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Agenda 11/15/2016 Item #16K5 16K.5 11/15/2016 EXECUTIVE SUMMARY Request that the Board of County Commissioners direct the Collier County Health Facilities Authority to disburse grant funds to certain nonprofit health service agencies. OBJECTIVE: For the Board of County Commissioners to direct and authorize the Collier County Health Facilities Authority(the"Authority")to disburse funds to certain health care agencies pursuant to the recommendations of the Authority and consideration by the Board. BACKGROUND: Chapter 154,Part III,Florida Statutes provides for the establishment of health facilities authorities by counties,which have the power to issue tax-exempt bonds for qualifying nonprofit health care facilities. Collier County established the Collier County Health Facilities Authority(the Authority") in 1979 by the adoption of Ordinance 79-95. Section 154.209 authorizes an authority to levy fees for its services, and, after allowing for the administrative expenses of the authority, directs the authority to donate any surplus funds that remain in its account to the Board of County Commissioners, which is then required by the statute to disburse those funds to"nonprofit human health service agencies." The Authority has established a fee for its bond issuance services,and has accumulated approximately $90,000 as a result of several bond issues it has authorized over the past five years. The Authority has determined that$30,000 will cover its administrative expenses for the foreseeable future until further bond issuance revenues are received,and therefore desires to turn over its surplus funds,in the amount of $60,000 to the BCC,for the Board's further disbursal of the funds to qualifying agencies, or, alternatively,the Authority will disburse the funds directly to the agencies in accordance with the Board's direction. The process by which the Authority brings these recommendations to the Board has been as follows: 1. The process described in this Executive Summary, is the process that was used in 2011,the last time the Authority made a funds distribution. That process was as follows: In 2011,after having accumulated funds from several bond issues previous to that,Authority staff discussed this matter with county management, and it was suggested that the Authority identify qualified agencies for grant funds and make recommendations to the Board of County Commissioners with regard to disbursal. The Authority then advertised the availability of funds,received applications,held public hearings on the applications,and made recommendations to the BCC. The Board adopted the Authority's recommendations and directed the Authority to disburse the funds in accordance with the Board's recommendations. 2. In the process of setting its budget for the 2015/2016 fiscal year,the Authority determined to donate$60,000 in total grants, leaving it with sufficient funds to operate until additional funds are received from future bond issues. Accordingly,the Authority placed a notice in the Naples Daily News advising agencies of the opportunity to apply for grant funds,and providing instructions as to the filing of grant applications. 3. The Authority received grant applications from the following agencies,requesting funds for the purposes briefly described: a. CHS Healthcare. The grant purpose is to assist in funding prenatal and postnatal oral healthcare on board the agency's new mobile unit,the Health and Smiles Mobile. Packet Pg. 1773 16.x.5 11/15/2016 b. Physician Led Access Network of Collier County(PLAN). PLAN acts as a referral resource where uninsured patients are treated by volunteer medical providers and clinics. The grant request is for funding for lab test costs which are needed by the providers to provide their services. c. Senior Friendship Centers' Friendship Health Clinic Collier. This facility allows retired professional volunteers-doctors,dentists,and nurses,to practice in partnership with the local county public health department,providing reduced fee services to low income seniors. A significant part of this is oral care,and the grant request is for the purchase of new dental equipment to assist in alleviating a backlog of patients needing restorative dental work. d. David Lawrence Mental Health Center,Inc. The grant request is to help with the cost of furnishing and equipping the Center's new children's outpatient behavioral health services building. Copies of each of the applications are attached. 4. Pursuant to a public notice in the Naples Daily News,the Authority held a public hearing on May 18,2016,heard presentations from each of the applicants and members of the public in support of the applications. The Authority continued the meeting to July 15,to consider additional applications and information. 5. At the continued meeting held on July 15,the Authority considered the refined requests, and adopted a motion to recommend that the Board of County Commissioners authorize grants as follows: a. That CHS Healthcare receive a grant in the amount of$20,000 for the purposes set forth in the application. b. That PLAN receive a grant in the amount of$8,000for the purposes set forth in the application. c. That Senior Friendship Center receive a grant in the amount of$4,500 for the purposes set forth in the application. d. That David Lawrence Mental Health Center,Inc.receive a grant in the amount of $27,500 for the purposes set forth in the application. Deciding among,and reducing some of the requests to fit within the funds available,was a difficult decision,and a careful evaluation of each request was made. All the applicants have demonstrated success in serving the public health needs of the county over many years. There is a true public need and public health benefit to be obtained from each of the requests. FISCAL IMPACT: The Authorities current available cash on hand from previous bond issue fees is approximately$90,000. After disbursing$60,000 in certain nonprofit health service agency grants as recommended, sufficient operating funds will remain until additional funds are received from future bond issues. GROWTH MANAGEMENT IMPACT: None Packet Pg. 1774 16.K.5 11/15/2016 LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to form and legality,and requires majority vote for approval. -JAK RECOMMENDATION: That the Board authorize the Authority to disburse grant funds in accordance with the above. All grants will be made pursuant to grant agreements that will require that the funds be used as indicated and provide for appropriate certifications as to compliance. Prepared by: Donald A.Pickworth,Executive Director and General Counsel Collier County Health Facilities Authority ATTACHMENT(S) 1. 