The original Trust Agreement executed on January 17, 1939 placed responsibility on the Board of Managers to distribute the income within the scope of the Foundation's objectives. The Agreement set forth the "General Purposes of the Foundation" as follows:
- To promote medical and surgical research and to assist in the acquisition, advancement, and dissemination of knowledge of medicine and surgery, and of means of maintaining health.
- To initiate and further activities designed to promote public health.
- To aid hospitals and health institutions in Cuyahoga County, Ohio, that are organized and operated exclusively for public, charitable purposes, by contributions for capital improvements or equipment, or purchase of rare and expensive drugs, or for expenses of operation or maintenance.
- To improve methods of hospital management and administration.
- To aid in establishment and support of plans or programs designed to make competent hospital and medical care available to individuals of all classes, especially those of low incomes.
Only grant requests which fall into one of those categories can be considered by the Board at its semi-annual meetings.
At its meeting on December 7, 1989, the Board of Managers unanimously adopted a further set of guiding principles for considering grant requests. Refined at subsequent meetings, the Board generally abides by the following guidelines in choosing which proposals to fund:
- The Foundation will give priority to grant requests from organizations in the private sector over those which are primarily government supported.
- The Foundation will make grants with a maximum term of commitment of five years, with preference accorded to requests of three years duration or less. Multi-year grant payments are conditional upon receipt of satisfactory annual progress reports from the recipient organization. No new grant will be approved until receipt of a final report on any previous grant.
- The Foundation does not contribute to national fundraising campaigns or to national charitable organizations.
- The Foundation strongly favors grant requests for specific direct care oriented projects over those requesting general operating support.
- The Foundation does not generally support grant requests for surveys, assessments, studies, planning activities or acquisition of information systems for healthcare organizations.
- The Foundation does not make grants to any individual for scholarships, grants-in-aid or other personal purposes, no matter how worthy they may be.
- The Foundation will not make contributions to endowment funds.