2019 Request for Proposals Increasing Access to Behavioral Health Care in Colorado

Transcription

1 2019 Request for Proposals Increasing Access to Behavioral Health Care in Colorado BACKGROUND The mission of The Denver Foundation is to inspire people and mobilize resources to strengthen our community. Since 1925, The Denver Foundation has helped generous people to be catalysts for good by building charitable legacies. As Colorado s largest and most experienced community foundation, The Denver Foundation has three roles: stewarding an endowment to meet current and future needs for Metro Denver, working with community leaders to address the core challenges that face the community, and managing more than 1,000 charitable funds on behalf of individuals, families, and businesses. For more information, visit denverfoundation.org. The Colorado Health Access Fund (the Fund) is a Field of Interest Fund managed by The Denver Foundation, which is entrusted to oversee its grantmaking and evaluation. Established in 2014 with an anonymous gift of $40 million, the Fund is dedicated to improving health outcomes for underserved Coloradans. Between 2015 and 2022, the fund was charged to distribute grants to increase access to health care and improve health outcomes for populations with high health care needs across the state. We are committed to allocating resources among rural, urban, and suburban areas. Areas of focus were informed by an asset-and-gap analysis commissioned by The Denver Foundation in The goal of the analysis, conducted by Colorado Health Institute (CHI), was to glean a solid understanding of Colorado s diverse health care landscape and to guide the development of this Request for Proposals (RFP). The report resulting from this analysis, Flashpoints and Fixes: An Asset and Gap Analysis of Barriers to Care for Coloradans with High Health Needs, can be found here. The CHI report noted that the majority of Colorado Health Statistic Regions included mental/behavioral health care as a local public health priority and this was echoed in every community dialogue conducted by CHI. In discussions with health and community foundations, mental health and substance use disorder were identified as the most pressing issues across the state. Thus, the Colorado Health Access Fund focuses on increasing access to the treatment of behavioral health care. The Fund includes four focus areas for funding of behavioral health care projects: 1. Education of those with high health needs, as well as their families and caregivers; 2. Transitions in care; 3. Innovation of care delivery; and 4. Improved access to care, particularly in rural communities. 1

2 WHAT WE HOPE TO ACHIEVE Overall, the Fund seeks to: Increase the number of Coloradans with access to behavioral health treatment; Reduce and remove barriers for Coloradans with high behavioral health care needs in accessing behavioral health treatment; Build on innovations and investments already in place around behavioral health care treatment and support strategies for sustainability within the communities; Support treatment solutions that will benefit and meet the needs of individuals and the local community; and Widely share solutions and approaches that improve access to behavioral health care treatment, as well as openly convey lessons learned. The Fund RFP is soliciting proposals for programs that have a wide potential reach and influence in the field of behavioral health. The focus should be on the treatment, rather than on the prevention or identification of behavioral health issues. In proposals applicants should: Demonstrate the behavioral health need(s) in their community or focus population via quantitative and qualitative data; Demonstrate alignment with The Denver Foundation s core values of community member engagement and racial equity; Provide evidence that they are prepared to tackle their defined behavioral health problems; Provide a mechanism to report measurable outcomes and an increase to accessing treatment for focus populations; Demonstrate sustainability beyond the term of grant funding; Engage community residents, programs, agencies, and key stakeholders in their work to increase access to behavioral health care treatment and to improve outcomes for those with behavioral health challenges at the local level; and Be immediately ready to implement their programs. Projects that require planning and extended periods of time before launching are not a good fit. The Colorado Health Access Fund defines behavioral health care as a continuum of services for individuals suffering from mental, behavioral, or addictive disorders. Behavioral health, as a discipline, refers to mental health, psychiatric, and addictions treatment, and marriage and family counseling. It includes services provided by clinical social workers, counselors, psychiatrists, psychologists, neurologists, peer groups, and physicians, as well as nurse practitioners and physician assistants. Behavioral health issues can also be addressed as part of comprehensive care. Often when people report poor mental health, they also report poor physical health (42.5 percent), per the Colorado Health Access Survey conducted by CHI in The co-occurrence of chronic conditions and behavioral health issues compound negative health outcomes, and neither 2

