8/3/2019 Gift Matching Program Application and Guidelines July 2009

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Questions, please contact:

303-344-7879

Community & Local GovernmentRelations

Attn: Gift Matching CoordinatorKP Regional Offices

10350 E. Dakota Ave.Denver, CO 80247

(303)-344-7879

Gif t Mat ch ing ProgramKaiser Permanente

Never doubt that a small group of

thoughtful, committed citizens canchange the world. Indeed, it is the

only thing that ever has

-Margaret Mead

Kaiser Permanente Colorados Gift

Matching Program was established to

support our organizations commitment

to building stronger, healthier

communities. We are proud of the

contributions that our staff andphysicians make to support our

community. KP Colorados Gift

Matching Program provides an

opportunity for employees and physicians

to increase the value of their

contributions to eligible organizations by

matching their charitable efforts.

Employees and physicians submitting anapplication for gift matching will be notifiedby letter when a donation has been matched.Additionally, the non-profit organization willreceive a letter with the gift matching checkindicating who made the matching donationpossible.

8/3/2019 Gift Matching Program Application and Guidelines July 2009

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Gift Matching Application

Name

Department. Location

Work Phone

I request that Kaiser Permanente match mypersonal donation of $ ($25-$100)Please provide proof of personal donation: a dated,

signed receipt or both sides of your cancelled check.

Receiving Organization

Contact Person

Address of Organization

Phone

Service provided by organization

I certify that all the above information is correct andthat my donation complies with all provisions of theGift Matching Program.

Employee/Physician Signature Date

Please complete and return the attachedapplication with necessary documentation to:

Kaiser Permanente Regional Offices, 10350 E.Dakota Ave, Denver, CO 80247, Attn: CLGR Gift

Matching Coordinator.

How does it work?

Kaiser Permanente will match staff andphysician cash donations greater than $25 andup to $100. Grants will be awarded to eligibleinstitutions on a first-come, first-served basisuntil the annual allocation has been dispersed.Grants are limited to one per individual peryear and may not be split among more thanone agency.

Eligible Individuals

All regular, full-time Kaiser Permanenteemployees and physicians are eligible.

Qualifying Organizations

All non-profit 501(c) 3 tax-exempt charitable

organizations that provide service in theDenver/Boulder/Longmont/Colorado Springsarea are eligible to receive a grant.

Ineligible Donations

Donations not eligible for gift matchinginclude those to United Way, KaiserPermanentes KP Helps Charitable Fund, gifts

for religious obligations (tithes), bequests,gifts to non-scholastic programs (e.g.,athletics) and gifts that result in a providedproduct or service.

Ineligible Organizations

Ineligible organizations include political,religious and fraternal organizations,individuals or organizations that pose aconflict of interest to Kaiser Permanente andorganizations outside of Kaiser Permanentesservice area. The program was not designed,nor does it have the funding, to match pledgessolicited by an employee running, walking orbiking in fundraising races.KaiserPermanente will match only the participatingemployees gift in a fundraising eventconsistent with the guidelines described in this

policy. Final determination of eligibility willbe made by the gift matching coordinator.