opportunity and we're putting in place a system that would allow us to repeat the exercise we have gone through to date for any other future clinics if a clinic should get to this point. certainly at this point we don't know of another clinic, but we think putting together a template for us is prudent to do, in part because it allows the city to have a game plan if in fact we approach this again. i think in the case of the department with lyon-martin, i think we were all a little surprised by the fiscal condition, and certainly because the department was not the contractor with the consortium -- not the consortium, but with lyon-martin, the level of information the department received was not the level of information a contractor would receive. we have taken a tactic to essentially treat lyon-martin as

if it were a contractor, even though it is a subcontractor, so now we will get and be able to monitor their progress in terms of operations, fiscal structure, governance, and we see that as an appropriate mechanism to do. and certainly as mentioned, if in fact the financial analysis that john church will be doing, the work that eric will be doing suggests that closure is perhaps an unfortunate decision that the board would have to make, we are cooperating and have collaborated on what that closure plan would look like and what the department's activities would be in terms of that. and the closure of an organization, there is cost involved. things don't close without cost. we would certainly look at how the organization and others could help facilitate the

covering of those costs if we were to face that. so with that, i think i want to say that you can see from the presentations today that not only is lyon-martin and their board engaged, i think all of us are quite frankly working from the same perspective in terms of trying to ensure as much as possible that if this organization continues, that it continues in a viable manner. that it really addresses their ability to serve their existing population in inappropriate and fruitful manner. with that, i am happy to take any other questions that the supervisors may have, either of myself or my other presentation partners. >> thank you. just a quick question. at first, i want to say the work

that has been done by the clinic consortium, the lyon-martin board and staff, and community and the ph, i think the information that is before us is a testament to how hard everybody is working to figure out what a solution could be. i just want to say that has been impressive. just a quick question about the time line. i know they had talked a little bit about the level of public support, the level of foundation funding that would be necessary, and it sounded like that was necessary by the end of march, and it was about $250,000, another 150,000 from the foundation side. i guess i am wondering, if the organization is able to be successful with the support of all these entities to bring that together by the end of march, what would we be seeing? is that enough cash flow to

allow the organization to take these corrective actions? >> a qualified yes. the $500,000 it is the number that was presented to us by hfs, and that was based on an analysis of the operating budget compared with revenue, which includes the existing debt. the numbers that i shared with you our projections. that is how we see them possibly happening. as indicated earlier, we would have to continue our analysis to figure out where that comes from. the threat at this point is if we cannot raise or least have some assurance is there is half million dollars in the bank or available to us by the end of the month, then we would have to be looking at the exit strategy, at the closure strategy. at that point, that would give us enough financial resources to

finance a closure of that has to happen. supervisor kim: the related time frame is to see at the end of the month where we stand with the foundation possibility or the organization's ability to receive the money that has been talked about? >> yes, as well as looking internally at the revenue projections and also a restructuring the budget so it is responsive to the need as of well. supervisor kim: the other thing, as i read the corrective action agreement, some of the issues, the governments, financial management, all of the components make sense. on the financial recovery side, it looks at analyzing and taking a look more deeply into the mixture of clients or patients. i would imagine even if we take corrective action on financial recovery, being able to diversify the client base is something that would have to happen over a long time? >> yes, that is correct.

supervisor kim: i guess i am wondering if the recovery plan allows the time to do that? >> given that we have a march 31 deadline and given that it could involve moving people into those programs, i would have to say at this point i don't have enough information to share with you. the example i will share, if we're looking at an uninsured person whom we wish was eligible for an existing program, that enrollment process may take 30 days to do. but if we know that we have the resources available to us by march 31, then that enrollment process really -- i do want to say it becomes a moot point, but we look at the revenue generated. >> i don't want to put eric on- the-spot, but we have been looking --

