LODESTAR DAY RESOURCE APPLICATION - SRPM 2014.PDF

Admin Tribe Selection
Created Wednesday, October 22, 2014
Page 1
Please select to which tribe this Organization has applied to:
Salt River

Created Wednesday, October 29, 2014
Page 1
General information
General information I Organization Lodestar Day Resource Center
General information I Contact First name David
General information I Contact Last name Bridge
General information I Contact e-mail dbridge@hsc-az.org
General information I Contact phone number 4803885563
Address
Address I Street 1125 W Jackson
Address I City Phoenix
Address State AZ
Address ZIP Code 85007
What is the name of the program or project for which your organization is requesting grant
funds?
Coordinated Assessment
For what grant amount does the organization plan to request funding?
$70,000
Page 1

INTERNAL REVENUE SERVICE DEPARTMENT OP THE TREASURY
P. O. BOX 2508
CINCINNATI, OH 45201
AUG 0 2 2007,
Employer Identification Number:
Date: 26-0235106
DLN:
LODESTAR DAY RESOURCE CENTER INC 17053184069037
C/O JEFFREY MCMULLIN Contact Person:
1222 E BASELINE RD STE 200 ROGER W VANCE ID# 31173
TEMPE, AZ 85283 Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:
June 30
Public Charity Status:
170(b)(1)(A)(vi)
Form 990 Required:
Yes
Effective Date of Exemption:
June 14, 2007
Contribution Deductibility:
Yes
Advance Ruling Ending Date:
June 30, 2011
Dear Applicant:
We are pleased to inform you that upon review of your application for tax
exempt status we have determined that you are exempt from Federal income tax
under section 501(c)(3) of the Internal Revenue Code. Contributions to you are
deductible under section 170 of the Code. You are also qualified to receive
tax deductible bequests, devises, transfers or gifts under section 2055, 2106
or 2522 of the Code. Because this letter could help resolve any questions
' regarding your exempt status, you should keep it in your permanent records.
Organizations exempt under section 501(c)(3) of the Code are further classified
as either public charities or private foundations. During your advance ruling
period, you will be treated as a public charity. Your advance ruling period
begins with the effective date of your exemption and ends with advance ruling
ending date shown in the heading of the letter.
Shortly before the end of your advance ruling period, we will send you Form
8734, Support Schedule for Advance Ruling Period. You will have 90 days after
the end of your advance ruling period to return the completed form. We will
then notify you, in writing, about your public charity status.
Please see enclosed Information for Exempt Organizations Under Section
501(c)(3) for some helpful information about your responsibilities as an exempt
organization,
Letter 1045 (DO/CG)

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LODESTAR DAY RESOURCE CENTER INC
We have sent a copy of this letter to your representative as indicated in your
power of attorney.
Sincerely,
Robert Choi
Director, Exempt Organizations
Rulings and Agreements
Enclosures: Information for Organizations Exempt Under Section 501(c) (3)
Statute Extension
Letter 1045 (DO/CG)

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LODESTAR DAY RESOURCE CENTER INC
INFORMATION FOR ORGANIZATIONS EXEMPT UNDER SECTION 501(c)(3)
WHERE TO GET FORMS AND HELP
You can obtain forms and instructions by calling toll free 1-800-829-3676,
through the Internet Web Site at www.irs.gov , and at local tax assistance
centers.
You can obtain additional information about most topics discussed below through
our customer service function by calling toll free 1-877-829-5500, or on our
Web Site at www.irs.gov/eo . In addition, you should sign up for Exempt
Organization's E0 Update, a regular e-mail newsletter that highlights new
information posted on the charities pages of irs.gov . To subscribe, go to
www.irs.gov/eo and click on "E0 Newsletter."
NOTIFY US ON THESE MATTERS
If you change your name, address, purposes, operations or sources of financial
support, please inform our TE/GE ED Determinations Office at the following
address: Internal Revenue Service, P.O. Box 2508, Cincinnati, Ohio 45201.
If you amend your organizational document or by-laws, or dissolve, provide
the EO Determinations Office with a copy of the amended documents. Please
use your employer identification number on all returns you file and in all
correspondence with the Internal Revenue Service.
FILING REQUIREMENTS
In your exemption letter, we indicated whether you must file Form 990, Return
of Organization Exempt From Income Tax. If your exemption letter states that
you are not required to file Form 990, you are exempt from these requirements.
Otherwise, if your gross receipts are normally more than $25,000, you must file
Form 990 or Form 990-HZ with the Ogden Submission Processing Center, Ogden, UT
84201-0027.
You are eligible to file Form 990-EZ if your gross receipts are normally
between $25,000 and $100,000, and your total assets are less than $250,000.
You must file the complete Form 990 if your gross receipts are over $100,000,
or your total assets are over $250,000. The Form 990 instructions show how to
compute your "normal" receipts.
Form 990 Schedule A is required for both Form 990 and Form 990-EZ.
Organizations With Gross Receipts of $25,000 or Les$
For tax periods beginning after December 31, 2006, you must file an annual
electronic notice if your gross receipts are normally $25,000 or less.
Alternatively, you may file a complete Form 990 Package if we send one to you.
Exception: Section 509(a)(3) supporting organizations must file Form 990 or
Letter 1045 (DO/CG)