3 should be treated in isolation. Treating a person s physical and behavioral health needs will, ultimately, yield greater overall health outcomes. FOCUS POPULATIONS The intent of the Fund is to increase access to behavioral health care to Coloradans with high health care needs across the state. Those with high health care needs are defined as those who have an identified behavioral health issue and are a member of at least one of these populations that are known to be un/underserved: Persons with multiple chronic or acute health conditions; Persons impacted by racial health disparities; Individuals enrolled in Health First Colorado; Persons who lack health insurance coverage or have significant barriers to accessing coverage; Persons who are experiencing homelessness; Persons who are justice-involved; Persons with a disability; and/or Persons whose primary language is other than English. TYPES OF SUPPORT The Colorado Health Access Fund has three funding opportunities:1.) Project/ Program Support; 2.)Capital Improvements; and 3.) Collaboratives. Applicants cannot combine requests, such ascombining a program and capital request, for example. However, a nonprofit organization is eligible to apply as a part of a collaborative AND apply for funding for their own organization in the same cycle. Additionally, organizations may be on more than one collaborative application. Finally, an organization may apply once per year if they are serving a distinctly different population and/or geographic area than their active grant. It is the responsibility of the applicant to use both quantitative and qualitative data to demonstrate the behavioral health need(s) in their community. The applicant must demonstrate how they are increasing and/or expanding access to treatment for those with high health care needs in the focus population(s) through evidence-based/informed approaches. 3

4 Focus Area Education of those with high health care needs as well as their families/caregivers Examples of Programs /Capital that align with Focus Areas Increase understanding of available behavioral health resources and how to navigate them Increase family understanding of behavioral health issues, treatment, and resources Transitions in Care Provide behavioral health care across care settings, including justice involved settings Intensive Outpatient Therapy for those exiting in-patient care Crisis stabilization services Innovation of Care Delivery Improved Access to Care, primarily in rural communities Integration of behavioral health services in primary care and other settings (dental offices, courts, etc.) Creating or expanding MAT programs for substance use disorder Replicating evidence-based practices in peer service delivery for focus populations Implementing telehealth/telepsych services Delivering integrated services in schools Increasing office hours to evenings and weekends Obtaining service providers with cultural competency and language diversity Adding behavioral health providers to increase capacity Expanding space to increase BH treatment rooms Providing multiple services in one convenient location Project & Program Support Please note that the purpose of the table is only to provide examples of projects that might fall under each focus area. The types of projects that are likely to be successful are not limited to these examples. Capital Improvements Capital Improvements include requests for infrastructure, furniture, fixtures, technology, and equipment that would increase the capacity of a facility to serve those with high behavioral health needs. Collaboratives Collaboration and partnership are important parts of any work in the community. The issue of behavioral health is complex, and it will take a variety of partners working together to make lasting change. Therefore, the CHA Fund will support organizations that are already formally working together to meet shared goals around behavioral health. A collaborative is a formal partnership of three or more unrelated organizations and/or public entities working together to achieve greater impact than they could alone. There is shared history of successes, challenges, governance, and finances. The Fund will support existing collaboratives of unrelated organizations, those that do not operate under the same 501(c)(3) umbrella. 4

5 GRANT AWARDS Award Amounts Grant awards for a 12-month period are expected to range in size from $50,000 to $250,000. Grants may be awarded for up to three consecutive years. Proposal requests must not exceed 25% of the organization s total annual budget. Similarly, collaborative applications may ask for no more than 25% of the collaborative s annual budget. CHA Fund funding is limited to no more than 50% of the total expansion project budget. Learning and Evaluation The Colorado Health Access Fund is committed to a rigorous evaluation. The Fund wants to understand the full impact of the work achieved by grantees through this funding, and developed an evaluation report form that can be used a number of ways. The Fund has implemented a long-term plan to evaluate grantmaking throughout its eight-year existence. Grantees will be asked to participate in a one all-day meeting in Denver during each grant year. The purpose of the meeting will be to bring grantees together to share experiences, learnings, and broaden networks. Funding for evaluation is expected to be included in the requested budget. If your organization receives a grant, you must submit a final report (or an annual progress report if it is a multi-year grant). Funding Cycles The Fund is unable to provide ongoing, continuous funding. The CHA funding philosophy is to support one program for a maximum of three years. The Fund uses an annual RFP process, please keep in mind: All Multi-Year Grantees/Awardees: Organizations that are awarded multi-year grants are not required to resubmit proposals annually. Rather, annual reports are submitted and reviewed by The Denver Foundation staff. Continued funding is contingent upon meeting the terms of the grantee agreement and progress on the proposed work. Any applicants who chose to apply for one or two years may experience a gap in funding. In this Fund, there is not an opportunity to apply for a renewal. Again, applicants are encouraged to apply for multi-year funding when appropriate. 5

