Responsive Grants Program

Sierra Health Foundation is a private philanthropy investing in and serving as a catalyst for ideas, partnerships and programs that improve health and quality of life in Northern California through convening, education and strategic grantmaking. For information about Sierra Health, visit www.sierrahealth.org. Responsive Grants Program Application Instructions and Criteria READ ALL INSTRUCTIONS AND CRITERIA CAREFULLY The Funding Opportunity Responsive grants are available to qualifying nonprofit organizations and public agencies that serve people living in Sierra Health s 26-county funding region (see the map on page 2). Grants up to $40,000 are available to support projects in the following areas: Expanding Health Insurance Improving Health Care Access Promoting Health Sierra Health has a broad definition of health, believing that health includes more than just physical condition and well-being. It is influenced by many factors, including, but not limited to, socioeconomic conditions, environment, genetics, health care and individual behavior choices. Sierra Health has committed a total of $1.2 million to this program in 2008. Special Consideration and Funding for Rural Communities of Northern California Thirty percent of Responsive Grants Program funds ($360,000) will be available exclusively to projects serving rural areas of Sierra Health s funding region. For projects serving both urban and rural areas to qualify for a grant from the 30% set-aside funds, the proposed projects must be offered in rural communities. What is Rural? For purposes of this grant program, Sierra Health defines rural as a Medical Service Study Area (MSSA) that has a population density of 250 persons or less per square mile and has no incorporated area greater then 50,000 people. 1 To determine if the geographic area to be served by your proposed project is rural, see the map on page 2, which shows the urban and rural MSSAs in Sierra Health s funding region. If you need further clarification on your service area s rural/urban designation, contact Sierra Health by sending an e-mail to grants@sierrahealth.org. Funds Available to All Applicants All applicants, both those serving in urban areas and those serving in rural areas, are eligible to apply for the remaining 70% of grant funds ($840,000). 1 MSSA is a designation defined by the California Health Manpower Policy Commission. As a general rule, MSSAs are deemed to be "rational service areas" for purposes of designating health professional shortage areas, medically underserved areas or medically underserved populations. An MSSA is composed of one or more complete census tracts. Sierra Health combines rural and frontier communities into its rural category for the purposes of this grant program. Source: California Health Manpower Policy Commission, California Rural Health Policy Council, a program of the California Office of Statewide Health Planning and Development. Sierra Health Foundation 1

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Eligibility Criteria Sierra Health Foundation will fund nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code and are designated a 509(a)(1) or 509(a)(2) organization. Sierra Health will also fund public agencies. Applicant organizations must serve residents living in one or more of the 26 counties of Sierra Health s funding region (see the map on page 2). Selection Criteria The most competitive applications will: Support projects in one or more of the three funding areas (Expanding Health Insurance Coverage, Improving Health Care Access and Promoting Health); Make the case for need related to the population to be served; Leverage resources and/or demonstrate sustainability, if applicable; Demonstrate the anticipated positive impact, e.g., numbers of people positively affected, long-term impact, etc., as proposed in the performance measures framework included in the application; Include a reasonable project scope and budget, based on Responsive Grants Program parameters; and Be based on accepted best practices. Additionally, proposal reviewers will, to the extent possible, consider geographic location of those to be served in order to distribute grant funds throughout the funding region. Funding Information The maximum grant amount is $40,000. Grants will support one-time projects. The grant term may be up to one year. Only one grant proposal per organization for rural funds and one for urban funds will be considered each cycle. Grantees will be required to submit a final report at the end of the grant period, reporting on the performance measures detailed by the applicant on the Performance Measures table. Grants for capital equipment will be considered. Only 10% of the grant funds may go to capital items if the primary purpose of the proposed project is program-related activities. Sierra Health Foundation 3

Examples of projects considered for funding in each of the three funding areas (proposed projects are not limited to these examples): Expanding Health Insurance Educational programs regarding coverage options Activities to improve enrollment into publicly sponsored insurance programs Activities to retain insurance program enrollees Improving Health Care Access Translation services Transportation to/from services Promoting Health Senior injury prevention Obesity prevention programs for youth Chronic disease management What We Do Not Fund Responsive Grants funds may not be used for debt retirement or operational deficits. In addition, Sierra Health does not fund requests to support individuals, activities that exclusively benefit the members of sectarian or religious organizations, nor 509(a)(3) supporting organizations. Proposal Timeline PROPOSAL DEADLINE: August 15, 2008, 12 noon APPROXIMATE AWARD ANNOUNCEMENT: November 21 APPROXIMATE DATE FUNDS AVAILABLE: December 15 Your proposal must arrive at Sierra Health Foundation by 12 noon on August 15. Proposals received after the due date/time will not be reviewed regardless of e-mail or postmark date. Proposers Conferences Participation in a proposers conference or teleconference is recommended, though not required. The proposers conference schedule is as follows: June 23, 1:30 to 4 pm at Sierra Health Foundation in Sacramento July 1, 1:30 to 4 pm at College of the Siskiyous in Weed July 2, in Redding, time and location to be determined July 16, 2 to 4 pm, a teleconference will be held for those unable to attend an in-person conference July 17, 1:30 to 4 pm at King-Kennedy Memorial Center in Modesto Registration information for all proposers conferences and the teleconference are posted on Sierra Health s Web site, www.sierrahealth.org Sierra Health Foundation 4

