HomeMy WebLinkAboutC12-075 Colorado Health Foundation Grant %
The Colorado Health Foundation'
February 2, 2012
Ms. Nola Nicholson
Economic Services Program Coordinator
Eagle County Health and Human Services
551 Broadway
P.O. Box 660
Eagle, CO 81631
Dear Ms. Nicholson:
We are pleased to inform you that the Colorado Health Foundation has approved a fifteen -month
grant in the amount of $86,000 for "Eagle County Increased Enrollment in Medicaid and Child
Health Plan Plus (CHP +)."
We appreciate your active commitment to improving the health and health care of Coloradans
and look forward to supporting your efforts to achieve the results outlined in your proposal.
The agreement below provides the terms and conditions of this grant. Please mail the executed
agreement and attached budget to the attention of Sara Guillaume, Director of Grants
Management.
Please include your grant identification number, shown below, on all future correspondence with
the Colorado Health Foundation. Also enclosed are guidelines for communicating your grant.
Congratulations on this recognition of your important efforts. We look forward to working with
you during the coming year. If at any time you have any questions regarding this grant, please
contact Sara Guillaume at (303) 953 -3672 or sguillaume@ColoradoHealth.org.
Sincerely, (5,v,
•
E
Kel DLL
Y nkin Erica Snow
Vice President, Philanthropy Program Officer
Enclosures (2)
Grant ID #4587
- 1 -
501 South Cherry Street, Suite 1100 0 Denver, CO 80246 TEL: 303.953.3600 Fax: 303.322.4576 www.ColoradoHealth.org
The Colorado Health Foundation"
GENERAL GRANT TERMS, CONDITIONS AND UNDERSTANDINGS
Title of Project:
Eagle County Increased Enrollment in Medicaid and Child Health Plan Plus (CHP +)
Grant ID #: 4587
Purpose of Project:
Increase enrollment in Medicaid and CHP+ by installing computer enrollment stations (kiosks) with access to the Program Eligibility Application Kit
(PEAK) at four community-based organizations and four schools.
Grantee Organization: Checks to be Made Payable to:
Eagle County Health and Human Services Eagle County Government
551 Broadway 551 Broadway
P.O. Box 660 P.O. Box 660
Eagle, CO 81631 Eagle, CO 81631
Tax Identification Number: 846000762
Amount of Grant Awarded: Period for Which Support is Granted:
$86,000 over a 15 -month period From 2/15/2012 Through 5/14/2013
Contingencies:
Special Provisions: Desktop computers /kiosks will be used for the sole purpose of utilizing the Programs Eligibility Application Kit (PEAK) software
for at least three years.
Intended Measurable Results to be Reported on:
Health Coverage - increase enrollment of eligible Coloradans in Medicaid and the Child Health Plan Plus (CHP +) by: 300.
Expected Intermediate Milestones:
- Complete Memoranda of Understanding with eight sites
- Hire enrollment specialist
- Purchase and install eight computers and enrollment stations
- Enroll 300 individuals in Medicaid and CHP+
- Complete project evaluation
Payment and Requirements Schedule:
Requirement Due Date Requirement Payment Amount Approximate Payment Schedule
2/23/2012 Signed Grant Agreement $86,000 3/1/2012
6/15/2013 Final Report
Payments are contingent upon receipt and approval of the associated requirements.
The Foundation requests that you provide your reports using the format found at www.coloradohealth.org.
Grant ID #4587 - I -
501 South Cherry Street, Suite 1100 o Denver, CO 80246 TEL: 303.953.3600 Fax: 303.322.4576 www.ColoradoHealth.org
*Project Director * *Grantee Organization Primary Contact
(please correct the information below if necessary) (please correct the information below if necessary)
Ms. Nola Nicholson Ms. Rachel Oys, J.D.
