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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.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
COMMUNITY FOUNDATION OF NORTH CENTRAL
MASSACHUSETTS INC
Employer identification number
04-3537449
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) 15-40 Connection
53 Otis St
Westborough,MA01581 		26-2873903   18,865 0     Health & Human Services
(2) Boys & Girls Club of NCM
365 Lindell Ave
Leominster,MA01453 		04-3576700   575,287 0     Education
(3) City of Fitchburg
166 Boulder Drive
Fitchburg,MA01420 		04-6001388   0 13,960 Actual Cost Lucas Machine Health & Human Services
(4) City of Gardner
95 Pleasant St
Gardner,MA01440 		04-6001389   0 13,960 Actual Cost Lucas Machine Health & Human Services
(5) Doyle Field Donation Account
109 Graham St
Leominster,MA01453 		54-2106411   58,303 0     Field restoration
(6) Fitchburg Art Museum
185 Elm St
Fitchburg,MA01420 		04-6111758   13,000 0     Arts & Culture
(7) Fitchburg Historical Society
50 Grove St
Fitchburg,MA01420 		04-6060118   28,721 0     Arts & Culture
(8) Fitchburg Schools
166 Boulder Drive Suite 108
Fitchburg,MA01420 		04-6001388   46,581 0     Education
(9) Fitchburg State University
160 Pearl Street
Fitchburg,MA01420 		04-2661048   15,081 0     Scholarships
(10) Friends of New Salem Library
5 South Main St
New Salem,MA01355 		27-1799778   10,000 0     Arts & Culture
(11) Friends of Sholan Farms
1125 Pleasant St
Leominster,MA01453 		04-3584313   12,000 0     Environment
(12) FSU Foundation
160 Pearl St
Fitchburg,MA01420 		  157,446 0     Scholarhips
(13) Gardner Emergency Housing
17 Cross St
Gardner,MA01440 		04-3537449   12,500 0     Health & Human Services
(14) Greater Ennis United Ways
PO Box 639
Ennis,TX75120 		23-7087962   30,214 0     Health & Human Services
(15) Groton Community School
110 Boston Rd
Groton,MA01450 		04-2111386   10,000 0     Education
(16) Indian Hill Music Center
PO Box 1484
Littleton,MA01460 		04-2867945   23,400 0     Arts & Culture
(17) Jewish Community Center
268 Washington St
Leominster,MA01453 		04-2104344   7,000 0     Education
(18) Leominster Ed Foundation
24 Church St
Leominster,MA01453 		20-8787341   33,267 0     Arts & Culture
(19) LUK Crisis
535 Westminster St
Fitchburg,MA01420 		22-2592809   5,815 0     Health & Human Services
(20) Mont Interfaith Hospitality
923 Main St
Fitchburg,MA01420 		04-2551175   10,756 0     Health & Human Services
(21) Morgan Memorial Goodwill
1010 Harrison Ave
Boston,MA02119 		04-2106765   25,000 0     Health & Human Services
(22) MWCC Foundation
444 Green St
Gardner,MA01440 		23-7136083   277,097 0     Education
(23) Narragansett Regional School
462 Baldwinville Rd
Baldwinville,MA01436 		04-6006593   5,843 0     Arts & Culture
(24) Nashoba Conservation Trust
PO Box 188
Pepperell,MA01463 		23-7066018   5,700 0     Environment
(25) Nashua River Watershed
592 Main St
Groton,MA01450 		23-7055674   28,507 0     Environment
(26) Nashua Valley Boy Scouts
1980 Lunenburg Rd
Lancaster,MA01523 		04-2349692   27,143 0     Support for Boy Scouts of NCM
(27) NMRS Scholarship Foundation
Main St
Townsend,MA01469 		04-2586706   25,489 0     Scholarships
(28) North County Land Trust
325 Lindell Ave
Leominster,MA01453 		22-3193109   36,280 0     Environment
(29) Pathways for Change
588 Main St
Worcester,MA01608 		04-2734584   7,030 0     Health & Human Services
(30) RCAP Solutions
205 School St STE 401
Gardner,MA01440 		04-2454675   10,250 0     Health & Human Services
(31) River Cities United Way
PO Box 966
Lake Havasu,AZ86405 		23-7373816   27,872 0     Health & Human Services
(32) Salvation Army Montachusett
739 Water St
Fitchburg,MA01420 		04-2103624   17,000 0     Education
(33) Social Venture Partners
71 Commercial St
Boston,MA02109 		45-4232024   11,000 0     Health & Human Services
(34) St Leo School
120 Man St
