{"edition":"los-angeles","organization":"Lestonnac Free Clinic","organizationId":"org:lestonnac-free-clinic","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-14","model":{"version":"la-lestonnac-clinical-portfolio-v2-full-cost","costScope":"Entire recipient annual gross accrual cost, including separately netted fundraising events: FY 2024 Part IX $4,655,295 plus Part VIII, line 8b $40,258 = $4,695,553. Not surgical program cost or donated-service sticker value. FY 2024 before the new center is a scale anchor; cost drift is stressed. Unrecognized volunteer opportunity cost, separately funded hospital costs and patient travel are outside private-donor denominator, so this is not a societal cost-effectiveness estimate.","geographicAttribution":"LA MSA includes Los Angeles and Orange counties; Inland Empire excluded. Listed weekly opening-hour proxy: Orange 54 + Los Alamitos 9 + Fullerton 12 + Norwalk 18 + Los Angeles~6 = ~99 local, versus San Bernardino 38 plus intermittent Inland Empire clinics~4.4 = ~141.4 total; about 70%. g=.70 is a judgment prior requiring similar patient throughput/clinical value per opening hour and predominantly local residence. Not weighted by population or assumed from headquarters. Mobile work, differing staffing, surgery and cross-county patients are unmeasured; g=.4–.9 stressed, not bounds.","formula":"For an ordinary gift D, additional effective patient-years = (D / E) × N × e × b. Q_all(D) = (D / E) × N × e × b × q / (1 + d); Q_LA(D) = g × Q_all(D). At the annual-cost normalization D = E, Q_all = N × e × b × q / (1 + d). Price per ten LA QALYs = 10 × E / Q_LA(E). Glasses, dental and surgical counts are not added separately to this aggregate clinical mix.","counterfactual":"Other safety-net clinics, possible insurance coverage, emergency care, existing volunteers, Hoag and other grants, and reserves continue. e discounts care that is screening-only, incomplete, ineffective or otherwise available. b discounts marginal funding that only replaces existing support, builds unused capacity or cannot unlock volunteer appointments. Demand or a waiting list alone does not identify e or b.","attribution":"Direct clinical delivery avoids coalition attribution but not substitution. e concerns incremental effective care for a patient under expanded throughput; b concerns whether extra dollars expand throughput at all. g concerns beneficiary residence independently. q is conditional net health gain, not value of insurance, education scores or donated medical charges.","uncertainty":"Low-confidence judgment-based central with source-grounded cost and scale but no organization-specific causal calibration. All e, b, q, g are subjective. Benefit beyond one year excluded; harmful care or reduced alternative access could yield net negative health. Source patient-count definitions and new-center cost dynamics remain material.","nativeOutcomes":"Clinically consequential additional care patient-years, with visits and overlapping programs counted only once. The central scenario has 1,225 all-population effective patient-years at the annual-cost normalization, including 857.5 within LA and Orange counties before discounting health benefits. q = 0.02 is the net utility-year conversion. A patient-year represents the aggregate 12-month clinical package, not a separate year for each visit.","inputs":[{"name":"E","value":4695553,"unit":"USD/year","basis":"observed","rationale":"FY 2024 full recipient gross expense: original Part IX $4,655,295 plus separately netted Part VIII, line 8b event costs $40,258.","sourceIds":["lest24"]},{"name":"N","value":10000,"unit":"patient-scale anchor/year","basis":"observed","rationale":"Conservative lower count from 2024 reported over 10000 patients; unique-person definition and repeat reporting should be verified.","sourceIds":["lest24"]},{"name":"e","value":0.35,"unit":"fraction with incremental consequential clinical care","basis":"judgment","rationale":"Discounts alternative care, incomplete pathways and low-benefit encounters; not measured treatment success.","sourceIds":["lest-programs","oregon-clinical"]},{"name":"b","value":0.35,"unit":"funding-to-throughput additionality","basis":"judgment","rationale":"Ordinary-gift response reduced for public/partner funding, reserves and volunteer constraints.","sourceIds":["lest24","hoag26","lest-volunteer"]},{"name":"q","value":0.02,"unit":"QALY/effective patient-year","basis":"judgment","rationale":"Aggregate clinical-mix prior below external Oregon 0.05 mapping; not validated transfer from insurance to free-clinic treatment.","sourceIds":["oregon-value","oregon-clinical"]},{"name":"g","value":0.7,"unit":"LA+Orange resident health fraction","basis":"judgment","rationale":"Approximately 70% schedule-informed clinic capacity proxy; not observed patient residence.","sourceIds":["lest-locations"]},{"name":"d","value":0.03,"unit":"annual discount rate","basis":"judgment","rationale":"Only one 12-month benefit period, at year 1.","sourceIds":[]},{"name":"mobile_target","value":2000,"unit":"exams/glasses per year target","basis":"observed","rationale":"Prospective second-unit target only; excluded from achieved/central extra output.","sourceIds":["lest-room"]}],"scenarios":[{"id":"central","label":"Whole-clinical-portfolio judgment central","costUSD":4695553,"allPopulationQalys":23.78640776699029,"editionQalys":16.650485436893202,"assumptions":"N = 10,000; e = 0.35; b = 0.35; q = 0.02; g = 0.7; one year of benefit; d = 0.03."