Economic Services Program Coordinator Executive Director, Health and Human Services
Eagle County Health and Human Services Eagle County Health and Human Services
551 Broadway 551 Broadway
P.O. Box 660 P.O. Box 660
Eagle, CO 81631 Eagle, CO 81631
* The project director is the individual directly responsible for developing the proposed activity, its implementation, and day -to -day direct
supervision of the project. * *The organization primary contact is the CEO/Executive Director of the grantee organization.
Grant ID #4587 - 2 -
The Colorado Health. Foundation is awarding this Grant to the above named organization ( "Grantee ") and
Grantee agrees to, the following:
1. Tax Exempt Status, Grantee represents that:
a. To provide current and appropriate documentation if organization is a government supported
agency, such as school, museum, library or government agency or department.
b. To provide The Colorado Health Foundation with immediate written notification of any changes
in the organization's tax - exempt status.
2. Expenditure of Funds
This Agreement (together with any income earned upon investment of Grant funds) is made for the
purpose outlined herein and may not be expended for any other purpose without the Colorado Health
Foundation's prior written approval. Expenditures of Grant funds must adhere to the specific line
items in the attached Grant Budget. If the grant is greater than $15,000, changes to individual line
items (increases and decreases) that are greater than 25% of that line item and greater than $1,000
must be requested in writing to the Colorado Health Foundation Grants Director and approved in
writing by Foundation staff. Requests should be submitted using the form and instructions found at
www.ColoradoHealth.org in the "For Grantees" section.
If the Grant is intended to support a specific project or for a specific period, any portion of the Grant
unexpended at the completion of the project or the end of the period specified above on Page 1 (the
"Grant Period ") shall be returned immediately to the Colorado Health Foundation. With prior
written approval from the Colorado Health Foundation the Grant Period may be extended in order to
reach the anticipated outcomes. Requests should be submitted using the form and instructions found
at www.ColoradoHealth.org in the "For Grantees" section.
3. Prohibited Use of Funds
Grantee will not permit any Grant funds or income derived from such funds to be used for
"political expenditures" as defined in Section 4955 of the Code , including but not limited to
participation or intervention in a political campaign for a public office.
So that Grantor may monitor its election under Section 501(h) of the Code, Grantee will not
permit any Grant funds or income derived from such funds to be used for any "lobbying
expenditures" as defined in Section 4911 of the Code without the Colorado Health Foundation's
specific written consent. Section 4911 of the Code describes "lobbying" as a variety of activities
including attempting to influence legislation at any level of government. Influencing legislation
is further described as attempts to influence public opinion on a legislative subject or direct
communications with those who formulate legislation. This restriction does not preclude the
Grantee from expending funds for nonpartisan analysis, study, and research.
Grant ID #4587
Grantee represents that it is knowledgeable about Executive Order 13224 and the USA Patriot
Act of 2001 and Grantee will not permit any Grant funds or income derived from such funds to
be expended or re- granted so as to benefit any person or organization with ties to terrorists.
4. No Assignment or Delegation
Grantee may not assign or otherwise transfer its rights or delegate any of its obligations under this
Agreement without the prior written approval of the Colorado Health Foundation.
5. Records and Reports
Grantee must keep a record of all receipts and expenditures relating to this Agreement and to provide
the Colorado Health Foundation with a written report summarizing the project promptly following
the end of the Grant Period. The Colorado Health Foundation may also require interim reports.
Grantee reports should describe progress achieving the Grant Purposes (including progress toward
measurable results and intermediate milestones outlined above on Page 1) and include a detailed
accounting of the uses or expenditure of all Grant funds. Grantee also agrees to provide any other
information reasonably requested by the Colorado Health Foundation. If Grantee obtains any audited
financial statements covering any part of the period of this Agreement, copies of such statements
shall be provided to the Colorado Health Foundation promptly after receipt. Grantee must keep the
financial records with respect to the Grant and this Agreement, along with copies of any reports
submitted to the Colorado Health Foundation, for at least four years following the year in which all
Grant funds are fully expended.