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LODESTAR DAY RESOURCE CENTER INC
Form 990-EZ even if gross receipts are normally $25,000 or less. However,
supporting organizations of religious groups with gross receipts that are
normally $5,000 or less may file an annual electronic notice instead of
Form 990 or Form 990-EZ.
Due Date of Return or Annual Electronic Notice
Your return or annual electronic notice is due by the 15th day of the fifth
month after the end of your annual accounting period. There are penalties for
failing to file a complete return timely. For additional information on
penalties, see the Form 990 instructions or call our toll free number.
Revocation of Tax-Exempt Status
For tax periods beginning after December 31, 2006, your tax-exempt status will
be revoked as of the filing due date of the third year if you fail to file for
three consecutive years Form 990, Form 990-EZ, or the annual electronic notice.
If your tax-exempt status is revoked because you failed to file for three
consecutive years, you must reapply for exemption and pay the appropriate user
fee.
UNRELATED BUSINESS INCOME TAX RETURN
If you receive more than $1,000 annually in gross receipts from a regular trade
or business, you may be subject to Unrelated Business Income Tax and required
to file Form 990-T, Exempt Organization Business Income Tax Return. There are
several exceptions to this tax:
1. Income you receive from the performance of your exempt activity,
2. Income from fundraisers conducted by volunteer workers, or where
donated merchandise is sold, and
3. Income from routine investments such as certificates of deposit,
savings accounts, or stock dividends.
There are special rules for income derived from real estate or other
investments purchased with borrowed funds. This income is called "debt
financed" income. For additional information regarding unrelated business
income tax, see Publication 598, Tax on Unrelated Business Income of Exempt
Organizations, or call our toll free number shown above.
PUBLIC INSPECTION or APPLICATION AND INFORMATION RETURN
You are required to make your annual information return, Form 990 or
Form 990-ES, available for public inspection for three years after the later
of the due date of the return, or the date the return is filed. This rule also
applies to any Form 990-T filed after August 17, 2006. You are also required
to make available for public inspection your exemption application, any
supporting documents, and your exemption letter, You must also provide copies
Letter 1045 (DO/CG)

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LODESTAR DAY RESOURCE CENTER INC
of these documents to any individual, upon written or in person request,
without charge other than reasonable fees for copying and postage.
You may fulfill this requirement by placing these documents on the Internet.
Penalties may be imposed for failure to comply with these requirements.
Additional information is available in Publication 557, Tax-Exempt Status for
Your Organization, or call our toll free number shown above.
FUNDRAISING
Contributions to you are deductible only to the extent that they are gifts and
no consideration is received in return. Depending on the circumstances, ticket
purchases and similar payments in conjunction with fundraising events may not
qualify as fully deductible contributions.
CONTRIBUTIONS OF $250 OR MORE
Donors must have written substantiation from the charity for any charitable
contribution of $250 or more. Although it is the donor's responsibility to
obtain written substantiation from the charity, you can assist donors by
providing a written statement listing any cash,eontribution or describing any
donated property.
This written statement must be provided at the time of the contribution. There
is no prescribed format for the written statement. Letters, postcards and
electronic (e-mail) or computer-generated forms are acceptable.
The donor is responsible for the valuation of donated property. However, your
written statement must provide a sufficient description to support the donor's
contribution.
For contributions of cash, a check or other monetary gift made on or after
January 1, 2007, a donor cannot claim a tax deduction unless the donor
maintains a record of the contribution in the form of either a bank record
(such as a cancelled check) or a written communication from the charity (such
as a receipt or letter) showing the name of the charity, the date of the
contribution, and the amount of the contribution.
For additional information regarding donor substantiation, see Publication
1771, Charitable Contributions - Substantiation and Disclosure Requirements.
For information about the valuation of donated property, see Publication 561,
Determining the Value of Donated Property.
CONTRIBUTIONS OF MORE THAN $75 AND
CHARITY PROVIDES GOODS OR SERVICES
You must provide a written disclosure statement to donors who receive goods or
services from you in exchange for contributions in excess of $75.
Contribution deductions are allowable to donors only to the extent their
contributions exceed the value of the goods or services received in exchange.
Letter 1045 (DO/CG)

