2022_GRANT_APPLICATION_LEUKEMIA AND LYMPHOMA SOCIETY.PDF
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SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY 10005 E. Osborn Road, Scottsdale, Arizona 85256 / Phone 480-362-7520 / Fax 480-362-7593 12% Gaming Grant Program Application Calendar Year 2022 About the Grant Program Application: The Salt River Pima-Maricopa Indian Community 12% Gaming Grant Program (“Program”) application will serve to provide a comprehensive review of the programming requests for Arizona cities, towns, counties, non-municipal public service organizations, and non-profit organizations selected to apply for grant funding. It is not the intent of the Program to award grants that would benefit individuals, be used as sponsorships, be used for religious activities, primarily fund the indirect or administrative costs of a program/organization, or be used for the direct benefit of the Salt River Pima Maricopa Indian Community. Date of Application: 7/1/2021 Organization Name: The Leukemia & Lymphoma Society Organization/Municipal Government Mailing Address: 3877 N 7th ST #300 Phoenix AZ 85014 Organization History: (Provide a brief summary of the origins of the organizations and any notable milestones and/or significant audit findings) The Leukemia & Lymphoma Society (LLS) was born out of a family's grief following the death of their son, who was 16 when he succumbed to leukemia in 1944. Frustrated by the lack of effective treatments for what was then a hopeless disease, parents Rudolph and Antoinette de Villiers started a fundraising and education organization. Driven by the de Villiers' nearly boundless belief that leukemia was indeed curable, the foundation grew steadily, opening its first chapters in the New York City area. Today, LLS, a 501(c)(3) organization, is the largest not-for-profit health agency dedicated to finding cures and better treatments for people with blood cancer, funding cutting-edge research worldwide to advance breakthrough therapies and bring them to more patients faster. With the size and scope to fund research on a scale that makes progress happen, LLS funds more blood cancer research than all other blood cancer organizations combined. Advised by leading biomedical research and clinical experts, LLS identifies and funds the most promising blood cancer research found anywhere and has invested more than $1.3 billion in research to advance therapies and save lives. Unlike corporations that invest in drugs offering the best profit potential, LLS funds research based on unmet medical needs of blood cancer patients, without restriction by commercial return, market size or geography. LLS recognizes that finding cures is not enough; we need to ensure that patients have access to the treatments they need. Through diverse and extensive outreach initiatives we advocate, educate, assist and support patients, and fight for them on the national and state levels. The LLS community – including patients and their families, donors, volunteers and our research and clinical partners – rely on us to be financially stable, transparent and a responsible steward of the funds we raise and invest in our mission. Organization Structure: (Provide a list of current board members and key staff members) LLS Executive Director Jim Brewer Board of Trustees Fiscal Year 2022 EXECUTIVE COMMITTEE ________________________________________ Tony Lee, M.D., Chair Wes Gullett, Vice Chair MEMBERS ________________________________________ Hamilton Baiden M. Preston Clarke John Gray Alison Handel Katherine Hurd Jenny Lewis Brad Lontz Autumn Mitchell Matthew Pruitt Carissa Rose Liz Scott Annette Tanori Do any conflicts of interest exist within the organization structure? (I.e. family, professional or personal conflicts, SRPMIC representatives on board, etc.) There are no conflicts of interested at this time that exist within the organizational structure. Contact Person and Project Manager if different from Contact Person: Breanna Weeks Title: Regional Director of Advancement Address: 3877 N 7th ST #300 Phoenix AZ 85014 Phone: 619-433-2714 Fax: n/a Email Address: breanna.weeks@lls.org Project Name: Local Travel Assistance for Patients Provide a brief description of the project being submitted to the 12% SRPMIC Grant program. In the description provide a summary of the relevant experience, administrative activity, and program development related to the grant request. The Leukemia & Lymphoma Society’s mission is to cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. We have one goal: a world without blood cancers. LLS is the leading provider of free information, education and support services to blood cancer patients and their families, touching patients in local communities through our chapters across the U.S. and Canada. LLS is dedicated to removing barriers to care. We are the voice