The Foundation acts as a fiscal intermediary for qualifying ACMC departments in providing financial assistance for the handling of their funds. This also provides the department with a 501(c)(3) “umbrella” under which they may receive monies from funders that require a nonprofit corporation status.

Administrative Fee

For this service the Foundation collects a one-time administrative fee on each deposit made, according to the following schedule:

$0-20,000	10%
$20,001-50,000	6%
$50,001-100,000	5%
$100,001-200,000	3%
$200,001 and above	2%

All accounts must maintain a minimum balance of $1,500.00. In addition, any interest earned on the restricted fund shall be retained in the Foundation’s general fund.

Memorandum of Understanding [PDF]*

This document contains all the vital information about the Donor Advisory Funds Program and how it works. It should answer all or most of your questions about the program. It is also your Agreement with the Foundation. Please complete one copy and return it to our office, and keep one copy for your records.

Exhibit A. Definition of Services [PDF]
Make sure you include the scope and purpose of your program. We also need all the applicant contact information, as well as the signature(s) of the persons in your organization who are authorized to request deposits to and disbursements from your funds.

Exhibit B. Disbursement and Deposit of Funds Request [PDF]
We can send you a starter supply of this form (or you can print out your own on blue paper). Every request for disbursement or deposit of funds must be made with this form, with original documents (invoices, receipts, etc.) attached to a sheet of letter size paper if they are smaller than 8½” x 11”. Please include an Expense Detail [Excel] spreadsheet whenever you have multiple items under Deposit or Disbursement of Funds. Requests received in our office by the 25th of the month will be paid by the 5th of the following month, including contract employee wages.

For your convenience, you may download an electronic copy of an acknowledgement letter on ACHCF letterhead which you may customize and send to your funders. [Sample Acknowledgement Letter - Word]

DAF Contractor Packet

Exhibit C: Standard Agreement [PDF]
If you will have consultants working for you whose wages are being funded by your program, they will need to execute a Standard Agreement (Exhibit C) with Alameda County Health Care Foundation. Please complete two copies, with signature, and return them to our office; and we will return one copy to you for your records.

IRS Form W-9 [PDF], with Instructions [PDF]
If you are paying any contract employees out of Donor Advisory Funds, they must complete a W-9 and submit it to the Foundation, who will issue a 1099 to them at the end of the year.

Invoice [Excel] and Time Sheet [Word]
Your contract employees must complete a Time Sheet, which requires signatures of the employee and your program’s authorized contact. It must be accompanied by an Invoice, prepared by your program. Both the invoice and time sheet should be attached behind a Disbursement of Funds Request form (see above).

If you have any questions about this process, please Cherlyn Spencer, Executive Director, at (510) 437-8365.

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