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Additional Information – Form 1023

Body of Christ Community Clinic, Inc


27-0645782

Part IV – Narrative Description of Activities

The Body of Christ Community Clinic (BOCCC) will provide personalized, quality health
services to the medically underserved of the greater Belton, Texas area. The Clinic will
serve adults and children of all ages who have no health insurance or inadequate health
insurance (such as catastrophic high deductible not assisting with clinical care) and
whose income is at or below 185 percent of Federal Poverty Level, and will not provide
services to persons who are currently on Medicaid, Medicare or other government
health programs. The Clinic will rent space from a local non-profit, Helping Hands. At
this time, volunteers are renovating the space to accommodate the medical clinic.
Opening date is expected to be in January 2010.

The BOCCC will have three components:


• Medical care – acute and chronic. In additional to medical exams, this will
include various tests such as strep and pregnancy; referrals for X-rays and
diagnostic testing; and medical referrals for patients needing care in specialty
areas.
• Dental care – cleaning, extractions and sealants. The Clinic will have two dental
rooms.
• Social services – assistance in applying for government programs;
pharmaceutical assistance programs; referrals to appropriate programs.

Patients will provide documentation of their income and residency. The Clinic will
accept patients who meet the above criteria without discrimination as to race, color,
religion or national origin. Proof of citizenship is not required. Persons seeking
treatment who do not meet required criteria will be referred to other medical programs.

The BOCCC will be staffed by volunteer doctors, nurses, other medical personnel, and
non-medical community volunteers from Belton and surrounding communities. A paid
part-time (25 hours per week) Executive Director will oversee day to day operations and
work with the Board of Directors and the volunteer “Counsel of Servant Leaders”
composed of health care, administrative, social work, fund raising and volunteer
coordination teams. Initially, the Clinic will be open one evening a week with operating
hours anticipated to expand in the second year of operation.

Partner churches will commit a certain percentage of their offerings and volunteers to
support the BOCC. These churches will be represented on the governing Board of
Community Representatives which is projected to have its first board meeting in
October 2009. In addition, funding will come from individuals, businesses,
organizations and churches. Foundation grants may also be solicited as the Clinic
grows. Patient donations will be accepted but not required to receive services.

Part V – Compensation, etc.

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Additional Information – Form 1023
Body of Christ Community Clinic, Inc
27-0645782

#3a - Each of the three persons listed in Item 1A has extensive business and/or health
care experience. They are an entirely volunteer group and form the core of the much
larger governing board that will become operational by the projected date of October
2009.

(1) Craig Pearson is a retired U.S. Army Colonel with 26 years time in service. Since
retiring he has served over 10 years as the Executive Pastor for Administration at
First Baptist Church of Belton, Texas. Craig is in his third term on the Belton City
Council and is serving on numerous advisory boards including the University of
Mary Hardin-Baylor College of Business and the Central Texas Area Agency on
the Aging. He has already contributed numerous hours to the planning and
organization of the clinic, serves on the initial board of directors, and will
volunteer at the clinic once it is operational.
(2) Dr. William (Billy) Ligon is American Board of Family Medicine certified. He
recently opened and is currently serving as the Medical Director of the Scott and
White Clinic in Salado, Texas. He is also an Assistant Professor of Family and
Community Medicine in the Texas A&M Health Science Center College of
Medicine. Dr. Ligon has already contributed numerous hours over the last 14
months researching the feasibility, establishing collaborative links and assisting in
the organization of the clinic. He serves on the initial board of directors and
plans to serve as the BOCCC Medical Director and regularly see patients when
the clinic is operational.
(3) Julie O'Rear is a Bachelor prepared Registered Nurse licensed in the state of
Texas. She has 19 years experience as a nurse that includes patient care,
clinical research and administration. She is also the First Lady of the University
of Mary Hardin-Baylor. Julie has already contributed numerous hours to the
planning and organization of the clinic, serves on the initial board of directors,
and will volunteer at the clinic once it is operational.

Part V – Compensation and other Financial Arrangements with Your Officers, directors,
Trustees, Employees and Independent Contractors

#5a - The conflict of interest policy is Appendix 3 of the Body of Christ


Community Clinic Bylaws adopted by the Board of Directors on August 5, 2009.

Part VI – Individuals that Receive Benefits, etc.