6 WHAT WE DON T FUND The Colorado Health Access Fund will not support the following projects or activities: Projects that do not serve Coloradans with an identified behavioral health issues and/or do not represent a focus population; Screening for behavioral health conditions; Projects that focus on prevention of behavioral health issues; Electronic medical records. The use of EMR/EHR does not increase access to treatment; Grief counseling and hospice; Workforce development, including but not limited to: provider training, specialty licensure status, and training of graduate students, etc.; Support services for developmentally disabled people that are unrelated to treatment of mental health disorders; Social and emotional learning/development of children; Awareness, stigma reduction, or marketing projects; The formation of new collaboratives; For-profit hospitals or the foundation arm of a for-profit hospital; Planning grants, or grants that include planning as part of the request; Scholarships, stipends, or support for students studying behavioral health care; and, Individual insurance coverage or payments, including for medications. In addition, The Denver Foundation does not support: Organizations with fund balance deficits as indicated on the balance sheet for their most recently completed fiscal year (i.e., an organization cannot have a negative balance in any of the net asset line items on their balance sheet); Funding to an organization and/or program that discriminates on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, except to serve a historically disadvantaged group; Activities, projects, or programs that will have been completed before funding becomes available (no retroactive funding); Endowments or other reserve funds; Membership or affiliation campaigns, dinners, or special events; Conferences, symposia, or related travel (other than the required attendance at the annual Learning Circle event); Grants that further political doctrine or religious activities; Grants to individuals; Scholarships or sponsorships, including special events or fund raisers; or Grants to parochial or religious schools. 6

7 OTHER IMPORANT INFORMATION Grants will be awarded primarily to nonprofit organizations. Grants may be awarded to government agencies if they collaborate with a nonprofit and can demonstrate that the community outcomes in behavioral health care for those with high health care needs will be met via the collaboration. For-profit hospitals, by themselves, are not eligible to apply for funding but can apply as a partner only. The foundation arm of a for-profit hospital is also ineligible to apply for funding. Applicants are strongly encouraged to incorporate health care practices that are based upon scientific evidence and demonstrate effective health outcomes, or new practices that have the strong potential for effective behavioral health outcomes based upon current literature. No less than 20% of the grant funds allocated annually will be distributed for the benefit of rural populations. Up to 80% of the grant funds allocated annually will be distributed for the benefit of urban/suburban populations. Your grant request does not need to have the split between rural and urban/suburban areas. It is the responsibility of the Fund to ensure the equitable distribution of monies. o Rural is defined by the donor to include the following counties: Alamosa, Archuleta, Baca, Bent, Chaffee, Cheyenne, Conejos, Costilla, Crowley, Custer, Delta, Dolores, Eagle, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, Kit Carson, La Plata, Lake, Las Animas, Lincoln, Logan, Mineral, Moffat, Montezuma, Montrose, Morgan, Otero, Ouray, Phillips, Pitkin, Prowers, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Sedgwick, Summit, Washington, and Yuma. o When asked to identify your geographic area of focus, indicate where you provide the services outlined in your funding request, regardless of where your headquarters might be located. TIMELINE Thursday, January 3 Thursday, January 3 Tuesday, February 26 Thursday, February 28 Tuesday, March 5 Friday, March 8 Before the end of August Monday, September 2 Request for Proposals released RFP Q&A Webinar details available on the webpage Last day for content questions Last day to register with The Denver Foundation s web-based application system. No exceptions. Last day for technical questions related to the online application Proposals due All applicants will be notified of their status Grant cycle begins for awardees 7

