Ludwig Community Benefit Nomination Form

This field is for validation purposes and should be left unchanged.

Nominee Information

Name of Nominated MHA-Member Organization

Name of Program

Name of Key Contact Person For Program

Title

Organization

Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Email(Required)

Submitter Information

Name(Required)

First Last

Job Title(Required)

Organization(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Narratives

Program Overview(Required)

Statement Of Problem And Goal (5 points)(Required)

State the specific health needs or problem that was addressed and the short- and long-term goals of the program designed to resolve it.

Briefly outline the steps taken to reach those goals.

Leadership/Community Involvement Role (30 points)(Required)

Provide highlights of any collaborative efforts with other healthcare providers, community agencies or other organizations to evaluate the problem and address it properly.

Describe how investing in the program improved the health and well-being of individuals both in and out of the hospital.

Program Design and Assessment (35 points)(Required)

Explain the steps taken to solve the problem by describing the program’s demonstrated and measurable impact on the community’s health and well-being.

Provide highlights of how the program advances health equity and/or access to care.

Summarize plans for the program’s future, including those for measuring its continuing impact on the community and other stakeholders.

Sustainability (30 points)(Required)

Describe the financial and time resources necessary to sustain commitment to the program and how the program will evolve in the future.

Outline how the cash award will be used to enhance the program, should the organization win the award.

NOMINATIONS MUST BE RECEIVED BY THE MHA BY THE CLOSE OF BUSINESS WEDNESDAY FEB. 18, 2026.

Any additional materials, including photos of the program should be emailed to eleyko@mha.org.

Note: Forms will not be accepted if they include URLs.

Ludwig Community Benefit Nomination Form

Nominee Information

Submitter Information

Narratives

Michigan Health & Hospital Association

mihospitalassoc