>> please come closer to the microphone? >> the $500,000 gives us the cash flow in the short term to continue operations. we have some immediate debt that we need to pay down, probably at least $100,000. we recognize and we took into consideration in our projections changing the patient mix. that will probably take a closer to a year to see the complete results of that. we factored in also working more diligently to collect a sliding fee scale payment at the time of visit, and number of things that require not only training of staff but trading of patients as well. -- but training of patients. we looked at what it would take also in terms of having a cash reserve to get us through the month where we have a larger expenses that we have revenue coming in.

that happened several times during the year. although i will saber the budget that was -- although i will say the budget presented to the board should a revenue expense at the end of the year, but that necessitated having this influx of cash in order to do that. i think we need to wait until iraq has the opportunity to work with the financial people -- until eric has the opportunity to work with the financial people to come up with a plan. but we have to have $500,000 to get us over this horrendous mountain. supervisor kim: thank you, and i want to recognize another supervisor who has joined us. >> i wanted to add another thing. we have already taken some action to try to shift the mixture. part of that is downsizing the healthy san francisco, and the other part is working closely

with the health plan to become part of the automatic and roll process for the seniors with disabilities who will need to enter into the program, which is not a process we have been involved with before, and they're committed to helping us take on more of those patients. >> ok, thank you. supervisor mirkarimi? supervisor kim: -- supervisor mirkarimi: very quickly, what is the remainder of the subcontractor amount that the city is dispersing to lyon- martin. >> of the $322,000 over the contract, a total of $160,000 was advanced on both sides. so you have the remainder of about $170,000 remaining on the

contract. the department would certainly look to end work with eric and his physical team to determine what would be inappropriate advance amount. -- what would be an appropriate advance amount. we would certainly be able to do that for lyon-martin. supervisor mirkarimi: and with the clinic -- and with the clinic then be renewed as a candidate in the fiscal year in july? should all the corrective actions that have been mentioned here take place, then the renewed amounts starts all over again with the new fiscal year? >> certainly if in fact lyon- martin is able to fulfill all components of the action plan, and raise the additional $500,000 they believe they need by march 31, there would be no

reason for the department to contract with -- there would be no reason for the department not to contract with lyon-martin. we would have additional monitoring program and reporting on the very monthly or quarterly basis to make sure that the department and city as a founder is knowledgeable about the fiscal condition of the organization. in terms of the amount itself, the amount they would receive under healthy san francisco would be reduced because we are in the process of transitioning some of their clients at this time, so they would not receive the entire amount there because they are serving fewer people. but with respect to the mental- health and substance-abuse contracts, because they would have to be annualized, those contracts would obviously be higher. supervisor mirkarimi: okay.

>> just a follow-up question, could you explain when it is appropriate to do it and advance? -- when it is appropriate to do in advance? when is it that dph feels or analyzes and determines is appropriate to do the advance? >> the first thing is we want to make sure that first lyon- martin has fully invoiced us for the services. for example, we have advanced them on the behavioral health side and they are in the process of completing those invoices. we want to have all of those invoices before we advance them again, just to be sure that we can document the service being provided. that is something we all want to happen. second, we would want to meet with eric and the cfo in charge

to get at what their monthly cash flow needed is. certainly, the $300,000 that has been raised to date has been very helpful helping the organization meet its cash flow, but we want the information about what their monthly meeting is before we release the money. i believe on march 12, when eric goes to the board, that information will be a component of that. that would be a second thing that we would want before. and third, i think it is important have a good sense that other founders, philanthropy, and/or other donations are forthcoming to help meet the $500,000 need before we would advance. there is the chicken and eight of the huge advance funds to an organization to help them meet

their payroll when, in fact, it may be by march 31 the are not able to raise the $500,000? we want to see where they are on their long-term fund-raising strategies for the $500,000 before advancing those dollars. i think those three conditions would be required for the department to go forward and advance any additional dollars above and beyond the $160,000 we have already advanced. >> thank you. supervisor mirkarimi: thank you. i will call from a series of cards, but now it also like to invite the former supervisor who has been part of the flank on the ground rallying people's opinion in support of save lyon- martin. >> thank you for letting me speak briefly, and i want to acknowledge and thank you, both