8 Q&A WEBINAR A Webinar will be offered beginning on Thursday, January 3, Participation is optional, but strongly encouraged. Please check our webpage for updates to participate at Access-Fund. Questions after you ve attended the webinar? Please call or our team at cha@denverfoundation.org prior to Tuesday, February 26, WEB-BASED APPLICATION The Denver Foundation utilizes a web-based application for the CHA Fund. Registration is required and the deadline to register is Thursday, February 28, Organizations must anticipate and allow 48 hours for The Denver Foundation to approve their registration request. Create Your Profile The Colorado Health Access Fund is using one online application for Program/Projects, Capital Improvement and Collaboratives. All applicants- collaborative and individual organizational applications- will use this application. You are strongly encouraged to register, utilize the prescreening tool, and explore the application early. Begin your registration and create a profile here: 8

9 Please remember The Denver Foundation needs 48 hours to approve your registration. The deadline to register is February 28, No exceptions. After your registration is approved you will have full access to the application. You must download the required budget template and project work plan template from the Colorado Health Access webpage here: Access-Fund The Application The application is laid out in tabs, as displayed in the snapshot here. The questions and character limits are detailed in the pages below. There is a pre-screening which is for your benefit only and not recorded by the Foundation. Many of the proposal questions use skip logic so some questions will appear (or disappear) based on your responses. Questions and character limits are laid out in a similarly to how they appear online. Technical Issues If you have technical challenges, please reach out to cha@denverfoundation.org no later than Tuesday, March 5, Content Questions Do you have a question after reading the RFP and listening to the webinar? Please reach out to cha@denverfoundation.org no later than Tuesday, February 26,

10 Colorado Health Access Fund Application for Organizations Application Screening Thank you for your interest in the Colorado Health Access Fund (CHA Fund). The CHA Fund is focused on increasing access to behavioral health services for those populations with the greatest barriers to care. This field of interest fund is designated by the donor to focus on increasing access to behavioral health care for those most in need. Focus Population. The intent of the Fund is to increase access to behavioral health care to Coloradans with high health care needs across the state. Those with high health care needs are defined as those who have an identified behavioral health issue and are a member of at least one of these populations that are known to be un/underserved: Persons with multiple chronic or acute health conditions; Persons impacted by racial health disparities; Individuals enrolled in Health First Colorado; Persons who lack health insurance coverage or have significant barriers to accessing coverage; Persons who are experiencing homelessness; Persons who are justice-involved; Persons with a disability; and/or Persons whose primary language is other than English. The following pre-screening questions are here to help you assess if the work you are proposing is a good fit for the CHA Fund. It is a required step prior submitting an application. You will receive feedback based on your answers. This pre-screening activity is for your organization s benefit and is not recorded by The Denver Foundation. Q1. Will the body of work support individuals outside of Colorado? Q2. Are you able to demonstrate the behavioral health need(s) in your community via quantitative and qualitative data? Q3. Do you have evidence or are you using evidence-informed practices in the approach for which you are seeking funding? Are you able to cite literature or best practices? Q4. Will you be able to demonstrate measurable outcomes and increase access to treatment for the population in need? Q5. Will the body of work involve public policy and/or broad advocacy? 10

11 Q6. Will the body of work involve the following: social emotional learning of children, grief counseling, BCBA staffing, or hospice work? Q7. Will the body of work involve the following: professional and workforce development, including but not limited to: provider training, specialty licensure status, and training of graduate or post-doc students? Q8. Will the funding request include: prevention, screening, awareness campaign, stigma reduction projects? Q9. Is this a capital campaign request? Q10. Are you applying on behalf of a for-profit hospital or the foundation arm of a for-profit hospital? Q11. Will the funding request support insurance coverage or payments, including medications? Q12. Will the funding request include electronic health or medical records? Q13. Will the funding request include activities like athletic events, social activities, field trips, and related equipment? Q14. Is part of the request supporting conference attendance or broad training? Q15. Does your organization have a plan ready for implementation to address expansion of behavioral health services? Thank you for taking this pre-screening questionnaire. Please be aware that the CHA Fund does not support: Organizations with fund balance deficits as indicated on the balance sheet for their most recently completed fiscal year (i.e., an organization cannot have a negative balance in any of the net asset line items on their balance sheet); Funding to an organization and/or program that discriminates on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, 11

