Since its inception,, St Thomas CHC has been an independent, not-for-profit clinic. The majority of patients have little or no insurance. Being independent has given the clinic the opportunity to be flexible and quickly responsive to community direction and needs. Independence has also meant ongoing challenges to financial security and sustainability. Revenue generation, grants, and donor contributions remain critical. Cost effectiveness and efficiencies are constantly reviewed. While the revenues generated by being a Federally Qualified Health Center are crucial, continuation of all St Thomas CHC services will continue to require ongoing grant support.