Organization Name:
Project Name:
Grant Identification #: / Grant Amount:
Project Start & End Dates: / Date of Report:
Contact Name: / Contact e-mail & phone:

Introduction

Grants and investments made by Community Benefit Programs support Kaiser Permanente’s mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. To understand the results of your work, convey the impact of our Community Benefit Programs portfolio, and to ensure that budget and other grant expectations are met, we require grantees to submit narrative and expenditure final reports.

Instructions

  • Please complete the workplan, narrative, and budget sections provided in this document.
  • Document must besaved in Microsoft Word.
  • Please use font size 10 point or larger and number all pages.
  • Please title and save this attachment as: “Final Report for [Organization and Grant ID number]”.

Where to Submit

This document must be attached and submitted with through your electronic (IGAM) final report account.

  • If you have already opened your electronic IGAM final report you can simply save this template on your computer and attach it on the attachment page.
  • If you have not already logged into IGAM, please log in here:
    [using the same login information used to submit your Kaiser Permanente Grant application]
  • Click on the Requirements link and open your electronic final report template
  • Save this template on your computer and attach it on the attachment page.
  • Submit your finished IGAM report with template attached.

Questions?

Please contact your grant manager if you have any questions. You can also send general inquiries to or call (510) 625-6370.

WORK PLAN SUMMARY

Using the Work Plan submitted with your proposal, please complete the following information. You may add additional columns, rows or tables, as needed.

Goal:
Objective as stated in the workplan / Did you accomplish this objective? If no, please explain / Actual Impact: Include number of people reached and impact the activities made / Comments
Goal:
Objective as stated in the workplan / Did you accomplish this objective? If no, please explain / Actual Impact: Include number of people reached and impact the activities made / Comments

NARRATIVE REPORT

Please respond to the following questions.

  1. How was your project successful? (please consider impact on the population served, your organization, the health field, leveraged funds, etc.)
  1. Please share one or more story or quote that illustrates how this project has made a difference in the lives of the people your program serves. We always appreciate stories or quotes with a client's real name, but if they have not given their explicit permission for you to share their story, please use a pseudonym. The following are some guiding questions for your story:

Who is the story about?

What sets the story in motion?

What obstacle did they face?

What happened?

What was the resolution?

How did the grant make this possible?

  1. What did you learn from the implementation of this grant?
  1. What challenges were encountered? Were the challenges overcome? If so how? If not, were your objectives and activities modified as a result of the challenges? What, if anything, would you do differently in the future?
  1. What aspects of this project will be sustained beyond this grant? Please specify how you will continue or build upon the work supported by this grant.

BUDGET REPORT

Expenditure Report

Using the Expenditure Report Template below, please insert your most recently approved budget and complete the following information for each line item.

  • Expenses to date
  • Any Unspent balance

Budget Narrative

Please complete the budget narrativecolumn describing how funds were spent.

Unspent Funds

If there is an unspent balance remaining for your grant, please contact your grants manager to discuss the situation. Please be prepared to discuss the reason for unspent funds as well as thoughts and timeline for spending balance.