The Colorado Health Access Fund Request for Proposals: Increasing Access to Behavioral Health Care in Colorado

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1 The Colorado Health Access Fund 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, we have 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 that are distributed statewide, nationally, and internationally. For more information, visit The Colorado Health Access Fund is a Field of Interest Fund managed by The Denver Foundation, which is entrusted to oversee its grantmaking and evaluation. Established in 2015 with an anonymous gift of $40 million, the Colorado Health Access Fund is dedicated to improving health outcomes for underserved Coloradans. Between 2015 and 2022, the fund will award up to $5 million per year to initiatives that serve high-needs populations across the state. The intent of the Colorado Health Access Fund is to increase access to health care and improve health outcomes for populations with high health care needs across the state. Over the course of eight years, the Fund is committed to allocating resources among rural, urban, and suburban areas. The Fund includes four focus areas for funding of 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. These 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). As a result of the analysis, the Fund (1) learned about current projects, activities, and investments in order to build upon work already happening within communities; (2) engaged stakeholders statewide to understand local community health care needs; and (3) reviewed existing assessments of health care needs to understand both similarities and unique differences across communities. This CHA RFP Page 1

2 report, Flashpoints and Fixes: An Asset and Gap Analysis of Barriers to Care for Coloradans with High Health Needs, as well as the executive summary, can be found here: Fund. The CHI report noted that 15 of the 21 Colorado Health Statistic Regions included mental/behavioral health care as a local public health priority. Furthermore, mental and behavioral health care was cited as a priority community need 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 will focus on increasing access to the treatment of behavioral health care. Overall, the Colorado Health Access Fund seeks to: Reduce and remove barriers for Coloradans with high behavioral health care needs in accessing behavioral health care 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 the local community, as well as explore how those solutions could be replicated and/or scaled to meet the needs of communities across the state; and Widely share solutions and approaches that improve access to behavioral health care treatment, as well as openly convey lessons learned. WHAT WE HOPE TO ACHIEVE The Colorado Health Access Fund RFP is soliciting proposals for initiatives that have a wide potential reach and influence in the field of behavioral health. Each individual community can decide its focus for behavioral health. The focus should be on the treatment, rather than on the prevention, of behavioral health issues. In their proposals, applicants should: Demonstrate the behavioral health need(s) in their community via quantitative and qualitative data; Provide evidence that they are collectively prepared to tackle their defined behavioral health problems; Provide a mechanism to demonstrate measurable outcomes and an increase to accessing treatment; and Engage community residents, programs, agencies and key stakeholders who can increase access to behavioral health care treatment and strive to improve CHA RFP Page 2

3 outcomes for those with behavioral health challenges (diagnosed or undiagnosed) at the local level. 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, marriage and family counseling, and addictions treatment, and includes services provided by social workers, counselors, psychiatrists, psychologists, neurologists, 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 should be treated in isolation. Treating a person s physical and behavioral health needs will, ultimately, yield greater overall health outcomes. Applicants, not the Fund, define their community whether that is a town, county, region, or specific population. TARGET 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: People 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: Have multiple chronic or acute health conditions; Lack health insurance coverage, have inadequate coverage, or have significant barriers to accessing coverage; Are low-income and/or homeless; Have a disability; Come from a culture different from the mainstream; and/or Do not speak English well. TYPES OF SUPPORT The Colorado Health Access Fund has four funding opportunities. Applicants cannot combine requests, (e.g. combining a program and capital request.) However, a nonprofit organization is eligible to apply as a part of a collaborative AND apply for funding for their CHA RFP Page 3

4 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. The onus is on the applicant to use both quantitative and qualitative data to demonstrate the behavioral health need(s) in their community. Once the applicant community identifies their community s behavioral health need(s) through data, they must demonstrate how they are increasing and/or expanding access to treatment for those with high health care needs in the target population through evidence-based/informed approaches. 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 (as well as what would not be considered). The types of projects that are likely to be successful are not limited to these examples. Focus Area Potential E xamples t a Good Fit Education of those with high health care needs, as well as their families and caregivers Increase understanding of available behavioral health resources and how to navigate them Mental Health First Aid training to families of caregivers as it does not connect them directly to mental health treatment Scholarships other for students in the behavioral health fields. ACA tools and education on a website Transitions in Care Provide behavioral health care in settings outside of the hospital or other facility Ensure provider referrals that provide continuity of services between care settings Transitions in care to providers outside Colorado or for those living elsewhere who are temporarily being treated in Colorado CHA RFP Page 4

