Charitable Donations

Applicant Guidelines

  1. General Policy. SI-BONE may provide donations to non-profit entities in the form of financial or in-kind support in order to support bona fide charitable purposes in accordance with its policy and applicable U.S. laws, regulations and industry guidelines.
     
  2. Requirements.
    1. Applicants must have tax-exempt status as public charities under section 501(c)(3) of the Internal Revenue Code, or as state instrumentalities under Section 170(c)(1) of the Internal Revenue Code.
    2. Donations will not be made to individuals, private practice groups, non-tax exempt foundations, or to 501(c)(3) entities that are not public charities.
    3. Donations must be pursuant to a broadly-disseminated solicitation to fund a specific effort (e.g., building fund, charitable mission) or a specific fundraising event.
    4. Donations must advance a bona fide charitable purpose, such as supporting indigent care, patient education, public education, public health or the sponsorship of an event for which the proceeds are intended for charitable purposes.
    5. All donations must be consistent with SI-BONE's mission or disease areas of interest to SI-BONE.
    6. Donations will not be made for the personal benefit of an individual.
    7. Donations will not be used to support Educational Activities or Research, each of which is governed by separate policies.
    8. Donations shall not be used to support consulting or other services to SI-BONE, which are governed by a separate policy.
    9. Donations will not be offered or provided with the intent of, directly or indirectly, implicitly or explicitly influencing or encouraging the recipient to use, purchase, lease, order, or arrange for or recommend the use, purchase, lease, or order of SI-BONE products or as a reward for such behavior in the past.
    10. All requests for donations must be independently initiated in writing by the charitable entity that would receive the donation.

 

Application Process Overview

  1. Keeping in mind the Charitable Donation requirements stated above, Applicants must compete the form below in as much detail as possible.
  2. The SI-BONE Grant Committee will then review the request and make a decision to approve or deny the request to ensure compliance with its policy and applicable U.S. laws, regulations and industry guidelines.
  3. The review process may take up to 60 days. If your request is approved, SI-BONE will notify you.
  4. All recipients must sign SI-BONE’s template letter agreement, which states the terms and conditions upon which the donation is made.

Application for Charitable Donations

Applicant Information

If you would like to submit one or more supporting documents for your application, please upload them here. File types allowed: doc/docx, xls/xlsx, pdf and jpg. Maximum file size: 5MB



Three files maximum via this form. If you have additional files, please check the box below and SI-BONE will follow up separately.