for blood cancer patients, working with regulatory bodies (i.e., FDA) and state and federal legislatures to drive policies that accelerate the development and approval of innovative treatments and ensure that patients have access to quality, affordable, coordinated care. LLS has invested more than $1.3 billion in research to advance therapies and save lives since its founding. Advised by leading biomedical research and clinical experts, LLS identifies and funds the most promising blood cancer research found anywhere. Last year alone, LLS invested in 270 cutting-edge projects at prestigious academic research institutions worldwide. LLS also supported 22 projects through its Therapy Acceleration Program, a strategic initiative through which we build business alliances and collaborations with biotechnology companies and academic researchers in order to speed the development of new therapies and diagnostics. Since 1999, LLS has locally invested nearly $6.8 million in 17 Arizona based research projects. In addition, in the last fiscal year, LLS distributed over $1.5 million in direct financial assistance to Arizona families battling blood cancers. This includes direct financial aid and our Co-Pay Assistance Program, which helps patients meet their co-payment obligations related to treatment. The program detailed in this proposal will aim to connect more blood cancer patients and their families, particularly those from underserved populations in Arizona with patient services and community resources to address their informational, practical and supportive needs from the time of their cancer diagnosis, through treatment and, hopefully, survivorship. LLS will mobilize community-based partners, medical professionals and representatives from underserved populations toward meaningful action that will result in increased access to cancer care and support. LLS is the only volunteer health organization with comprehensive support services for blood cancer patients in the Arizona area. We are also one of the few with services for pediatric blood cancer patients. Oncologists and practice managers rely heavily on patient advocacy organizations like LLS to provide reimbursement for treatment-related expenses such as transportation to assist patients’ access to care, and LLS is viewed by healthcare professionals as a crucial resource that provides education and support to patients. Goals and Objectives The program detailed in this proposal will broadly address the LLS Local Travel Assistance for the State of Arizona for blood cancer patients, as well as other support, particularly for vulnerable populations, and ultimately improve the quality of life of patients and their families. The LLS Desert Region will engage and connect blood cancer patients and their families with LLS resources and local travel assistance services Local Travel Assistance Program for Patients LLS' Patient Travel Assistance Program provides financial assistance to people diagnosed with a blood cancer who struggle to pay for treatment-related transportation and/or lodging costs (e.g., parking, tolls, gasoline, plane or train tickets, temporary housing). Qualified patients receive an annual stipend of $500 to help cover these expenses. Applicants to the program must meet the following eligibility criteria: Have a household income that is at or below 500 percent of the U.S. federal poverty guidelines as adjusted by the Cost of Living Index (COLI). You will be asked for your zip code to determine your COLI. Be a United States citizen or permanent resident of the U.S. or U.S. territories. Have a blood cancer diagnosis confirmed by a doctor Patient must be in active treatment, scheduled to begin treatment, or is being monitored by their doctor. Patients may be insured or uninsured Patients cannot receive travel assistance from more than one fund in a 6-month period. The 2021 poverty guidelines are in effect as of January 13, 2021 Source: https://aspe.hhs.gov/poverty-guidelines 2021 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA PERSONS IN FAMILY/HOUSEHOLD POVERTY GUIDELINE For families/households with more than 8 persons, add $4,540 for each additional person. 