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Created: 05/13/2015 Last updated: 05/20/2015 Page 1 General information Organization VisionQuest 20/20 Contact First name Rhonda Contact Last name Bannard Contact e-mail rhonda@inspiredconnections.net Contact phone number 602-370-3560 Address Street 2211 N. 7th Street City Phoenix State AZ ZIP Code 85006 From what tribe is the organization requesting the grant? Tohono O’odham Nation Total grant amount request 75,000 The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this project or program from the Gila River Indian Community, enter the amount to be requested each year. Amount Year 1 (Gila River Indian Community Only) Year 2 (Gila River Indian Community Only) Year 3 (Gila River Indian Community Only) Year 4 (Gila River Indian Community Only) Year 5 (Gila River Indian Community Only) 1 of 1 ra 'RC Department of the Treasury itt L7 Internal Revenue Service P.O. Box 2508, Room 4010 In reply refer to: 4077550282 Cincinnati OH 45201 June 02, 2008 LTR 4168C 0 04-3747651 000000 00 000 00026552 BODC: TE VISIONQUEST 20 20 % RICHARD S TIRENDI PO BOX 93094 PHOENIX AZ 85070-3094941 007132 Employer Identification Number: 04-3747651 Person to Contact: Barb Herald Ton- Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your request of May 15, 2008, regarding your tax-exempt status. Our records indicate that a determination letter was issued in October 2003, that recognized you as exempt from Federal income tax, and discloses that you are currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. If you have any questions, please call us at the telephone number shown_i_n_th,e_hdlnw of this_le,t,t„er_ Sincerely yours, htt Cindy Westcott Manager, ED Determinations May 19, 2015 VISION Chairman Ned Norris Jr. Because Every Child Deserves To See Tohono O'odham Nation PO Box 837 Executive Committee Sells, Arizona 85634 James W. O'Neil, M.D. Founder & President Re: 12% Grant Fund Richard S. Tirendi Dear Mr. Norris Co-Founder & CEO Treasurer Dan Ortiz Thank you for inviting VisionQuest 20/20 to respectfully submit this Letter of Intent for your consideration. On behalf of the children we serve, VisionQuestv20/20 is truly honored by this Randal Christensen, M.D. M.P.H. opportunity to seek support to significantly advance our mission of protecting children from Scott Harelson undetected vision disorders and preventable blindness. We are committed to eliminate the needless suffering from academic, physical, behavioral and social underperformance due to Bradley Hartman undetected vision problems. Joseph M. Miller, M.D. M.P.H. With up to 25% of school-age children having vision disorders and between 2.5% and 5% Alison Rapping susceptible to amblyopia, which can lead to monocular blindness, vision disorders are both Robert Kaplan prevalent and severe. As vision changes throughout childhood, vision should be accurately assessed annually. In Arizona, sadly, screening children for vision disorders is not required by law. As a result, countless children are left struggling and suffering in silence with unidentified vision problems. The few schools that do voluntarily vision screen their students use antiquated methods that allow for memorization (cheating) or peeking and are subject to human interpretation. VisionQuest 20/20 is committed to using 21st century technology to eliminate these shortcomings while dramatically improving accuracy, reliability and affordability. To this end, VisionQuest 20/20 developed the state-of-the-art vision screening system, EyeSpy 20/2OTM, which employs a computerized video game format for visual acuity, depth perception, and color vision testing of school aged children. In addition, we have developed a HIPAA compliant, cloud based data system for vision screenings to monitor results, help coordinate necessary medical follow up, and facilitate reporting to program coordinators and/or health providers. With humility and respect, VisionQuest 20/20 is seeking a grant in the amount of $75,000 from The Tohono O'odham Nation 12% Fund to distribute EyeSpy 20/20 vision screening systems including necessary supplies and training to 10 school districts in Arizona. We anticipate providing 50 schools with the tools necessary to serve an estimated 23,750 children annually. As the schools will receive non-expiring, unlimited usage licenses for EyeSpy 20/20, current and future students will be served by this single grant for years to come. Sincerely, Richard Tirendi Co-Founder and CEO 2211 N. 7th Street Phoenix, Arizona 85006 www.VisionQuest2020.orq EIN 04-3747651 1-888-MY-VQ2020 Identify Needs to be Addressed; Target Population The need for accurate, annual vision screenings of our children falls along the axes of health, academic performance, economics, and policy decision-making. That said, the health and wellbeing of our children is the primary concern of VisionQuest 20/20. It is estimated that up to 1 in 4 school aged children have vision disorders. 