supervisor mirkarimi and supervisor kim were at the incredible event that was held for lyon-martin. my first point is i have been proud as a supervisor to have been a partner with lyon-martin and feel very strongly about their continuation. more than any other service in the city, our health services have to be culturally competent. i think you'll hear from individual sharing their personal testimony that without lyon-martin, their health needs would not have been met. i think to imagine a san francisco in which we transitioned out of lyon-martin would be difficult, impossible for me to see. with the lgb community center, you have all helped us improve the viability of the center. one of the key elements was a philanthropist came together,

the foundation came together and took part in the planning. as a result of being part of it they made significant financial commitments. i like to think with the work already taking place and moving forward, recognizing the health department has been engaged with the community clinics consortiums that we need to quickly bring together the foundation stakeholders. i think to seek city funds, which is a legitimate question for us to ask in this difficult time, i think $150,000, if we meet the goal, we would be matching almost at a five-one basis. the energy that you see at this hearing and in the community to support lyon-martin i think will continue, and i will redouble and contribute everything i have contributed over the past month, and i think many members of our community will do that. i think we have to say there are so many individuals who

approached me on the street and say with their insurance has been -- what their experience has been with lyon-martin. what you have here today is a small cross section of these individuals have -- who have relied on the simple health center. i have the upmost confidence. i very much appreciate this hearing being held. i appreciate the community commitment that we are seeing, that you will continue to see, and i think the foundation will step up and work with the department to keep lyon-martin open. thank you. supervisor mirkarimi: thank you. i will call from the yellow stack of cards that i have. please come forward. rabbi david, morgan russo, gabriel holland, thomas, and danny. supervisor kim: before the

public comment gets underway, i like to thank supervisor dufty for being at the hearing. i also like to thank all the people who came to the hearing today and say to dph, lyon- martin, for all the hard work that you have put in to make this a possibility. unfortunately, i will have to leave at 6:00. i just want to let you know ahead of time. but i think you for coming out and sharing your stories. >> thank you. my name is david. i am a san francisco resident and a rabbi. religiously, jewish tradition recognizes the committal and civic commitment to help those in the community who are most vulnerable and offer the protection and care. i think i am at the winged the

supervisors and the implications of a potential loss of lyon- martin are not only local but reached nationally and internationally, given the role that san francisco plays in world culture. if san francisco does not make extraordinary efforts to help these people, how are we going to convince less progressive communities and the u.s. and worldwide? attention must be paid. mahnke. supervisor kim: -- thank supervisor mirkarimi: you. thank you very much. next speaker, please? >> miami transgendered woman. -- i am a transgendered woman. at 58 years old, if lyon-martin ceases to exist, i would be back to rolling the dice for my

health care. i would not seek it. it is too frightening. i am from new jersey. i began my transition there, and it was a whole lot different dealing with the health care system there. i am assured -- i am insured, disabled, on social security, so i am covered, but i am more concerned about most of the people that lyon-martin serves. they are not here. they're looking for cover from the rain. and is just -- it would be really hard.

i worked as a stand-up comedian in san francisco, and i -- i just cannot imagine a san francisco without lyon-martin. i just cannot. it is so safe, so compassionate, and thank you. supervisor mirkarimi: think you very much. next speaker, please? >> supervisors, gabriel holland. in 1984, started the process of coming out as trans injured -- of transgendered. i started coming out, and 1996, 1997, sought out transgendered health care and had an amazingly hostile experience with my