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-LODESTAR DAY RESOURCE CENTER INC
Ticket purchases and similar payments in conjunction with fundraising events
may not necessarily qualify as fully deductible contributions, depending on the
circumstances. If you conduct fundraising events such as benefit dinners,
shows, membership drives, etc., where something of value is received, you are
required to provide a written statement informing donors of the fair market
value of the specific items or services you provided in exchange for
contributions of more than $75.
You should provide the written disclosure statement in advance of any event,
determine the fair market value of any benefit received, determine the amount
of the contribution that is deductible, and state this information in your
fundraising materials such as solicitations, tickets, and receipts. The amount
of the contribution that is deductible is limited to the excess of any money
(and the value of any property other than money) contributed by the donor less
the value of goods or services provided by the charity. Your disclosure
statement should be made, no later than, at the time payment is received.
Subject to certain exceptions, your disclosure responsibility applies to any
fundraising circumstances where each complete payment, including the
contribution portion, exceeds $75. For additional information, see Publication
1771 and Publication 526, Charitable Contributions.
EXCESS BENEFIT TRANSACTIONS
Excess benefit transactions are governed by section 4958 of the Code. Excess
benefit transactions involve situations where a section 501(c)(3) organization
provides an unreasonable benefit to a person who is in a position to exercise
substantial influence over the organization's affairs. If you believe there
may be an excess benefit transaction in which you are involved, you should
report the transaction on Form 990 or 990-EZ. For information on how to
correct and report this transaction, see the instructions for Form 990 and
Form 990-EZ, or call our toll free number shown above.
EMPLOYMENT TAXES
If you have employees, you are subject to income tax withholding and the social
security taxes imposed under the Federal Insurance Contribution Act (FICA),
You are required to withhold Federal income tax from your employee's wages and
you are required to pay FICA on each employee who is paid more than $100 in
wages during a calendar year. To know how much income tax to withhold, you
should have a Form W-4, Employee's Withholding Allowance Certificate, on file
for each employee. Organizations described in section 501(c) (3) of the Code
are not required to pay Federal Unemployment Tax Act (FUTA) tax.
Employment taxes are reported on Form 941, Employer's Quarterly Federal Tax
Return. The requirements for withholding, depositing, reporting and paying
employment taxes are explained in Circular E, Employer's Tax Guide,
(Publication 15), and Employer's Supplemental Tax Guide, (Publication 15-A).
These publications explain your tax responsibilities as an employer,
CHURCHES
Letter 1045 (DO/CG)

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LODESTAR DAY RESOURCE CENTER INC
Churches may employ both ministers and church workers. Employees of churches
or church-controlled organizations are subject to income tax withholding, but
may be exempt from FICA taxes. Churches are not required to pay FUTA tax. In
addition, although ministers are generally common law employees, they are not
treated as employees for employment tax purposes. These special employment tax
rules for members of the clergy and religious workers are explained in
Publication 517, Social Security and Other Information for Members of the
Clergy and Religious Workers. Churches should also consult Publications 15 and
15-A. Publication 1828, Tax Guide for Churches and Religious Organizations,
also discusses the various benefits and responsibilities of these organizations
under Federal tax law.
PUBLIC CHARITY STATUS
Every organization that qualifies for tax-exemption as an organization
described in section 501(c)(3) is a private foundation unless it falls into one
of the categories specifically excluded from the definition of that term
[referred to in section 509(a)(1), (2), (3), or (4)1. In effect, the
definition divides these organizations into two classes, namely private
foundations and public charities.
The Code section under which you are classified as a public charity is shown in
the heading of your exemption letter. This determination is based on the
information you provided and the request you made on your Form 1023
application. Please refer to Publication 557 for additional information about
public charity status.
GRANTS TO INDIVIDUALS
The following information is provided for organizations that make grants to
individuals. If you begin an individual grant program that was not described
in your exemption application, please inform us about the program.
Funds you distribute to an individual as a grant must be made on a true
charitable basis in furtherance of the purposes for which you are organized.
Therefore, you should keep adequate records and case histories that demonstrate
that grants to individuals serve your charitable purposes. For example, you
should be in a position to substantiate the basis for grants awarded to
individuals to relieve poverty or under a scholarship or education loan
program. Case histories regarding grants to individuals should show names,
addresses, purposes of grants, manner of selection, and relationship (if any)
to members, officers, trustees, or donors of funds to you.
For more information on the exclusion of scholarships from income by an
individual recipient, see Publication 970, Tax Benefits for Education.
Letter 1045 (DO/CG)