How to Apply Review all instructions and criteria carefully, and follow all instructions. Incomplete proposals will not be reviewed. Refer to the Application Materials Checklist below for all items required. Electronic submissions are preferred. You may, however, submit your application via e-mail, mail or other physical delivery. If applying via e-mail Submit all materials listed under Application Materials Checklist in Microsoft Word, PDF or Microsoft Excel format as attachments. Do not put the application information in the body of your e-mail message. Do not include any materials not requested in the application. If an item is not applicable to your request, explain it in the space provided on the Application Cover Sheet form. Submit all materials electronically. Send to grants@sierrahealth.org. On the subject line type: Responsive Grants Application. If applying by mail or other physical delivery Do not bind your proposal, use covers or include any materials not requested. If an item is not applicable, please explain in the space provided on the Application Cover Sheet form. Clip the proposal at the upper left-hand corner. Submit an original and three (3) copies (four total) of the materials listed under Application Materials Checklist to: Responsive Grants Program Sierra Health Foundation 1321 Garden Highway Sacramento, CA 95833 We encourage early application submission. If applying via e-mail, this will help alleviate a possible e- mail backlog that could delay our receipt of your application. If application e-mail attachment files are large, we will accept your application files in consecutive e-mails. Questions about this grant program and the application process may be sent to grants@sierrahealth.org. Application Materials Checklist All forms can be downloaded from Sierra Health s Web site, www.sierrahealth.org, or contact Sierra Health at 916-922-4755. Completed Responsive Grants Application form, which includes: Application Cover Sheet form (see the sample with instructions on page 6) Proposed Project Description Proposed Project Budget and Budget Explanation Performance Measures table (An example Performance Measures table for each of the three funding areas is posted on Sierra Health s Web site at www.sierrahealth.org.) 501(c)(3) determination letter (if a public agency, please note in space provided on the application cover sheet form) Most-recent annual income statement and balance sheet (reviewed or audited if available) Organization s current annual operating budget. Public agencies may submit only the program s budget, in lieu of the department or agency budget. Sierra Health Foundation 5

EXAMPLE Responsive Grants Application Application Cover Sheet INSTRUCTIONS ONLY Do not type on this form To complete this form, save this document in Microsoft Word and type into each shaded field. Use the TAB key to move from field to field, or click in each field. Limit your responses to the space provided. Applicant Information Organization Name of 501(c)(3) organization (as it appears on IRS determination letter) or public entity Address Address of the above City State Zip Code Phone Director s phone Ext e-mail Director s e-mail address Director Director of 501(c)(3) or public entity Title Director s title Tax Exempt ID# of 501(c)(3) or public entity Web site Web address of 501(c)(3) or public entity Date of Last Audit Application Name of primary contact at 501(c)(3) or public Title Title of primary contact Contact entity Address Address of primary contact City State Zip Code Phone Primary contact s phone Ext e-mail Primary contact s e-mail address Project Summary Information Project Name Primary Funding Area Name of program and/or project Health Insurance Coverage Health Care Access Health Promotion Target Age Group of the Proposed Project/Effort (Select One) General/All Ages Adults (19-54) Seniors (55+) Young Children (0-5) Youth (6-18) Brief Project Description (limited to 190 characters): The purpose of the proposed project/effort is: To Project Start Date Date grant funds are needed Project End Date Not more than 12 months after start date Amount Requested Dollar amount requested from Sierra Health for this project Sierra Health Foundation 6

EXAMPLE Primary Use of Funds (select one) Capital/Equipment Communication Community Development Conference/event Implementation Policy Existing Program Development New Program Development Staff Development Technical Assistance Counties and areas that will be affected by the project The proposed project activities will take place in all 26 counties of Sierra Health s funding region: Yes No If no, indicate in the space next to the county s name the percentage of project activity to take place there (best estimate). Alpine % Amador % Butte % Calaveras % Colusa % El Dorado % Glenn % Lassen % Modoc % Mono % Nevada % Placer % Plumas % Sacramento % San Joaquin % Shasta % Sierra % Siskiyou % Solano (eastern part including Fairfield) % Stanislaus % Sutter % Tehama % Trinity % Tuolumne % Yolo % Yuba % Indicate whether the proposed project serves an urban or rural area, or both (see page 1 of the Application Instructions and Criteria for instructions on determining this). Serves an urban area Serves a rural area Serves both urban and rural areas What percent of people served by the proposed project live in a rural area (best estimate; see page 1 of the Application Instructions and Criteria for instructions on determining rural areas.)? % Application Materials Checklist Completed Responsive Grants Application form, which includes: Application Cover Sheet form (see the sample with instructions on page 6) Proposed Project Description Proposed Project Budget and Budget Explanation Completed Performance Measures table 501(c)(3) determination letter (if a public agency, please note in space below) Most-recent annual income statement and balance sheet (reviewed or audited if available) Organization s current annual operating budget. Public agencies may submit only the program s budget, not the department or agency budget. If an item on the check list is not applicable, please briefly explain: Name of authorized 501(c)(3) or public agency officer Title Sierra Health Foundation 7