Save A Life Information & Application

General Information

Through the Sioux Empire United Way Safe a Life program, Sioux Empire non-profit organizations that have gifts which are deductible by the donor for federal income tax purposes according to the Internal Revenue Service. Those non-profit organizations can purchase Automated External Defibrillators (AEDs) at half the cost. Through the Avera Heart Hospital, the cost of one AED is $1,650 and one wall mount is $150; therefore, each matching grant from Sioux Empire United Way will be $900 AED + wall mount or $825 for just the AED. Your nonprofit must be within the Sioux Empire: Lincoln, Minnehaha, McCook and Turner County, to qualify for this grant.

In acceptance of the above AED grant, the organization will agree to:

Receive CPR/AED training within one month of receiving the AED and every two years thereafter. Each location should determine the appropriate number of individuals to be trained. If you are in need of assistance finding training options, contact Jeremy Robertson with Sioux Falls Fire Rescue at 605-367-8271.
Show the AED video to as many staff as possible to increase awareness.
Use the cabinet to wall-mount the AED unit in a central location that is easily visible and accessible. The AED sign should also be secured above the cabinet.
Designate one individual to conduct monthly checks of the AED. This person is to simply ensure the AED machine signifies “OK”. If it says anything other than “OK”, the representative from the organization should call Becky Smith with Avera Heart Hospital at: 605-977-7026.
Replace the electrode pads and battery of the AED after every use and/or every four years. The replacement cost to your organization will be approximately $140.00 for electrodes & $245.00 for the battery. To make replacement orders, contact Becky Smith with Avera Heart Hospital at: 605-977-7026. Please note: Opening and closing the AED wears on the battery.
Report all incidents of equipment usage to Jeremy Robertson with Sioux Falls Fire Rescue at: 605-367-8271.
Sign a waiver releasing the Sioux Empire United Way and anyone associated with the Save a Life Today project from any liability should there be any claims made as a result of placement of use of the AED.
Consider developing and implementing a Cardiac Emergency Response Plan. The American Heart Association has general checklists, templates, and more available at www.heart.org/cerp. Reach out to Tim.Nikolai@heart.org for questions or additional assistance.

Timeline

Applications may be mailed, sent electronically, or hand delivered. All applications must be clearly legible. Poor quality copies, handwritten responses, or missing information may result in your application being delayed or eliminated from consideration. Notification of award will be sent by email along with additional documents needed to complete the process. United Way reserves the right to terminate grant support at any time during the process.

Additional Information
For additional information about this grant opportunity, please contact Sioux Empire United Way (336-2095 or unitedway@seuw.org).

Grant Application

Applicant

Name of contact person

Title of contact person

Address

City/Town

State/Province

ZIP/Postal Code

Phone

Employer Identification Number (EIN)

Is your nonprofit organization exempt from paying sales tax?

Proof of Tax Exemption

Upload requirements

How many AED matching grants are being requested? (limit 2 per Organization, Business or group) Will the unit(s) be centrally located so that it is accessible within 3 minutes of any given place? Please explain

Will the AED(s) be replacing an expired AED unit(s)? If so, please list the brand and model of the existing AED unit(s). If not, please explain how the need for the AED(s) was identified.

Will the AED(s) require a new wall mount case? Please explain.

Please describe the general population at the site of which the defibrillator(s) will be located, including the number of people and the average age of the individuals.

Do you conduct special events or classes that bring additional people to your site(s)? If so, please describe.

Do you have regular staff and/or volunteers that are willing to be complete AED/CPR training? Please explain.

Applicant's Name

Applicant's Signature

I understand that matching funds must be available upon submission of this application and payment must be submitted to SEUW with the signed agreement (An agreement will be sent to you after review of your application).

General Information

Grant Application

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