SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
UMASS MEMORIAL HEALTH CARE INC & AFFILIATES
 
Employer identification number

91-2155626
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
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   No 541,913 227,352 314,561
 
JNB ASSOCIATES
21 WATER STREET
 
AMESBURY, MA01913 		FUNDRAISING   No 0 96,000 -96,000
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow 541,913 323,352 218,561
3
List all states in which the organization is registered or licensed to solicit contributions 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) 2014
Page 2
Schedule G (Form 990 or 990-EZ) 2014
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.




VerticalRevenue
(a) Event #1

 
(event type) 		(b) Event #2

 
(event type) 		(c) Other events

8
(total number) 		(d) Total events
(add col. (a) through col. (c))

1
Gross receipts . . . . .
375,693
305,899
333,165
1,014,757

2
Less: Contributions . . . .
313,504
162,940
254,795
731,239
3 Gross income (line 1 minus
line 2) . . . . . .
62,189
142,959
78,370
283,518



VerticalDirectExpenses
4 Cash prizes . . . . .        
5 Noncash prizes . . . .   26,101 11,567 37,668
6 Rent/facility costs . . . . 21,608 80,403 3,134 105,145
7 Food and beverages . . . 19,067     19,067
8 Entertainment . . . . 8,747   18,100 26,847
9 Other direct expenses . . . 12,767 36,455 66,350 115,572
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 304,299
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow -20,781
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.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1
Gross revenue . . . . .
 
 
 
 
VerticalDirectExpenses

2
Cash prizes . . . . .
 
 
 
 

3
Noncash prizes . . . .
 
 
 
 

4
Rent/facility costs . . . .
 
 
 
 

5
Other direct expenses . . .
12,767
36,455
66,350
115,572


6

Volunteer labor . . . .
%
%
%


7
Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow
 

8
Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow
 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2014
Page 3
Schedule G (Form 990 or 990-EZ) 2014
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
13
Indicate the percentage of gaming activity conducted 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 right arrow
Address right arrow
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 right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
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 right arrow$  
Part IV
Supplemental Information. 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).
Return Reference Explanation
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.
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: 1. SPEAKEASY HELD BY HEALTHALLIANCE HOSPITALS 2. DENNEHY GOLF TOURNAMENT HELD BY HEALTHALLIANCE HOME HEALTH AND HOSPICE, INC. 3. LOVELIGHT HELD BY HEALTHALLIANCE HOME HEALTH AND HOSPICE, INC. 4. NICU GOLF-A-THON WAS HELD BY THE PARENT 5. LINKS TO THE FUTURE EVENT WAS HELD BY THE PARENT, 6. GALA BALL WAS HELD BY CENTRAL NEW ENGLAND HEALTHALLIANCE, INC. 7. GOLF TOURNAMENT WAS HELD BY MARLBOROUGH HOSPITAL, INC. 8. 125TH ANNIVERSARY EVENT WAS HELD BY CLINTON HOSPITAL ASSOCIATION
Schedule G (Form 990 or 990-EZ) 2014
Additional Data


Software ID:  
Software Version: