Mini-Grant Application

Joe and Mary Wilson Community Benefit Fund

of Mary Washington Hospital

Stafford Hospital Community Benefit Fund

Mini-Grant Application Guidelines

Introduction:

Mary Washington Hospital (MWH) and Stafford Hospital (SH) Foundations are now accepting mini-grant requests of $1,000–$5,000 from nonprofit organizations.

MWH and SH Mini-Grants will be awarded by Mary Washington Hospital and Stafford Hospital to assist nonprofit organizations which provide services that address the top three areas of focus for the 2022–2025 Community Health Improvement Plan (CHIP) and the Community Needs Assessment (CHA) conducted by Mary Washington Healthcare (MWHC) and the Rappahannock Area Health District (RAHD) as well as the other five health needs determined by the community in the CHA.

The top three priorities of the CHIP, which will also be the highest priorities for mini-grant funding, are:

Access to Healthcare (Enhanced collaboration among community partners, enhanced public transportation, and improved access to behavioral health services for community members.)
Affordable Housing (Development and promotion of policies that ensure equitable housing opportunities for all, including the homeless, and the provision of affordable home ownership opportunities.)
Mental Health (Improved access and collaboration for preventive services for all community members, and development of a comprehensive pipeline strategy to increase the local healthcare workforce.)

The remaining five community health initiatives of the CHA for which mini-grants may also be awarded are:

Chronic Diseases (including heart disease, stroke, hypertension, diabetes, and cancer)
Education (including PreK–12 and post-secondary schooling and training)
Infant and maternal health outcomes in the African American community (including strategies to reduce inequities and disparities)
Obesity (including the causes, treatment, and impact on overall health)
Substance abuse (including causes, addiction and impact of opioid and alcohol abuse)

In addition, mini-grants may be awarded for initiatives that align with and support MWHC’s mission and strategic community health priorities and/or Social Determinants of Health.

Please contact the Grant and Community Benefit Funds Manager at 540.741.1433 if you need assistance.

Policy:

Eligible nonprofit organizations may submit a MWH or SH Mini-Grant application at any time during the year. Requests must be between $1,000 and $5,000.

Recipients are restricted to receiving one grant per calendar year unless approved by the Foundation Office. Grants will be awarded on a continuous basis as applications are received. Funding will be available until December 31 of the designated year, or until funds have been exhausted. Consequently, applicants are advised to plan, as fewer requests can be granted towards the end of the year. All mini grant applications are due in the office by December 10th of each year.

Grantees with current Mary Washington Hospital or Stafford Hospital Community Benefit Fund grants are not eligible to receive a MWH or SH Mini-Grant unless the grant application is in support of a CHIP goal.

Criteria:

Applicant organizations must be classified as tax-exempt by the Internal Revenue Service and provide services to residents within the Mary Washington Hospital and Stafford Hospital primary service areas, which includes the City of Fredericksburg and Stafford, Spotsylvania, Caroline, King George, Westmoreland, eastern Orange, and southern Prince William counties.

The decision of which Foundation will review your grant application will be determined by the areas served by the grant.

Restrictions

MWH and SH Mini-Grants will not be made for the following purposes:

Events or programs which are exclusive
Reduction of organization deficit or debt
Capital building expenses
Fundraising events
Lobbying
Individual stipends

Submitting an Application

All applicants are required to submit an online Mini-Grant Application. The application must include a completed application with the requested signature. Applications lacking the correct signature will not be considered.

Applicants must complete each section of the application fully, describing well-defined services and/or programs that are consistent with the mission of Mary Washington Hospital, Stafford Hospital, and the funding priorities of Mary Washington Healthcare.

Applications will be processed within a reasonable timeframe based on the date the request is received at the Mary Washington Healthcare Foundations Administration Office and the implementation date for the proposed project. Applicants will be notified via electronic mail regarding the final determination.

For all approved Mini-Grant Applications, a Letter of Agreement must be signed by the applicant organization and received at the Foundations Administration Office prior to release of the designated funds.

The organization receiving a MWH or SH Foundation Mini-Grant must provide a progress report within three months after receiving the grant (as stipulated in the Letter of Agreement) describing the following in a narrative format:

The extent to which the organization has met performance objectives.
How the organization delivered services and programs to the target population.
Community commitment and support for the organization and the project.
Evidence of the project’s impact on the community.
Detailed budget reconciliation.

If you have any questions or need assistance, please contact the MWHC Grant and Community Benefit Funds Manager at 540.741.1433.

Agency Name*

Federal Identification Number*

Program Title*

Area(s) of Focus*

Access to HealthcareAffordable HousingMental HealthOther areas (please identify)

Contact Person*

First NameLast Name

Title*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email address*

example@example.com

Phone Number*

Please enter a valid phone number.

Phone extension

Fax Number

Please enter a valid phone number.

Amount of Request*

Service Area(s) - Please select all that apply*

Is your organization an IRS 501 (c)(3) tax-exempt entity?*

YesNo

If not a 501(c)(3), please provide the IRS Code Section tax-exempt status

What is the organization’s founding date and mission statement? What are the services and programs provided by the organization? Provide a description of the target population to be served, the approximate number of people to be served, and the geographical area to be served. (175 word limit)*

0/175

Give an explanation of the problem or community need that will be addressed. What are your performance objectives? Provide a description of the activities that will happen in order to reach the objectives. How will you evaluate effectiveness? What is the time frame for activities? (175 word limit)*

0/175

What is the budget for this project? Specifically, how will the requested funds be spent? How much funding or in-kind support will be obtained from other sources? Please attach an itemization of the budget and provide the names and amounts for each funding source. (175 word limit)*

0/175

If the grant will address a healthcare inequity or will serve underrepresented populations, please indicate any here and describe how they will be addressed and measure. (175 word limit)*

0/175

Please certify that the following information is on file at your agency. The attachments are not required with the application submission. However, if requested at a later date, copies must be provided before a grant payment is made.*

	Yes	No
Audited Financial Statement for the past year and/or current IRS form (990)
A list of the organization’s current governing board.
The organization’s current annual budget as approved by its board.
Minutes of Board of Directors meetings for the last six months.

Please do not submit attachments that are not listed in the guidelines (e.g. -videos, newsletters, flyers, etc.).

Using the upload fields below, please attach one (1) copy of the organization’s IRS Letter of Determination and one (1) completed and signed copy of the organization’s W-9 form which must be attached to your application, or the request will not be considered. Incomplete applications will not be accepted.

IRS Letter of Determination*

Completed and signed W-9 form*

If another organization will act as the responsible fiscal agent for any funds received from the mini-grant and will comply with applicable tax laws, regulations and policies, please indicate the name below and provide that organization’s IRS Letter of Determination and a current signed copy of its W-9 using the upload fields.

Executive Director signature

Executive Director Name

First NameLast Name

To complete your application, the application also needs to be signed by the chair of the board of directors of your organization. Please provide the name and email address of the board chair below, and we will email them a copy of your application to sign.

Board Chair

First Name* Last Name*

Email*

Please verify that you are human*