Leominster,MA01453 		  11,876 0     Scholarships
(35) Stevens Memorial Library
32 Main St
Ashburnham,MA01430 		  10,433 0     Arts & Culture
(36) The Arc Opportuity
564 Main St
Fitchburg,MA01420 		04-2226199   111,584 0     Health & Human Services
(37) Town of Ashburham
32 Main St
Ashburnham,MA01430 		04-6001071   0 13,960 Actual Cost Lucas Machine Health & Human Services
(38) Town of Ashby
895 Main St
Ashby,MA01431 		04-6001072   0 13,960 Actual cost Lucas Machine Health & Human Services
(39) Town of Clinton
242 Church St
Clinton,MA01510 		04-6001118   0 13,960 Actual Cash Lucas Machine Health & Human Services
(40) Town of Devens
33 Andrews Parkway
Devens,MA01434 		04-3431714   0 13,960 Actual Cost Lucas Machine Health & Human Services
(41) Town of Dunstable
511 Main St
Dunstable,MA01827 		46-5613940   0 13,960 Actual Cost Lucas Machine Health & Human Services
(42) Town of Hubbardston
7 Main St
Hubbardston,MA01452 		04-6001257   0 13,960 Actual Cost Lucas Machine Health & Human Services
(43) Town of Lancaster
701 Main St
Lancaster,MA01523 		04-6001194   0 13,960 Actual Cost Lucas Machine Health & Human Services
(44) Town of Orange
6 Prospect St
Orange,MA01364 		04-6001257   0 13,960 Actual Cost Lucas Machine Health & Human Services
(45) Town of Petersham
3 South Main St
Petersham,MA01366 		04-6001247   0 13,960 Actual Cost Lucas Machine Health & Human Services
(46) Town of Phillipston
50 The Common
Phillipston,MA01331 		04-6001268   0 13,960 Actual Cost Lucas Machine Health & Human Services
(47) Town of Shirley
7 Keady Way
Shirley,MA01464 		04-6001299   0 13,960 Actual Cost Lucas Machine Health & Human Services
(48) Town of Templeton
160 Patriots Road
E Templeton,MA01438 		04-6001321   0 13,960 Actual Cost Lucas Machine Health & Human Services
(49) Townsend Council on Aging
16 Dudley Rd
Townsend,MA01469 		04-6001326   8,128 0     Health & Human Services
(50) Townsend Fire EMS
13 Elm St
Townsend,MA01469 		04-6001326   8,401 0     Health & Human Services
(51) Townsend Historical Society
72 Main St
Townsend,MA01469 		23-7212599   5,173 0     Arts & Culture
(52) Townsend Public Library Endowmen
12 Dudley Rd
Townsend,MA01469 		26-3562595   32,000 0     Arts & Culture
(53) United Way of Central Alabama
PO Box 320189
Birmingham,AL35232 		63-0288846   46,635 0     Health & Human Services
(54) United Way of Greater Stark County
4825 Highbee Ave NW
Canton,OH44718 		13-4254191   41,643 0     Health & Human Services
(55) United Way of Laurens County
16 Peachtree St
Clinton,SC29325 		23-7011064   47,976 0     Health & Human Services
(56) United Way of NCM
285 John Fitch Highway
Fitchburg,MA01420 		04-2233021   430,855 0     Health & Human Services
(57) University of Mass Lowell
220 Pawtucket St
Lowell,MA01854 		66-6001753   10,000 0     Scholarships
(58) Worcester Public Schools
20 Irving St
Worcester,MA01609 		04-5001418   17,000 0     Health & Human Services
(59) YWCA
1 Salem Square
Worcester,MA01608 		04-2105873   12,000 0     Education
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
58
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2017

Schedule I (Form 990) 2017
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) College Scholarships 137 132,057      
(2) Clothing/Medical Assistance 22 45,114   Actual costs Clothing/medical/Utility/Transporta
(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
Grantmaker's Description of How Grants are Used The Community Foundation monitors the grants from its general endowment by working closely with the funded agencies. In addition, semiannual reports are submitted detailing expenditures and program measurements and outcomes.This thorough review by Foundation staff and community volunteers helps ensure that donors' contributions are effective and making a difference in the community.
Schedule I (Form 990) 2017



Additional Data


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