12 marital status, sexual orientation, or military status, except to serve a historically disadvantaged groups; Activities, projects, or programs that will have been completed before funding becomes available (no retroactive funding); Endowments or other reserve funds; Membership or affiliation campaigns, dinners, or special events; Conferences, symposia, and related travel; Grants that further political doctrine or religious activities; Grants to individuals; Scholarships or sponsorships, including special events or fund raisers; Grants to parochial or religious schools. 12

13 General Applicant Info Applying as a collaborative? Name of Formal Partners Legal Name of Organization DBA (if applicable) Mailing Address (Line 1) Mailing Address (Line 2) Mailing City Mailing State Mailing Zip Code Is your physical address different from your mailing address? Physical Address (Line 1) Physical Address (Line 2) Physical City Physical State Physical Zip Code Organization's Phone # Organization's Fax # Organization's Tax ID Organization's Website Organization's CEO or Executive Director's First Name 13

14 CEO or Executive Director's Last Name CEO or Executive Director's Phone # CEO or Executive Director's Phone Ext CEO or Executive Director's Applicant's First Name Applicant's Last Name Applicant's Job Title Applicant's Phone # Applicant's Phone Ext Applicant's Address Year Organization was Founded Is Your Organization A Nonprofit 501(c)3 Public Charity? Other than 501(c)(3), describe: Using a fiscal sponsor? Name of fiscal agent/sponsor Organization Mission Statement # of Full-Time Employees # of Part-Time Employees 14

15 Grant Request Info Organization's Definition of Community Pertaining to Grant (195 Characters) Geographic Area Served Definition (specific to this proposal) What areas is your project serving? (multiple selections allowed) Rural Suburban Urban What is the increase in the number of individuals that will directly access behavioral health treatment over the course of this funding request? Is this a multi-year grant request? # of Years Requested: 2 3 Year 1 Request Amount: Year 2 Request Amount: Year 3 Request Amount: Total Amount Requested: Type of Grant Requested: Capital Improvement Program or Project Support Name of Program or Project: Grant Focus Area (multiple selections allowed) Education Improved Access Innovation of Care Delivery Transitions in Care Briefly describe what the grant will be used for: (360 Characters) Organization's Current Budget for Fiscal Year Ending: 15

16 Organization's Revenue: Organization's Expenses: Program/Project or Capital Improvement Start Date: Program/Project or Capital Improvement End Date: Program/Project or Capital Improvement Revenue: Program/Project or Capital Improvement Expenses: 16

17 Narrative Page 1. ORGANIZATION BACKGROUND. Discuss the founding and development of the organization. Explain the original issue and/or opportunity the organization was founded to address and how that may have changed over time. If applying as a collaborative include a summary of each formal partner, as well as a summary of the founding and development of the collaborative. (2100 Characters) 2. GOALS. Describe the organization s current goals. If applying as a collaborative, please describe the collaborative's goals. (1800 Characters) 3. CURRENT PROGRAMS. Provide a brief description of the organization s current programs. Include population and numbers served (past year and cumulative, if available), as well as expected results for this program year. If this request is for a specific program, describe the organization s other programs here. Describe the program for which you are seeking funding in Question 5. If applying as a collaborative, please describe that programmatic body of work. (3000 Characters) 4. FOCUS POPULATION SERVED. Describe the focus population being served. Applicants must describe the population they are addressing in the community via existing quantitative and qualitative data to demonstrate the need. (2100 Characters) 5. SUMMARY OF PROJECT/PROGRAM Provide a summary of how you plan to address the behavioral health treatment need in your community. Include how the project fits into a specific focus area(s) (i.e., education of those with high health needs, as well as their families and caregivers; transitions in care; innovation of care delivery; and improve access to care, particularly in rural communities). Explain why the organization is approaching the behavioral health issue and/or opportunity in this way including how the organization is incorporating health care practices that have demonstrated effective outcomes, or new practices that have the strong potential for effective behavioral health outcomes based upon current early evidence. (3500 Characters) 6. EXPLANATION OF INCREASED ACCESS. Describe how your request is increasing access to behavioral health to Coloradans with identified behavioral health issues. Strong applications will clearly demonstrate an increase in accessing and/or expanding treatment to the Fund s focus population(s). (1800 Characters) 7. CAPACITY. Describe which staff person(s) will be designing and implementing this project, as well as their 17

