Grant Application - Henry L. Guenther Foundation

Name of Organization:*
Doing Business As (If Applicable):*
Mailing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Street Address (If Different):
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone Number:*
Extension
Website*
First Name of Correspondent:*
Last Name of Correspondent:*
Greeting*
Title of Correspondent:*
Email Address:*
Type of Organization & Nature of Operations (LIMIT 500 CHARACTERS):*

Incorporation Date & State of Incorporation:*
IRS Tax Exemption Granted Under Section:*
Date of IRS Tax Exemption Granted:*
California Tax Exemption Granted Under Section:*
Date of California Tax Exemption Granted:*
Federal Information Return Filed In Name of:*
Form (990, 990t, 990ar, Other):*
Date Form Was Last Filed:*
Amount of Request:*
Brief Description of How Grant Funds Will be Utilized (LIMIT 250 CHARACTERS):*
Geographical Area/City(ies) Covered By Proposal (LIMIT 100 CHARACTERS):*
Have you previously received a grant from The Guenther Foundation?*
- Yes
- No
If yes, what month and year? Previously funded organizations must wait a minimum of three (3) years to submit a new application, beginning from the date of the receipt of grant funds.

PLEASE PROVIDE THE FOLLOWING INFORMATION FROM THE ORGANIZATION’S MOST RECENTLY COMPLETED FORM 990
Year Being Reported:*

COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES PROVIDE TOTALS FOR EACH CATEGORY OF PERSON SHOWN BELOW (PAGE 7 PART VII ON FORM 990):
For Directors*
Number of Directors Reportable Compensation Estimated Amount of Other Compensation
For Officers*
Number of Officers Reportable Compensation Estimated Amount of Other Compensation
For Key Employees*
Number of Key Employees Reportable Compensation Estimated Amount of Other Compensation

STATEMENT OF REVENUE AMOUNT REPORTED ON (PAGE 9 PART VIII ON FORM 990):
Total Revenue (Line 12 on Form 990)*
Government Grants (Line 1e on Form 990)*
Total Contributions, Gifts, Grants (Line 1h on From 990)*
Total Program Service Revenue (Line 2g on From 990)*

STATEMENT OF FUNCTIONAL EXPENSES AMOUNT REPORTED ON (PAGE 9 PART IX ON FORM 990)
Grants to Other Organizations (Line 1 on Form 990)*
Total Program Service Management/General
Grants to Individuals (Line 2 on Form 990)*
Total Program Service Management/General
Grants to Foreign Organizations (Line 3 on Form 990)*
Total Program Services Management/General
Compensation of Officers, Etc. (Line 5 on Form 990)*
Total Program Services Management/General
Total Functional Expenses (Line 25 on Form 990)*

BALANCE SHEET (PAGE 9 PART X ON FORM 990)
Total Assets – End of Year*
Total Liabilities – End of Year*

SUPPLEMENTAL MATERIAL
Copy of a valid Internal Revenue Service letter granting exemption under Section 501(c)(3) of the Internal Revenue Code.*
Drop files here or

Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
Copy of a valid California Franchise Tax Board letter granting exemption under Section 23701d of the Revenue & Taxation Code.*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
Copy of a valid Notification of Status under Section 509(a) of the Tax Reform Act of 1969 issued after January 1, 1970, classifying the organization as: "a private foundation;" "a private operating foundation;" or "not a private foundation.”*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
Current, complete audited financial statements. Financial statements prepared by other than independent auditors must be signed by two officers of the board of directors or trustees. All accompanying notes to the statements must be included.*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
Current list of officers, directors, and/or trustees.*
Officers Directors Trustees
A detailed statement of the request, including a complete program budget (not agency budget), showing how Guenther funds will be utilized, projected timeline for implementation and completion of the project, and all other applicable details. Provide complete financial information (sources and amounts of all loans, grants, pledges, and other fundraising activities; copies of contractors' estimates and/or bids from suppliers; etc.).*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
A statement of how the organization's proposed project will benefit California residents and, if applicable, those residing in Southern California.*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
A detailed statement defining the need for the services or facilities that would be provided by the requested funds.*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
A statement describing the manner in which the organization would report to the Guenther Foundation the disbursement of monies and the results obtained with the requested funds, within the required reporting guidelines set forth above (section #11 of the Policies).*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
A signed statement on letterhead from the governing body of the organization authorizing the presentation of the application as a prime need within the scope and limitations of the Guenther Foundation's policies.*
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Accepted file types: pdf, Max. file size: 4 MB, Max. files: 1.
Website

THE HENRY L. GUENTHER FOUNDATION
APPLICATION FOR GRANT

Step 1 of 8

PLEASE PROVIDE THE FOLLOWING INFORMATION FROM THE ORGANIZATION’S MOST RECENTLY COMPLETED FORM 990

COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES PROVIDE TOTALS FOR EACH CATEGORY OF PERSON SHOWN BELOW (PAGE 7 PART VII ON FORM 990):

STATEMENT OF REVENUE AMOUNT REPORTED ON (PAGE 9 PART VIII ON FORM 990):

STATEMENT OF FUNCTIONAL EXPENSES AMOUNT REPORTED ON (PAGE 9 PART IX ON FORM 990)

BALANCE SHEET (PAGE 9 PART X ON FORM 990)

SUPPLEMENTAL MATERIAL

SUSANNE SUNDBERG

PHILLIP BATTAGLIA

ERIC MOOBERRY

DR. RICHARD T. BATTAGLIA

CHARLES LEATHERBURY

ANN LEATHERBURY

ALBA COLORADO

Officers	Directors	Trustees

THE HENRY L. GUENTHER FOUNDATION APPLICATION FOR GRANT

Step 1 of 8

PLEASE PROVIDE THE FOLLOWING INFORMATION FROM THE ORGANIZATION’S MOST RECENTLY COMPLETED FORM 990

COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES PROVIDE TOTALS FOR EACH CATEGORY OF PERSON SHOWN BELOW (PAGE 7 PART VII ON FORM 990):

STATEMENT OF REVENUE AMOUNT REPORTED ON (PAGE 9 PART VIII ON FORM 990):

STATEMENT OF FUNCTIONAL EXPENSES AMOUNT REPORTED ON (PAGE 9 PART IX ON FORM 990)

BALANCE SHEET (PAGE 9 PART X ON FORM 990)

SUPPLEMENTAL MATERIAL

THE HENRY L. GUENTHER FOUNDATION
APPLICATION FOR GRANT