Baptist Health Strategic Investment Letter of Inquiry

Please notify Lynn Sherman at lynn.sherman@bmcjax.com when you submit. Allow 10 days to receive a response. Consideration is based upon alignment with Baptist Health's mission and strategic priorities.

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1. Organization

Legal Name

Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

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2. Tax ID #

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3. Website Address

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4. President or Chief Executive Officer

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5. Briefly describe your organization's mission.

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6. Contact Person

Name

Email Address

Phone Number

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7. Name of Program/Initiative

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8. What is the problem or need addressed by program/initiative?

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9. Who is the targeted population for your program/initiative? (Character limit 2,000)

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10. What services are provided by the program/initiative?

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11. Amount requested

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12. List other funding sources including the amounts.

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13. What is the length of time your organization has implemented this program?

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14. Indicate the prioritized population health need the program/initiative will address. (Please check all that apply.)

Baptist Health Priority: All children in Northeast Florida have health care

Baptist Health Priority: Adults living in need have access to quality health care

Baptist Health Priority: Elderly people live independent, fulfilling lives

Community Health Need Priority: Access to Care (physical and mental)

Community Health Need Priority: Behavioral Health

Community Health Need Priority: Health Inequities

Community Health Need Priority: Senior Health

Community Health Need Priority: Social Determinants of Health

Mental Health

For questions, contact Lynn Sherman at lynn.sherman@bmcjax.com or (904) 202-5112