18 role(s) in the organization. Identify the individual(s) who will be involved with the work (whether it is overseeing or implementing), as well as a brief overview of their background and experience. Do not include resumes, licensure information, or other documents. (1800 Characters) 8. SUSTAINABILITY. A project or program s potential for sustainability after CHA funding increases its competitiveness. Describe your strategies either during and/or after the grant period on how to support the sustainability of the activities or demonstrated outcomes. What funding mechanisms will be used to push this work forward after CHA funding ends? (3000 Characters) 9A. DESCRIPTION OF MEASURABILITY. Describe how the organization or collaborative measures impact. If this is a program or project request, describe how impact is measured for the program that is the subject of this proposal. It is expected that 10%-15% of your budget will be dedicated to evaluation. (3000 Characters) 9B. SUMMARY OF EVALUATION RESULTS. Summarize key and/or recent evaluation results or findings that demonstrate the potential impact of this proposal. Indicate the time frame for the results or findings. Demonstrate alignment between the outcomes of your proposed work and the Fund s purpose to increase access to behavioral health care to Coloradans with high health care needs. (3000 Characters) 10. COLLABORATION. Describe the organization s or collaborative's most significant interactions with other organizations and efforts and how community residents, other programs, agencies and key stakeholders are engaged. For program and project requests, address this question with respect to that program or project only. (1800 Characters) 11. INCLUSIVENESS. What forms of diversity (gender, racial, cultural, ethnic, religious, immigrant/refugee background, linguistic etc.) do you think are important for strengthening the quality of work proposed and why? Does your organization s staff and governance reflect this diversity? (2400 Characters) (1800 Characters) 12. BOARD/GOVERNANCE. Describe the role of the board of directors in advancing the mission of the organization. Include the key issues related to board effectiveness that is being addressed this year, the organization s policy regarding board terms, and the percentage of the board that contributes financially to the organization. If applying as a collaborative, please describe the structure of the collaborative and the role of the board of directors for each organization. Include key issues to the collaborative's effectiveness that are being addressed this year. (1200 Characters) 18

19 13. PLANNING. Describe the challenges and opportunities facing the organization or collaborative in the next three to five years. Additionally, describe how the organization engages in planning and describe the focus of any current planning efforts. (2400 Characters) CORE VALUES QUESTIONS These core values are at the heart of The Denver Foundation grantmaking programs. Please respond to the four questions below. Every nonprofit s starting place, progress, and challenges are unique. Please be candid in sharing your nonprofit s internal and external experiences. It will help us to understand how you are thinking and evolving, and what practices you are putting into place. We want to learn more about your approach to community member engagement and racial equity. 14. CORE VALUE QUESTION 1 How does your nonprofit engage community members and constituents in planning, programming, and making decisions? (1800 Characters) 15. CORE VALUE QUESTION 2 What challenges, if any, have you encountered in engaging community members nd constituents? What are you doing to overcome them? (1800 Characters) 16. CORE VALUE QUESTION 3 How does your nonprofit advance racial equity? (1800 Characters) 17. CORE VALUE QUESTION 4 What challenges, if any, have you encountered to advancing racial equity? What are you doing to overcome them? (1800 Characters) 18. OPTIONAL. If there is additional information that is vital to convey in this proposal, do so here. (1200 Characters) 19