health care provider, kaiser, to drive me away from ever seeking gynecological care, i was so traumatized. that said, i went to lyon- martin to get hormonal treatment, and had such a positive experience and understood how important transgendered health benefits are, and out of that experience work with other transgendered activists to pass health benefits for city employees in 2001 and working on legislation statewide to provide health-care benefits and the anti- discrimination legislation. things have changed, no question, and some would say things are better. i can say that the thing that is true is they are the model in many ways, and it has profoundly influenced not just san francisco, nationally and

internationally what it looks like to provide health care for transgendered. and the needs is very specific. and i also think they're one of the more sensitive places in terms of training women. across the board, they have been a model of care. the only thing i would sit with this, i think we are poised, supervisors, to save lyon- martin. we are pleased in that moment, and your action could send the right message and help in terms of foundation and other big fund raised -- and other big fund- raisers which would be at the chicken and egg. once they get the sense that you are willing to do things to say if lyon-martin, that could reshape the debate and bring it together in terms of saving lyon-martin. supervisor mirkarimi: thank you very much. next speaker, please?

>> hello, i am a nurse practitioner at a clinic in the city. i'm a registered nurse at san francisco general hospital. i just want to remind the supervisors about the great stress of closing lyon-martin on the already overburdened department of public health. i have no people to wait and the emergency room 40 hours before they get a bed. there has been a time when there has not been and i see you open. -- there has been a time when the i.c.u. has not been opened. i personally tried in the past few months, and there has been a weight of three months to get an appointment. i think it is in the department of health's interest and the patient's interest to keep the clinic open. thank you. supervisor mirkarimi: thank you. before this next speaker, i will

read a few more names. the kathleen, linsey, brian. >> good evening, supervisors, i am thomas. the issue in front of you is not whether the individuals are entitled to medical treatment but whether or not lyon-martin should be the provider. i am very troubled by the questions posed by this committee and the dearth of answers provided by lyon- martin's leadership. there are no protocols in place to prevent another shot down without advising clients and patience of where to go next. there is no budget presented to you tonight. in fact, there is no leadership people on the lyon-martin board at the present time. they will have a new board and the executive director has been

on board today is. -- has been on the board to days. but it makes economic sense to give them $160,000, because if you don't, they will be a greater financial burden on the general fund. i will say this, if you give them the $150,000 loan, there should be conditions on the loan. number one, he should get guaranteed they will get the additional financing, from either the public or other foundations. second, they should provide a budget that is realistic and that they will be an ongoing entity in 2012. finally, let me say that the problems with lyon-martin, the department of public health has failed to do the oversight.

the department of public health, they have to ever see the budget. so these nonprofits and the department of public health has not achieved that. thank you. supervisor mirkarimi: thank you. next speaker, please? >> hello, i am a disabled 55- year-old woman. when i started at lyon-martin, it was ok, i will go to that clinic. i had no idea. i had lost my last job. i had been almost two years on unemployment. i am talking about $100 per week, living in san francisco.

i lost my housing. i was unbelievably depressed. there were days when my arthritis prevented me from time in my shoes and i stayed home and did not get out of bed. once in a while i would go to the library. in going to lyon-martin, i found credible, comprehensive, kindness, care, and ability. mental and emotional and physical. maybe the staff is not officially train to transform a from healthy san francisco, but that is what happened because of their addressing all of my physical, emotional, and mental needs. i became more confident and aware that i was entitled. they helped me do that. they wrote letters for me. they got me in that. that was because of the comprehensive health care. i am sure i am one of their 17% of homeless.

there is a niche, and there are more people like me who need lyon-martin health care. there are an unbelievably caring and qualified staff. thank you. supervisor mirkarimi: thank you. next speaker, please? >> thank you for your time. i live a couple blocks from the clinic. i am a community member, friend, a supporter. i moved to san francisco a couple years ago for a job, but also because i knew san francisco to be a really special place. outside of san francisco, the world feels like it is falling apart. people are being intimidated and silence for their beliefs at an alarming rate. people who are in the most critical need are being further marginalize, pushed further out to the fringes, there needs de-