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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
2022
Open to Public
Inspection
Name of the organization
CENTRAL MASSACHUSETTS AGENCY ON
AGING INC
Employer identification number
04-2547633
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) CENTRAL MA HOUSING ALLIANCE
6 INSTITUTE ROAD
WORCESTER,MA01609 		04-2791448 501C3 55,000       ELDER HOME REPAIR
(2) JEWISH FAMILY SERVICES
646 SALISBURY ST
WORCESTER,MA01609 		04-2104350 501C3 30,000       GUARDIANSHIP
(3) COMMUNITY LEGAL AID
370 MAIN ST STE 200
WORCESTER,MA01608 		04-2446242 501C3 141,379       LEGAL ASSISTANCE
(4) LEOMINSTER SPANISH AMERICAN CENTER
112 SPRUCE ST
LEOMINSTER,MA01453 		04-2761759 501C3 30,000       INFO & ASSISTANCE
(5) MONTACHUSETT OPPORTUNITY COUNCIL
133 PRICHARD ST
FITCHBURG,MA01420 		04-2401111 501C3 447,833       ELDER NUTRITION
(6) MONTACHUSETT OPPORTUNITY COUNCIL
133 PRICHARD ST
FITCHBURG,MA01420 		04-2401111 501C3 79,269       NSIP
(7) ELDER SERVICES OF WORCESTER
67 MILLBROOK ST
WORCESTER,MA01606 		04-2545221 501C3 757,125       ELDER NUTRITION
(8) ELDER SERVICES OF WORCESTER
67 MILLBROOK ST
WORCESTER,MA01606 		04-2545221 501C3 365,180       NSIP
(9) ELDER SERVICES OF WORCESTER
67 MILLBROOK ST
WORCESTER,MA01606 		04-2545221 501C3 25,000       CRISIS INTERVENTION
(10) ELDER SERVICES OF WORCESTER
67 MILLBROOK ST
WORCESTER,MA01606 		04-2545221 501C3 8,500       MONEY MANAGEMENT
(11) ELDER SERVICES OF WORCESTER
67 MILLBROOK ST
WORCESTER,MA01606 		04-2545221 501C3 170,967       CAREGIVER SUPPORT
(12) AGING SERVICES OF NORTH CENTRAL MA
680 MECHANIC ST
LEOMINSTER,MA01453 		04-2551175 501C3 25,000       CRISIS INTERVENTION
(13) AGING SERVICES OF NORTH CENTRAL MA
680 MECHANIC ST
LEOMINSTER,MA01453 		04-2551175 501C3 8,500       MONEY MANAGEMENT
(14) AGING SERVICES OF NORTH CENTRAL MA
680 MECHANIC ST
LEOMINSTER,MA01453 		04-2551175 501C3 102,540       CAREGIVER SUPPORT
(15) TRI VALLEY INC
10 MILL ST
DUDLEY,MA01571 		04-2594201 501C3 118,308       NSIP
(16) TRI VALLEY INC
10 MILL ST
DUDLEY,MA01571 		04-2594201 501C3 467,685       ELDER NUTRITION
(17) TRI VALLEY INC
10 MILL ST
DUDLEY,MA01571 		04-2594201 501C3 25,000       CRISIS INTERVENTION
(18) TRI VALLEY INC
10 MILL ST
DUDLEY,MA01571 		04-2594201 501C3 8,500       MONEY MANAGEMENT
(19) TRI VALLEY INC
10 MILL ST
DUDLEY,MA01571 		04-2594201 501C3 131,785       CAREGIVER SUPPORT
(20) TRI VALLEY INC
10 MILL ST
DUDLEY,MA01571 		04-2594201 501C3 16,900       HEALTHY LIVING
(21) HABITAT FOR HUMANITY OF NC MA
201 GREAT ROAD STE 301
ACTON,MA01720 		04-2999854 501C3 8,096       ELDER HOME REPAIR
(22) INDIA SOCIETY OF WORCESTER
152 MAIN ST
SHREWSBURY,MA01545 		22-2533832 501C3 18,300       OUTREACH
(23) MA COLLEGE OF PHARMACY & HEALTH SCI
25 FOSTER ST
WORCESTER,MA01608 		04-2104700 501C3 29,977       MEDICATION MGMT
(24) UHAI FOR HEALTH
65 JAMES ST STE 205
WORCESTER,MA01605 		27-2980093 501C3 15,000       REFUGEE PROGRAM
(25) CENTER FOR LIVING AND WORKING
18 CHESTNUT ST STE 540
WORCESTER,MA01608 		04-2564426 501C3 20,560       REACHING UNDERSERVED
(26) YWCA OF CENTRAL MA
ONE SALEM SQ
WORCESTER,MA01608 		04-2105873 501C3 23,636       ALED HEALTHY LIVING
(27) QUINSIGAMOND COMMUNITY COLLEGE
670 WEST BOYLSTON ST B07A
WORCESTER,MA01696 		04-2897624 501C3 30,028       SENIOR DENTAL PROG
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
15
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) 2022
Page 2

Schedule I (Form 990) 2022
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)
(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 FISCAL MONITORING: GRANTEES SUBMIT MONTHLY FINANCIAL REPORTS WHICH DETAIL PROGRAM EXPENDITURES AND REVENUES. BACK-UP DOCUMENTATION ACCOMPANIES THE FINANCIAL REPORT. A SPREADSHEET IS MAINTAINED THAT RECORDS MONTHLY REQUESTS MADE BY GRANTEES AND INSURES THAT GRANT REQUESTS DO NOT EXCEED TOTAL OBLIGATION. PROGRAM MONITORING: RELEVANT INFORMATION FOR MONITORING INCLUDES: 1) EVIDENCE DOCUMENTING PROGRESS TOWARD ATTAINMENT OF THE SERVICE OBJECTIVES OUTLINED IN THE SERVICE PROVISION AGREEMENT, AS WELL AS INFORMATION DEMONSTRATING THAT CLIENTS HAVE BEEN GIVEN AN OPPORTUNITY TO MAKE A DONATION TO HELP SUPPORT THE EXTENSION OF PROGRAM SERVICES; 2) COMPLETION OF AN ACCEPTABLE CLIENT SATISFACTION SURVEY OR PROGRAM EVALUATION; 3) EVIDENCE OF PROVISION OF PROGRAM PROVIDED TO EACH CLIENT. ON-SITE MONITORING MAY ALSO INCLUDE: 1) INTERVIEWS WITH BOTH DIRECT SERVICE AND SUPERVISORY STAFF; 2) REVIEW OF CLIENT FILES; 3) VISITS TO BOTH ADMINISTRATIVE AND DIRECT SERVICE LOCATIONS. FOR THE NUTRITION PROGRAMS, UNANNOUNCED VISITS ARE MADE TO THREE MEAL SITES IN EACH PROJECT AREA. AN ANNUAL VISIT IS MADE TO PROJECT ADMINISTRATION TO REVIEW RECORDS AND RESULTS OF KITCHEN MONITORING UNDERTAKEN BY PROJECT STAFF AND DISCUSS ANY PROBLEMS DISCOVERED DURING MEAL SITE AND HDM MONITORING. COPIES OF MONITORING REPORTS ARE PROVIDED TO GRANTEES AND KEPT ON FILE AS PART OF THE ORGANIZATION'S RECORD OF PROGRAM PERFORMANCE.
Schedule I (Form 990) 2022



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