11.15.16 DLC Application (PDF) 2. 11.15.16 Healthcare Network SWF Application (PDF) 3. 11.15.16 PLAN Collier Health Facilities Authority Grant Application (PDF) 4. 11.15.16 SrHFC Application (PDF) C Packet Pg. 1775 16.K.5 11/15/2016 COLLIER COUNTY Board of County Commissioners Item Number: 16.K.5 Item Summary: Request that the Board of County Commissioners direct the Collier County Health Facilities Authority to disburse grant funds to certain nonprofit health service agencies. Meeting Date: 11/15/2016 Prepared by: Title: Operations Coordinator—Office of Management and Budget Name: Valerie Fleming 11/01/2016 11:51 AM Submitted by: Title: Division Director-Corp Fin&Mgmt Svc—Budget and Management Office Name: Mark Isackson 11/01/2016 11:51 AM Approved By: Review: County Attorneys Office Jeffrey A.Klatzkow Level 3 County Attorneys Office Review Completed 11/01/2016 1:10 PM COffice of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 11/01/2016 3:52 PM Budget and Management Office Mark Isackson Additional Reviewer Completed 11/01/2016 3:59 PM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 11/06/2016 11:50 PM Board of County Commissioners MaryJo Brock Meeting Pending 11/15/2016 9:00 AM 0 Packet Pg. 1776 16.K.5.a Application for Grant Recommendation —Collier County Health Facilities Authority : ca co 1. Organization Information David Lawrence Mental Health Center, Inc. 6075 Bathey Lane Naples, FL 34116 Phone: (239)455-8500 Email: darcyt@dlcmhc.com Contact: Darcy Taylor 2. Form of Organization David Lawrence Mental Health Center, Inc. is a nonprofit corporation under section 50, (c)(3) of the Internal Revenue Code. N U) 3. Board of Directors: Douglas Johnson, PhD, Chairman 0 Brian McAvoy, Vice Chairman Pablo Veintimilla,Treasurer Russell Budd, Director ci William O'Neill, Director Michael Reagen, Director ca L. Patt Schneider, PhD, Director mo Viola Steffan, Director Lieutenant George Welch, Director Allison Durian, Director N N CT Executive Team: cc Scott Burgess, President and Chief Executive Officer Nancy Dauphinais, Chief Operating Officer o Scott Geltemeyer, Chief Financial Officer James Warnken, Chief Planning and Business Development Officer 4. Activities of Organization David Lawrence Mental Health Center, Inc. (DLC) is a leading provider of behavioral he.Ith a solutions in Southwest Florida, dedicated to inspiring and creating life-changing wellne s for every individual. Established in 1968 through the vision, hard work and determination f community leaders and founders, DLC was the first mental health and substance abuse clinic in r Collier County.Today,from three Collier County locations, DLC provides innovative, comprehensive inpatient, outpatient, residential, and community-based prevention an treatment services for children and adults who experience mental health, emotional, psychological, and substance abuse challenges. Our mission is restoring and rebuilding ives by Packet Pg. 1777 1 6.K.5.a providing compassionate, advanced and exceptional mental health, substance abuse d a integrated healthcare solutions, available to all. DLC is accredited by the Joint Commission on Accreditation of Healthcare Organizatio . and is Y licensed by the Florida Department of Children and Families and the Agency for Healt are 0 Administration. c 0 DLC's programming includes: v L 1. Adult and Elder Programs, including: m • Inpatient Crisis Stabilization through the Adult Crisis Stabilization Unit, a 24-bed, non hospital °c� Inpatient facility; 2 r • Addiction and Recovery Services, including a 15-bed non-hospital inpatient detoxific. ion 0 unit, interim 2 i5 residential, intensive outpatient treatment and aftercare services; ` • Outpatient Mental Health Services, including family and individual therapy, group th::rapy, c 0 psychiatric medical services, and behavioral therapy; .N • TeleHealth, a web-based behavioral health service; _ E • Community Services, including case management, supported living services, homeless. o outreach,supported employment services, motivational support, and supportive housi g units; • Specialty Court-Related Services, including mental health court, drug court, deferred c prosecution programs,forensic reintegration support, and competency restoration ser ices; o and c • Holistic Therapies, including art therapy, equine-facilitated psychotherapy, pet thera ii y, 12 ra tobacco cessation services,wellness and nutrition programs, yoga,fitness, and spiritua mo support. 0 2. Children's Programs, including: • Inpatient Crisis Stabilization through the Children's Crisis Stabilization Unit, a 4-bed, on- -= hospital n- hospital inpatient facility; a • Outpatient Services, including individual and family therapy, psychiatric medical servi es, 0 substance abuse group therapy,and behavioral therapy; c • TeleHealth, a web-based behavioral health service; c • Community Services, including case management,therapeutic behavioral services, sp-cialty N mental health treatment, and education day treatment; c o • Specialty Court-Related Services, including juvenile assessment services; • Holistic Therapies, including art therapy, equine-facilitated psychotherapy, pet thera. , and u music therapy 0. 3. Prevention Programs. DLC provides an array of prevention education and outreach s I rvices t) for both children and adults that focus on a variety of mental health and substance abu.e o topics. co r 1.6 r With an annual operating budget of almost$20 million, David Lawrence Center has 40 1,istinct programs and services designed to meet the mental health and substance abuse needs •f the c community. Annually, DLC serves more than 11,000 clients, plus more than 58,000 pe.ale E through triage, prevention,outreach and information services. 