1. a) General Information

   1. 1) Project Summary. The applicant shall provide a description of the project, including the project's needs and expected accomplishments. The summary shall also provide a description of the resources, both available and needed, for the project.

   2. 2) Project Narrative. The narrative shall state the need for the project, the expected impact on hospital operations, and the anticipated population to be served. The narrative shall also address any of the following (as applicable):

      1. A) Projects to satisfy any building code, safety standard or life safety code;
      2. B) Projects to maintain, improve, renovate, expand or construct buildings or structures;

   3. C) Projects to improve, replace or acquire equipment;

      1. D) Projects to maintain, establish or improve health information technology;
   4. E) Projects to maintain or improve patient safety;

   5. F) Projects to maintain or improve quality of care; or

      1. G) Projects to maintain or improve access to care. (Section 2310-640(a) of the Act)
      2. 3) Project Objectives. The applicant shall document the measurable objectives that the project will accomplish. Once the objectives are identified, the applicant shall describe the implementation plan for the objectives and a timetable for achievement of the objectives.

      3. 4) Project Budget. The applicant shall list the total dollar amount needed for the project, including the amount to be provided by the hospital and other funding sources and the amount of funding requested through the grant. In the budget, the applicant shall identify all revenue sources and amounts and provide budget estimates, including capital expenditures for the duration of the project.

         1. A) The project's budget could include, for example, the following costs:
      4. i) Architectural and engineering;
      5. ii) Construction or modernization;
      6. iii) Contingencies;
      7. iv) Debt financing (including the cost of leased assets);
      8. v) Equipment;
      9. vi) Preplanning;

      10. vii) Site preparation.

          1. B) The applicant shall also provide the sources of funds for the project. This could include, for example, the following:

             1. i) Cash and equivalents. The applicant shall document that cash is held in reserve and will be used for the project.
             2. ii) Debt financing. Documentation shall include a commitment letter from the applicant's financial institution attesting that financing is available.
             3. iii) Government appropriations. The applicant shall furnish a copy of the statute or ordinance that documents that an appropriation was awarded.
             4. iv) Other sources. The applicant shall document the amount and type of other funds (e.g., pledges, gifts and grants) available.
          2. C) The cost of the project shall equal or exceed the amount of grant funding requested.
      11. 5) Budget Narrative. The applicant shall provide a description of all amounts included in the project's budget. This narrative shall describe the relationship between the funding request and the project's goals and objectives.

   6. b) For projects that involve construction or modernization, the applicant shall document that the project will result in the renovation, replacement or expansion of facilities. Documentation shall consist of:

      1. 1) Hospital Licensing Act requirements that mandate the construction or modernization;
      2. 2) Illinois administrative rules that mandate the construction or modernization;
      3. 3) Building, fire or life safety code standards that mandate the construction or modernization;
      4. 4) Expansion of treatment, training or other support services that is necessary to meet the requirements of existing services;
      5. 5) Requirements for increased access to care, quality of care, or patient safety; and

   7. 6) Requirements for improved or enhanced operational efficiency.

      1. c) For projects that involve replacing or acquiring medical equipment, the applicant shall document the following:
   8. 1) The type of equipment being acquired;
   9. 2) Anticipated benefits that the new equipment will provide;

   10. 3) The age of the current equipment being replaced;

       1. 4) Down time or time spent out of service due to operational failures of the current equipment;

   11. 5) Upkeep and annual maintenance costs of the current equipment; and

       1. 6) Equipment that has expended its useful life (documentation shall consist of the grantee's most recent depreciation schedule that demonstrates that the equipment is totally depreciated and only scrap value remains).
       2. d) For projects that involve replacing or acquiring information technology, the applicant shall document the following:
   12. 1) The type of new technology being acquired;
   13. 2) Anticipated benefits that the new technology will provide;
   14. 3) The purpose of or need for the new technology;

   15. 4) The life cycle of the new technology; and

       1. 5) The cost savings or cost avoidance (if any) of implementing the new technology.

       2. e) The applicant shall document that the project does (or does not) require a CON or a COE from the Health Facilities and Services Review Board. Documentation shall consist of the following:

          1. 1) For projects that do not require a CON or COE, the applicant shall document that the project does not include any of the items listed in the CON/COE Assessment of Applicability referenced in Section 976.100(a)(8).
          2. 2) For projects that require a CON or COE, the applicant shall document that an application has been (or will be) submitted to the Health Facilities and Services Review Board. In accordance with Section 976.120(b), projects eligible for a grant that also require a CON or COE will be issued contingent awards until the CON or COE is obtained.

       3. f) Licensure Requirement. The applicant shall document that the project does (or does not) require a licensure review from the Department's hospital licensing program. Documentation shall consist of one of the following:

          1. 1) For projects that do not require a review, the application shall contain a letter from the Department stating that licensure review is unnecessary.
          2. 2) For projects that require a review, the applicant shall provide documentation that the Department has received and accepted the project for licensure review and that a project tracking number has been issued.

Grant applications shall contain the following: