Hermanowski Family Foundation Initial Request Form

---

Organization Name: Planned Parenthood Arizona
Legal Name (if Different):
Also Known As:
Mailing Address: 4751 N. 15th Street
City: Phoenix
State: Arizona
Postal Code: 85014
Main Phone: 6022634265
Main Fax:
Organization Website: https://www.plannedparenthood.org/planned-parenthood-arizona
Employer ID Number:
Organization Tax Status: 501c3

Proposal Information

---

Today’s Date: 9.22.2025
Requested Amount: $8,000

Project Title: Patient Care Fund: Young Adults 18-21
Project Description:

Our Patient Care Fund is a program that provides funds for patients living on or below the poverty line, underinsured or uninsured, who cannot afford health care services. We have a Self-Pay Fee for patients without insurance, and these fees are the lowest we can afford to charge. Often, though, even these costs are too much. For our patients who cannot access health care services due to cost, we cover their fees through the Patient Care Fund. We believe in equitable access to quality health care, regardless of a person’s financial circumstances, and never want to turn a patient away because they cannot pay. Our young adult patients, ages 18-21, rely upon us for medical care such as annual reproductive exams, STD testing, and cervical and breast cancer screenings. We respectfully request your support so that we can provide them with the health care access they need but often can’t afford.

Total Project Budget: $8,000

Other Funding
Sources For The Project (Committed & Potential):

Project Duration: November 2025-November 2026
Geographical Area Served: Phoenix Metropolitan Area in Arizona
Age Group To Be Served: 18-21

Contact Information

---

Contact Prefix (Mr,Mrs etc.): Dr.
Contact First Name: Kathleen
Contact Last Name: Iudicello
Contact Title:
Contact Phone: 602.263.4265
Contact Email: kathleen.iudicello@ppaz.org