6. Required Notification
Grantee must provide the Colorado Health Foundation with immediate written notification of: (1) its
inability to expend the Grant funds for the Grant Purposes; or (2) any expenditure of Grant funds for
any purpose other than the Grant Purposes; and, (3) any other breach by Grantee of this Agreement.
7. Reasonable Access for Evaluation and Oversight
Grantee will permit the Colorado Health Foundation and its representatives, at its request, to have
reasonable access during regular business hours to its files, records, accounts, personnel and clients,
or other beneficiaries for the purpose of making such financial audits, verifications, or program
evaluations as the Colorado Health Foundation deems necessary or appropriate concerning the Grant
and to discuss Grantee's programs, procedures and operations with Grantee's personnel.
8. Research Involvin g Subjects:
Subjects:
If the Grant is to be used in whole or in part for research involving human subjects, Grantee hereby
certifies that Grantee, applying the ethical standards and the criteria for approval of grants set forth in
its Internal Review Boards and professional oaths, has determined that the human subjects involved
in this Grant will not experience risk over and above that involved in the normal process of care and
are likely to benefit from the proposed research program.
Grant ID #4587 _4 -
' I
9. Publicity:
The Colorado Health Foundation encourages Grantee to publicize information concerning the Grant
in the Grantee's newsletters, annual reports, press releases, Web -site and other relevant media.
Grantee will obtain the prior written approval of the Colorado Health Foundation prior to releasing or
publicizing such information.
The Colorado Health Foundation welcomes any photographs relevant to the Grant for the Colorado
Health Foundation's use. Photos must have prior client releases (if applicable) for publication
purposes.
Without further notice to or consent from Grantee, the Colorado Health Foundation may include
information regarding this Agreement and/or Grant, the amount and purpose of the Grant and
photographs, logo or trademark, and other published/printed information or materials (provided by
Grantee) and its activities, in the Colorado Health Foundation's periodic public reports, newsletters,
Web -site and news releases.
10. Colorado Charitable Solicitations Act
Grantee represents that it is aware of and in compliance with the Colorado Charitable Solicitations
Act governing fundraising in Colorado.
11. Right to Modify or Revoke
The Colorado Health Foundation reserves the right to discontinue, modify or withhold any payments
to be made under this Agreement or to require a total or partial refund of any Grant funds if, in the
Colorado Health.Foundation's sole judgment , such action is necessary or prudent: (1) because the
Grantee has not fully complied with the terms and conditions of this Agreement; (2) to protect the
purpose and objectives of this Agreement or any other charitable interest of the Colorado Health
Foundation; or (3) to comply with the requirements of any law or regulation applicable to Grantee,
the Colorado Health Foundation, or this Grant.
12. Termination
The Colorado Health Foundation's obligations under this Agreement shall automatically terminate in
the event of the insolvency, receivership, bankruptcy filing, or dissolution of Grantee.
In addition to its right of revocation under Paragraph 11 above, the Colorado Health Foundation may
terminate this Agreement at any time by giving Grantee at least 30 days of written notice. Upon
termination of this agreement for any reason, all payments by the Colorado Health Foundation to
Grantee shall cease at such time as may be determined by the Colorado Health Foundation.
Grant ID #4587 - 5 -
Termination or revocation of this Agreement by the Colorado Health Foundation will not terminate
Grantee's obligations under this Agreement with respect to Grant funds expended or otherwise not
returned to the Colorado Health Foundation. Grantee's obligations under Paragraphs 5, 7, 9 and 16
shall also survive termination of this Agreement.
13. Special Conditions and Reporting
Grantee will submit reports to the Colorado Health Foundation according to the reporting schedule
set forth on page one of this Agreement.
14. Amendment
This Agreement may be amended, supplemented or extended only by written agreement signed by
the Colorado Health Foundation and Grantee.
15. No Partnership Agency or Third Part Beneficiaries
Nothing contained in this Agreement shall create or be deemed to create a partnership or agency
between the Colorado Health Foundation and Grantee and nothing contained in this Agreement shall
be deemed to give rise to any rights or benefits to third parties not a party to this Agreement.