1 $12,880 2021 POVERTY GUIDELINES FOR THE 48 CONTIGUOUS STATES AND THE DISTRICT OF COLUMBIA PERSONS IN FAMILY/HOUSEHOLD POVERTY GUIDELINE 2 $17,420 3 $21,960 4 $26,500 5 $31,040 6 $35,580 7 $40,120 8 $44,660 This grant will be restricted to the Arizona State LLS Local Travel Assistance Program and will aid blood cancer patients with financial need in the state of Arizona by helping to cover treatment-related travel and lodging expenses. LLS has recognized this as an area of unmet patient need and a significant barrier to access for many patients. Funds will serve blood cancer patients residing within the 15 counties in the state of Arizona. We have initiated the program because patient feedback consistently identified financial assistance as an area of unmet need. Often times a lack of financial resources represent a significant barrier to access of proper necessary care. Patients often express fear and concern over the immense financial burden that comes with a cancer diagnosis. LLS regularly fields calls from patients who cannot move forward with their treatments because they cannot afford the transportation to get to their providers. While LLS does offer co-pay assistance to help with insurance co-pay obligations and premiums, the expenses of traveling to and from treatments can be quite substantial and these expenses are not covered under the co-pay program. LLS will target the assistance to those who need it most by requiring an attestation of financial need. LLS regularly receives calls from patients in crisis who cannot move forward with potentially life-saving treatments because they cannot afford to pay for transportation to get to their providers, e.g., doctors, hospitals, transplant centers, and research or clinical trial centers. As patients increasingly need to travel to see a specialist for treatment, follow-up, or special tests to make the most of their chance to fight for life, these costs and burdens are only increasing. Salt River Pima Maricopa Indian Community support will help LLS break down this financial barrier and allow more patients to access the care they need. What percentage of the grant request are Direct Costs of the programming and Indirect Costs, respectively? A 10% administration fee will be applied to the gift. The fee covers expenses associated with communicating with applicants, processing applications, creating and distributing the credit card, staff costs for LLS employees who manage the program and overhead costs such as rent, utilities, etc. Define the Project Category and/or relevant sub-category: (i.e. Education, Public Safety, Transportation, Economic Development, Health Care, Social Services, or Cultural and Environment) The project category falls under health care. Beginning Date of Project: Can usually begin approving patients for funds a few weeks after received. End Date of Project: June 30, 2022 Geographic Area to be served: The geographic area to be served will be the state of Arizona. ** Attach Detailed Budget** Amount of Total Project: Goal: $300,000 Amount of 12% Request: $100,000 (No Multi-Year Request will be 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): LLS will seek additional funding to support this program. Sources may be internal (grants and/or allocations from the society’s home office) or external (support from corporate donors, foundations and individual contributors). If you receive SRPMIC 12 % funding, will it be spent (Check One): Monthly Quarterly X Lump Sum List any SRPMIC 12% funds you have received in the past. If the organization has received funding through the SRPMIC 12% Gaming Grant Program for five consecutive years, they will be required to submit a comprehensive report of grant funding toward the stated program objectives and mission of the organization. In addition, you will be asked to provide a formal presentation to the 12% Gaming Grant Committee prior to the awarding of any additional funding. 2020 $25,000 2019 $25,000 2018 $50,000 2017 $50,000 2015 $20,000 2014 $50,000 2013 $50,000 2012 $50,000 2011 $100,000 2010 $100,000 2009 $100,000 2008 $100,000 List any other 12 % grant funds your organization may be seeking from other Tribal Governments in 2021-2022. Gila River Indian Community $42,500 received in 2020 for Local Travel Assistance Pascua Yaqui Tribe Approved for $15,000 for Local Travel Assistance Fort McDowell Yavapai Nation Applied for $15,000 for LLS Children’s Initiative List any other funds you have received from the Salt River Pima-Maricopa Indian Community (Enterprises Included) and identify the amount and the source: $50,000 2017 Man/Woman of the Year $30,000 2015 Man/Woman of the Year $25,000 2013 Man/Woman of the Year $25,000 2012 Man/Woman of the Year $25,000 2011 Hope Ball $25,000 2010 Hope Ball Has your organization ever applied for and received any local, state or federal grants? If so, please detail. The Leukemia & Lymphoma Society has not applied or received any local, state or federal grants. 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. Any funds provided would still be directed to help patients with local travel assistance. Which municipal governmental entity will serve as your pass through agency to accept 12% gaming grant on your behalf? LLS intends to use the City of Scottsdale as our pass through entity to accept the 12% gaming grant on our behalf 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. 07/01/2021 Signature for the Applicant Date Jim Brewer, Regional Executive Director 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.