5 Innovation of Care Delivery Improved Access to Care, Primarily in Rural Communities Integration of behavioral health services in primary care and other settings Implement telehealth/telepsych services Ensure transportation to behavioral health services for those with limited access Increase behavioral health specialists to meet needs within communities Stakeholder groups for health professionals Strategic planning and related activities to improve care delivery Provide support and train health care providers to integrate behavioral health Efforts to increase behavioral health screening Providing a referral list and handbook to individuals with potential behavioral health needs General Operating Support The Colorado Health Access Fund will consider proposals for general operating support to organizations when: The population(s) served by all of the organization s programs and services are a fit with the Fund s target population (i.e., Coloradans who have an identified behavioral health issue and are a member of at least one population that is known to be un/underserved). There is a clear strategic alignment between the applicant s mission and the Fund s intent to increase access to behavioral health. In other words, 80- to 100 percent of the applicant s everyday work must be focused on behavioral health care treatment. The proposal must demonstrate how the organization will increase/expand access to treatment. Applicants are already doing exemplary behavioral health care work (i.e., organizations are well established) in their communities and can demonstrate their successes. General operating support will be limited to approximately 30% (or roughly $1.5M) of the total annual grants awarded by the Fund. If all the applicant s programs and services are not CHA RFP Page 5

6 a strong fit for both the target population and focus areas of the Fund, please consider applying for a program grant for those programs that are a strong fit. 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 CHA Fund is will support existing collaboratives of unrelated organizations (entities that do not operate under the same 501(c)(3) umbrella). GRANT AWARDS Award Amounts Grant awards for a 12-month period are expected to range in size from $50,000 to $250,000. 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 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 model that can be used a number of ways. The Fund has implement 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. CHA RFP Page 6

7 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 CHA Fund is unable to provide ongoing, continuous funding. The CHA funding philosophy is to support one program for a maximum of three years. As the CHA Fund moves to 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 Denver Foundation staff. Continued funding is contingent upon meeting the grantee agreement and progress on the proposed work. Any applicants who chose to apply for one or two years will experience a gap in funding. In this example, there is not an opportunity to apply for a renewal. Again, applicants are encouraged to apply for multi-year funding when appropriate. WHAT WE DON T FUND The Colorado Health Access Fund will not support the following projects or activities: Screening for behavioral health conditions; Projects that focus on policy and/or advocacy; Projects that do not serve Coloradans with an identified behavioral health issues; Projects that focus on prevention of behavioral health issues (rather than on treatment); 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 the developmentally disabled 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; Capital campaigns; For-profit hospitals or the foundation arm of a for-profit hospital; Planning grants, or grants that include planning as part of the request; CHA RFP Page 7

8 Scholarships, stipends, or support for students studying behavioral health care; and, Individual insurance coverage or payments, including for medications. In addition, the 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; 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. 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 only as a partner. The foundation arm of a for-profit hospital is also not eligible 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. less than 20 percent of the grant funds allocated annually will be distributed for the benefit of rural populations with high health care needs. Up to 80 percent of the grant funds allocated annually will be distributed for the benefit of urban/suburban populations with high health care needs. 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 as counties outside of Boulder, El Paso, Teller, Larimer, Mesa, Weld, Pueblo, and the Denver Metro Area. The Denver Metro Area CHA RFP Page 8

