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
2016
Open to Public
Inspection
Name of the organization
UMass Memorial Health Care Inc & Affiliates
 
Employer identification number
91-2155626
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
noncash assistance		 (h) Purpose of grant
or assistance
(1) Edward M Kennedy Community Health Center Inc
650 Lincoln Street
Worcester,MA01605 		04-2513817 501 (c)(3) 1,000,000 0 N/A N/A Support for Health Center's mission
(2) Family Health Center of Worcester Inc
26 Queen Street
Worcester,MA01610 		04-2485308 501 (c)(3) 1,000,000 0 N/A N/A Support for Health Center's mission
(3) University of Massachusetts Medical School
55 Lake Ave N
Worcester,MA01655 		04-3167352 University of MA 88,996 0 N/A N/A EOHHS ICB Grant $29,681 and Complex Aortic Aneurysm Repair Study $59,315
(4) Physician Health Services Inc
860 Winter Street
Waltham,MA02451 		22-3234975 501 (c)(3) 12,500 0 N/A N/A Support for Caring for Physician Health Campaign
(5) Arthritis Foundation
1330 West Peachtree Street
Atlanta,GA30309 		58-1341679 501 (c)(3) 10,000 0 N/A N/A Central MA WTCA Sponsorship
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
5
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2016
Page 2

Schedule I (Form 990) 2016
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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) COMMUNITY SUPPORT 6 23,000     0
(2) Scholarship 13 9,400     0
(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
Schedule I, Part II, Line 1(h) SCHEDULE I, PART II, LINE 1H MEDICAL CENTER: The standard set forth is a reasonable expectation that the Grants will contribute meaningfully to each of the Health Center's ability to maintain or increase the availability, or enhance the quality, of services provided to a medically underserved population serviced by the Health Centers. Each Health Center has documented the basis for said reasonable expectation. This EOHHS grants are for Health Care Infrastructure and Capacity Building funding for Hospitals and Community Health Centers. The primary objective of the present study is to evaluate the safety and efficacy of physician-modification of FDA-approved off-the-shelf endovascular grafts in the treatment of patients with complex Aortic Aneurysm Repair.
Schedule I, Part III Schedule I, Part III Type of grant or assistance Central New England HealthAlliance: Community Support is related to the Doyle Community fund that offers annual grant opportunities for non-profits in the community who seek to improve health and wellness and/or who impact our youth at risk and families in need.
Schedule I, Part III Schedule I, Part III Type of grant or assistance Marlborough Hospital: Scholarships awarded to students pursuing a career in health care. MacLaren Scholarship and the Auxiliary Scholarship.
Schedule I, Part II, Line 1(h) Schedule 1, Part II, Line 1(H) Medical Group: 2017 donation to Physician Health , Inc. is to provide confidential consultation and support to physicians, residents, and medical students.
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. MEDICAL CENTER: AT REASONABLE INTERVALS RE-EVALUATION OF THE GRANTS WILL OCCUR TO ENSURE THAT THE ARRANGEMENTS ARE EXPECTED TO CONTINUE TO SATISFY THE STANDARD SET FORTH. THE HEALTH CENTERS WlLL DOCUMENT THE RE-EVALUATION CONTEMPORANEOUSLY. AS PART OF THE FUNDRAISING AGREEMENT, BI-ANNUAL UPDATES WILL BE PROVIDED TO THE SENIOR VICE PRESIDENT FOR OPERATIONS OF THE MEDICAL CENTER RESPONSIBLE FOR THE MUSCULOSKELETAL CENTER OF EXCELLENCE. GRANT FUNDED ON A PER YEAR BASIS FOR THE DURATION OF THE STUDY. WITH ANNUAL COST RECONCILIATIONS PERFORMED AND PROVIDED TO THE MEDICAL CENTER
Schedule I (Form 990) 2016



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