20 Project Work Plan Instructions: The purpose of the Project Work Plan is for the Colorado Health Access Fund to ascertain how you will implement and measure the impact of your request. Goal (General long-term purpose of project) Objectives (SMART - specific, measurable, achievable, realistic, and time-bound) Activities to Accomplish Objective (List major steps, expected completion date/results) Activities Expected Completion Date Expected Results Measurement Tools (List and describe the tools and methods that will be used to measure the objectives) Deliverables (List any tangible objects produced as a result of the activity) 20

21 Attachments *Special instructions for collaboratives only. Please note that only files uploaded as a.pdf will be accepted. This helps ensure that your documents maintain their intended formatting and can be viewed on any operating system. Links on how to save or convert a document to PDF: Microsoft Office Instructions to Save or Convert a document to PDF PDF Converter: Convert Word, Excel, PowerPoint, Images and other files to PDF? Large PDFs, e.g., financial audits, university or hospital group audits are accepted. However, if you do experience issues trying to upload a large file attachment. Please consider compressing the file for free at the following site: Is your most recent fiscal year audit complete? Were revenues above $500,000? Full Financial Audit Internal financial statements for the most recently completed fiscal year PREVIOUS YEAR S audit/review Statement of Financial Position, a.k.a. Balance Sheet Statement of Activities, a.k.a. Income Statement or Profit & Loss Current Organizational Budget with Revenue and Expenses *Collaboratives must include Current Organizational Budget with Revenue and Expenses for each formal partner within one pdf. Project/Program or Capital Requests Budget Template (use template provided) Project/Program or Capital Requests Budget Narrative Statement of Financial Position, a.k.a. Balance Sheet, dated in the last three months Statement of Activities, a.k.a. Income Statement or Profit & Loss, dated in the last three months Major contributors and amounts of contributions for last two fiscal years Board of Directors list with affiliations and skill sets *Collaboratives must include Board of Directors for each formal partner within one pdf. 21

22 Anti-discrimination statement adopted by the board of directors *Collaboratives must include Anti-discrimination statements for each formal partner within one pdf. Memorandum of Understanding between formal partners. Letter of Support. No more than 6 pages total in one PDF. Is the most recent years financial audit complete for your fiscal agent/sponsor? Were revenues above $500,000 for your fiscal agent/sponsor? The memorandum of understanding or the contract between the organization and the fiscal sponsor Board of directors list for the fiscal agent/sponsor Proof of IRS federal tax-exempt status, updated within the last five years for the fiscal agent/sponsor Full Financial Audit for fiscal agent/sponsor Internal financial statements for the most recently completed fiscal year for fiscal agent/sponsor PREVIOUS YEAR S audit/review for fiscal agent/sponsor Statement of Financial Position, a.k.a. Balance Sheet for fiscal agent/sponsor Statement of Activities, a.k.a. Income Statement or Profit & Loss for fiscal agent/sponsor 22

23 Declarations & Agreements No Applicant is entitled to receive a grant, either by reason of previous grant history, an employee's history of contributions to The Denver Foundation, or any perceived inference from a Denver Foundation employee. The Denver Foundation, its employees, and Advisory Committee members reserve the right to consult with collaborators/partners of the applicant, other funding partners, and other Foundations about this application and their history with the applicant. Your application may be shared with these entities to fully assess the proposal. Your submission of this application: (i) certifies that the information provided is true and complete, (ii) authorizes The Denver Foundation to obtain and/or verify all information necessary to process this application, and (iii) releases The Denver Foundation from any liability associated with the rejection of funding for this application. In the event The Denver Foundation discovers that the applicant has provided any false information, The Denver Foundation will decline the application. Submissions are final. Incomplete applications will be declined and not reviewed for content. By submitting this application, you verify that you have read and agree to the declarations and agreements above. The CHA Fund s target timeline for notifications: To be responsive to applicants, the decline notifications will be made on a rolling basis during the review process. Please do not call for updates during the review process. Declined applicants will receive a Rationale for Decision, which provides written feedback on the application. Approvals notifications are targeted for August Approved grants are targeted to begin in September For questions, please contact our team at cha@denverfoundation.org. The Colorado Health Access Fund, A Field of Interest Fund at The Denver Foundation 55 Madison Street, 8th Floor, Denver, CO