DUKE HEALTH CHARITABLE GIVING POLICY

DUKE HEALTH CHARITABLE GIVING POLICY

Mission The mission of Duke Health is to advance the health and well-being of the communities served through integrated, innovative and compassionate care. Duke Health includes Duke University Health System, Inc., the Duke University School of Nursing, and the Duke University School of Medicine. As one of the world s leading academic health systems, Duke Health combines strengths in education, biomedical research, and hospital and clinical care to deliver outstanding health care to local and global communities. Funding Policy Duke Health fulfills its mission not only through its services and programs, but also through its Charitable Giving Program by supporting the efforts of community-based organizations and global initiatives whose goals and activities are compatible with Duke Health. Duke Health receives hundreds of requests for philanthropic assistance each year. The Duke Health Office of Community Relations considers all grant requests that do not exceed $5,000 on an ongoing basis. The Duke Health Charitable Grants Committee considers requests for grants that exceed $5,000. That Committee is composed of representatives from each of the major entities within Duke Health, and meets in the spring and fall of each calendar year. Community organizations that are recognized as tax-exempt under Section 501(c)(3) of the Internal Revenue Code are encouraged to apply for a charitable grant from Duke Health provided the proposed activities fall within at least one of the following four focus areas: Healthcare related services. Wellness and Disease Prevention efforts. Education services that relate to health and wellness. Activities that promote health and wellness through the economic and cultural vitality of the community. Please Note: The following are examples of proposals that will not be funded by Duke Health:

Political campaigns or political parties. Solicitations received from groups that discriminate based on age, race, color, disability, genetic information, veteran status, sex, sexual orientation, gender expression or identity, religion or national origin. Any proposal by a charitable organization that is not qualified as tax-exempt under Section 501(c)(3) of the Internal Revenue Code. A proposal that would benefit a specific individual person or persons. Procedure Submit each request for funding according to the following procedures: 1) An application for grants shall be made to: Duke Health Office of Community Relations Attention: Contribution Grants Program (for grant requests that do not exceed $5,000) Or Attention: Charitable Grants Program (for grant requests that exceed $5,000) DUMC 3701 Durham, NC 27710 2) Charitable Grant applications will be reviewed twice a year, normally in the fall and spring. To qualify for consideration during a particular calendar year, grant applications must be received no later than Nov. 1 for the fall consideration and May 1 for the spring consideration. Contribution Grant applications may be submitted anytime during the calendar year. 3) An applicant may expect to receive a decision on a grant application within 60 days of the deadline for submission of that application. 4) Requests for all Duke Health charitable giving grants must be submitted on the Duke Health Charitable Grant Application Form (attached) together with the documentation required by that form. You may print the form below, or call 919-668-3792 to have an application sent to you via mail. 5) Successful applicants will be required to complete and file written reports of the funded project within 30 days of completion of that project.

Thank you for your interest in inviting Duke Health to help support your community initiative or program. Contact us at maryann.black@duke.edu or call 919-668-3792 if you have questions. Please check the applicable box: Duke Health Charitable Giving Program Application Form [Please print or type] Contribution Grants Program (requests for $5,000 or less) Charitable Grants Program (requests that exceed $5,000) 1. Date: 2. Name of organization: 3. Address: City: State: Zip: 4. E-mail address: 5. Phone Number: 6. Contact individual s name and position: 7. Purpose and mission of the requesting group: 8. Number of members in your organization: 9. Tax ID Number: 10. Attach the following documentation to this application:

(a) Letter from the Internal Revenue Service indicating current (within the 12 months preceding the applicable grant application deadline) Section 501 (c) (3) tax-exempt status. (b) Current (within the 12 months preceding the applicable grant application deadline) financial statements including balance sheet and statement of income and expenses. (c) Copy of income tax return for most recent fiscal year preceding the applicable grant application deadline. 11. Have you received funding from Duke Health in the Past? Yes No If yes, in what year(s)? Description of prior-funded initiative: 12. Brief description of initiative/event for which the funding is requested (purpose, target audience, how often will it be held, and recognition Duke Health will receive, etc.): 13. Date(s) of Event / Initiative: 14. What is the amount requested? 15. By what date is a funding decision needed? 16. What are the expected or intended results from use of donated funds? _ 17. If Duke Health should support the organization/event, would it be the exclusive health care supporter? Yes No If not, what other health care entities have agreed to sponsor this organization/event? 18. Description of recognition and other benefits Duke Health will receive:

19. How will funding this request help Duke University Health System further its mission of meeting the health care needs of the people we serve, improving community health, and fostering excellence in medical education and biomedical research? Executed on behalf of the applicant organization by: Print Name: Title: Please photocopy this application for your files and return the completed original form to the address below. Duke Health Office of Community Relations Attention: Contribution Grants Program Or Attention: Charitable Grants Program DUMC 3701 Durham, NC 27710