16. Intellectual Property
(a) Grantee represents and warrants that it owns or has the right to use all intellectual property that
will be employed by Grantee or its agents in the performance of this Agreement, including without
limitation, Grantee's obligations under subsection (c) below.
(b) All works and matters created or discovered through the performance of this Agreement,
including but not limited to, implementation methodologies, best practices guides and training
curricula (the "Work "), are owned by the Grantee provided, however, that the Work may be used by
Grantee only to fulfill its charitable mission (i.e., activities recognized by the IRS as charitable and
not resulting in "unrelated business taxable income" as defined in Section 512 of the Code), unless
otherwise agreed in writing by The Colorado Health Foundation.
(c) Grantee hereby grants to The Colorado Health Foundation a nonexclusive, irrevocable, perpetual,
worldwide, fully transferable, royalty -free license to (i) the Work, to make, use, sell, license to
others, reproduce, create derivative works of, publish, republish, distribute, perform and display the
Work in any current or future form and for any purpose in furtherance of its charitable mission, and
(ii) any other intellectual property incorporated into or used in connection with the Work to the
• extent reasonably necessary to enable The Colorado Health Foundation to use and practice the
licensed Work. The license herein granted to The Colorado Health Foundation shall vest without any
further action on the part of Grantee. Without the prior written consent of The Colorado Health
Foundation, Grantee will not enter into any agreement with a third party that would restrict Grantee's
ability to perform its obligations under this subsection (c).
17. Disclaimer
Grant ID #4587 - 6 -
Nothing contained herein, including the required reporting and review procedures, shall be construed
as a warranty, representation, or approval by the Colorado Health Foundation that the services
rendered by Grantee are adequately or properly rendered on either an individual or program -wide
basis. Grantee shall have sole responsibility for all damages, costs, fines, attorneys' fees, or
liabilities of any kind or nature arising from any claims, demands or suits resulting from the
Grantee's performance or failure to perform under this Agreement.
18. Controlling Document
The terms and conditions of this Agreement shall be the controlling document between the Colorado
Health Foundation and Grantee. All verbal communication, notes, minutes or other documentation
of the Colorado Health Foundation shall be deemed merged into this Agreement. In making this
Grant, the Colorado Health Foundation has relied on the information and representations submitted
to the Colorado Health Foundation by Grantee and Grantee represents that all such information and
representations are true and complete.
19. Future Funding
Grantee acknowledges that, except as expressly provided in this Agreement, the Colorado Health
Foundation has no obligation to Grantee with respect to any additional or future funding.
Kelly Dunkin Date
Vice President, Philanthropy
The Colorado Health Foundation
The undersigned certify that they are duly authorized officers of Grantee and, as such, are authorized to
accept this contract on behalf of Grantee, to obligate the Grantee to observe all of the terms and conditions
placed on this Agreement, and in connection with this Agreement to make, execute, and deliver on behalf of
the Grantee all agreements, representations, receipts, reports, and other instruments of every kind.