9 includes Adams, Arapahoe, Broomfield, Clear Creek, Denver, Douglas, Elbert, Gilpin, Jefferson, and Park counties. 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. more than 50 percent of the rural grant awards will be used for capital improvements. more than 25 percent of the urban/suburban grant funds will be used for capital improvements. TARGET TIMELINE Wednesday, February 1, 2017 Monday, February 13, 2017 Wednesday, March 1, 2017 Thursday, March 2, 2017 Wednesday, March 8, 2017 Friday, March 10, 2017 Friday, August 11, 2017 Friday, September 1, 2017 Request for Proposals released RFP Q&A Webinar at 10:00 am MT See details below Last day to register with The Denver Foundation s web-based application system. exceptions. Last day for content questions 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 Q&A WEBINAR A Q&A Webinar will be offered on Monday, February 13, 2017 at 10 am MST. Participation in the Q&A session is optional, but strongly encouraged. Please check our webpage for updates to call in and participate at Access-Fund. Questions after you ve attended the Q&A session? Please call or our team at cha@denverfoundationn.org prior to Thursday, March 2, CHA RFP Page 9

10 WEB-BASED APPLICATION IN 2017 Beginning in 2017 The Denver Foundation will utilize a web-based application for the CHA Fund. Registration is required and the deadline to register is March 1, 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 in 2017 for Program/Projects, Capital Improvement, and General Operating. All applicants- collaborative and individual organizational applications- will use this application. You are strongly encouraged to register, utilize the pre-screening tool, and explore the application early. Begin your registration and create a profile here: Please Remember The Denver Foundation needs 48 hours to approve your registration. The deadline to register is March 1, exceptions. After your registration is approved you will have full access to the application. You must download the required budget template from the Colorado Health Access webpage here: Funds/Colorado-Health-Access-Fund The Application The application is laid out in tabs, as displayed in the snapshot here. There is a pre-screening CHA RFP Page 10

11 which is for your benefit only and not recorded by the Foundation. Many questions in the application use skip logic so some questions will appear (or disappear) based on your responses. Questions and character limits are laid out in the pages that follow, for the most part, exactly how you will see it online. Technical Issues If you have technical challenges, please reach out to no later than Wednesday, March 8, 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 Thursday, March 2, CHA RFP Page 11

12 of 14 1/23/ :23 PM Your Name Will Appear Here (The Denver Foundation) 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. Target Population. The intent of the Fund is to increase access to behavioral health care to all Coloradans with high health care needs, which is defined as: People 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: Have multiple chronic or acute health conditions; Lack health insurance coverage, have inadequate coverage, or have significant barriers to accessing coverage; Are low-income and/or homeless; Have a disability; Come from a culture different from the mainstream; and/or Do not speak English well. The following pre-screening questions are here to help you assess if the work you are proposing is a good fit for he 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 Foundation. Q1. Will the body of work support individuals outside of Colorado? Q2. Are you able to demonstrate the behavioral health need(s) in their 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?

13 2 of 14 1/23/ :23 PM 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?

14 of 14 1/23/ :23 PM 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, 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. General Applicant Info Legal Name of Organization or Name of Formal Partners (if applying as a collaborative) 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

15 of 14 1/23/ :23 PM Organization's CEO or Executive Director's First Name 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 nprofit 501(c)3 Public Charity? Other than 501(c)(3), describe: Using a fiscal sponsor? Applying as a collaborative? Name of fiscal agent/sponsor Organization Mission Statement # of Full-Time Employees # of Part-Time Employees Grant Request Info Organization's Definition of Community Pertaining to Grant 195 Characters

16 of 14 1/23/ :23 PM 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 General Operating Support 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: 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:

17 of 14 1/23/ :23 PM Program/Project or Capital Improvement Expenses: 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. 2,100 Characters 2. GOALS. Describe the organization s current goals. If applying as a collaborative, please describe the collaborative's goals. 1,800 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 Questions 4-8. If applying as a collaborative, please describe that programatic body of work. 3,000 Characters 4. TARGET POPULATION SERVED. Describe the target population being served. Applicants must describe the population they are addressing in the community via existing quantitative and qualitative data to demonstrate the need. 2,100 Characters

