50,000 in Year 1, growing to $82,000 in Year 5.
- Hospital Community Benefit Funding: $25,000 in Year 1, growing to $50,000 in Year 5.
- Individual Donors: $10,000 in Year 1, growing to $26,000 in Year 5.
- Pay (a full year, per person, including payroll taxes and workers' compensation): executive Director $60,000; community Health Worker $29,000; nurse Supervisor (part-time) $26,000.
- Other yearly costs in Year 1: bilingual Outreach and Translation $6,000; community Health Events and Supplies $4,000; sliding-Scale Patient Subsidy $7,000; mileage and Home Visit Supplies $6,000; training and Certification $4,000; data System and Reporting $5,000; administration and Insurance $10,000. These grow between 4% and 6% a year.
- Equipment: $10,000 at the start, then $2,000 to $3,000 a year.
- Startup costs: $19,500, paid once from $68,000 in startup money.
- Patients enrolled: about 100 in Year 1, growing to about 220 in Year 5. Outreach sites: 1 in Year 1, growing to 3 by Year 5. Each community health worker carries a caseload of about 50 patients.
- About 4% 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