Investing in our Community’s Health and Future

1 Northern California Region Napa-Solano Area community Benefit Program 2011 -2013 Grant Guidelines Investing in our community 's Health and Future For nearly 60 years, Kaiser Permanente's social mission has been the foundation of its community service programs. As a value-driven, not-for-profit integrated Health care organization, Kaiser Permanente is dedicated to improving the Health of our members and the communities we serve. Through partnerships with community organizations and governmental entities, Kaiser Permanente strives to benefit the community by addressing issues and concerns that affect overall community Health . Many of these partnerships are created through grants that support community events, activities, projects and programs. Kaiser Permanente community Benefit Program responds to requests from organizations that provide service throughout Napa and Solano counties.

2 This provides us with the opportunity to collaborate locally with agencies, non-profit organizations and community groups to identify areas of need, and by directly Investing in programs and services that improve the Health of the people in our communities. All people deserve to lead healthy lives and be treated with compassion and respect. Kaiser Permanente will continue to dedicate itself to this principle for the benefit of our members and our communities. Kaiser Permanente Grant Program The Napa-Solano Area of Kaiser Permanente provides financial support to local public entities and non-profit Health and human service organizations with an emphasis on vulnerable populations. The organization looks for opportunities to assist groups in Napa and Solano counties that address the following community Health priority areas for 2011 -2013: Increase access to prevention and primary care services (for low-income and uninsured individuals).

3 Reduce obesity and overweight rates in adults and children (by increasing physical activity in community settings and/or increasing consumption of fruits and vegetables). Decrease Risky Teen Behaviors (specifically sexual activity and substance abuse). Prevention of community Violence (in schools and at-risk communities). Reduce Health Disparities (to improve Diabetes control among Blacks and Latinos and increase breastfeeding among Blacks and Asians [Filipino]). The funding range for 2013 community grants will be $7,500 - $25,000. Northern California Region Napa-Solano Area community Benefit Program 2011 -2013 Grant Guidelines Grant Eligibility Criteria When submitting a grant request to the Napa-Solano community Benefit Grant Program, please comply with the following criteria: Funds must be used for vulnerable populations of Napa and Solano counties.

4 Proposals must address the community Health priority areas listed in the previous section (see Kaiser Permanente Grant Program). Only non-profit or public benefit organizations (eg., schools) are eligible to receive community benefit grants. Unincorporated groups or agencies can make arrangements to utilize an eligible non-profit agency as a fiscal sponsor. Grant Making Process Applicants may contact Charmaine Gandy, community Benefit Associate, at (707) 651-4665 to discuss the scope of project. All applications must be received no later than 5:00 pm on Friday, January 25, 2013. Applicants will be notified of results on or before May 1, 2013. Grant funds will be disbursed approximately 4-6 weeks after signed award acceptance letter is received by the Kaiser Permanente Napa-Solano community Benefit Office. Application Requirements All applicants must submit the following documentation: 1.

5 A brief cover letter including a summary of the request on agency or fiscal sponsor letterhead (be sure to include Tax ID # in cover letter ). 2. Copy of current tax exempt status letter 3. List of the names, titles, and affiliations of the members of your board of directors 4. Detailed project budget showing: 1) projected expenses; 2) the amount requested of Kaiser Permanente and; 3) other funding sources of the project (budget template provided). 5. Non-discrimination statement/policy on Organization's letterhead 6. Completed Application Supplemental template 7. Completed Workplan template 8. Memorandum of Agreement with Fiscal Agent (if applicable). 9. Your organization's current operating budget (for requests $20,000 and above). 10. A copy of your organization's most recent Form 990 (for requests $20,000 and above).

6 11. Your organization's most recent audited financial report (for requests $20,000 and above). Northern California Region Napa-Solano Area community Benefit Program 2011 -2013 Grant Guidelines Reporting Requirements Grantees must complete two community Benefit forms (Grant Agreement and Acknowledgement Receipt) included in your award letter. Six-month report due on or before December 13, 2013. Twelve-month report due on or before June 3, 2014. Eligibility Limitations community Benefit Grants are not awarded for: Arts Cultural events Athletic programs (eg., sports programs, leagues). Fundraising activities such as charitable dinners/lunches Annual fund drives Building/Capital campaigns Individuals Activities that exclusively benefit the members of sectarian or religious organizations Transportation Political campaigns*.

7 *As a non-profit organization, Kaiser Permanente is legally prohibited from funding political campaigns and/or lobbying efforts. For more information on the grant program, please contact: Cynthia Verrett community Benefit Manager (707) 651-3670. FAX (707) 651-3699. Charmaine Gandy community Benefit Associate (707) 651-4665. FAX (707) 651-3699.