• Form 1023 (Rev. 0-2006) Name: EIN; 20 0235106 Page 11
Lginig Public Charity Status (Continued)
e 509(a)(4)--an organization organized and operated exclusively for testing for public safety. El
f 509(a)(1) and 170(b)(1)(A)(N)—an organization operated for the benefit of a college or university that is owned or El
operated by a governmental unit.
g 509(a)(1) and 170(b)(1)(A)(vi)—an organization that receives a substantial part of its financial support in the form
of contributions from publicly supported organizations, from a governmental unit, or from the general public,
h 509(a)(2)—an organization that normally receives not more than one-third of Its financial support from gross El
investment income and receives more than one-third of its financial support from contributions, membership
fees, and gross receipts from activities related to its exempt functions (subject to certain exceptions).
i A publicly supported organization, but unsure if it is described in 5g or 5h. The organization would like the IRS to 0
decide the correct status.
If you checked box g, h, or i in question 5 above, you must request either an advance or a definitive ruling by
selecting one of the boxes below. Refer to the instructions to determine which type of ruling you are eligible to receive.
a Request for Advance Ruling: By checking this box and signing the consent, pursuant to section 6501(c)(4) of
the Code you request an advance ruling and agree to extend the statute of limitations on the assessment of
excise tax under section 4940 of the Code. The tax will apply only if you do not establish public support status
at the end of the 5-year advance ruling period. The assessment period will be extended for the 5 advance ruling
years to 8 years, 4 months, and 15 days beyond the end of the first year. You have the right to refuse or limit
the extension to a mutually agreed-upon period of time or issue(s). Publication 1035, Extending the Tax
Assessment Period, provides a more detailed explanation of your rights and the consequences of the choices
you make. You may obtain Publication 1035 free of charge from the IRS web site at www.irs.gov or by calling
toll-free 1-800-829-3676. Signing this consent will not deprive you of any appeal rights to which you would
otherwise be entitled. If you decide not to extend the statute of limitations, you are not eligible for an advance
ruling.
Consent = Elosessmentd er Section .4940.of the Internal: Revenue Code
For Organization
rTesGrq&_x---, 6 640--
ignature of Officer, Director, Trustee, (Type or print name of 'gner) (Date)
authorized official) 'VC
(Type or print title or authority of signer)
For IRS Use Only
AULi 0 2 2007
IRS Director, Exempt Organizations (Date)
b Request for Definitive Ruling: Check this box if you have completed one tax year of at least 8 full months and El
you are requesting a definitive ruling. To confirm your public support status, answer line 6b(i) if you checked box
g in line 5 above, Answer line 6b(ii) if you checked box h in line 5 above. If you checked box 1 in line 5 above,
answer both lines 6b(i) and (11).
(I) (a) Enter 2% of line 8, column (e) on Part IX-A. Statement of Revenues and Expenses.
(b) Attach a list showing the name and amount contributed by each person, company, or organization whose El
gifts totaled more than the 2% amount. If the answer is "None," check this box.
(1i) (a) For each year amounts are included on lines 1, 2, and 9 of Part IX-A. Statement of Revenues and
Expenses, attach a list showing the name of and amount received from each disqualified person,. If the
answer is "None," check this box. 0
(b) For each year amounts are included on line 9 of Part IX-A. Statement of Revenues and Expenses, attach
a list showing the name of and amount received from each payer, other than a disqualified person, whose
payments were more than the larger of (1) 1% of line 10, Part IX-A. Statement of Revenues and
Expenses, or (2) $5,000. if the answer is "None," check this box. El
7 Did you receive any unusual grants during any of the years shown on Part IX-A. Statement of Yes 0 No
Revenues and Expenses? If "Yes," attach a list including the name of the contributor, the date and
amount of the grant, a brief description of the grant, and explain why it is unusual.
Form 1023 (nev. 6-2006)

