2019 Impact Report - Baptist Health Strategic Investment

Please complete and return by October 31st.

Question Title

* 1. General Information:

Organization

Name of Person Submitting Report

Title

Email Address

Phone Number

Question Title

* 2. Program Name:

Question Title

* 3. Program Start and Finish Dates:

Question Title

* 4. Amount funded by Baptist Health:

Question Title

* 5. Purpose of funding:

Question Title

* 6. Have you had any changes in your organizational leadership since this investment was awarded or do you anticipate any changes? If yes, please explain:

Question Title

* 7. Have there been any changes to your organization’s IRS 501(c) (3) nonprofit status since you were awarded this funding? If yes, please explain:

Question Title

* 8. What date was your organization's executive leadership succession plan approved by your board of directors?

Question Title

* 9. Please attach the succession plan here.

PDF, DOCX, DOC file types only.

Question Title

* 10. I certify information in this report is true and accurate. Typed name indicates signature.