Designated Fund Contribution Form

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1 1 Designated Fund Cntributin Frm Name(s) Address Street City State Zip Alternate Address: Business Seasnal Street City State Zip Telephne Wrk Hme Cell Alternate Hw did yu hear abut the Cmmunity Fundatin? Whm may we thank fr referring yu t the Fundatin? 1. The dnrs give the sum f $ and/r the fllwing described prperty (descriptin f assets given) t The Cmmunity Fundatin f Nrth Central Massachusetts (Fundatin); with the request, subject t the Articles f Organizatin and By- Laws f the Fundatin, as they currently exist r may hereafter be amended, that the funds r prperty thus transferred be used t establish, r add an Endwed Fund t be knwn as the Fund (name f fund). Which all net distributins will be made t: (Name f nn-prfit(s)) 2. The investment bjective requested is: (Review ur investment results carefully and initial ne f the fllwing) Shrt Term Fund (Less than 3 years) The primary investment bjective f this Fund is stability f principal. This fund is apprpriate fr nn-endwed funds, r ther situatins where funds can be withdrawn with little r n advance ntice, and/r in situatins where nly minimal fluctuatins t principal can be tlerated. Agencies and dnrs with time hrizns under three years shuld cnsider this strategy. Medium Term Fund (3-5 Years) The primary investment bjective f this Fund is t prvide payuts with mderate year t year vlatility. This Fund may experience sme reductin f purchasing pwer ver time due t inflatin. This fund is apprpriate fr endwed funds that require minimal, r n, nminal grwth (befre inflatin) after payuts, r nn-endwed funds that have a time hrizn that is between three and five years. This fund will mst likely experience mderate fluctuatins t principal.

2 2 Lng Term Fund (5+ Years) The primary investment bjective f this Fund is preservatin f purchasing pwer t prvide a relatively stable, inflatin adjusted, annual payut t supprt grant-making r ther dnr missins. This Fund is apprpriate fr endwed funds r nn-endwed funds with time hrizns beynd five years. There will be sme inevitable vlatility in principal value frm this strategy, but it may ffer the ptential fr a sustainable payut plus inflatin prtectin, understanding that this may result in a less stable payut frm year t year. 3. Distributins will be made frm the fund in accrdance with the Fundatin s spending rule fr endwment funds as stated in the Investment, Distributin & Fee Guidelines, which may be mdified by the Bard f Trustees frm time t time (Please initial the fllwing): n an annual basis n a quarterly basis Nte: All distributins are subject t the variance pwer cntained in Article II (1) f the Articles f Organizatin f the Fundatin. 4. I/We hereby acknwledge that I/we have been ffered cpies f and have reviewed the fllwing dcuments: a. The Fundatin s Investment Plicy Statement (initial) b. The Fundatin s Articles f Organizatin (initial) c. The Fundatin s By-Laws. (initial) d. Perfrmance Reprt f three fund ptins (initial) 5 Administrative Fee charges will be assessed n an annual basis as per the Fundatin s Guidelines, which are subject t reasnable mdificatin by the Bard f Trustees. 6. Distributins can be taken frm the fund nce it has reached $10,000, and at least ne year has passed frm the date the fund was established. (See the Fundatin s Investment, Distributin and Fee Guidelines). If fr sme reasn the fund is nt funded with a ttal f at least $10,000, the Fundatin will meet with the dnr r the advisrs t discuss disslving f the fund and distributing the entire fund fr charitable purpses. 7. Timeframe f the Fund: (Check One) On-Ging (Endwed) # f Years 8. The dnr hereby authrizes the Fundatin t pay its administrative fees and investment management expenses frm the fund in accrdance with the Investment, Distributin and Fee Guidelines f the fundatin in effect frm time t time.. (initial) 9. The gift r prperty described abve will be transferred t the fundatin using the fllwing methd: (Please initial ne f the fllwing) Check Securities-Gift Accunt Transfer * Securities-Certificates Transfer * Other Securities-Electrnic Transfer * *(Please cntact the Cmmunity Fundatin fr instructins n securities transfers) 10. The dnr understands that the gift described abve will becme an asset f the Fundatin and is irrevcably cmmitted fr charitable purpses. (initial) 11. The dnr understands that, upn the death f the advisrs and successr advisrs named (if any), the assets f the fund created by this dcument will be added t the Fundatin s General Fund. (initial) 12. Cntributins are Irrevcable. All gift cntributins made t the Fundatin becme assets f the Fundatin and are irrevcable as tax deductible gifts. All gifts t the Fundatin must further the charitable purpse and missin f the Fundatin. The Fundatin reserves the right t review and apprve all cntributins.

