COACH KILL CANCER FUND
Application Guidelines
Mission Statement

Improving the quality of life for needy individuals and families facing a financial burden resulting from the medical treatment of cancer and other childhood diseases.

Program Description

Eligibility Requirements: Any person or family throughout the southern 16 Illinois counties (Randolph, Perry, Franklin, Hamilton, White, Jackson, Williamson, Saline, Gallatin, Union, Johnson, Pope, Hardin Alexander, Pulaski, and Massac) facing a financial burden resulting from the medical treatment of cancer and other childhood diseases. Financial assistance will be provided solely for the purpose of offsetting direct medical costs or for those expenses incurred in seeking medical care.

Applications:Applications are available at Southern Illinois Healthcare (SIH), SIH System office or on-line. Applicants may request assistance for themselves only. Coach Jerry Kill, Rebecca Kill, and/or the Director of Fund Development at SIH may also request assistance for a family, individual or charitable institution in need. Completed applications should be placed in a sealed envelope and mailed to Coach Kill Cancer Fund, P.O. Box 3988, Carbondale, IL 62902 or can be delivered to SIH at 1239 E. Main St., University Mall, Carbondale, IL 62901. The Director of Fund Development at SIH may contact the applicant if additional information is needed.

Approval/Disapproval of Applications: Payments will be made directly to the institution requesting payment for services. If other arrangements are needed additional approval must be obtained. Adequate documentation will be necessary to process payment of funds. In being the best stewards of this fund, an attempt will be made to help as many individuals as possible; therefore all requests may not receive full funding. Only one application per individual will be considered within a 12-month period. All applications will be reviewed on their individual merit and awards will be based solely on need, and not on the identity of the applicant's medical provider or based upon any Donor's contributions. Assistance to applicants of the Fund will be awarded independent of donor contributions and all eligibility determinations will be determined on a first-come, first-served basis using objective criteria. Applicants may have selected his or her medical provider and would not be prohibited from changing providers even while receiving assistance from the Fund. Applicants or recipients of Fund proceeds will not be referred to any specific medical provider. The program will expand, rather than limit, a patient's access to care and freedom of choice for providers. Coach Jerry Kill and/or Rebecca Kill, the SIH Controller, and the Director of Fund Development at SIH, or his designee will make final approval/disapproval.

Confidentiality: Only Coach Jerry Kill and/or Rebecca Kill, the SIH Controller, and the Director of Fund Development at SIH will be aware of the name of applicant, and at NO time will this information be revealed to anyone privately or publicly without the consent of the applicant.

Contributions

The Coach Kill Cancer Fund is funded solely on donations made by generous contributors and fundraising efforts. Contributions can be made on-line or by mail at Coach Kill Cancer Fund, P.O. Box 3988, Carbondale, IL 62902-3988. No Donor will exert control over the Fund or its use of Donor contributions. Individuals will be awarded assistance without regard to any Donor's interests, without regard to any applicant's choice of medical providers, and based upon reasonable, verifiable, and uniform criteria. Donors will not be provided information that would allow them to correlate contributions with the use of medical services obtained by the applicant to the Fund. To ensure proper stewardship of the Fund, utilization of the Fundís resources will be monitored in order to maximize the impact to Fund beneficiaries and the community.

Reporting and Accountability

Maintenance of Records: Since contributions are made to the fund, it is important that proper reporting and accountability be assured. Completed applications are retained in a confidential and secure manner by the Director of Fund Development at SIH and/or his designee.

Monthly Reporting: An accounting of funds received and disbursed is reported by the SIH accounting department and monitored monthly by Coach Jerry Kill and/or Rebecca Kill, the SIH Controller, and the Director of Fund Development at SIH. At no time, unless authorized by the applicant, are the names of the applicants or recipients revealed.