},{"id":"poor","label":"Weak marginal treatment and funding stress","costUSD":5869441.25,"allPopulationQalys":0.4854368932038835,"editionQalys":0.1941747572815534,"assumptions":"e = 0.1; b = 0.1; q = 0.005; g = 0.4. Recipient costs are 25% above FY 2024. This is not a confidence bound."},{"id":"favorable","label":"Responsive capacity and effective clinical mix stress","costUSD":4695553,"allPopulationQalys":203.88349514563106,"editionQalys":183.49514563106797,"assumptions":"e = 0.6; b = 0.7; q = 0.05; g = 0.9. This is not an observed yield or confidence bound."},{"id":"zero","label":"No marginal effective care","costUSD":4695553,"allPopulationQalys":0,"editionQalys":0,"assumptions":"b=0 or e=0; no favorable finite price."},{"id":"harm","label":"Net adverse clinical effect stress","costUSD":4695553,"allPopulationQalys":-5.946601941747573,"editionQalys":-4.162621359223301,"assumptions":"q=-.005 stress only; not an observed harm finding."}],"sensitivity":["Price scales inversely with e, b, q, g. The clinical transfer and cash-response priors dominate geographic fine-tuning.","At q=.02 and 3% discount, $1 million/10 requires 2418.209795 incremental local effective patient-years on the corrected gross cost basis, compared with 857.5 central; $100 thousand/10 requires 24182.09795.","If every central health gain is outside LA/Orange, local value is zero; clinic geography must eventually be replaced by beneficiary residence.","No repeated lifetime benefit for glasses replacements or repeat chronic-care visits. New surgery could increase durable benefit and cost; current procedure mix and completed cases are unknown.","The 75%-funded mobile unit does not imply an automatic fourfold match, known remaining gap or ordinary-gift deployment."],"missingInputs":["Unique patient geography and actual per-site/mobile throughput, especially LA/Orange versus Riverside/San Bernardino.","Marginal ordinary-donation budget and the specific clinician/equipment/supply bottleneck it would relax.","Current 2025–26 costs and completed procedures since surgery-center opening; independent clinical outcomes and complications.","Clinical treatment mix, completion/adherence, alternative care and sustained utility outcomes.","Reconciliation of Part III service revenue with Part VIII and explanation of functional accounting classifications."]},"sources":[{"id":"lest24","title":"2024 Form990, original PartsI,III,VIII–X","publisher":"St Jeanne De Lestonnac Free Clinic / IRS","url":"https://projects.propublica.org/nonprofits/organizations/953499011/202543009349302119/full","published":"2025-10-27","retrieved":"2026-09-14"},{"id":"lest23","title":"2023 Form 990, original Parts VIII and IX","publisher":"St Jeanne De Lestonnac Free Clinic / IRS","url":"https://projects.propublica.org/nonprofits/organizations/953499011/202413049349301991/full","published":"2024-10-31","retrieved":"2026-09-14"},{"id":"lest-programs","title":"Programs","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/programs","published":null,"retrieved":"2026-09-14"},{"id":"lest-locations","title":"Current locations and opening schedules","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/contactus","published":null,"retrieved":"2026-09-14"},{"id":"lest-vision","title":"Vision programs","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/vision-programs","published":null,"retrieved":"2026-09-14"},{"id":"lest-dental","title":"Dental programs","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/dental-programs","published":null,"retrieved":"2026-09-14"},{"id":"lest-surgery","title":"Surgery days and new surgery center","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/surgery-days","published":null,"retrieved":"2026-09-14"},{"id":"lest-volunteer","title":"Surgery center volunteer onboarding","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/surgerycenter","published":null,"retrieved":"2026-09-14"},{"id":"lest-room","title":"Adopt A Room2026: second mobile vision unit","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/aar2026","published":null,"retrieved":"2026-09-14"},{"id":"hoag26","title":"How Hoag and Lestonnac Free Clinic are Expanding Free Surgical Care in Orange County","publisher":"Hoag Hospital Foundation","url":"https://www.hoaghospitalfoundation.org/hoag-and-lestonnac-free-clinic-expand-free-surgical-care-in-orange-county.html","published":"2026-07-03","retrieved":"2026-09-14"},{"id":"oregon-value","title":"The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment","publisher":"Finkelstein, Hendren and Luttmer / Journal of Political Economy","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8081392/","published":null,"retrieved":"2026-09-14"},{"id":"oregon-clinical","title":"The Oregon Experiment—Effects of Medicaid on Clinical Outcomes","publisher":"Baicker and colleagues / New England Journal of Medicine","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC3701298/","published":"2013-05-02","retrieved":"2026-09-14"},{"id":"lest-donate","title":"Official donation page","publisher":"Lestonnac Free Clinic","url":"https://www.lestonnacfreeclinic.org/donate","published":null,"retrieved":"2026-09-14"},{"id":"lest22","title":"2022 Form 990, original Parts VIII and IX","publisher":"St Jeanne De Lestonnac Free Clinic / IRS","url":"https://projects.propublica.org/nonprofits/organizations/953499011/202343179349311669/full","published":"2023-11-14","retrieved":"2026-09-14"}]}