www.deltadentalks.com Delta Dental of Kansas Community Benefit 2018 COMMUNITY DENTAL HEALTH GRANT GUIDELINES This document identifies the general guidelines applicable to Delta Dental of Kansas (DDKS) community dental health grant making process. DDKS may change these guidelines, or make grants that do not fall within the range of these guidelines, at its discretion. Grants are made once per year to eligible organizations for projects that support DDKS grant criteria. DDKS is interested in raising public awareness of oral health issues and encourages applicants to make this a part of any funded project through media communications and community participation. Community Dental Health Grants Community-based oral health programs in Kansas are encouraged to apply for grants up to $150,000 for programs designed to improve oral health. Special consideration will be given to those applicants whose programs focus on improving the oral health of low-income children and senior citizens; however, all grant submissions will be considered. Project Criteria Funding is provided for new initiatives, new components of existing programs, start-up funding or one-time events that will include one or more of the following grant criteria: prevention and education, significant and/or large impact, or sustainable and innovative solutions. Grants will be limited to projects related to the advancement of oral health. Grant applications should be for programs of one year in duration. Multi-year and/or renewable grants year-over-year will not be considered. Examples of allowed projects: Dental educational programs Dental education materials Types of projects NOT ELIGIBLE for funding: Administrative costs including any and all salaries Equipment/Supplies Projects outside the state of Kansas Lobbying Political organizations or political campaigns Ongoing programs, ongoing general operating expenses or existing deficits Projects not related to oral health Fundraising events Individual treatment costs Organization Eligibility To be eligible for funding consideration, an organization must be a: Public charity with tax-exempt status under section 501(c)(3) of the Internal Revenue Code, or Public or governmental entity such as a school or health district, or Tribal organization with 7871 tax-exempt status Organizations applying for a grant must have a physical presence in the state of Kansas. The project for which funds are requested must benefit only people living in Kansas. 1
Community Benefit Grant Criteria The focus of DDKS is to improve and transform the oral health of Kansans through funding focused on prevention and education; having a significant and/or large impact; and offer sustainable or innovative solutions. Priority will be given to proposals that: emphasize prevention and education; improve access to dental services; have measurable improvement goals; and/or show strong community support for the project. Grants will be limited to projects related to the advancement of oral health. Applicants must demonstrate they meet one or more of the following criteria: Prevention and Education: Intervention with early care Partnering with existing networks Oral health education Significant and/or Large Impact: Expanding services and collaborations that will affect large numbers of people, preventing the need for extensive dental care Addressing dramatic oral health care needs for the underserved Sustainable, Innovative Solutions: Building a trained workforce Providing a sustainable source of support Infusing new providers in existing networks Small Grants Up to $15,000 This program is designed for oral health projects requesting $15,000 or less. DDKS strongly encourages collaboration within agency programs when submitting Small Grant applications. Medium Grants $15,001 to $35,000 Delta Dental of Kansas Medium Grants are intended to: Support oral health projects that can be replicated in various areas of the state. Support oral health projects that can reduce barriers to care or provide insight into access to care issues. Focus on an enhancement to existing projects to provide a larger impact. Focus on stakeholder engagement and learning communities. Combine with funding from other sources. To encourage creative, proactive approaches that can contribute to long-term strategies as they develop. Large Grants $35,001 to $150,000 Delta Dental of Kansas Large Grants focus on the following initiatives: Educational projects to enhance the awareness of good oral health with a focus on children, the elderly, the indigent, and at-risk populations. Preventive outreach activities that aim to decrease the incidence, prevalence, and severity of dental disease. Research efforts to improve dental health, specifically those that address a prevalent dental disease or issue of significant impact to Kansans. Dental care accessibility and affordability projects that provide assistance to underserved areas and populations. Preventive programs that are population based. Other programs that align with DDKS mission and funding criteria. 2