77%of DLC clients requi e ZiZi Packet Pg. 1778 1 6.K.5a governmental or charitable subsidy. Revenue is derived from a combination of state a I d county contracts,client fees, donations and grants. DLC is committed to operating in a financi:lly U responsible manner that carefully balances the growing need for expanded mental he)Ith and ,i substance abuse services with the ability to generate increased revenue to support th:,se needs. To 5. Grant Request DLC is requesting funding to furnish and equip the new children's outpatient behavior.I health services building, which will include a children's partial hospitalization program (PHP). a� 0 Several projects are planned to expand the children's services continuum in order to b the leader in pediatric behavioral health in Southwest Florida. DLC's strategic plan specific.Ily calls for a focus on early identification, screening and assessment through the implementat sn of additional evidence-based practices,technologies, holistic treatments and new children 's intensive services as well as expansion of facilities. a, 0 Due to the increasing demand of children's outpatient behavioral health services,the i avid 0 Lawrence Center will be relocating this program to a larger space on the Golden Gate sampus E during the summer of 2016.The space will provide a dedicated group room and five a••itional c°v private offices for children and their families to meet with DLC counselors and medical .taff. Most of the current office furniture will be moved to the new location, however, DLC ill need to equip the additional offices and the group room and replace existing furniture in th: waiting room and a number of offices that is old and well past its useful life. Knowing the chall nges that these children and their families face,the plan is to also add wall coverings and pii ures that will create a warm,cheerful, and welcoming environment. 0° ra Included with this expansion is the establishment of a new service offered by DLC:the children's PHP. Geared toward children who need significant ongoing treatment and c•unseling for a period of time but not to the level of a 24 hour crisis stabilization unit,these child en CT would participate in this program for eight hours per day. Working with schools, DLC plans to 0 have on-site tutors and on-line distance learning capabilities to prevent children from f:fling c behind in their studies. Keeping up with their assignments will significantly reduce the .tress level once they are ready to return to school.To that end,this request also includes th:11 cost of furniture and several computer workstations for two offices and a second group room. his o service will be offered beginning in late summer, early fall 2016. 0. See the attached itemized list of planned equipment and furnishings. U to _ C Packet Pg. 1779 16.K.5.a N a) :a BUDGET: New Children's Outpatient Services Building Equipment and Furnishings as u- Description Quantity Costfitem Total cost co Office-Desk LLR69902 4 $ 119.00 $ 476.011 Office-Pedestal LLR69603 4 144.00 576.0o c Office -Chairs LLR86200 4 189.00 756.0�� (o Office-Bookcase BSXBLZ194NN 4 156.00 624.011 L Dell Desktop computer and monitor 4 695.00 2,780.0 11 °' Cisco Telephone 4 225.00 900.0 I, -j Reception chairs BSXVL852NSB11 12 199.00 2,388.0 j' a Reception Corner table BSXBHL317ON 6 103.00 618.011 Reception coffee table HON80191 NN 2 211.00 422.011 a Various children's motif wall coverings 1 6,000.00 6,000.01, Group Room table BSXBLC72RNN 2 233.00 466.01' w Group room and office chairs LLR4O201 75 132.00 9,900.01 c o Delivery and installation fees 1 250.00 250.01 ._ Kitchen table LLR65755 1 99.00 99.0; • N Kitchen Chairs BS)WL6O6SB11 4 81.00 324.0 B E TV-lobby and group rooms Samsung UN55J62 3 600.00 1,800.011 �j Refrigerator Frigidaire Lowes #72092 1 868.00 868.011 w Dishwasher Whirlpool Lowes #632514 1 699.00 699.0+; PHP Group Room-Table 2 233.00 466.011 ° U Q PHP Group Room-Chair 12 132.00 1,584.0' o PHP Group Room-Dell computer and monitor 4 695.00 2,780.O,jT. PHP Group Room- Cisco Telephone 1 225.00 225.011 0 PHP Office-Desk LLR69902 2 119.00 238.01 m a> PHP Office-Pedestal LLR69603 2 144.00 288.0i1 -c PHP Office-Chairs LLR86200 2 189.00 378.01 PHP Office-Bookcase BSXBLZ194NN 2 156.00 312.01; �' PHP Dell Desktop computer and monitor 2 695.00 1,390.01 a> PHP Cisco Phone 2 225.00 450.01 a .a) cL Q 0 M cNi1. c 0 Total $38,057.0,1a Q.. a U Ca tO r r r% c as 1 0 Umsi i I l Packet Pg. 1780 1 16.K.5.a internal Revenue Service Department of the Treasury District Director FEB 1 3 1985 Date: v Person to Contact: R. Van Meter/jlv Contact Telephone umber: as (404) 221-4516 avid Lawrence Mental Health Center, Inc. Employer Identification Number; o 6075 Golden Gate Parkway 59-2206025 U Naples. FL 33999 File Folder Number: o 580004608 .Dear Taxpayer: N Based on the information you recently submitted, we have classified your a� organization as one that is not a private foundation within the meaning of section o 509(a) of the Internal Revenue Code because you are an organization described in section 170(b)(1)(A)(vi.) & 509(a)(1). Your exempt status under section 501(c) (3) of the Code is still in effect. This classification is based on the assumption that your operations will continue as you have stated. If your sources of support, or your purposes, character, or method of operation change,g please let us know so we can consider ,the effect of the change on your exempt status and foundation status. ° This supersedes our letter 1048 presuming you to be a private foundation. ° m Because this letter could help resolve any questions about your foundation status, you should keep it in your permanent records. m If you have any questions, please contact the person whose name and telephone 0 number are shown above. m Q= Sincerely yours, ige:04,67r. 4:1 ° District Director 0 0 o. v J L_ tD !44:dttLer4 CrYthig114 tri i .tet [F_` ! fik..R 1 S i (V FE 18 1985 .� k" P.O.Box 1055,Atlanta, GA 30370 '"~�^- 1,v/or ✓.. • G -7,at,,,,� eo • Letter 1 78(010)(Rev.8-82 Packet Pg. 1781 16.K.5.b Collier Health Services,Inc.,d/b/a RCN,Narrative,Page 1 c O U -- 05 O Collier Health Services, Inc. d/h/a d Healthcare Network of Southwest Florida d L_ ii 0 L Prenatal Oral Healthcare o y N E E O C) a r.