KIDNEY FOUNDATION.PDF

Gila River Indian Community Grant Application Cover Sheet
Municipality Information
Date of Application: May 7, 2013
Name of City, Town or County: Maricopa County
Mayor or Board of Supervisor’s Chairman: Andrew Kunasek
Mailing Address: 301 W. Jefferson, 10th Floor
City: Phoenix State: AZ Zip Code: 85003
Department / Non-Profit Information
Department or Organization Name: National Kidney Foundation of Arizona
Mailing Address: 4203 E. Indian School Rd., #140
City: Phoenix State: AZ Zip Code: 85018
Contact Person*: James Ivie, PhD, LCSW Title: Director of Patient Services
Phone Number: (602) 840-1644 E-mail Address: jivie@azkidney.org
*The individual listed here will be our direct point of contact for grant-related questions or requests for
information. Duplicates of all grant correspondence will be sent to the contact person.
Grant Information
Program or Project Name: ESRD Patient Transportation Program
Purpose of Grant (one sentence): The purpose of the grant is to assist patients with end
stage renal disease (ESRD) who are unable to pay for transportation to dialysis or other
urgent medical appointments when alternative resources are not available.
Beginning and ending dates of Program or Project: 7/1/2013 to 6/30/2015
Year one: July 1, 2013 to June 30, 2014
Year two: July 1, 2014 to June 30, 2015
Amount Requested: $180,000.00 Total Project Cost: $299,870
( X ) Multi-year Request – If checked, # of years requested: 2 Amount/year: $90,000
Priority Funding Area:
( ) Economic Development ( ) Education (X) Healthcare ( ) Public Safety (X) Transportation
Geographic Area Served: Arizona statewide with emphasis on Maricopa County
Signature:
Mayor OR Chairman BOS:_____________________________ Date:_______________
Typed Name and Title: Andrew Kunasek, Chairman

Gila River Indian Community Grant Application
Purpose of Grant
Describe the proposed program or project: Most patients receiving dialysis treatment
must travel from their homes to an outpatient hemodialysis center three times each week
for the rest of their lives or until they receive a successful kidney transplant. At times,
some of those patients face an urgent need for cab rides to a surgery center for repair of
damage to their fistula, graft or catheter. Other patients need transportation to medical
appointments other than dialysis, such as appointments related to a transplant work-up.
The cost of transportation can create a severe financial hardship for some of those
patients. The National Kidney Foundation of Arizona (NKF AZ) assists patients who are
unable to pay for transportation to dialysis or other urgent medical appointments when
alternative resources are unavailable.
Describe how the proposed program or project satisfies one or more of the “priority
areas” identified by the Gila River Indian Community (GRIC): The NKF AZ
transportation program satisfies both the transportation and health care priority areas of
the GRIC. Transportation assistance is provided in a variety of forms such as bus passes,
Dial-A-Ride tickets, taxi vouchers, car repairs, car payments and gas cards. Reliable
transportation supports and facilitates statewide access to life-saving health care services
at dialysis and transplant treatment centers.
Identify the needs/problems to be addressed, target population and number of people to
be served by the project: For people who are low-income or who have lost the ability to
work due to the disabling effects of ESRD (End Stage Renal Disease), the cost of routine
transportation to dialysis treatments can become an obstacle to compliance with the
medical advice and treatment regimen prescribed by their doctors. Lack of transportation
resources can result in missed treatments; delay in the repair of damaged dialysis fistulas,
grafts or catheters; and increase the chances of preventable emergency room visits and
hospitalizations. Even though the NKF AZ transportation program reaches people
throughout Arizona, over 70% of patients receiving transportation assistance reside in
Maricopa County and about 80% of all expenditures for transportation assistance go to
Maricopa County residents. Historically, the transportation program has provided
assistance to an average of 250 ESRD patients each year. Dialysis patients need over 300
rides to and from dialysis per year, which means that NKF AZ has assisted with up to
75,000 rides per year. Over the past two years, applications for transportation assistance
have increased to 321 patients in fiscal year 2012 and 318 patients in the first 10 months
of fiscal year 2013. This growth represents a 28% increase in the number of patients
served, which implies help with as many as 95,000 rides per year. It is projected that
well over 300 patients will continue to need transportation assistance annually in the
years ahead, which means sustained growth well above the historical average of 250
patients in need of transportation assistance each year. Price increases for Dial-A-Ride
tickets (from $3.50 to $4.00 per ride, a 14% increase) and bus passes (from $27.50 to $32
per month, a 16% increase) took effect in Maricopa County on March 1, 2013. It is
projected that these increases will cost our program close to $10,000 more per year.