3 3 13. Estate Plans: D yu plan t name this fund as a beneficiary in yur estate plan? If s, please indicate the type f planned gift: Bequest IRA/retirement plan assets Charitable remainder trust Life insurance Charitable lead trust Other 14. Amendments. This agreement may be amended frm time t time by a dcument in writing signed by the Fundatin and by the dnr(s) if they are living r the acting fund advisrs. Signatures: Fr the dnr (s): Fr Cmmunity Fundatin f Nrth Central Massachusetts: Signature Date Philip M. Grzewinski Date President Signature Date Linda Mack Date V.P. f Develpment and Dnr Services PLEASE READ AND SIGN THE INVESTMENT, DISTRIBUTION AND FEE GUIDELINES. DONOR RECOGNITION: Please publish my fund name in yur publicatin(s) as it appears at tp f Page 1. Please d nt publish my name in yur publicatin(s). Please d nt publish my name in yur publicatin(s), hwever, yu may use my name t invite thers t jin the Fundatin. Quarterly Statements are available nline. Persn(s) will be using the nline access t yur fund and making grant distributins: Persn wh can have read nly access; What are yur charitable interests? Arts and Culture Educatin Envirnment Health and Human Services Husing and Cmmunity Develpment Civic Engagement Wrkfrce Develpment Nnprfit Sectr Other

4 4 The Cmmunity Fundatin f Nrth Central Massachusetts, Inc. Investment, Distributin and Fee Guidelines Investment Optins The dnr may select an investment bjective that best suits the fund's intended purpse. The Fundatin prvides infrmatin n perfrmance, asset allcatin, and fees fr each f the three investment ptins. An explanatin fr each ptin fllws: Shrt Term Fund (Less than 3 years) The primary investment bjective f this Fund is stability f principal. This fund is apprpriate fr nn-endwed funds r ther situatins where funds can be withdrawn with little r n advance ntice, and/r in situatins where nly minimal fluctuatins t principal can be tlerated. Agencies and dnrs with time hrizns under three years shuld cnsider this strategy. Medium Term Fund (3-5 Years) The primary investment bjective f this Fund is t prvide payuts with mderate year t year vlatility. This Fund may experience sme reductin f purchasing pwer ver time due t inflatin. This fund is apprpriate fr endwed funds that require minimal, r n, real grwth after payuts, r nnendwed funds that have a time hrizn that is between three and five years. This fund will mst likely experience mderate fluctuatins t principal. Lng Term Fund (5+ Years) The primary investment bjective f this Fund is preservatin f purchasing pwer t prvide a relatively stable, inflatin adjusted, annual payut t supprt grant-making r ther dnr missins. This Fund is apprpriate fr endwed funds r nn-endwed funds with time hrizns beynd five years. There will be sme inevitable vlatility in principal value frm this strategy but it may ffer the ptential fr a sustainable payut plus inflatin prtectin, understanding that this may result in a less stable asset balance frm year t year. Distributin Plicies Endwment Funds The Fundatin, maintaining exclusive legal cntrl f all cntributed assets, has adpted a ttal return apprach t investment management under the Unifrm Management f Institutinal Funds Law fr Permanent Endwment Funds. This allws the Fundatin t capture mre f the histrically higher appreciatin in the equity markets. "Ttal return" is a term used t describe the ttal change in fund value ver a given time perid that results frm bth incme (interest and dividends) and capital appreciatin (realized and unrealized gains). Under this apprach, a fund's incme fr grant making and/r distributins will be calculated by using a "spending rule" a fixed annual rate established by the Fundatin's Bard f Trustees and defined as a percentage f the market value f the assets in the fund. Fr example, a spending rule fr a given year might be 5% f the fur-year average f a cmpnent fund's asset value. The amunt available fr grant making determined by this spending rule can include interest and dividend incme, as well as realized and unrealized gains. Currently the spending rule is 4.5% f the average market value ver the past 20 quarters. N distributins are allwed fr ne year frm the time the endwment fund is established. Grants frm the permanent endwment will be made at the June Trustees meeting. It is imprtant t nte that depending n market cnditins, in sme years the spending rule may require the distributin f a prtin f the principal balance in a fund.

5 Revised May 5, 2015 Dnr Advised and Schlarship Funds The Fundatin will frm time t time receive advice frm dnrs r their designees regarding disbursements frm dnr advised, r schlarship funds. This advice will be cnsidered upn written request t the Fundatin. The President and/r the Executive Cmmittee f the Fundatin are authrized t cnsider this advice and make distributins. (Please nte that IRS regulatins prhibit distributins t fulfill pledges and/r t secure benefits frm the distributin recipient. With regard t Dnr Advised Funds, all disbursements must be fr the benefit f a charitable rganizatin.) Disbursements will ccur n the clsest f the fllwing dates: March 30, June 30, September 30 r December 30, unless therwise agreed. The Fundatin will send a letter t the dnr r designee, cnfirming the actin taken regarding his r her advice. As Funder f a Dnr Advised Fund r Schlarship Fund yu may appint new advisrs at any time by submitting them in writing t the Fundatin. Reprts The Fundatin will prvide dnrs r designees with quarterly statements n yur Fund's activity and investment perfrmance. Yu can access yur mnthly fund perfrmance by ging t ur website Fundatin.rg and creating a user name and passwrd t view yur fund balance, perfrmance and initiate distributins/grants. Administrative Fees Distributins will be made frm the Fund in accrdance with the Fundatin s spending rule as stated here in the Investment, Distributin & Fee Guidelines, which may be mdified by the Bard f Trustees frm time t time. Administrative tasks assciated with the management f funds include investigatin f grants, receipt and acknwledgement f cntributins, payment f grants, versight f investment management, and cmpliance with federal and state reprting requirements. T supprt these activities, the Fundatin currently charges a 1% fee n nn-endwed funds. Fr endwed funds a tiered annual fee ranging frm 1% t 0.10% f the fund s market value. The fee is calculated as 1/12 th % f the fund s market value at the end f each mnth. The tiered fees are brken dwn as fllws: First $2,000, % