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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
THE NORTHERN OHIO HEMOPHILIA
FOUNDATION
Employer identification number
34-1018501
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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
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) 2019
Page 2

Schedule I (Form 990) 2019
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) DIRECT PATIENT ASSISTANCE 65 21,890      
(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
SCHEDULE I, PAGE 1, PART I, LINE 2 EMERGENCY FINANCIAL ASSISTANCE POLICY UPDATED SEPTEMBER 25, 2014 EFFECTIVE JANUARY 1, 2015 THE PURPOSE OF THE MATTEO MEMORIAL ASSISTANCE FUND IS TO PROVIDED LAST RESORT ASSISTANCE TO PERSONS WITH BLEEDING DISORDERS FOR EMERGENCY EXPENSE NEEDS THAT ARISE BECAUSE OF MEDICAL COMPLICATIONS DIRECTLY RELATED TO THEIR BLEEDING DISORDER. RESOURCES ARE LIMITED AND PRIORITY WILL BE GIVEN TO FAMILIES WITH YOUNG CHILDREN WITH BLEEDING DISORDERS. APPLICANTS WHO ARE AFFILIATED WITH AN HTC MUST BE REFERRED BY THEIR HTC AND BE CURRENT WITH THEIR ANNUAL COMP VISITS. THE FOLLOWING ELIGIBILITY CRITERIA FOR THE EMERGENCY ASSISTANCE FUNDS HAVE BEEN ESTABLISHED: APPLICATIONS FOR THE FUNDS ARE LIMITED TO CURRENT CONSUMER MEMBERS OF THE NOHF. ALL REQUESTS FOR ASSISTANCE MUST BE REFERRED THROUGH THE HTC; FAMILIES NOT AFFILIATED WITH AN HTC MAY APPLY DIRECTLY TO THE NOHF, WITH A REFERRAL FROM THEIR HEALTHCARE PROVIDER. THERE MUST BE AT LEAST ONE PERSON WITH A BLEEDING DISORDER LIVING IN THE HOUSEHOLD. ALL PAYMENTS FOR APPROVED EMERGENCY ASSISTANCE MUST BE MADE TO A QUALIFIED THIRD PARTY, SUCH AS A LANDLORD, VENDOR, UTILITY COMPANY, ETC. THE APPLICANT IS REQUIRED TO PROVIDE DOCUMENTATION OF THE NEED AND COMPLETE A STANDARD APPLICATION FORM; THE MAXIMUM EMERGENCY ASSISTANCE PAYMENT PER FAMILY IS 500 PER CALENDAR YEAR. THE NOHF REALIZES THAT ALL FAMILIES WITH BLEEDING DISORDERS HAVE FINANCIAL BURDENS. HOWEVER, THE PURPOSE OF THE MATEO MEMORIAL FUND IS TO HELP PEOPLE WITH ONE-TIME ONLY EXTRAORDINARY EXPENSES. UNFORTUNATELY, THE NOHF DOES NOT HAVE THE RESOURCES TO HELP WITH THE USUAL AND CUSTOMARY LIVING EXPENSES. WE REGRET THAT NOT ALL FAMILIES CAN RECEIVE ASSISTANCE.
Schedule I (Form 990) 2019



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