+ C c Table of Contents U '46 2 L al Cover Page P. 1 coO m Organization's Information P.2 R Organization's Board Members P.2 II. 0 ) a) Organization Narrative P.3,4 s a) a_ Project Description and Narrative P.5,6 0 0 co N C O U Q. Q cn L O ,. a) z D L a) V ca ai co r r r r a> V W Packet Pg. 1782 16.K.5.b Collier Health Servtces,Inc.,d/b/a HCN,Narrative,Page 2 O U Organization's Contact Information Name: Collier Health Services,Inc. (d/b/a Healthcare Network of Southwest Florida) Address: 1454 Madison Avenue Imrnokalee, Florida 34142 Contact's Name: Stephen Wheeler °.' Contact's Title: Vice President of Development m Phone: 239.658.3111 Email: SWheelerZ healthcareswfl.org E 1= Organization Type: 501 (c)3 Non-profit as designated by the IRS HCN Foundation Board Members ° 1. Chair: Fred Pezeshkan 2. Vice Chair:Adria Starkey 3. Treasurer:Dennis Brown L Board Members a) 4. Doug Campbell 5. Richard Craven v 6. Harts Domond N 7. Mike Ellis 8. Jeffrey Fridkin 0 9. Charles Johns en 10. George R. McLaughlin 11. Edward Morton N 12.Pat Read Botthof I ° HCN Executive Staff/Officers o. I. CEO: Mike Ellis 10. Legal Counsel and Risk Management Officer: 2. COO:Dr.Emily Ptaszek Trey Fletcher 3. CFO: Sandra Steele 4. CMO Naples:Dr. Scott Needle 5. CMO Imrnokalee:Dr.Jorge Camina 6. VP of Oral Services: Dr.Elizabeth Orr 7. VP of Development: Stephen Wheeler 8. VP of HR: Maria Ramos as 9. VP of IT: Larry Allen LC; m £_ .r c l0 Packet Pg. 1783 I6.K.5.b Collier Health Services,Inc.,d/b/a HCN,Narrative,Page 3 c c O U HCN's History and Financial Information Introduction U a) HCN formerly Collier Health Services;has been a provider of healthcare in Collier U County for almost 40 years. We were founded in 1977 to address the existing health gaps within i3 the Migrant community in Immokalee. Our mission is to provide quality healthcare accessible to d c everyone in our community. We currently provide family,children,dental,behavioral health ° .N and women's care at our 21 service locations across Collier County; E including our two mobile E units: The Ronald McDonald Care Mobile and the Health and Smiles Mobile which will provide o oral health services throughout the County to both children and adults.In 2014 we served 41,413y' c patients including 28,224 children. In addition in 2014 HCN provided prenatal care to 646 o patients and assumed operating control of Total Women's Care and in 2016 and going forward o are expanding our prenatal health services throughout the County. m 0 m Among the other health services HCN offers,our dental team provides preventative .2 services(sealants),examinations,gum evaluation and treatment,cleaning and FIuoride treatments,x-ray services and education in preventive care. These services can include but are v 0 c not limited to:routine examinations and x-rays,teeth cleanings and fluoride treatments,sealants, = fillings,pulpotomies and stainless steel crowns,tooth extractions,nitrous oxide analgesia,spacect maintainers,limited orthodontics and iv sedation. 0 M N_ HCN's main facility is the Marion E. Fether Center located in Immokalee,Florida.This c ° rural,predominantly agricultural community is roughly forty miles from the county seat(Naples) o 1 and is home to a large migrant community.The area's population fluctuates seasonally,swelling a by more than 40,000 individuals as migrant and seasonal farm-workers move into the area during u- times of crop production and processing. The total Hispanic population of Immokalee(CDP)is 75.6%and in Collier County 25.9%of the total population;higher than the state average at ° 3 22.5%. In addition 23.1%of Collier County are foreign born;almost 4%higher than the state z average and 31.4% speak a language other than English at home for individuals aged 5 and over. a U As discussed above a large portion of the Immokalee area is of Hispanic descent and born cu a> ' in foreign countries;specifically Mexico, With this unique demographic HCN has encountered c=c unique barriers to care for treating patients in the Collier County area. i.r; l a U t "ti Packet Pg. 1784 16.K.5.b Collier Health Services,Inc.,d/b/a HCN,Narrative,Page 4 0 Regular health screening,preventive care,oral health care,adherence to medication regimens, and follow-up protocols are impacted by: • Language and culture; °' .c • Lack of knowledge of the health benefits of oral healthcare during pregnancy • Access to prescriptions,both due to financial influences and,for migrant patients,while N L moving to and from areas of crop production; c • Time away from job sites for medical and supportive services appointments; vyi • Lack of income for nutritional and supplemental care; E • Transportation to care; • Lack of health insurance; High rates of povertyU • Hi g and unemployment;and • Low rates of health literacy. m 0 CO In providing a continuum of care HCN has established long term collaborations with a variety of providers, universities and local community organizations. These include local hospitals such -� as NCH and Lee Memorial Health System, and community institutions including University of Florida College of Dentistry,Florida State University College of Medicine(FSUCM),and Naples Children and Education Foundation (NCEF). Others include the YMCA, and the Community c 0 Foundation of Collier County. In addition Healthcare Network has policies and procedures in place to provide accounting ° ca controls over assets, liabilities, revenues, and expenses. The finance department utilizes the Sage Master Accounting Suite(MAS 200) and Financial Staff are required to review any policies that u_ pertainto the completion of their designated responsibilities.All Financial policies are reviewed, updated and sent to the Board of Directors each year. An annual audit of fmancial statements is performed and reviewed by the Governing Body. a) t4 a) tD to t0 Packet Pg. 1785 16.K.5.b Z. Coliter Health Services,Inc.,d/b/a HCN,Narrative,Page 5 c c O U L a) O Project Description and Narrative c) a) HCN is a leading provider of prenatal care in Collier County.In 2014,we saw 646 u a> prenatal patients;47 of whom were between the ages of 15 to 19 years of age.In 2014,we also ii took over operational control of the Total Women's Care and in 2016 and going forward are L expanding our prenatal health services throughout the County. We are requesting$40,000.00 in N u) funding to provide oral healthcare to approximately 30 prenatal and postnatal women who are E underinsured and uninsured onboard