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 and physicians 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.

Gift Matching Program

Kaiser Permanente
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has -Margaret Mead

Questions, please contact: 303-344-7879 Community & Local Government Relations Attn: Gift Matching Coordinator KP Regional Offices 10350 E. Dakota Ave. Denver, CO 80247 (303)-344-7879

Employees and physicians submitting an application for gift matching will be notified by letter when a donation has been matched. Additionally, the non-profit organization will receive a letter with the gift matching check indicating who made the matching donation possible.

Gift Matching Application

Name

Department.

Location

Work Phone

I request that Kaiser Permanente match my personal 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

How does it work? Kaiser Permanente will match staff and physician cash donations greater than $25 and up to $100. Grants will be awarded to eligible institutions on a first-come, first-served basis until the annual allocation has been dispersed. Grants are limited to one per individual per year and may not be split among more than one agency. Eligible Individuals All regular, full-time Kaiser Permanente employees and physicians are eligible. Qualifying Organizations All non-profit 501(c) 3 tax-exempt charitable organizations that provide service in the Denver/Boulder/Longmont/Colorado Springs area are eligible to receive a grant. Ineligible Donations Donations not eligible for gift matching include those to United Way, Kaiser Permanentes KP Helps Charitable Fund, gifts for religious obligations (tithes), bequests, gifts to non-scholastic programs (e.g., athletics) and gifts that result in a provided product or service.

Address of Organization

Phone

Ineligible Organizations Ineligible organizations include political, religious and fraternal organizations, individuals or organizations that pose a conflict of interest to Kaiser Permanente and organizations outside of Kaiser Permanentes service area. The program was not designed, nor does it have the funding, to match pledges solicited by an employee running, walking or biking in fundraising races. Kaiser Permanente will match only the participating employees gift in a fundraising event consistent with the guidelines described in this policy. Final determination of eligibility will be made by the gift matching coordinator.

Service provided by organization I certify that all the above information is correct and that my donation complies with all provisions of the Gift Matching Program.

Employee/Physician Signature

Date

Please complete and return the attached application with necessary documentation to: Kaiser Permanente Regional Offices, 10350 E. Dakota Ave, Denver, CO 80247, Attn: CLGR Gift Matching Coordinator.