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BackgroundExcellus BlueCross BlueShield has been serving residents of upstate New York for more than 75 years. Throughout those years, the company has supported hundreds of programs aimed at improving the health status of area residents.
Excellus BlueCross BlueShield makes Community Health Awards available to support the financial needs of health and wellness programs within the 31 counties of upstate New York.
Through a competitive application process, the awards provide financial support of up to $4,000 each to 501(c)(3) nonprofit groups that have set clear goals to improve the health or health care of a specific population in the community.
The company’s Community Health Awards demonstrate a corporate commitment to support local organizations that share its mission of improving the health and health care of the residents of the communities it serves.
Focus of AwardsAwards are intended to focus on:
n Activities to improve the health status of the community or to reduce the incidence of specific diseases
n Communitywide health education
n Group-specific health education
n Wellness
Excellus BlueCross BlueShield will not fund grants to support programs involving political or government activities, endowments, capital campaigns or individual scholarships.
Region of EligibilityTo be eligible, the organization must be a 501(c)(3) nonprofit located in the 31 counties of upstate New York and primarily serve a population within one or more of the listed counties. The 31 counties include: Broome, Cayuga, Chemung, Chenango, Clinton, Cortland, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Oneida, Onondaga, Ontario, Otsego, Oswego, Schuyler, Seneca, Steuben, St. Lawrence, Tioga, Tompkins, Wayne and Yates.
National strength. Local focus. Individual care.SM
COMMUNITY HEALTH AWARDS
SMART FormatSpecific: Describes desired outcome in behavioral terms. What task(s) will be accomplished if the goal is achieved? Avoid being general.
Measurable: Results must be measurable. Different degrees of achievement can be measured in terms of cost, quality, quantity and timeliness.
Achievable: Can the goals be achieved in a timely manner with resources available?
Relevant: Is the activity or goal absolutely necessary to reach the overall goal?
Time Bound: Sets a definite and realistic date by which the goal must be achieved.
Submit Application To:Central New York region (Cayuga, Cortland, Jefferson, Lewis, Onondaga, Oswego, St. Lawrence and Tompkins counties): Email application to [email protected]
Rochester region (Livingston, Monroe, Ontario, Seneca, Wayne and Yates counties): Email application to [email protected]
Southern Tier region (Broome, Chemung, Chenango, Schuyler, Steuben and Tioga counties): Email application to [email protected]
Utica region (Clinton, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Madison, Montgomery, Oneida and Otsego counties): Email application to [email protected]
Applications must be received by February 9, 2015. Awards will be distributed in March 2015. Applications received after the due date will be disqualified and discarded. Submissions become the property of Excellus BlueCross BlueShield and will not be returned.
For Additional Information, Email:Central New York region: [email protected]; Rochester region: Community.Health.Awards. [email protected]; Southern Tier region: [email protected]; Utica region: [email protected]
CriteriaAwards will be made based on:
n Scope of need
n Goals of program
n Overall number of persons to benefit from the program
n Positive impact on the community’s health status
Requirementsn Programs must promote a safe and healthy lifestyle
n They must fund direct services, not staff salaries or benefits
n Programs must begin within 12 months of the date the award is delivered
n Applications must be signed by an officer or administrator of the applying organization
n Applications must be written in SMART format (please see below)
Organization name:
Address:
City: County: State: ZIP code:
Contact Person: Title:
Phone: Fax:
Email:
Is this organization a 501(c)(3) nonprofit? Yes No
What is the organization’s misson?
Amount requested (awards range up to $4,000):
Does this organization offer health insurance coverage to employees?
If so, which health insurance carrier do you offer? __________________________________________________
Title & description of program:
Explain how funds will be spent:
Other funding sources:
Number of persons to be served in program:
Geographical area to be served:
Goals of program (must be written in SMART format explained on page 2):
How will the outcomes of activities be measured:
Describe how you will promote your project and Excellus BlueCross BlueShield’s involvement (including social media activities):
Signature of Administrator or Board Officer Required.
Print or type name: Title:
Signature: Date:
You may attach additional pages.
9098-15 CC Blue Region