Delta Dental of Kansas Community Benefit 2018 COMMUNITY DENTAL HEALTH GRANT APPLICATION APPLICATION PROCESS: Grant applications are due on or before April 9, 2018 to Delta Dental of Kansas (DDKS) Corporate Headquarters - 1619 N. Waterfront Parkway, Wichita, KS 67206. Applications may also be submitted via fax to 316.462.3372 or by email to corpcomm@deltadentalks.com. Funding decisions are scheduled to be announced in the summer of 2018. To be considered for funding, applicants must submit the following: 1. Completed proposal 2. Completed application 3. Required attachments as indicated below. #1 - PROPOSAL: The Proposal should include the following items, in one document separated by headings (e.g., Prior Funding, Organization Description). Please keep applications concise. We ll reach out to you if we need additional information. Prior Funding: List any prior funding from DDKS including the amount and year it was given. Organization Description: Include history, mission and services provided (please limit to one paragraph). Project Summary: Include project timeline (including start and end dates of project), objectives, and activities. Need: Description of need, how the project addresses that need, how many people will benefit, and the geographic scope of the area to be served. Budget Narrative: Fill out a detailed expense budget for the project with the proposed use of DDKS funds highlighted; description of committed and potential revenue sources and amounts. Partners: List of leadership and partners including names and qualifications of staff responsible for project implementation. If a collaborative effort, identify project partners, the role played and contribution made by each. Sustainability: Include how the project will be sustained after DDKS funds have been expended. Evaluation Plan: Define project success and how effectiveness and outcomes will be measured. Acknowledgment Plan: Define how and when DDKS grant will be acknowledged. 3
#2 - APPLICATION: DATE OF APPLICATION / / ORGANIZATION INFORMATION Legal name of organization (as it appears on your IRS exemption letter) Address City, State, ZIP Telephone Fax Executive Director Phone & Ext. Executive Director Signature Email address Website PROPOSAL INFORMATION Project name Name of person writing grant application (if different than Exec. Director) Position Phone number and extension Email Sponsoring organization (if different from above) Dollar amount being requested $ Total anticipated project budget $ Annual organization budget $ Project term (in months) Project start date Project end date Number of people this project will benefit a. Estimated number of direct lives affected annually: Adults (20+) Children (under 20) b. Estimated number of indirect lives affected annually: Adults (20+) Children (under 20) Number of people served organization-wide Will this project/program target a specific population? If yes, please specify How many Kansas counties will be served with these funds? Which Kansas counties will be served with these funds? 4
Are you seeking other sponsors? Yes No If yes, please list name of funder(s), requested amount, and status (funded denied under consideration) Is your organization providing any funding for this project? Yes No If yes, what amount? Is this program a: a. New initiative? Yes No b. New component of an existing program? Yes No c. One-time event? Yes No d. Start-up funding? Yes No Does this program include treatment for developmentally disabled persons? Yes No Do you file or accept any private dental insurance? Yes No N/A Which of the following grant criteria applies to your program? (Check all that apply) Prevention and Education: Intervention with early care Partnering with existing networks Oral health education Significant and/or Large Impact: Expanding services and collaborations that will affect large numbers of people, preventing the need for extensive dental care Addressing dramatic oral health care needs for the underserved Sustainable, Innovative Solutions Building a trained workforce Providing a sustainable source of support Infusing new providers in existing networks Type of facility or requesting organization: Federally Qualified Health Center Primary Care Clinic Public or Governmental Entity Tribal Organization 501(c)3 Non-Profit Organization Other: Please indicate the amount, by percentage, of how your overall annual revenue falls into the following categories: Used for direct client care % Used for administrative overhead % Used for capital improvements and equipment purchases % Used for long-term loan obligations (not identified above) % Placed in reserves/surplus % Other purposes % Total 100% 5
Send ONE COPY of each of the following: #3 REQUIRED ATTACHMENTS: A list of board members and their affiliations A current detailed operating budget for the organization A copy of the most recent Form 990 (with attachments) A copy of the most current audited financial statement. If not available, a recent balance sheet (assets and liabilities) and a statement of income and expenses. A current copy of the applicant s U.S. Treasury (IRS) tax determination letter If requesting DDKS fund supplies and/or equipment: A copy of three bids for supplies and/or equipment INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. DDKS will have only one grant cycle in 2018. SUBMITTING THE FULL APPLICATION The full grant application (proposal, application and attachments) must be received on or before April 9, 2018. You may submit your application via mail, email or fax. Mail: Community Benefit Delta Dental of Kansas 1619 N. Waterfront Parkway Wichita, KS 67206 Fax: 316.462.3372 Email: corpcomm@deltadentalks.com If you have questions concerning your organization s eligibility for funding consideration, funding criteria or review process, please contact Delta Dental of Kansas Community Benefit Department at 316.462.3341 or email corpcomm@deltadentalks.com. 6