The Quincy Medical Group Foundation provides funding to organizations that directly impact the communities we serve through three categories:

Health Initiatives – Programs, projects, and initiatives that improve the overall health of the community
Community Development (bricks and mortar projects/new programs) – Construction-based projects or new programs that require start-up funds to lift the project off the ground
Youth Programs and Partnerships – Support community organizations that target youth development, health, and well-being

Eligibility Criteria – Foundation Giving Guidelines

Funds are awarded to non-profit organizations that have tax-exempt status under Section 501(c)3 of the IRS code or government exclusion, Schools [IRS section 170 (b) (1) (ii)], an churches [IRS section 170 (b) (1) (A) (I)]

The QMG Healthcare Foundation prefers to fund projects, programs, or improvements needed for organizations that are specific to a cause. Applications to support annual fundraising drives are discouraged.

Funding Application

Is your organization a government unit or a public charity that is non-profit and tax-exempt under 501 (c)(3) of the IRS Code?*
If applicable, please attach a copy of your IRS exempt determination letter.
Max. file size: 500 MB.
Have you ever received funding from the QMG Healthcare Foundation?*
If you answered yes to the above question, for what program or project?
Name of your Organization/Program*
Address of Your Organization*
Street Address City State ZIP Code
Name of Individual Completing Application*
First Last
Phone
Email
Brief overview of your mission and organization/program*
Which one of the Foundation focus areas are you applying for funding for?*
- Youth Partnerships & Programs
- Health
- Community Development
Dollar amount of funds being requested*
Intended use of funds*
Please attach any copies of bids, invoices, price quotes, or project financial statements or budgets to show how funds will be utilized
Accepted file types: jpg, gif, pdf, doc, docx, Max. file size: 500 MB.
What is the proposed time frame for using this funding?*
How many people will benefit from the project and what age group is being targeted?*
What geographic location will this project or program impact?*
Is this a pilot program? If not, please explain how it was previously funded*
How do you plan to maintain this project/program following initial QMG Healthcare Foundation Funding?*
How would only partial funding from the Foundation impact your ability to provide this project, program or meet general support needs?*
How will your organization contribute to this project?*
Is there the possibility of alternative funding for this specific request? If so, from what sources and in what amounts?*
Do you agree to file a QMG Healthcare Foundation funding report setting forth the expenditure of the funding money, when it was expended, to who it was paid, and the benefits received from the funds?*
Signed*
Today's Date*
MM slash DD slash YYYY

Foundation Organization Funding Report

Funds must be expended within one year of check date. Organizations will not be eligible to receive future funding if the Funding Report is not submitted to the Quincy Medical Group Foundation. Incomplete reports will prohibit consideration of further donations.

Organization Funding Report

Organization Name*
Organization's Address*
Street Address Address Line 2 City State ZIP Code
Contact Person*
Contact's Phone*
Contact's Email*
Report Completed By:

Only if report was completed by someone other than the contact person listed above.
Phone:
Only if report was completed by someone other than the contact person listed above.
Email

Only if report was completed by someone other than the contact person listed above.
Funds were given for*
Please describe how funds were used*
What region/geographical area is/was impacted by the project/program? (i.e. county, city, state, etc.)*
Number of people directly served/impacted by this program/project*
Age(s) served by these funds*
Gender(s) served by these funds*
What was the overall impact of the program/project to the community?*
Provide a financial statement that details the accounting for the funds received.*
Max. file size: 25 MB.
• Where necessary, provide a brief description or justification of line items.
• Only include costs and other income directly attributed to the project or program.
Attach copies of invoices if funding was for purchase of items
Max. file size: 500 MB.
(i.e. educational brochures, equipment, construction, etc.)

(Age 6 months and older)

(Age 6 months and older)

Apply for Funds

Eligibility Criteria – Foundation Giving Guidelines

Funding Application

Organization Funding Report