b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser)
|
(ii) Activity
|
(iii) Did fundraiser have custody or control of contributions?
|
(iv) Gross receipts
from activity
|
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
|
(vi) Amount paid to
(or retained by)
organization
|
|
|
Yes
|
No
|
|
|
|
|
UMASS MEMORIAL FOUNDATION INC
333 SOUTH STREET
SHREWSBURY,
MA01545
|
FUNDRAISING |
Yes |
|
1,129,201 |
52,694 |
1,076,507 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total .................
|
1,129,201 |
52,694 |
1,076,507 |
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
MA, NH
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
|
|
(a) Event #1
PARENT-WINTER BALL
(event type)
|
(b) Event #2
CNEHA GOLF TOURNAMENT
(event type)
|
(c) Other events
10
(total number)
|
(d) Total events
(add col. (a) through col. (c))
|
 |
1 |
Gross receipts
.
.
.
|
678,157 |
293,517 |
554,378
|
1,526,052 |
| 2 |
Less: Contributions
.
.
|
|
119,673
|
249,108
|
368,781 |
| 3 |
Gross income (line 1
minus line 2)
.
.
.
|
678,157 |
173,844 |
305,270 |
1,157,271 |
 |
4 |
Cash prizes
.
.
.
|
|
|
|
|
| 5 |
Noncash prizes
.
.
|
|
43,610
|
19,622
|
63,232 |
| 6 |
Rent/facility costs
.
.
|
|
104,868
|
30,440
|
135,308 |
| 7 |
Food and beverages
.
|
|
|
|
|
| 8 |
Entertainment
.
.
.
|
|
|
|
|
| 9 |
Other direct expenses
.
|
369,422
|
14,447
|
150,104
|
533,973 |
| 10 |
Direct expense summary. Add lines 4 through 9 in column (d) ...........
|
732,513 |
| 11 |
Net income summary. Combine line 3, column (d), and line 10. ..........
|
424,758 |
Part III
Gaming.
Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
|
|
(a) Bingo
|
(b) Pull tabs/Instant
bingo/progressive bingo
|
(c) Other gaming
|
(d) Total gaming (add col.(a) through col.(c))
|
| 1 |
Gross revenue
.
.
.
.
|
|
|
|
|
|
2 |
Cash prizes
.
.
.
.
|
|
|
|
|
| 3 |
Non-cash prizes
.
.
.
|
|
|
|
|
| 4 |
Rent/facility costs
.
.
.
|
|
|
|
|
| 5 |
Other direct expenses
.
.
|
|
|
|
|
|
6 |
Volunteer labor
.
.
.
|
|
|
|
|
|
7 |
Direct expense summary. Add lines 2 through 5 in column (d) ...........
|
|
|
8
|
Net gaming income summary. Combine lines 1 and 7 in column (d) ..........
|
|
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states?
............
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year?
.....
Schedule G (Form 990 or 990-EZ) 2012
Page 3
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility
......................
13a
b
An outside facility
........................
13b
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name
Address
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization
$
and the
amount of gaming revenue retained by the third party
$
.
c
If "Yes," enter name and address of the third party:
Name
Address
16
Gaming manager information:
Name
Gaming manager compensation $
Description of services provided
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year
$
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b,
columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this
part to provide any additional information (see instructions).
| Identifier |
Return Reference |
Explanation |
|
PART I, LINE 2B; COLUMN (III)
|
PART I, LINE 2B - FUNDRAISER ADDITIONAL INFORMATION
|
UMASS MEMORIAL FOUNDATION, INC. IS IDENTIFIED AS THE ADMINISTRATOR OF THE PHILANTHROPIC ACTIVITIES OF THE REPORTING ENTITIES OF UMASS MEMORIAL HEALTH CARE, INC. THIS INCLUDES THE COORDINATION OF ALL CHARITABLE WORK AND THE MANAGEMENT OF OFFICE OPERATIONS TO SUPPORT FUNDRAISING INCLUDING THE FOLLOWING PROCEDURES: 1) ACTIVE DEVELOPMENT WORK 2) DONOR RELATIONS AND COMMUNICATIONS 3) SERVICES TO UMASS MEMORIAL STAFF 4) CONTRIBUTION REPORTS, DONOR RECORD FILES 5) TRANSFER OF CONTRIBUTIONS RECEIVED (CONTRIBUTIONS RECEIVED BY THE FOUNDATION THAT ARE DESIGNATED TO A UMASS MEMORIAL REPORTING ENTITY ARE DEPOSITED INTO A DESIGNATED ACCOUNT OF THE RESPECTIVE REPORTING ENTITY UPON RECEIPT.) 6) EXPENDITURES OF CONTRIBUTIONS
|
|
PART I, LINE 2B; COLUMN (V)
|
PART I, LINE 2B - FUNDRAISER ADDITIONAL INFORMATION (CONTINUED)
|
UMASS MEMORIAL HEALTH CARE, INC. PAYS UMASS MEMORIAL FOUNDATION, INC. ITS PRORATA SHARE OF OPERATING EXPENSES BASED ON THE SPLIT OF UMASS MEMORIAL CONTRIBUTION RECEIPTS VERSUS THE OVERALL TOTAL CONTRIBUTION RECEIPTS AS COLLECTED BY THE FOUNDATION.
|
|
PART II
|
SCHEDULE G - ADDITIONAL INFORMATION
|
PART II, COLUMN (A) EVENT #1 THE WINTER BALL WAS HELD BY THE PARENT PART II, COLUMN (B) EVENT #2 THE HOSPITAL GOLF TOURNEY WAS HELD BY CENTRAL NEW ENGLAND HEALTHALLIANCE, INC. PART II, COLUMN (C) OTHER EVENTS (10 EVENTS REPORTED) ARE: GOLF TOURNAMENT HELD BY WING MEMORIAL HOSPITAL CORPORATION SPEAKEASY HELD BY HEALTHALLIANCE HOSPITALS DENNEHY GOLF TOURNAMENT HELD BY HEALTH ALLIANCE HOME HEALTH AND HOSPICE, INC. LOVELIGHT HELD BY HEALTHALLIANCE HOME HEALTH AND HOSPICE, INC. TEE UP FOR TOTS GOLF TOURNAMENT WAS HELD BY THE PARENT OTHER EVENTS WERE HELD BY THE PARENT, GOLF TOURNAMENT WAS HELD BY MARLBOROUGH HOSPITAL, INC. SPANISH FOR KIDS HELD BY COMMUNITY HEALTHLINK. MARANDA HOUSE MOTHER'S DAY FUNDRAISER WAS HELD BY COMMUNITY HEALTHLINK, AND DOG WALK PAWS FOR CAUSE WAS HELD BY COMMUNITY HEALTHLINK
|
Schedule G (Form 990 or 990-EZ) 2012
| Software ID: |
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| Software Version: |
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