S - Grant - Blue Cross and Blue Shield of North Carolina Foundation Grant Agreement

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A. Funding Terms. Funding by the BCBSNC Foundation is guaranteed for one time only. The BCBSNC Foundation has no obligation to provide any other funding or support to the Grantee. Funding is further conditioned upon: The execution and return of this Grant Agreement. Please initial each page of the Grant Agreement and sign the final page. Please keep a copy of this executed Grant Agreement for your records. The BCBSNC Foundation will keep the originally executed Grant Agreement for its records. Confirmation that the Internal Revenue Service has recognized the Grantee as a tax - exempt governmental unit or as an organization described in Section 501(c)(3) of the Internal Revenue Code and classified as a nonprivate foundation under Section 509(a). Further, Grantee confirms that its determination letter from the Internal Revenue Service remains valid as to its nonprivate foundation status and its status under IRC Section 501(c)(3) and that it has not undergone any material change in its character, purposes, activities, method of operation or sources of support that would be inconsistent with that status. Grantee agrees to notify the BCBSNC Foundation immediately if there is any change in its nonprivate foundation status or its status under IRC Section 501(c)(3). Grantee's agreement to use the Grant for charitable, educational, or scientific purposes only. Grantee's agreement to timely submission of project information and reports, as reasonably requested by the BCBSNC Foundation, certifying compliance with the terms of this Grant Agreement and documenting the use of the Grant and the progress of the Project. All such certification and expenditure reports shall be delivered by Grantee to the BCBSNC Foundation at least once per year, using the templates provided by the BCBSNC Foundation. Grantee agrees that it will return to the BCBSNC Foundation any monies contributed by the BCBSNC Foundation that are not used for the purposes set forth in the Grant Agreement. B. Reporting. All reports required to be submitted by the Grant Agreement shall be sent to: Jennifer MacDougall (or other approved representative) Blue Cross and Blue Shield of North Carolina Foundation PO Box 2291 Durham, NC 27702 Jennifer MacDougall is your primary contact for this grant and may be reached at(919) 765- 2128 or e -mail jennifer.macdougall@bcbsncfoundation.org. —I# (initial here)