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July 1, 2022 Julie Scholer Maricopa County Department of Public Health Office of Nutrition & Active Living 4041 N. Central Ave., #1400 Phoenix, AZ 85012 RE: FY2223 MCDPH Medical Assistance Grant – Heart & Lung (Contract #: 2223-DM-0021-MAG-###, EIN#86-6000472) Dear Julie: On May 19, 2022, the Vitalyst Health Foundation’s Board of Trustees considered the annual budget for the Medical Assistance Grants Program. Maricopa County Department of Public Health (MCDPH) was among the community partners approved for funding for the period July 1, 2022 – June 30, 2023. The Board approved the amount of $75,000 for heart & lung services. Funds are for direct services (such as screening, training, surgeries), program development related to direct services, and client-related equipment (such as regular and specialty aids, assistive devices, and adaptive equipment). Specific grant requirements include: - Individual receiving direct services must have family incomes of less than 150% of the Federal Poverty Level (FPL) with exception made based on approval by Vitalyst. - All services are to be provided to individuals residing in Maricopa County. - When providing direct service, the grantee must keep a log of individuals receiving services including names, financial eligibility, and dates of service kept on file at your location for review by Vitalyst upon request. - The grantee must submit a mid-year report and a final report based on the scope of work and number of individuals served. The following are required to be returned to Vitalyst Health Foundation by email (kotten@vitalysthealth.org) or uploaded in the online portal to process your award: 1. Agreement of Grantee (attached). If you have a fiscal sponsor, both the sponsor and the group doing the work need to sign the agreement. You are welcome to submit two separately signed agreements if that is easier. 2. A completed and signed W-9. If you have a fiscal sponsor, this is their W-9. A blank W-9 may be opened here: https://www.irs.gov/pub/irs-pdf/fw9.pdf. 3. Copy of IRS determination letter. If you have a fiscal sponsor, this is their IRS determination letter. Page 2 of 4 Upon receipt of the above information, an initial payment of $37,500 will be processed. The final payment of $37,500 will be disbursed upon receipt of the mid-year report. Vitalyst staff will be in touch by the end of the calendar year for a mid-year check-in. The final report is to be submitted to https://webportalapp.com/sp/vitalyst-medicalassistancegrants no later than June 30, 2023. If your organization announces this grant in any way, please refer to the grantor as “Vitalyst Health Foundation” and provide us with a copy of all such communications. If a narrative is needed, please use "Vitalyst Health Foundation is on a mission to inform, connect, and support efforts to improve the health of individuals and communities in Arizona. Over its history, the foundation has invested more than $134 million and established itself as a key thought leader, convener, and catalyst of key initiatives - ranging from statewide health policy and systems to housing collaboratives. More information is available at http://vitalysthealth.org." Vitalyst Health Foundation will issue a general communication summarizing the Medical Assistance Grants for this year, as well as share your efforts through our communication channels. We welcome you to send us any updates as you wish. Finally, as a Vitalyst grant partner, we invite you to regular learning sessions and to deepen our collaborations, so keep a look out for those opportunities. Please let me know if you have any questions. And again, congratulations! Sincerely, David Martinez III Director, Community Engagement Vitalyst Health Foundation dmartinez@vitalysthealth.org 602.385.6500 Page 3 of 4 AGREEMENT OF GRANTEE As a condition to a total grant from Vitalyst Health Foundation (Vitalyst) for $75,000 to Maricopa County Department of Public Health the undersigned agrees to comply with the following conditions: 1. Purpose. The Grant shall be used exclusively for the designated purposes as outlined in the grant award letter of July 1, 2022 and will not be used for purposes prohibited by law, including those purposes designated in Section 4945 of the Internal Revenue Code. Other restrictions and additions in the grant award letter shall also apply. If the funds are not used for the designated purposes within the time specified in the grantee's proposal or within any approved extension, the funds shall be returned to Vitalyst. 2. Accounting and Auditing. A systematic record shall be kept by the grantee of the receipt and disbursement of funds and expenditures incurred under the terms of the grant. Substantiating documents (bills, invoices, canceled checks, receipts) shall be retained in the grantee's files for a period of not less than three (3) years after expiration of the grant period. The grantee agrees to promptly furnish Vitalyst with copies of such documents upon Vitalyst’s request. Vitalyst, upon request, shall have complete access to the grantee's files and records for the purposes of making such financial audits, verifications, and investigations as it deems necessary concerning the grant. 3. Budget. Expenditures of the grant funds must adhere to the specific line items in the approved grant budget. Transfers among line items (increase and decreases) are restricted to one thousand dollars ($1000) or ten percent (10%) of the approved line-item amount, whichever is greater. If a transfer in excess of this restricted level becomes necessary, the grantee shall request authorization from Vitalyst in writing (letter or email). Such transfers may not be made without prior written approval by Vitalyst. 4. Reports. Narrative and financial reports shall be furnished by the grantee to Vitalyst as stipulated in the award letter. The narrative report shall include a report on the use of the funds in compliance with the terms of the grant, the progress made by the grantee towards achieving the grant purposes, and any problems or obstacles encountered in the effort to achieve grant purposes. The financial report should be in the same format as the approved grant budget and show the amount budgeted for each line item, the amount expended against each line item as of the date of the report, and the resulting balance remaining in each line. 5. Public Reporting. The grantee shall send to Vitalyst copies of papers, manuscripts, and other information materials, including print media publications, that are related to the project supported by Vitalyst. In all public statements concerning Vitalyst - press releases, annual reports, or other announcements - grantees are requested to refer to Vitalyst by its full name: Vitalyst Health Foundation. 6. Grant Reversion or Termination. The total amount of this grant or any payment thereof may be discontinued, modified or withheld at any time when, in the judgment of Vitalyst Health Foundation, such action is necessary to comply with the requirements of the law. The foregoing conditions are hereby accepted and agreed to as of the date indicated. Grantee Organization: MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH Grant Number: 2223-DM-0021-MAG-### Page 4 of 4 IN WITNESS WHEREOF, the parties agree to enter into this Agreement: FOR AND ON BEHALF OF MARICOPA COUNTY: ________________________ Bill Gates, Chairman, Board of Supervisors _____________ Date ATTEST: ________________________ Juanita Garza, Clerk of the Board _____________ Date APPROVED AS TO FORM: ________________________ Anne Longo, Attorney for Maricopa County _____________ Date