Describe the project goals and objectives, and your plan to meet them: The goal of our
transportation assistance is to get ESRD patients who are facing financial hardships to
and from dialysis; to and from pre-/post-transplant medical appointments; and to and
from urgent medical appointments, such as repair of damaged dialysis fistulas, grafts or
catheters. Our program supplements public transportation options that are sometimes
difficult for patients to use or afford, helps them to keep their own vehicles in good
repair, and pays temporarily for gas when patients commute to dialysis in rural areas.
Assistance is scheduled for distribution at least twice each month and urgent applications
are accepted whenever they are needed (such as when someone’s car breaks down or a
family member is ill and unable to drive). Assistance is provided in the form of Dial-A-
Ride tickets in Maricopa County, Sun Tran Paratransit Services in Tucson, City of
Phoenix bus passes, guarantees to cover 25% of cab fares that are paid for with taxi
vouchers issued by the City of Phoenix and the City of Glendale (the cities pay 75% of
the cab fares) and guarantees to pay for pre-approved emergency cab rides to dialysis or
other medical appointments. Circle K gas cards are issued to patients in rural areas who
have a long commute to dialysis and assistance with the cost of car repairs or car
payments can be approved when the vehicle is the patient’s primary means of
transportation to dialysis.
Define the project as a new or continuing program: The NKF AZ transportation
assistance program has been in operation for well over a decade. In 2006, NKF AZ
received over $500,000 in state funds to support our patient assistance programs for
transportation, medications, nutritional supplements and dental care. In 2007, state
funding was reduced to $300,000. In 2008, state funding was cut entirely and no state
funding has been available since then. The NKF AZ Board of Directors decided to
continue providing transportation assistance despite the loss of state funding and new
sources of support continue to be explored. That plan was only sustainable until 2011
when continuation of our transportation assistance program was made possible by a
generous grant from GRIC. Without those funds, NKF AZ would not have been
able to offer the extensive assistance programs that we do nor would we be able to
help as many people as we can. Last fiscal year, expenditures exceeded $104,000. This
fiscal year, transportation assistance is trending 14% higher than last year in terms of
both expenditure approvals and numbers of patients helped. It is projected that
transportation assistance will reach over 320 patients with expenditures exceeding
$104,000 by the end of the fiscal year in June. If NKF AZ does not receive funding
from GRIC to continue this program, a reduction in services will leave many
patients without transportation to dialysis and without an alternative resource to
turn to.
Identify other organizations, partners or funders participating in the project and their roles
(see attachments section): Support for the NKF AZ patient assistance programs has been
committed by and/or requested from the Arizona Women’s Board, the Southern Arizona
Foundation, the Arizona Kidney Community Foundation, the BHHS Legacy Foundation
and our donor network.