our new mobile unit,the Health and Smiles Mobile. Our o U program will offer a variety of services including: oral exams,radiographs as needed,teeth c cleanings, fluoride treatments,fillings,and extractions.If patients require additional o U comprehensive services,they will be referred to our land based dental clinics. o F. co O The Health& Smiles Mobile is a 40 foot long,8 foot wide,state-of-the-art dental office that CO a) delivers primary dental care to children and families in Southwest Florida. The mission of the ra Health& Smiles Mobile is to improve the health status of underserved children and families by Cproviding quality healthcare servicesand and subsequent follow-up. The Health Smiles Mobille n' will be moved throughout the County to various locations, including Women's Care Im0mokalee, m tr Grace Place,Guadalupe Center, RCMA,and Eden Park. The mobility of this program will allow 0 us to serve the community in locations that are convenient to our patients. Many of our patients M (NI do not have access to transportation and this will eliminate one of their barriers to care.The = 0 Health and Smiles Mobile will be operated o, U Another barrier to access of care is a person's socio-economic status.For instance a persons with higher annual incomes reported significantly higher rates of dental visits in Collier u_ County according to the 2013 Collier County Florida Health Assessment.In fact the Health N Y Assessment reported 90.2 percent of persons with annual incomes of$50,000 or more reported o visiting a dentist or dental clinic in the past year while only 40.6 percent of those with incomes a) z under$25,000 annually only reported having visited a dentist of dental clinic. In addition the L ca o Assessment also reported that in 2010 only36.3%of those who are living below the poverty level r co had access to oral healthcare services; leaving 63.7%who did not have access to adequate oral = health services. `r° ui c a) 0 .cU as :It- 4 Q a R 4 Packet Pg. 1786 1 16.K.5.b Collier Health Services,Inc.,d/b/a HC.WN.Narrative,Page 6 0 C.) Furthermore the Collier County Health Assessment determined that in 2012,Collier County residents made 817 emergency room visits for dental conditions. These dental U "emergencies"were categorized as avoidable had these patients had access to preventative care. The charges for these avoidable visits totaled$580,642.The number of preventable hospitalizations dude to dental conditions has also steadily increased for residents under 65 years of age as well. a) _o According to Prenatal Dental Care:A Review by Dr. Homa Amini,the most common N oral disease is gingivitis,which has been reported in 30-100%of pregnancies. In addition the Center for Oral Health states that"controlling the oral disease of a pregnant woman can potentially reduce the transmission of pathogenic bacteria from the mother to her baby and recommends encouraging all women at the first prenatal visit to schedule a dental examination if U one has not been performed in the past six months." ctsThese funds will provide prenatal and postnatal women with services to help treat and prevent oral health complications during their pregnancy. This is paramount to ensure both the health of the mother and baby during the pregnancy. This will also provide an opportunity to properly educate the expectant mother on proper oral hygiene during and after pregnancy. a Prenatal oral health is often overlooked duringw42)oman's a pre gnancy and some women feel that dental care during pregnancy is unsafe. Dental care can and should be rendered during all e) trimesters of pregnancy and can help to establish optimal oral hygiene ygiene during and after pregnancy to reduce the risk of transmission of pathologic bacteria from mother to child. Without the generosity of community partners,many of our prenatal patients would go without needed dental care in order to maintain proper oral health during and after pregnancy. Q u_ U, - i +05 z a) t, Ca d CD .F� C) G C. a.r Packet Pg. 1787 16.K.5.c 40 0 Application for Collier County Health Facilities Authority Grant 15 12 L a) c o 1. Name, address,phone and email address, and contact person's name and title: y E Physician Led Access Network of Collier County(PLAN) o 501 Goodlette Road North c.) a Suite B-300 = c Naples,FL 34102 c0 45 Contact Person: Dr. Bill Kuzbyt, Board Chairperson -E 239-898-7099 0 drkuzbyt@bhsfl.com 0 s 2. Applicant's form of organization: 2 PLAN is a Florida not-for-profit, 501(c)(3) corporation. m a- ' 3. Officer Names: Chairperson: Bill Kuzbyt, Psy.D., J.D. ct Treasurer: Kelly Daly 0M Secretary: David Whalley, MD `V c 0 4. Description of activities of the organization, including history of the organization and 0 information on budget: Q PLAN has been serving Collier County for over 12 years. The mission and a purpose of the organization is to provide the coordination of medical care for c residents of Collier County, ages 18 to 62,who need specialty medical care and c� who are indigent or qualify with incomes at or below 200%of the Federal Poverty Y Guidelines. L0 .c _ Our team of approximately 200 volunteer medical providers offer their services to Q qualified patients. The current annual budget of PLAN is approximately a $125,000. The Board of Directors of PLAN are all volunteers. There are two :U full-time employees who recruit physicians to become members of PLAN. These ,03 employees also complete the qualification process on patients,to be sure that they do not have insurance coverage or other ways to pay for the needed specialty care. 0 This system ensures that PLAN helps the neediest of residents. 5. Description of the uses for the requested grant monies: U PLAN has coordinated care for an average of 500 people,per year, and our team e of over 200 volunteer medical providers and health care facilities have donated, a on average, 2 million dollars,per year,to our patients. ui c 0 as o Packet Pg. 1788 16.K.5.c In recent years,PLAN has been presented a challenge by many of our providers. *' . While the provider and their staff donate their time and talent to our patients, there are obviously other costs associated with patient care. The providers have o indicated that they need support services in order to effectively treat the patient. These services include radiology studies, operating room time, and laboratory testing. PLAN and its partners have done a good job of securing both radiology o services and operating room time, however,have struggled to provide the U necessary laboratory resources that our providers have requested. 