understand Ryan’s Reach is not obligated to provide any grants or sums of money and the decision to do so rests in the sole and exclusive discretion of Ryan’s Reach. No legal liability shall arise from an application not being accepted or assistance provided. Ryan’s Reach makes no representation or warranty that the application will be considered or that grants will be made. I understand that my application will not be considered complete until all required documents are submitted. I further understand that should I be requested, and fail to provide, any other information, my application shall be incomplete until any further requested information is provided. I further understand that if I, or my representative, are contacted for an interview, whether in person or by phone, that I will cooperate. I grant Ryan’s Reach an unrestricted right and permission (but not an obligation) to exhibit, publish, broadcast, and otherwise exploit any grant or assistance provided in response to this application, in whole or in any manner, on the Ryan’s Reach website, on social media, and through any other markets and media, without compensation to me or any other person. I confirm that I have the right to grant this permission and I do so freely and without consideration. I declare under penalty of perjury, under the laws of California (if executed in this state) that the foregoing is true and correct.

Under the HIPAA privacy regulations, individuals have several rights relating to their personal health information (PHI) used or maintained by an employee or business associate within our company. Although as a non-profit we are not subject to all the HIPAA privacy and security regulations; we are subject to some of the privacy rules relating to the PHI of our charity caregiver recipients that received our volunteer services. Unless permitted in writing by the recipient, the recipients’ PHI, including personal information such as diagnosis, nature of services, treatment, and provider records cannot be released to the outside public or even to the recipient unless there is a signed consent by the recipient. However, we may use general statistical data on all our recipients such as some patient demographic data, health insurance status, dates of patient services, general type of department in which a patient is serviced, treating physician information, and outcome information for the purpose of fundraising and marketing events. Any data sent electronically about our recipients is also safeguarded by the company, and this information is limited to employees and management that have received HIPAA training. If a breach of information occurs, we will notify the recipient by phone and in writing and immediately move to correct the breach. There are a few exceptions mandated by the government under the following HPAA rules: 1.PHI may be used or disclosed for the treatment, payment and health care operations of any healthcare provider having a relationship with the recipient. We may also share information as it directly relates to being able to provide financial support for your situation (ex: sharing your spouse’s condition with the home health aide company for whom we would pay to provide help to your spouse). With the consent of the recipient, the company may use and release PHI such as their name, general condition, religious affiliation, and location of the provider’s facility to those individual entities involved in the recipient’s care and with the recipient’s permission for the purposes of notifying family members and others, regarding an individual’s location condition or death. An example would be a pharmacist dispensing a filled prescription to a person acting on behalf of the patient. 2.PHI may be disclosed when the recipient is incapacitated or in an emergency when the disclosure is in the best interest of the recipient. I have read and understand this document and agree with how my PHI may be disclosed by Ryan’s Reach