Indicate any application to and/or awards made by a Tribe other than the Gila River
Indian Community for state shared revenues for this and/or any other projects/programs:
The Fort McDowell Yavapai Nation awarded $2,000 to NKF AZ in August 2012 to
support our dental assistance program. An application was submitted to the Pascua
Yaqui Indian Tribe in June 2012 to support our free community health screenings but a
decision on the application is still pending. An application was submitted to the Tohono
O’odham Nation in June 2012 to support the publication of a revised edition of our renal
cookbook but it was not approved.
Provide a timetable for implementation: Funding will be applied to expenditure approvals
made during fiscal year 2014, which begins on July 1, 2013 and ends on June 30, 2014.
If a multiple year award is granted, funding would be applied to expenditure approvals
made during fiscal year 2014 and fiscal year 2015.
Identify long-term funding resources or project sustainability: We plan to continue our
vital assistance programs for ESRD patients through ongoing community outreach and
fundraising. Our Board allocates funding from many sources of revenue that we receive
throughout the year including our special event fundraisers such as our Dancing with the
Stars, golf tournaments, donated cars, individual and memorial contributions.
Reports
Describe your plan to document progress and results. Interim and final reports will be
required for every grant awarded: Outcomes for the patient transportation program are
measured in terms of the number and demographics of patients assisted, how well those
numbers compare with previous years and the extent to which we are able to maintain the
level of assistance that patients need. Outcomes can also be tracked in terms of the
number of rides approved, the level of demand for each form of assistance (tickets, fares,
vouchers or repairs) and the extent of assistance distribution to different parts of Arizona.

ESRD PATIENT TRANSPORTATION PROGRAM
Budget Period: July 1, 2013 to June 30, 2014
Proposed Budget Amount Requested Amount secured Total Budget
from GRIC from other Funders
Salaries / Wages $5,000 $14,145 $30,300
Payroll Taxes $2,000 $2,635
Patient
Transportation* $80,000 $27,000 $107,000*
Project Supplies $5,000 $5,000 $10,000
Totals: $90,000 $48,145 $149,935
Note: 100% of funding not yet secured
*PATIENT TRANSPORTATION DETAIL
Budget Expenditures Percentage of Unduplicated Average Amount of
Category per Category Expenditures Count of Help Given per
per Category Patients Patient
Helped
Dial-A-Ride
Tickets $65,274 61% 138 $473
Taxi Cab $19,796 18% 96 $206
Fares
Tucson Sun
Tran Passes $11,770 11% 48 $245
City of
Phoenix Bus $ 4,295 4% 19 $226
Passes
Car Repairs $ 3,120 3% 3 $1,040
Car $ 1,605 2% 3 $535
Payments
Fuel Cards $ 1,140 1% 19 $60
TOTAL: $107,000 100% 326 $328

54-61 Department of the Trunsnry
,t1A21‘) 11. il'LLYtiiIeri,,I Revenue SC1111.:1;
P.O. Box 2508, Room 4010 In reply refer to: 6077550277
Cincinnati OH 45201 July 06, 2010 LTR 4168C 0
86-6052363 000000 00
00032602
BODC: TE
NATIONAL KIDNEY FOUNDATION OF
ARIZONA
4203 E INDIAN SCHOOL RD STE 140
PHOENIX AZ 85018-5341
124958
Employer Identification Number: 86-6052343
Person to Contact: Ms Benjamin
Toll Free Telephone Number: 1-877-829-5500
Dear Taxpayer:
This is in response to your Apr. 22, 2010, request for information
regarding your tax-exempt status,
Our records indicate that your organization was recognized as exempt
under section 501(c)(3) of the Internal Revenue Code in a
determination letter issued in July 1964.
Our records also indicate that you are not 2 private foundation within
the meaning of section 509(a) of the Code because you are described in
section 509(a)(2).
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.
Beginning with the organization's sixth taxable year and all
succeeding years, it must meet one of the public support tests under
section 170(b)(1)(A)(vi) or section 509(a)(2) as reported on Schedule
A of the Form 990. If your organization does not meet the public
support test for two consecutive years, it is required to file Form
990-PF, Return of Private Foundation, for the second tax year that the
organization failed to meet the support test and will be reclassified
as a private foundation.
if you have any questions, please call us at the telephone number
shown in the heading of this letter.
Sincerely yours,
6.st Tiki
Cindy Thomas
Manager, EO Determinations