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Capital Credit Community Fund Donation Request Form

The CCC fund is funded by unclaimed member capital credits. Under the cooperative business model, any revenues exceeding operating expenses – called operating margins - are allocated to members in accordance with a method determined by the Board of Directors (Board). These allocations are referred to as capital credits. From time to time, the Board retires capital credits, which means DMEA pays members their allocated share from a given year. However, if a member does not claim their capital credits within three years (i.e., the check is returned, uncashed, etc.), it is placed in a fund for DMEA to donate back to the service area community.

Donations are given to a variety of local programs and to local non-profits that support the DMEA service territory in accordance with guidelines established by the Board. These can be found in Board Policy 117: Donations & Contributions. Please review this policy before submitting a request to ensure your request complies with the policy.

• Requests for $10,000 and under are reviewed by DMEA’s CEO upon receipt. Please allow two weeks for review and response.

• Requests for over $10,000 are reviewed by the Board on a quarterly basis at a Regular Board Meeting. Those requesting funds will have the opportunity to present their request to the Board at the meeting. DMEA’s Chief of Staff will notify the contact person below of the date and time of the meeting.

Amount Requested

Date of Request

Organization applying for request

Contact person for organization

Mailing address

City

State

Zip

Contact Phone Number

Contact Email address

Confirm you have reviewed Board Policy 117

Yes

Please give a brief description of the scope of the project for which funds are requested.

Please attach any supporting documentation to this form prior to submission, including a copy of your W9.