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Home My WebLink AboutCHCW KCHn Fiscal Sponsorship Agreement (2)Today's Date 02/28/2017 Fund/Department 116 -Public Health ' lj Kittitas County � Review Form �-- fl Grants & Contract Agreement Agenda Date Contract/Grant Information Contract /Grant Agency: CHCW KCHN Fiscal sponsorship Agreement Period Begin Date: 02/01/2017 Period End Date: 06/30/2017 Total Grant/Contract Amount: $1000.00 Grant/Contract Number: Contract/Grant Summary: The Fiscal Sponsorship Agreement between Community Health of Central Washington and Kittitas County Health Network Steering Committee: Central Washington University, City of Ellensburg, HopeSource, Kittitas County Public Health Department, Kittitas Valley Fire and Rescue, and Southeast Washington Aging And Long Term Care. The Sponsor Board of Directors has approved the establishment of a restricted fund to receive donations of cash from the Committee designated for support of the project known as the Kittitas County Health Network and to make disbursements to Deborah Gauck Consulting n the furtherance of the Project's purpose to improve population health through cross -sector collaboration and systems integration. Recommendation for Board of Health and Board of Health Review on Department Head Signature: , Administrator Date: Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: APPROVED AS TO FORM: Signature of Prosecutor's Office Date Signature of Auditor's Office Date Signature of Board of Health member Date Grant/Contract Review Page 1 Financial Information Total Amount $1000.00 State Funds $1000.00 Federal Funds $ Percentage County Funds Matching Funds $ CFDA# In -Kind $ Explain Is Equipment being purchased? Who owns equipment? New Personnel being hired? Contact HR hiring — reporting requirements Future impacts or liability to Kittitas County: Budget Information Budget Amendment Needed? Yes ❑ attach budget form New Division Created? Revenue Code 116-612.91.54902 —1000.00 (paid from 612.91.334.06.902) Pass Through Information Agency to Pass Through Amount to Pass Through $ Sub -Contract Approved Date: No ❑ Why not Prosecutor Review Has the Prosecutor reviewed this agreement? Yes 0 No County Departments Impacted Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted Signature: Date: Department: Assignment of Tracking Intormation Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Grant/Contract Review Page 2 Reviewer I Date Grant/Contract Review Page 3 FISCAL SPONSORSHIP AGREEMENT This Fiscal Sponsorship Agreement ("Agreement") is made by and between Community Health of Central Washington ("Sponsor") and the following members the Kittitas County Health Network Steering Committee ("Committee"): Central Washington University, City of Ellensburg, HopeSource, Kittitas County Public Health Department, Kittitas Valley Fire and Rescue, and Southeast Washington Aging and Long Term Care. Sponsor is a Washington nonprofit corporation located in Yakima, Washington, qualified as exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code ("IRC"). The Committee is an unincorporated nonprofit association established to oversee the affairs of the Project described below. RF.C:ITAI Ns A. The Sponsor Board of Directors has approved the establishment of a restricted fund to receive donations of cash ("contributions") from the Committee designated for support of the project known as the Kittitas County Health Network (the "Project") and to make disbursements to Deborah Gauck Consulting ("Contractor") in furtherance of the Project's purpose to improve population health through cross -sector collaboration and systems integration. B. Sponsor desires to act as the fiscal sponsor of the Project, by receiving contributions identified for the purposes of the Project from the Committee and using them to pursue those purposes, which Sponsor's Board has determined will further Sponsor's health care goals. The Committee desires to oversee the Project on behalf of Sponsor. NOW, THEREFORE, THE PARTIES HEREBY AGREE AS FOLLOWS: 1. Restricted Fund. Beginning on February 1, 2017, each Committee member shall contribute $1,000 to Sponsor for the purposes of the Project. Sponsor shall place all contributions received by Sponsor from the Committee into a restricted fund to,be used for the sole benefit of the Project's purpose. Neither party shall spend or otherwise obligate Sponsor to pay for an amount or amounts exceeding the balance in the restricted fund, nor shall either party authorize or permit anyone to do so. 2. Performance of Project Purpose. All of the contributions received by Sponsor from the Committee under the terms of this Agreement shall be devoted to the purpose of the Project, within the tax- exempt purposes of Sponsor. 