0 PLAN has done two things to address this issue. First,we have negotiated a very favorable contract with LabCorp to provide many lab tests at pennies on the dollar -o for PLAN patients. Secondly, PLAN has secured funding from the United Way o for$10,000 to help pay for lab tests. Unfortunately,this money does not cover 00 the need that PLAN has to secure all necessary lab tests for its patients. PLAN has had to place a limit on the total dollar amount patients can utilize because the need is so great. N We are requesting$8,000 to add to the money PLAN allocates for laboratory services. While this is only a short-term fix, it will certainly provide a significant impact on the need. Based upon past laboratory studies utilized by patients,the $8,000 is likely to pay for approximately$80,000 worth of laboratory costs. 0 We appreciate the opportunity to apply for this grant and are available to discuss the details of our request at your convenience. Q CIS Ta rrLnn J 0. NE+ F a-+ Packet Pg. 1789 .a ;oaalp sJauoisslu:uao3 is unoD Jo pieo8 ails.teq 4senbaj : 00£Z) uol}eollddy DAHIS 9VSVI.I. :}uauagoe}4y © ui n' d COLLIER COUNTY HEALTH FACILITIES AUTHORITY SC 03 5100 TAMIAMI TRAIL SUITE 103 a NAPLES, FL 34103 2016 GRANT APPLICATION Organization Name:Senior Friendship Health Center Address:2355 Stanford Court Unit 701 Naples, FL 34112 Phone: (239)566-7425 Email: Hcochran@SrFHC.org Contact person: Haylee Cochran, Operations Supervisor Organization:501(C) (3)-EIN: 594522614 BOARD OF DIRECTORS Local Management Board—Collier County Carl E.Westman, Esq., Chair R.Wayne Mullican,Vice Chairman/ Board of Governors-Local Management Board Liaison Cherry Smith Arnold Lerner Bruce Genovese, MD Denise McNulty Ed Boyer Emily Ptaszek, PsyD Robert Nordland, MD Jan Gazdic Jerry Lanz Susan Dalton Regional Board of Governors(geographic area represented) Kathy Silverberg,Chair(Charlotte) John Counsell,Vice Chairman(Lee) Kevin W. O'Neil, MD Bob Harris,Treasurer(Sarasota) Gloria Schranz, DDS,Secretary(Venice) Suzanne Abercrombie Dale Adler, MSW Patricia Courtois Darrin Halsey(DeSoto) Kevin Maisch 1 1 0 i �' ;oaalp saauolss!wwoO # uno3 Jo paeo8 ay;;eq;;senbeJ : 00£Z) uol;eollddy adHaS 94'S4'4l :;uauagoe;;d � rn Y', r C Of a R.Wayne Mullican (Collier) Harold Ronson (Sarasota) a Albert Tripodi, MD(Sarasota) Carmen Valenti (Sarasota) STAFFING Operations Supervisor—Haylee Cochran Clinical Coordinator—Janet Mattucci, LPN Dental Coordinator—Jennifer Smith BUDGET Attachment 1: 2016 Budget Attachment 2:990 Statement- Friendship Centers(parent organization) GRANT REQUEST The Senior Friendship Health Center has served low income 50+adults with comprehensive medical and dental services since 1985. We utilize a nationally acclaimed and award-winning model, staffing our program entirely with volunteer physicians,dentists, clinical and clerical teams. The Senior Friendship Health Center provides a broad continuum of care for the patient in a traditional ambulatory multispecialty center. Our providers work to improve the health status of our population through education,access to maintenance care and guidance through complimentary social and educational services. Annually we manage over 2500 patient visits. Many of these patients would use the local hospital emergency rooms for care if they were not served by us.Our volunteers help us make the most of each dollar raised by eliminating the cost of extensive professional staffing. Senior Friendship Health Centers' dental program has been a critical component to our facility as it serves nearly 60%of our patient population.Our program encompasses all facets of oral care,from hygiene to surgery,with consistent follow up within the practice. In the past five years our dental program has continued to expand as the population ages with limited access to much needed dental care. Currently our program is seeking new dental equipment, in specific dental hand pieces to aid in restorative dentistry.These hand pieces,also referred to as a drill is a small high speed device which is utilized to remove decay, shape tooth structure prior to a filing or crown, and even assist in endodontic procedures. These hand pieces would provide significant value in treating our backlogged patients, 64% of whom currently need restorative dental work. Senior Friendship Health Center is requesting$4,500.00 to purchase these much needed dental hand pieces with hopes of serving 300 patients currently registered in our dental program.This will contribute to our mission and vision to provide for the aging population in Collier County where we are able to restore smiles with new teeth, and most importantly return hope to those who are experiencing some of life's most challenging times.These dollars will not be utilized for administrative or fundraising costs. .a pomp saauo!ss!Wuao3 A;uno°}o pieog eql Imo;sanbaa : 00£Z) uai;eO!Iddy OIHaS 9VSV41, :wewgae;}y rn cri a. Senior Friendship Centers Summary Budget Comparison-Unposted Transactions Included In Report 04-COLLIER m From 1/1/2016 Through 12/31/2016 IL bizI Ac... Ac... YTD Budget$ (7,6(() pL) J Type Code Account Title Original REV 4100 DONATIONS 48,000.00 REV 4110 DONATIONS-SFC FOUNDATION 48,155.00 5%SUPPORT REV 4112 ANNUAL APPEAL 7,000.00 REV 4113 SPECIAL FUNDRAISING 88,325.00 REV 4202 CASH MATCH 650.00 REV 4316 UNITED WAY 33,280.00 REV 4401 PRIVATE GRANT 100,000.00 REV 4502 CLIENT FEES 81,000.00 REV 4508 MEDICARE 16,800.00 REV 4520 UNINSURED CLIENT FEES 34,000,00 REV 4900 IN-KIND-PROFESSIONAL 409,127.00 REV 4926 IN-KIND-OTHER PERSONNEL 68,726.00 To... 935,063.00 REV EXP 6110 SALARIES&WAGES 177,620.00 EXP 6120 FICA 13,588.00 EXP 6130 FLORIDA UNEMPLOYMENT 2,854.00 EXP 6140 WORKERS COMPENSATION 2,122.00 INSURANCE EXP 6145 RETIREMENT 8,022.00 EXP 6150 EMPLOYEE GROUP INSURANCE 5,044.00 EXP 6160 IN-KIND-PROFESSIONAL 409,127.00 EXP 6165 IN-KIND-OTHER PERSONNEL 68,726.00 EXP 6175 CRIMINAL BACKGROUND CHECK 200.00 EXP 6185 TRAINING&MATERIALS 1,000.00 EXP 6210 TRAVEL-IN AREA 1,000.00 EXP 6240 TRAVEL-CONFERENCES 400.00 EXP 6310 RENT 57,456.00 EXP 6410 TELEPHONE 4,700.00 EXP 6415 POSTAGE 1,300.00 EXP 6510 PRINTING 700.00 EXP 6526 PROGRAM SUPPLIES 97,598.00 EXP 6630 EQUIPMENT($100-$999.99) 1,000.00 EXP 6720 MEALS-OTHER EXPENSES 2,300.00 EXP 6992 COST POOL-GENERAL ADMIN 54,035.00 1 • ALLOCATION / r dee Cte rpt ' EXP 6994 COST POOL SUPPORT 5,616.006—� " Co(I t e t �J i ALLOCATION EXP 7206 SECURITY 480.00 EXP 7208 EQUIPMENT LEASE 6,605.00 EXP 7403 PROFESSIONAL FEES-LICENSES 500.00 EXP 7408 PROFESSIONAL FEES-SAMS 470.00 VENDOR EXP 7572 DUES&SUBSCRIPTIONS 2,600.00 EXP 7594 SFC EVENTS 10,000.00 To... 935,063.00 EXP Date:12/29/15 09:28;56 AM Page:1 -a ;aaaip sJauoiss!wwoo R4unoa Jo paeo8 ay;4ey;;senbe : 00£Z) uoileoHddy aIHaS 94'56'1.1. :4uaulq3e;1br r, ori rn v— ti) Senior Friendship Centers Summary Budget Comparison-Unposted Transactions Included In Report 10-NON COUNTY SPECIFIC ca 021-INDIRECT-COST POOLS 4. 