1 In fact, vision problems are the 4th leading public health crisis for children, often leading to lifelong health, academic, and psychosocial problems, including poor grades, low self-esteem and the inability to fully participate in sports or other group activities. Poor vision is often easily treated with corrective lenses but the challenge is detecting the vision deficit. Other conditions such as amblyopia (lazy eye) are often inexpensively corrected when caught at a young age but can lead to permanent blindness if left untreated. Ideally, every child should receive a full eye examination from an eye care professional annually but this is neither logistically nor financially feasible. Both the American Academy of Pediatrics and American Academy of Pediatric Ophthalmology recommend vision screening children to protect children's vision. The lifetime costs associated with visual impairment are estimated at $601,000 per person in 2003 dollars. 2 In school, just one child held back in Arizona costs taxpayers at least $7,000. 3 In Maricopa County alone, it is estimated that 3,300 children will not move forward in the next school year because of their inability to read at grade leve1. 4 If just 4% of those are the result of detectable vision disorders, the immediate cost is nearly $1 million to the state and taxpayers. Arizona is one of only eight states that does not require vision screening children, putting our children at a distinct disadvantage., This means that the detection and treatment of vision deficits are sporadic and inconsistently applied. Absent legislative changes that require uniform vision screening of all school children, whatever can be done to provide reliable and affordable screening technology in our state is imperative for all the reasons discussed above. In addition, every 6% minutes, in the United States, a family is informed that their child is permanently blind due to undetected amblyopia. As devastating as this is, what is absolutely heartbreaking is that the majority of this blindness is preventable, had the disorder been detected before age 9. EyeSpy 20/20 is the state-of-the-art, scientifically proven vision screening technology replacing the 150 year old method of traditional screenings. The most common method of screening employs the wall chart. This method is woefully inadequate as children often memorize the chart or peek through their fingers; and the accuracy is entirely dependent upon human interpretation of the responses from each child. The grant will provide expansion of the EyeSpy 20/20 vision screening program and supplies to a total of 10 school districts in Arizona, joining the 140 schools in Arizona already using EyeSpy 2020. An estimated 50 schools will be provided the tools necessary to serve 23,750 screenings on individual children between the ages of 5 to 11. Implementation will include training, follow up reporting and continual optimization of the program and process. Designated Contact Person Richard Tirendi, CEO & Co-Founder VisionQuest 20/20, 2211 N. 7th Street, Phoenix, AZ 85006 rtirendivisionguest2020.org • 602-791-7140 Governmental Entity Acknowledgment Maricopa County 1 American Optometric Association. 2 Healthy People 2010 Progress Review (2008) 3 Dr. Don Covey, superintendent Maricopa County school district. 4 Valley of the Sun United Way. 5 Prevent Blindness America, 2010. 2211 N. rh Street Phoenix, Arizona 85006 www.VisionQuest2020.orq EIN 04-3747651 1-888-MY-VQ2020 Tribe $69,300 $5,700 $75,000 89 56 84 84 89 70 84 275 593 275 975 313 117 457 112 1,279 1,979 6,930 100.0% Total O'odham Total discount TOTAL $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Project - - - - - - - - - - - w/ 56 84 84 89 70 7.1% 112 495 Tohono Materials district 20/20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ per 84$ - - - - - - - - - - - - - - - - EyeSpy 84 1.2% kits Outside Services $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ *Additional - - - - - - - - - - - - - - 93 28 93 Serv 215 3.1% Non-Prsnl Comp $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ - - - - - - - - - - - - - - - 75 187 261 3.8% Travel grant) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ (dollars) - - - - - - - - - - - - - 19 19 19 93 for 149 2.2% Phone $5,700 District $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ to Per - - - - - - - - - - - - - - - 93 93 1.3% Human Outside (discounted Budget $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ - - - - - - - - - - - - - - - Itemized 182 93 275 4.0% $7,500 Human Education = kit $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ per - - - - - - - - - - - 37 42 93 93 182 182 630 9.1% $125 Human Admin @ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 5 10 - - - - - - - - districts 475 89 2375 23750 2.92 593 219 607 271 117 364 68.2% 6,930 1,139 1,330 4,727 69,300 Human Program 10 x $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ district frames per School cables District Screenings glasses District kits Cards Districts Per / ext. / District test occluding Cards Puzzles Cost Screening License additional Students Annual mouse 3D Stereo / Students Support School VA Cost Consult Customization of of LEA of / Activation Installation Calibration Percentage 6 Schools Program District Outreach Database Training Reports USB pair pair Near Near 3D New Avg. Total Total No. Cost Tech S&H Total I.T. VISION 6 6 6 6 6 6 *PLUS