3. Termination. This Agreement shall terminate on June 30, 2017. The balance of assets in Sponsor's restricted fund for the Project shall be transferred to another nonprofit organization that is tax-exempt under IRC Section 501(c)(3) and is willing and able to sponsor the Project ("Successor") at the end of the notice period or any extension thereof, subject to the approval of any third parties that may be required. If no Successor is found within a reasonable time, Sponsor may dispose of the Project assets in any manner consistent with applicable tax laws. Either party may terminate this Agreement, based upon a material breach of this Agreement by the other party, by giving ten (10) days' written notice to the other party, and any Project assets shall be disposed of at the end of the notice period in a manner consistent with the provisions stated above in this Paragraph. 4. Miscellaneous. In the event of any controversy, claim, or dispute between the parties arising out of or related to this Agreement, or the alleged breach thereof, the prevailing party shall, in addition to any other relief, be entitled to recover its reasonable attorneys' fees and costs of sustaining its position. Each provision of this Agreement shall be separately enforceable, and the invalidity of one provision shall not affect the validity or enforceability of any other provision. This Agreement shall CHCW KCHN Fiscal Sponsorship Agreement be interpreted and construed in accordance with the laws of the State of Washington applicable to contracts to be performed entirely within such State. Time is of the essence of this Agreement and of each and every provision hereof. The failure of Sponsor to exercise any of its rights under this Agreement shall not be deemed a waiver of such rights. 5. Entire Agreement. This Agreement constitutes the only agreement, and supersedes all prior agreements and understandings, both written and oral, among the parties with respect to the subject matter hereof. All Exhibits hereto are a material part of this Agreement and are incorporated by reference. This Agreement, including any Exhibits hereto, may not be amended or modified, except in a writing signed by all parties to this Agreement. IN WITNESS WHEREOF, the parties have executed this Fiscal Sponsorship Agreement as of the effective date set forth in Paragraph 1 above. \1 11' 11 1'. 1' j ?)1: c'"; 111:11 �\-,%S1 IING ()\' \11 i \k[PIi.. Chi.�t'l.wculhe Offlecr CENTRAL WASHINGTON UNIVERSITY LIM James Gaudino, President Dated: CITY OF ELLENSBURG By: Rich Elliott, Mayor Dated: HOPESOURCE By: _ Susan Grindle, Chief Executive Officer Dated: KITTITAS COUNTY PUBLIC HEALTH DEPARTMENT By: Dated: Robin Read, Administrator KITTITAS VALLEY FIRE AND RESCUE By: Dated: John Sinclair, Chief SOUTHEAST WASHINGTON AGING AND LONG TERM CARE Lori Brown, Director Dated: CHCW KCHN Fiscal Sponsorship Agreement EXHIBIT A SCOPE OF WORK Funding is provided for the following activities and deliverables: 1. Manage the Project. a) Deliverable: By June 30, 2017, the Contractor will have developed monthly Project meeting materials. b) Deliverable: By June 30, 2017, the Contractor will have monitored Project tasks. 2. Facilitate Project meetings. a) Deliverable: By June 30, 2017, the Contractor will have facilitated monthly Project meetings. 3. Recruit additional Project members. a) Deliverable: By June 30, 2017, the Contractor will have developed a community engagement plan. b) Deliverable: By June 30, 2017, the Contractor will have convened the Steering Committee and provided an overview of Network and planning activities. 4. Facilitate Project training. a) Deliverable: By June 30, 2017, the Contractor will have facilitated Pathways Community HUB Model training. b) Deliverable: By June 30, 2017, the Contractor will have facilitated Collective Impact Framework training. 5. Develop Project communication strategies. a) Deliverable: By June 30, 2017, the Contractor will have identified and profiled audiences. b) Deliverable: By June 30, 2017, the Contractor will have developed messages. c) Deliverable: By June 30, 2017, the Contractor will have selected communication channels. d) Deliverable: By June 30, 2017, the Contractor will have chosen activities and materials. 6. Develop Project support/buy-in a) Deliverable: By June 30, 2017, the Contractor will have researched funding strategies. b) Deliverable: By June 30, 2017, the Contractor will have identified potential grant sources. CHCW KCHN Fiscal Sponsorship Agreement EXHIBIT B COMPENSATION 1. As full compensation for satisfactory performance of the work as described herein, Sponsor shall pay Contractor compensation in an amount not to exceed $7,000. The Contractor agrees to: a) Submit invoices to Sponsor within ten (10) days following the last day of the month being invoiced. b) Submit invoices for actual expenses incurred during the billing period. (Sponsor will not pay invoices for an equal monthly amount based on full contract compensation.) c) Provide detail of expenses being billed for. CHCW KCHN Fiscal Sponsorship Agreement