If you would like to request a charitable donation for financial support or an equipment donation from Boston Scientific and fall into one of the following groups, please complete the U.S. HCPs and National Associations Charitable Donations Application Form below.

• Health Care Providers (HCPs) - includes U.S. individuals and entities (i) involved in the provision of health care to patients, and (ii) which purchase, lease, recommend, use, arrange for the purpose or lease of, or prescribe Boston Scientific products (and their related foundations and similar entities). This includes both persons providing services (such as licensed physicians) and persons who do not provide services directly but who are involved in the decision to purchase, lease, or recommend a medical device. These individuals include, for example, purchasing agents, physician’s practice managers and management within group purchasing organizations (GPOs).
• National Associations - entities that the U.S. Internal Revenue Service recognizes as tax exempt and that operate at a national or international level to focus on specific health care or medical issues (e.g., the American Heart Association, American Cancer Society, Sudden Cardiac Death Foundation and Society, Health Rhythm Society).

Who Can Submit a Request?

A request must be submitted by the charitable entity to which the charitable donation will be made, if granted.

• Research, educational or fellowship grants.
• Grants to non-HCPs or entities that are not National Associations. These may include donations to local schools, STEM programs or non-health related organizations that support education related activities in the community.
• Donations of Boston Scientific product.
• Requests for donations from Boston Scientific Foundation, Inc.

If you are a Boston Scientific employee and would like to submit a request to purchase tickets or tables at an HCP's or National Association's fundraiser, visit the Boston Scientific Corporate intranet for more information and an application form.

What Are the General Criteria for Support for U.S. HCPs and National Associations?

General Criteria for Support for U.S. HCPs and National Associations:

• Entities recognized by the IRS as Tax-Exempt
• Donation must be in support of bona fide charitable efforts, such as:
• Charitable fundraisers
• Public health education awareness
• General community health research
• Charitable sponsorships
• Indigent care
• The request must be made directly by the charitable entity
• The requesting charity must be soliciting contributions from the community broadly
• Preference is given to communities where Boston Scientific has a significant employee presence

Donated Funds May Not Be Provided:

• For physical plant improvements (e.g., “bricks and mortar”)
• For the purchase of equipment used in patient care
• To supplement Medicare or Medicaid coverage gaps
• To fund recreation or entertainment (e.g., golf tournaments)
• For faith-based organizations whose programs are not open to the public or do not directly serve the public interests, and/or include religious-based programming as a requirement of participation
• For clubs, fraternal groups, political campaigns, or lobbying groups
• To MA-licensed HCPs that are not recognized by the Internal Revenue Service as a 501(c)(3) entity or Vermont-licensed HCPs
• To individuals or entities that are debarred/excluded from participation in federal health care programs

Application Submission and Instructions

Each application must be complete and received by Boston Scientific in a timely manner (e.g., at least four weeks prior to a scheduled event to be considered at that meeting).

Boston Scientific accepts and reviews charitable donation and equipment requests on a rolling basis. Unfortunately, because of finite resources, not every program will receive our support. Factors in determining which programs will be funded include a review based on pre-established criteria and scope of the proposed donation and whether the request is consistent with our mission and guidelines for charitable giving. Equipment donations include used office equipment and do not include Boston Scientific in-kind product donations.

Application Form

Boston Scientific HCP and National Associations Charitable Donations Application Form

In addition to the application, please be sure to include the following information with your application:

• If you are an IRS tax-exempt entity, proof of your organization's IRS tax-exempt status (e.g., the IRS determination letter)
• A completed December 2011 W-9 (PDF)
• A detailed event budget
• A list of all available sponsorship levels
• A list of board members, including their affiliations
• A copy of the event brochure or invitation

Please email or mail your request to one of Boston Scientific's business units:

For general questions, please contact charitableadmin@bsci.com