SALT RIVER PIMA-MARICOPA
INDIAN COMMUNITY
10,005 E. Osborn Road, Scottsdale, Arizona 85256 / Phone 480-362-7520 / Fax 480-362-7593
12% Gaming Contributions Application
Date of Application: May 13, 2014
Organization Name: Lodestar Day Resource Center
OrganizationiMunicipal Government Street & Mailing Address: 1125 W. Jackson, Phx, AZ 85007
Contact Person and Project Manager if different from Contact Person: David Bridge
Title: Managing Director
Address: 1125 W Jackson, Phoenix AZ 85007
Phone: 602.223.3413
Fax: 602.2584615
Email Address: dbridge@hsc-az.org
Project Name: Engagement to Housing
In 200 words or less, please provide a brief description of the project submitted to the
12% SRPM1C Grant program.
The Lodestar Day Resource Center (LDRC) serves as the main resource point for homeless
individuals who are accessing the supportive services that are used in conjunction with the
emergency shelter, food and medical/dental care provided on the Human Services Campus
(Campus). Services are provided directly by the LDRC or through partnership with homeless
providers and are aligned to move individuals towards housing in an efficient and effective
manner. The LDRC provides access to legal identification; job readiness and placement
assistance; benefit enrollment through DES; substance abuse treatment and behavioral
healthcare; and resolution of legal issues through the Homeless Court. In addition, the LDRC
offers a Learning Center and a US Post Office.
In 2013, the efforts of the LDRC were enhanced through partnership with the Human Services
Campus LLC (HSC) to implement the Coordinated Assessment Program (CAP). The CAP team
is now the primary point of contact for identifying, engaging, assessing and connecting homeless
individuals with services and housing necessary to end their homelessness in the shortest
possible time. Following assessment, individuals are directed to services and resources available
at the LDRC aTid on the Campus or diverted to community resources -Mr homeless youth, victims
of domestic violence, and veterans.
Beginning Date of Project: July 1,2014 End Date of Project: June 30, 2015
Geographic Area to be served: Maricopa County

** Attach Detailed Budget**
Amount of Total Project: $1,560,630 Amount of 12% Request: $70,000
(No Multi-Year Request will he accepted)
If the Amount of funding received is less than the amount needed for the project, do you have other
funds to complete the project? (Please Explain):
The LDRC works to maintain a diversified funding base so that no program is completely dependent on
any single source of funding. The funding base includes government funding through the AZ Department
of Housing; grants through public and private sources; revenue from special events; and financial support
from individual donors. In 2013, the LDRC began partnering with the Human Services Campus to
increase staffing efficiencies and reduce cost while increasing and program effectiveness. The LDRC and
the HSC are also now partnering on fundraising including joint grant applications.
If you receive SRPMIC 12 % funding, will it be spent (Check One):
X Monthly
# Quarterly
# Lump Sum
List of SRPMIC 12% funds you have received in the past and a list of other 12 % grants funding
you are seeking from other Tribal Governments for the 2013-2014 12% cycle.
SRPMIC
2012 $70,000; 2013 $70,000. The LDRC will be submitting a grant to the Tohoto O'odham for $70,000
for FY 14/15.
List any other funds you have received from the SRPMIC and identify the source: None.
Funding for project/programs may be based on available funding. As such, if funding were not
available for the full the amount of request how would you prioritize funding.
A.) Maintaining staffing for the CAP to allow the LDRC/HSC to implement this new program and to
help ensure the Maricopa Continuum of Care remains in compliance with HUD guidelines in order to
protect all funding for homeless and housing programs.
B.) Maintaining front desk staffing (Client Care Coordinators) is critical to connecting with individuals
coming to the LDRC and to engage them in activities that will end their homelessness and help each to
obtain housing.
C.) Ensuring the availability of the Intensive Engagement Specialist is also a priority. This individual
works with an on-Campus Emergency Medical Technician to address urgent medical needs. Persistent
health problems will be mitigated through enhanced medical and behavioral healthcare in the supportive
environment of the Human Services Campus
D.) Lastly, funding for supplies associated with addressing the basic needs of our clients by providing
items such as food and water.
Which municipal governmental entity will serve as your pass through or accept 12% funds on your
behalf? Maricopa County.

By execution of the 12% Gaming Contribution Grant Application the undersigned agrees that the
information contained in the Application is true to the best of the Applicants knowledge. The
Applicant shall notify the SRPMIC if any information in this Application changes.
6.4.1 a tLd 5/15 / 14
Signature for th'frApit Date
Dm!) Batt:16E , MAtoerwierDlToR.,
Name and Title
The Application shall be signed by the senior elected official of the local government, or in the case
of a non-profit entity, the Chief Executive Officer authorizes to commit the non-profit entity to
apply for, accept, and implement an award from the SRPMIC utilizing 12% Gaming
Contributions.