# 1a – Individuals will receive services from the Body of Christ Community Clinic in
three areas:

(4) Medical treatment for either acute or chronic health conditions. This will be
provided by a volunteer, licensed physician supported by other volunteer medical
staff. If a patient requires diagnostic tests or specialty care, it will be provided on
site or referred out to the appropriate medical facility or provider. Patients may
be given a prescription to be filled at a local pharmacy. If this medication is low
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Additional Information – Form 1023
Body of Christ Community Clinic, Inc
27-0645782

cost, the patient will pay for it. If the drug is more expensive or the patient cannot
pay for his medication, the Clinic will have a system for the pharmacy to bill the
Clinic for medications. Also, the patient may be referred to the Clinic’s social
services program for enrollment into a Pharmaceutical Assistance Program if the
patient takes medications for an ongoing health condition such as diabetes. This
program provides free medications to patients through application to
pharmaceutical companies.
(5) Dental care for extractions, cleanings and sealants will be provided at the Clinic
on site by volunteer, licensed dental staff.
(6) Social services such as eligibility screening for Medicaid, Medicare, State
Children’s Health Insurance Program and other programs will be provided by
trained volunteers.

#2 – Persons eligible for services must have an income at 185 percent of Federal
Poverty Level or below and live in the Greater Belton, Texas, area.

Part VIII – Specific Activities

#4a – Fundraising Programs:


• Mail - Letters, brochures and information about the BOCC will be mailed to
selected individuals, churches, civic organizations, businesses, foundations and
other entities which might provide funds or services to the Clinic.
• Email – Information about the Clinic such as an annual report or newsletter may
be sent to individuals and organizations that request contact by email.
• Personal – Persons interested in the Clinic and its mission will talk to friends,
business acquaintances and family members, informing them about the Clinic
and giving them an opportunity to contribute.
• Foundation grants – Grants requesting funding from various foundations may be
written and submitted.
• Accept Donations on Your Website – In the future the clinic may accept
donations solely for the clinic electronically via its website.
• Other – The Clinic may conduct fund raising events such as a golf tournament or
dinners to raise funds for operations.

#4d – States and Local Jurisdictions: All solicitations will be done solely by and for the
Body of Christ Community Clinic, Inc, and be done primarily in the State of Texas.
However, grant applications may be submitted to foundations located within any of the
United States of America. Also, if any organizations, family or friends who live in
another state might offer support, we will provide information which will enable them to
contribute. No solicitations will be done in a foreign country.

Part IX –Financial Data

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Additional Information – Form 1023
Body of Christ Community Clinic, Inc
27-0645782

Line 23, Expenses for Program Services - This category will cover operating expenses
such as medical and office supplies, medication costs, computers and software,
technical services, telephone services, printing, licenses and permits, cleaning services,
and necessary equipment.
Balance Sheet – The amount shown on the balance sheet is the start up contributions.
The Clinic does not have a recently completed tax year.

SCHEDULE C – HOSPITALS AND MEDICAL RESEARCH ORGANIZATIONS – Section


I

#1a – Only licensed doctors who agree to treat patients on a volunteer basis will have
staff privileges. These doctors may not receive any fees or income from such services.
Physicians will be recruited from local hospitals and the Bell County Medical Society.

#2a – The Clinic will serve only those who have no health insurance or inadequate
health insurance (such as catastrophic high deductible not assisting with clinical care)
and who meet the income criteria previously described.

#2b – Same as #2a. The Clinic will not serve anyone covered by government health
care programs.

#2c – Same as #2a. The Clinic will not serve anyone covered by government health
care programs.

#4a, b & c – The Clinic will not operate an emergency room as it not envisioned to
achieve that level of care and will initially be open only one evening a week.

#5b – No person who is qualified to receive services will be denied service. Persons
may make a donation when receiving care, but will be seen regardless of their ability to
give a donation.

#5c – The Clinic has no experience regarding the number of charity patients which
might be served by the Clinic.

#5d – The Clinic has no agreement with any federal, state, or local governments.

#8 – Please refer to the narrative description and the description of the qualifications
and duties of the members of the Board of Directors on Page 1, Part IV of this
document.

#14 – The conflict of interest policy is Appendix 3 of the Body of Christ Community
Clinic Bylaws adopted by the Board of Directors on August 5, 2009.