.ACCEPTED AND AGREED TO:
CEO /Executive *' ; sr of Eagle County Health and Human Services (typed /printed name)
CEO/Executive Director (signature) Date
Grant ID #4587 _
•
COUNTY OF EAGLE, STATE OF
COLORADO, By and Through Its
ATTEST: BOARD OF COUNTY COMMISSIONERS ' Z
� ��� _ 4.w- t * B �/
•t he B A�• rd o r o
County Commissioners : Peter F. Runyon -�
of °R� Chairman
Organization Name: Eagle County Health and Human Services
Project Title: Eagle County Increased Enrollment in Medicaid and Child Health Plan Plus (CHP +)
Request ID: 4587
Proposal Expenses Approved Budget
Year 1 Year 2 Year 3 Total
Direct Costs
Personnel $ 46,800.00 $ 46,800.00
Benefits and Taxes $ 3,710.00 _.- $ 3,710.00
Total Personnel + Benefits $ 50,510.00 $ - $ - $ 50,510.00
Pro•ram Services $ 25,760.00 $ 25,760.00
Administrative /O•eratin• $ 1,000.00 - $ 1,000.00
Travel /Milea•e $ 3,000.00 $ 3,000.00
Conferences /Meetin.s $ 500.00 $ 500.00
Trainin• $ 730.00 $ 730.00
Fund Develo•ment/Marketin• $ 200.00 $ 200.00
Other - , $ -
Total Direct Costs $ 81,700.00 $ - $ - $ 81,700.00
Indirect Cost % Max 10%
Total Indirect Costs $ - $ - $ - $ -
Direct + Indirect Costs $ 81,700.00 $ - $ - $ 81,700.00
Other Costs
Consultants /Subcontracts $ 4,300.00 $ 4,300.00
E.ui•ment $ -
Fiscal S•onsor's Fee (If applicable) ■ -- $ -
Other ,- $ -
Total Other Costs $ 4,300.00 $ - $ - $ 4,300.00
GRAND TOTAL $ 86,000.00 $ - $ - $ 86,000.00
The • r •' —
Credit /Debit.Authorization Form
The Colorado Health Foundation now otters Electronic Payment via ACHl if you would like
to receive future payments electronically, please complete the information below and
return this fora: by mail or fax to:
The Colorado Health Foundation - Attn: Jessica McCane
501 S Cherry St, Ste 1100 - Denver, CO 80246
Tel: 303- 953 -3697 - Fax: 303 - 322 -4576
•
I (we) hereby authorize The Colorado Health Foundation (TCHF) to initiate entries to my
(our) checking /savings accounts at the financial.institu ion listed below (THE FINANCIAL
INSTITUTION), and, if necessary, initiate adjustments for any transactions credited/
debited in error. This authority will remain in effect until TCHF is notified by me (us) in
writing to cancel it in such time as to afford TCHF and THE FINANCIAL INSTITUTION a
reasonable opportunity to act on it. •
•
Name of Financial institution: •
Address of Financial Institution - Branch, City, State, & Zip:
• Authorized Signature: • Date:
• Name of Authorized Signer:
Business Name:
Address: •
•
Payment Notification Required: Yes ❑ No 0
Payment Contact:
•
Email Address:
Is this a checking account? ❑ Savings account?
Financial Institution Routing Number:
•
Checking /Savings Account Number:
Please note that e routing r ,
roar > -�.r., roi.�mcd ,.urr.�er may differ from; our r:CH routing number. Please
provide the numbers that appear on the bottom of your check as follows:
23 1 2 3 5: ? S O E 3 •
Routing Number Account Number
The Colorado Health Foundation"
•
MEMORANDUM
To: The Colorado Health Foundation Grantees
From: Chuck Reyman, Vice President of Communications
Suzanne Beranek, Director of Communications: Policy and Philanthropy
Subject: Your New Grant and a Communications Partnership
Congratulations on securing funding from the Colorado Health Foundation to support your work to help
make Colorado the healthiest state in the nation. As we begin this important partnership, we encourage
you to work with us to maximize the impact of your work through effective communications.
Getting the Word Out
It is important to inform your constituents about your new grant through appropriate communication
channels such as a news release to your local media and email to your key stakeholders. As you do, .
please let us know in advance so that together we can ensure that our respective organizations and our
relationship with you are represented accurately. Please let us know when you successfully place
community news in your Chamber of Commerce newsletter, community bulletin, newspaper or elsewhere
so that we can help share the news of your good work. Your primary communications point of contact at
the Foundation is Suzanne Beranek at 303.953.3668 or sberanek aaColoradoHealth.orq.
Additionally, if your organization supports other groups or projects with funding from the Colorado Health
Foundation, please encourage your grantees to reference the Colorado Health Foundation's support,
where appropriate, in their communications.