054-COST POOL-SUPPORT 060-NAPLES From 1/1/2016 Through 12/31/2016 Ac.,. Ac... YTD Budget$- / ( $-t C+°5C Type Code Account Title Original �� �� EXP 6110 SALARIES&WAGES 2,682.00 EXP 6120 FICA 206.00 EXP 6130 FLORIDA UNEMPLOYMENT 31.00 EXP 6140 WORKERS COMPENSATION 32.00 INSURANCE EXP 6145 RETIREMENT 119.00 EXP 6150 EMPLOYEE GROUP INSURANCE 47.00 EXP 6520 OFFICE SUPPLIES (<$100) 1,000.00 EXP 7404 ADVERTISING-MARKETING 1,500.00 To... 5,617.00 EXP Date:14)24(15 01:48:21 PM Paye:8 -a ioai p sJaUO!ss!wwo3 kluno3}o p.reog elft 4244 4sanbaa : 00£Z) uoi}eoiiddV 31HJS 94'94'44 :luaulyoellV rn oi ~ T cc do a Senior Friendship Centers y Summery Budget Comparison-Unposted Transactions Included In Report c.) 04-COLLIER ca 010-HEALTH SERVICES-COLLIER D. 302-MEDICAL From 1/1/2016 Through 12/31/2016 Ac... Ac... YTD Budget$- Type Code Account Title Original REV 4100 DONATIONS 45,000.00 REV 4110 DONATIONS-SFC FOUNDATION 48,155,00 5%SUPPORT REV 4202 CASH MATCH 650,00 REV 4316 UNITED WAY 33,280.00 REV 4401 PRIVATE GRANT 60,000.00 REV 4502 CLIENT FEES 1,000.00 REV 4508 MEDICARE 16,800.00 REV 4520 UNINSURED CLIENT FEES 34,000.00 REV 4900 IN-KIND-PROFESSIONAL 277,527.00 REV 4926 IN-KIND-OTHER PERSONNEL 64243.00 To... 581,155.00 REV EXP 6110 SALARIES&WAGES 94,096.00 EXP 6120 FICA 7,199.00 EXP 6130 FLORIDA UNEMPLOYMENT 1,536,00 EXP 6140 WORKERS COMPENSATION 1,124.00 INSURANCE CEXP 6145 RETIREMENT 4,451.00 EXP 6150 EMPLOYEE GROUP INSURANCE 3,783.00 EXP 6160 IN-KIND-PROFESSIONAL 277,527.00 EXP 6165 IN-KIND-OTHER PERSONNEL 64,743.00 EXP 6175 CRIMINAL BACKGROUND CHECK 100.00 EXP 6185 TRAINING&MATERIALS 600.00 EXP 6210 TRAVEL-IN AREA 800.00 EXP 6310 RENT 40,219.00 EXP 6410 TELEPHONE 3,700.00 EXP 6510 PRINTING 200.00 EXP 6526 PROGRAM SUPPLIES 24,600.00 EXP 6630 EQUIPMENT($100-$999.99) 500.00 EXP 6720 MEALS-OTHER EXPENSES 600.00 EXP 6992 COST POOL-GENERAL ADMIN 25,514.00 ALLOCATION EXP 6994 COST POOL-SUPPORT 2,652.00 ALLOCATION EXP 7206 SECURITY 480.00 EXP 7208 EQUIPMENT LEASE 5,430.00 EXP 7403 PROFESSIONAL FEES-LICENSES 500.00 EXP 7408 PROFESSIONAL FEES-SAMS 470,00 VENDOR EXP 7572 DUES&SUBSCRIPTIONS 1,500.00 £�+ To... 562,324.00 EXP Date:12/24/1509:29:4SAM Pam'1 ;oa.tip saauoissIWuao3 k unoo jo paeo8 ay;;eg;;senbaa : 00£Z) uogeoieddy odHJS 9VSI.'46 :;uewt{oe;;y ,n ii a Senior Friendship Centers Summary Budget Comparison-Unposted Transactions Included In Report 04-COLLIER co 010-HEALTH SERVICES-COLLIER O. 304-DENTAL From 1/1/2016 Through 12/31/2016 Ac... Ac... YTD Budget$- Type Code Account Title Original REV 4100 DONATIONS 3,000.00 REV 4401 PRIVATE GRANT 40,000.00 REV 4502 CLIENT FEES 80,000.00 REV 4900 IN-KIND-PROFESSIONAL 131,600,00 REV 4926 IN-KIND-OTHER PERSONNEL 3,983.00 To.,. 258,583,00 REV EXP 6110 SALARIES&WAGES 83,524.00 EXP 6120 FICA 6,389.00 EXP 6130 FLORIDA UNEMPLOYMENT 1,318.00 EXP 6140 WORKERS COMPENSATION 998.00 INSURANCE EXP 6145 RETIREMENT 3,571.00 EXP 6150 EMPLOYEE GROUP INSURANCE 1,261.00 EXP 6160 IN-KIND-PROFESSIONAL 131,600.00 EXP 6165 IN-KIND-OTHER PERSONNEL. 3,983.00 EXP 6175 CRIMINAL BACKGROUND CHECK 100.00 EXP 618S TRAINING&MATERIALS 400.00 EXP 6210 TRAVEL-IN AREA 200,00 EXP 6310 RENT 17,237.00 EXP 6510 PRINTING 100.00 EXP 6526 PROGRAM SUPPLIES 72,000.00 EXP 6630 EQUIPMENT($100-$999.99) 500.00 EXP 6720 MEALS-OTHER EXPENSES 600.00 EXP 6992 COST POOL.-GENERAL ADMIN 24,986,00 ALLOCATION EXP 6994 COST POOL-SUPPORT 2,597.00 ALLOCATION EXP 7208 EQUIPMENT LEASE 1,175.00 EXP 7572 DUES&SUBSCRIPTIONS 100.00 To... 352,639.00 EXP Date;12/a9/15 09;94;45 AM ; -a paaip saauoissiuuwo3 AWuno3 jo preo8 egi Imoq }senbaa : 00£Z) uoi4eo!iddy 3IHJS 9VSV41., :}uatutpe;4y to rn �i ti Y u; a Senior Friendship Centers a Summary Budget Comparison-Unposted Transactions Included In Report v 04-COLLIER co a 010-HEALTH SERVICES-COLLIER MENT-NAPL-ES— E een i From 1/1/2016 Through 12/31/2016 Ac... Ac... YTD Budget$- Type Code Account Title Original REV 4113 SPECIAL FUNDRAISING 88,325.00 To... 88,325.00 REV 0 1I Date:12139J15 09::9:45 AM Page:3 ;aaaip sieUo!ssivauao3 I;uno3 4o paeo8 eta 4 co Isenbe : 00£Z) not eouddV 3IHaS 94'54'66 :�uauayoe3; f r, rn co Senior Friendship Centers d Summary Budget Comparison-Unposted Transactions Included In Report .� 04•COLLIER 028-CORPORATE-COLLIER a 501-ADMINISTRATION-MANAGEMENT&GENERAL From 1/1/2016 Through 12/31/2016 Ac,.. Ac... YTD Budget$- Type Code Account Tide Original EXP 6240 TRAVEL-CONFERENCES 400.00 EXP 6410 TELEPHONE 1,000,00 EXP 6415 POSTAGE 1,300.00 EXP 6526 PROGRAM SUPPLIES 998.00 EXP 6720 MEALS-OTHER EXPENSES 1,100.00 EXP 6992 COST POOL•GENERAL ADMIN 3,448.00 ALLOCATION EXP 6994 COST POOL-SUPPORT 358.00 ALLOCATION EXP 7572 DUES&SUBSCRIPTIONS 1,000.00 EXP 7594 SFC EVENTS 10 000.00 To... 19,604.00 EXP Dake:12/39115 09:29:45 AM Page;4 -a ;oaiip sJeuo!ssIwWO3 IC;uno3Io pieoe eq q4 4senbeJ : 00£Z) uoE;eoiiddy BAN'S gvsvu I, :;uauat;oe;;y co rn mi ti u; th 0- Senior Senior Friendship Centers m Summary Budget Comparison-Unposted Transactions Included In Report Y v 04-COLLIER das 028-CORPORATE-COLLIER 760-ANNUAL APPEAL From 1/1/2016 Through 12/31/2016 Ac... Ac... YID Budget$- Type Code Account Title Original REV 4112 ANNUAL APPEAL ,_m, i 7,000.00 To... 7,000.00 REV EXP 6510 PRINTING 400.00 EXP 6992 COST POOL-GENERAL ADMIN 87.00 ALLOCATION EXP 6994 COST POOL-SUPPORT 9.00 ALLOCATION To.., 496.00 EXP Report Difference 0.00 C CDate:1a'•9flS 09:29MS AM Page:S .o toaaip s.lauoissltuwo0 A uno0 Jo pieo8 atil Imo tsanbaH : 00£Z) uogeo)iddy OgHaS 9v5V(.