HomeMy WebLinkAboutFiscal Sponsorship AgreementFISCAL 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.
RECITALS
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. Pertomlance of Projec t Purp os e. 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. Terminati on. 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. Ifno 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. M isce ll aneous . 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 perfonned 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 A ement. 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.
Datcd :
CENTRAL WASHINGTON UNIVERSITY
By:
James Gaudino, President
Dated:
Note: CWU decided not to sponsor.
CITY OF ELLENSBURG
By: . ....::> S"
Dated:
HOPESOURCE
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By: ~~===i;:z:~~;;::::==-------
Oatcd :
KITTITAS CO~;.:.....:,-,,-,=
By:
Dated:
o in Real' Administrator f!t ~g { IJ
KITTITAS V ALLEY FIRE AND RESCUE
By: ~~
Dated:
SOUTHEAST WASHINGTON AGING AND LONG TERM CARE
By: ~-~-~cc-----:
Lori Brywn.'blrector
Dated: ~/J.rr UJ I r-_~~_~~ __
CHCW KCHN Fiscal Sponsorship Agreement 2
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 supportlbuy-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 3
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 4
Kittitas County
Review Form
Grants & Contract Agreement I llS
Today's Date
02/28/2017
Fund/Department
116-Public Health
Contract/Grant Information
Agenda Date y
Contract /Grant Agency: CHCW KCHN Fiscal sponsorship Agreement
Period Begin Date: 02/01/2017 I I 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 Signatu ~ jS..:;:Ib -:-Administrator Date :.?[ It! {/7
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPRO ED AS TO FORM:
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 D attach budget form No 0 Why not
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:
Prosecutor Review
I Has the Prosecutor reviewed this agreement? I Yes 0 No 0
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted I Signature:
Department:
I Date:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Grant/Contract Review Page 2
I Reviewer I Date
Grant/Contract Review Page 3