Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
THE HEALTH FOUNDATION OF CENTRAL
MASSACHUSETTS INC
Employer identification number
04-2633274
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) PERNET FAMILY HEALTH SERVICE
237 MILLBURY ST
WORCESTER,MA01610 		04-2453851 501(C)(3) 10,000   BOOK   PERNET FAMILY HEALTH SERVICE
(2) COMMUNITY LEGAL AID
405 MAIN ST 4TH FLOOR
WORCESTER,MA01608 		04-2446242 501(C)(3) 2,500   BOOK   COMMUNITY LEGAL AID
(3) THE CASA PROJECT
100 GROVE ST SUITE 403
WORCESTER,MA01605 		04-2711865 501(C)(3) 2,500   BOOK   THE CASA PROJECT
(4) MONTACHUSETT OPPURTUNITY COUNCIL
133 PRITCHARD ST
FITCHBURG,MA01420 		04-2401111 501(C)(3) 350,000   BOOK   REIMAGINE NORTH OF MAIN
(5) WORCESTER PUBLIC SCHOOLS
120 IRVING ST
WORCESTER,MA01609 		04-8001418 501(C)(3) 165,000   BOOK   WORCESTER HEARS
(6) ASCENTRIA COMMUNITY SERVICES (ACA)
14 EAST WORCESTER ST SUITE 300
WORCESTER,MA01604 		04-3566243 501(C)(3) 170,722   BOOK   PARTNERSHIP FOR REFUGEE WELLNESS
(7) REGIONAL ENVIRONMENTAL COUNCIL CENTRAL MASS
PO BOX 255
WORCSTER,MA01613 		04-6364330 501(C)(3) 161,650   BOOK   WORCESTER REGIONAL FOOD HUB
(8) GAAMHA INC
208 COLEMAN ST
GARDNER,MA01440 		04-2437107 501(C)(3) 39,499   BOOK   COMMUNITY BASED DAY SERVICES
(9) EMPLOYMENT OPTIONS
82 BRINGHAM STREET
MALBOROUGH,MA01752 		23-7089596 501(C)(3) 78,000   BOOK   CATERING OPTIOINS SOCIAL ENTERPRISE
(10) HMEA
8 FORGE PARK EAST
FRANKLIN,MA02038 		04-2300014 501(C)(3) 56,700   BOOK   STUDENTS FOR HIGHER: RISING UP FOR AUTISM
(11) WORCESTER COMMUNITY HOUSING RESOURCES
11 PLEASANT ST SUITE 300
WORCESTER,MA01609 		22-2719744 501(C)(3) 85,000   BOOK   STORE-FRONT RENEWAL PROJECT
(12) CMWIB (CITY OF WORCESTER)
CITY HALL ROOM 206 455 MAIN ST
WORCESTER,MA01608 		04-6001418 501(C)(3) 84,800   BOOK   CAREER CENTER 2.0
(13) MASS ED CO
484 MAIN ST SUITE 500
WORCESTER,MA01608 		23-7055676 501(C)(3) 73,700   BOOK   ON OUR WAY - EDUCATION FOR A BRIGHT TOMORROW
(14) COMMUNITY HARVEST PROJECT
37 WHEEKER ROAD
NORTH GRAFTON,MA01536 		04-3424018 501(C)(3) 100,000   BOOK   ORCHARD HIGH DENSITY GROWING PROJECT
(15) WORKING FOR WORCESTER (SCHAB)
330 MERRIMAC STREET
NEWBURYPORT,MA01950 		30-0707429 501(C)(3) 29,114   BOOK   EXPANDING CAPACITY AND REACH INITIATIVE
(16) LATIN AMERICAN HEALTH ALLIANCE
27 VERNON ST
WORCESTER,MA01610 		20-5359235 501(C)(3) 89,203   BOOK   CAFE REYES CATERING
(17) NEW VUE COMMUNITIES (TWIN CITIES CDC)
470 MAIN ST
FITCHBURG,MA01420 		04-2690210 501(C)(3) 50,000   BOOK   HOUSING STABILITY PROJECT
(18) ADVOCATES INC
1881 WORCESTER RD
FITCHBURG,MA01701 		23-7451423 501(C)(3) 123,771   BOOK   WORCESTER INITIATIVE FOR SUPPORTED RE-ENTRY
(19) WORCESTER HOUSING AUTHORITY
40 BELMONT STREET
WORCESTER,MA01605 		04-6004472 501(C)(3) 604,657   BOOK   A BETTER LIFE: HELPING FAMILES FIND THEIR WAY
(20) CENTRAL MASS REGIONAL PLANNING COMMISSION
2 WASHINGTON SQUARE 2ND FLOOR
WORCESTER,MA01604 		04-2318872 501(C)(3) 25,000   BOOK   CENTRAL MASS DATA COMMON- PHASE 2
(21) HEALTH LAW ADVOCATES
1 FEDERAL STREET
BOSTON,MA02110 		04-3298116 501(C)(3) 104,130   BOOK   SPECIAL INITIATIVE TO PROTECT CONSUMERS' RIGHTS TO COVEREAGE UNDER HEALTH REFORM
(22) THE JANE FUND OF CENTRAL MASSACHUSETTS
PO BOX 562
HOLDEN,MA01520 		91-1811542 501(C)(3) 5,000   BOOK   JANE FUND OF CENTRAL MASSACHUSETTS
(23) ST JOHN'S CHURCH
44 TEMPLE ST
WORCESTER,MA01604 		04-2106729 501(C)(3) 102,500   BOOK   ST. JOHN'S CHURCH FOOD FOR THE POOR PROGRAM
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015
Page 2

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
non-cash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of non-cash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
PART I, LINE 2: THE HEALTH FOUNDATION AND THE GRANTEE SIGN A CONTRACT OUTLINING THE DELIVERABLES, PAYMENT, AND REPORTING REQUIREMENTS FOR THE PROJECT. TYPICALLY, PROJECT PROCESS EVALUATION REPORTS ARE SUBMITTED TO THE FOUNDATION MIDWAY THROUGH THE CONTRACT YEAR. A PROJECT SUMMARY REPORT IS ALSO REQUIRED TO BE SUBMITTED TO THE FOUNDATION APPROXIMATELY TWO MONTHS AFTER THE CONTRACT END DATE, OUTLINING THE RESULTS AND EXPENSES. IN ADDITION, MULTI-YEAR GRANTEES ARE REQUIRED TO MEET WITH FOUNDATION STAFF ON A QUARTERLY BASIS TO ASSESS PROJECT PROGRESS.
Schedule I (Form 990) 2015



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