(. :}uat.uyoe1,y a, ui am Y co EXTENDED TO NOVEMBER 16, 2015 rCh OM8 No.1545-0047 d QQ Return of Organization Exempt From Income Tax 2014 Form �J�® Under section 501(c),527,or 4947(a)(1)of the Internal Revenue Code(except private foundations) Y Department of the Treasury I► Do not enter social security numbers on this form as it may be made public. Open to Public R Internal Revenue Service ► Information about Form 990 and its instructions is at www tra gnvlfnrm44n Inspection p.. A For the 2014 calendar year,or tax year beginning and ending B Check If C Name of organization D Employer identification number applicable: I MTV SENIOR FRIENDSHIP CENTERS, INC. I Ichange Doing business as 59-1522614 I Getuan Number and street(or P.O.box if mail is not delivered to street address) Room/suite E Telephone number I JFlnal 1888 BROTHER GEENEN WAY (941) 955-2122 rerurn/ termin- ated City or town,state or province,country,and ZIP or foreign postal code G mss receipts$ 11,638,044. I Iretunded SARASOTA, FL 34236 H(a)Is this a group return I lull®' F Name and address of principal officer.ROBERT J J. CARTER for subordinates? Yes X No pending SAME AS C ABOVE H(b)Are all subordinates Included?! IYes ( I No I Tax-exempt status:IXI 501(c)(3) U 501(c)( )'4 (insert no.) L__I 4947(a)(1)or Li 527 If"No,'attach a list.(see instructions) J Website:►WWW.FRIENDSHIPCENTERS.ORG H(c)Group exemption number► K Form of organization: I X I Corporation I I Trust I I Association I I other 10- I L Year of formation: 19 7 3 M State of legal domicile:FL Part I Summary a, 1 Briefly describe the organization's mission or most significant activities: SEE ATTACHED STATEMENT LOCATED c AT SCHEDULE 0 co k9 2 Check this box ► I I if the organization discontinued its operations or disposed of more than 25%of its net assets. 'a 3 Number of voting members of the governing body(Part VI,line 1 a) 3 14 CS atf 4 Number of independent voting members of the governing body(Part VI,line 1b) 4 14 m 5 Total number of individuals employed in calendar year 2014(Part V,line 2a) 5 167 6 Total number of volunteers(estimate if necessary) 6 1470 4 7 a Total unrelated business revenue from Part VIII,column(C),line 12 7a 0• b Net unrelated business taxable income from Form 990-T,line 34 7b 0• Prior Year Current Year 0, 8 Contributions and grants(Part VIII,line 1h) 1,840,151. 1,448,582. a9 Program service revenue(Part VIII,line 2g) 9,264,236. 9 ,755,188. r 10 Investment income(Part VIII,column(A),lines 3,4,and 7d) 54,134. 32,191. 11 Other revenue(Part VIII,column(A),lines 5,6d,8c,9c,10c,and 11e) 279,945. 250,991. 12 Total revenue-add lines 8 through 11(must equal Part VIII,column(A),line 12) 11,438,466. 11,486,952. 13 Grants and similar amounts paid(Part IX,column(A),lines 13) 3,248,647. 3,755,691. 14 Benefits paid to or for members(Part IX,column(A),line 4) 0. 0. d 15 Salaries,other compensation,employee benefits(Part IX,column(A),lines 5.10) 4,661,423. 4,400,212. 2 16a Professional fundraising fees(Part IX,column(A),line 11e) 0. 0• wb Total fundraising expenses(Part IX,column(D),line 25) ► 0• 17 Other expenses(Part IX,column(A),lines 11a-11d,11 f-24e) 3,542,691. 3,528,769. 18 Total expenses.Add lines 13-17(must equal Part IX,column(A),line 25) 11,452,761. 11,684,672. 19 Revenue less expenses.Subtract line 18 from line 12 —14,295. —197,720. 0o, Beginning of Current Year End of Year N 20 Total assets(Part X,line 16) 8,293,711. 8,108,455. a� 21 Total liabilities(Part X,line 26) 1,638,365. 1,595,340. * 6,655,346. 6 513 115. 22 Net assets or fund balances.Subtract line 21 from line 20 , , PartII Signature Block Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,it Is true,correct,and complete.Declaration of preparer(other than officer)is based on all information of which preparer has any knowledge. Sign ® Signature of officer Lnate Here 0, ROBERT J. CARTER, PRESIDENT & CEO Type or print name and title Print/Type preparer's name Preparer's signature Date Check I I PTIN Paid REBECCA U. STONER srt.employed P00585910 Preparer Firm's name . KERKERING, BARBERIO & CO. Firm's EIN . 59-1753337 Use Only Firm's address, P.O. BOX 4934 8 SARASOTA, FL 34230-6348 Phone no.941-365-4617 May the IRS discuss this return with the preparer shown above?(see instructions) U Yes Li No 432001 11-07-14 LFIA For Paperwork Reduction Act Notice,see the separate instructions. Form 990(2014) SEE SCHEDULE 0 FOR ORGANIZATION MISSION STATEMENT CONTINUATION -a toa.0 sJauo!ssleuwo3 1C1uno3 Jo pteoa agi.ley}lsanbaj : 00£Z) uopeollddy 0AHJS 94'54'64 :4uawgoel y o 0000010 05;13;14 CO th rioRO DAl DR-14 C. �, Consumer's Certificate of Exemption R.04/11 l mV �r \.: Issued Pursuant to Chapter 212,Florida Statutes n. DEPARTMENT OF REVENUE 85-8012643756C-1 07/31/2014 07/31/2019 501(C)(3)ORGANIZATION Certificate Number Effective Date Expiration Date Exemption Category This certifies that 1 1i 3 SENIOR FRIENDSHIP CENTERS INC 1888 BROTHER GEENEN WAY 1 1SARASOTA FL 34236-7118 F 1 is exempt from the payment of Florida sales and use tax on real property rented,transient rental property rented, tangible personal property purchased or rented,or services purchased. 1 F 1 n R'I DSA DR-14 1 Important Information for Exempt Organizations R.04/11 1 ;.1 \tf i DEPARTMENT OF REVENUE 1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases. CSee Rule 12A-1.038, Florida Administrative Code(F.A.C.). 2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. Purchases made by an individual on behalf of the organization are taxable,even if the individual will be reimbursed by the organization. 4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible personal property, sleeping accommodations,or other real property is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property(Rule 12A-1.070, F.A.C.). 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for payment of the sales tax plus a penalty of 200%of the tax, and may be subject to conviction of a third-degree felony. Any violation will require the revocation of this certificate. 6. If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account Management at 800-352-3671. From the available options,select"Registration of Taxes,"then"Registration Information,"and finally"Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480, Tallahassee, FL 32314-6480.