When a reporter asks questions about the Colorado Health Foundation that are outside the scope of your
specific grant and corresponding project, please refer that reporter to Suzanne at 303.953.3668 or
sberanekCa?ColoradoHealth.org.
Using Social Media
The Colorado Health Foundation is actively engaged in social media. Our Twitter handle is
@ColoradoHealth, and our Facebook address is Facebook.com /coloradohealth. If your organization is
active in social media, please send us your Facebook address and Twitter handle so that we can connect
with you and follow your efforts online. If your organization is interested in exploring the possibilities that
social media may offer, look for upcoming announcements from the Colorado Health Foundation.
Referencing the Foundation
The department of Communications at the Colorado Health Foundation is happy to answer any general
communications questions you may have and direct you to information resources on how to leverage
media and other communication channels. In the meantime, were happy to provide these general tips
and style guidelines to use when referencing the Foundation in any traditional or social media:
• Please refer to us as the "Colorado Health Foundation," with a lowercase "the" unless the name
begins a sentence or stand alone. Please do not use an acronym in a second reference; instead,
refer to us as "the Foundation."
• Please contact Samantha Travelstead at stravelstead (acoloradohealth.orq for a copy of our
logo. In your e-mail, please indicate how you plan to use the logo — in print, broadcast or
electronic form — so we may send the correct format.
TEL: FAX: www.CoioradoHealth.org
va
T Vii(' Colorado 1 lealtr2 1 oundauori
Colorado KaleidosCOpe: Stories of a State's Health
Fact Sheet
Everyone loves a good story. Yet this simple truth only scratches the surface of the importance of
storytelling. Good storytelling teaches, informs and, most importantly, inspires and engages. We
know, too, that compelling stories from our grantees and the people they serve are playing out
daily throughout Colorado.
We think we've found an effective way to capture and tell inspiring stories of Colorado's health. We
invite you, our grantee partner, to submit your stories to us in video or narrative form as part of our
statewide storytelling campaign called "Colorado KaleidosCOpe: Stories of a State's Health." We'll
select, produce and post the best stories on a new Colorado KaleidosCOpe website and reward
each published grantee organization with a general operating grant of $5,000 per video and $1,000
per written narrative. In addition, the stories we post on the Colorado KaleidosCOpe website will
have the potential to be viewed by thousands of visitors to the Colorado Health Foundation website
every month. Along with Coloradans interested in good health, those visitors include influential
policymakers as well as business and community leaders.
To drive the ongoing effectiveness of this effort, we're looking for "street - level," "real -life" stories
about the people who benefit from the work you're doing in your communities.
In addition to spreading the word about important health issues our communities face every day,
there are many benefits to participating in Colorado KaleidosCOpe:
• If your story is chosen, your organization will receive a $5,000 general operating grant per
video and $1,000 per written narrative (we encourage you to submit photographs with
written narratives).
• Selected video stories will be professionally produced by the award - winning videographers
at Chance Multimedia.
• Your work will be highlighted on the Colorado KaleidosCOpe website and through well-
established Colorado Health Foundation communication channels such as traditional and
social media.
• You can hone your storytelling skills by participating in a KaleidosCOpe webinar on June 27
with Chance Multimedia, which will provide expertise about best practices and technical
advice for video, photo and narrative forms. You'll learn that you don't have to be a
professional videographer, photographer or writer to tell compelling stories, as this
storytelling example from Chance illustrates.
• Whether chosen or not, you can repurpose the stories you develop through your own
channels, such as your website, pitches to the media and social media.
Submissions to KaleidosCOpe can be made on an ongoing basis and chosen pieces will be
subsequently granted awards as outlined above. When submitted, grantees will be responsible for
all signed release forms, available in both English and Spanish on the KaleidosCOpe website.
For more information on the Colorado KaleidosCOpe campaign, please visit the Foundation
website and the KaleidosCOpe page.
TEL: >:!: FAX. 0 www.ColoradoHeaith.org