18 of 14 1/23/ :23 PM 5. SUMMARY OF TREATMENT. Provide a summary of how you are addressing the behavioral health treatment need in your community. Include how the project fits into a specific focus area (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). Finally, include goals and objectives, activities, and timeline in your project template. 2,250 Characters 6. EXPLANATION OF APPROACH. Explain why the organization is approaching the behavioral health issue and/or opportunity in this way. Describe how the organization is incorporating health care practices that are based upon scientific evidence and demonstrating effective health outcomes, or new practices that have the strong potential for effective behavioral health outcomes based upon current literature. 2,250 Characters 7. EXPLANATION OF INNOVATION & INVESTMENT. Explain how this request builds on innovations and investments already in place around behavioral health care and support strategies for sustainability within your defined community. 1,200 Characters 8. EXPLANATION OF INCREASED ACCESS. Describe how your request is increasing access to behavioral health to Coloradans with identified behavioral health issues. Strong

19 of 14 1/23/ :23 PM applications will clearly demonstrate an increase in accessing and/or expanding treatment to the Fund s target population. 1,200 Characters 9A. DESCRIPTION OF OVERALL APPROACH. Describe the organization s or collaboratives overall approach to evaluation. 1,800 Characters 9B. DESCRIPTION OF MEASUREABILITY. 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 (whether for program or general operating support requests) will be dedicated to evaluation. 3,000 Characters 9C. SUMMARY OF EVALUATION RESULTS. Summarize key evaluation results or findings that demonstrate the impact of the proposal. Indicate the time frame for the results or findings. Demonstrate alignment between the outcomes of your proposed word and the Fund s purpose to increase access to behavioral health care to Coloradans with high health care needs. 3,000 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

20 of 14 1/23/ :23 PM this question with respect to that program or project only. 2,400 Characters 11. INCLUSIVENESS. Describe how the organization or collaborative strives to be inclusive in its programs, staff, board, and volunteers, and describe the progress to date. Inclusiveness refers to whether diverse individuals are able to participate fully in the decisions made within the organization or group. Inclusive organizations not only have diverse people involved, but are also learning-centered and incorporate the needs, assets, and perspectives of everyone (including residents and consumers) into everything they do. Inclusiveness generally refers to the how. 1,800 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. 1,200 Characters 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. 2,400 Characters

21 0 of 14 1/23/ :23 PM 14. CAPACITY. Describe which staff person(s) will be designing and implementing this project, as well as their 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. 1,800 Characters 15. SUSTAINABILITY. Recognizing that the Colorado Health Access Fund will only be in existence for eight years, explain how you will sustain your work into the future, with or without support from this Fund. Describe your strategies either during and/or after the grant period on how to support the sustainability of the activities or demonstrated outcomes. Examples of sustainability could include identifying other/diverse sources of funding, third party billing, establishing mechanisms within the community/system to create an ongoing funding source, identifying solutions to the barriers that need to be removed in order for the work to be sustained or continued, and talking to and sharing with decision makers and influencers about lessons learned. 3,000 Characters 16. OPTIONAL. If there is additional information that is vital to convey in this proposal, do so here. 1,200 Characters (Character count: x) Project Work Plan ***The information below is not needed if your grant request is for General Operating Support. Please continue on to the next page*** 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.

22 11 of 14 1/23/ :23 PM Goal (General long-term purpose of project) Objective (SMART - specific, measurable, achievable, realistic, and time-bound) Activities to Accomplish Objective (List major steps, expected completion date/results) Expected Activities Completion Date Expected Results Measurement Tools (List and describe the tools and methods that will be used to measure the objectives)

23 12 of 14 1/23/ :23 PM Deliverables (List any tangible objects produced as a result of the activity) 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: /compress_pdf. Proof of IRS federal tax-exempt status (updated within the last five years). *Collaboratives must include proof of IRS federal tax-exempt status for each formal partner within one pdf. 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

24 3 of 14 1/23/ :23 PM 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 In-kind 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. 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. more than 6 pages total in one PDF. Optional Attachment 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

25 14 of 14 1/23/ :23 PM 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 Declarations & Agreements 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@denverfoundaiton.org. The Colorado Health Access Fund, A Field of Interest Fund at The Denver Foundation 55 Madison Street, 8th Floor, Denver, CO 80206

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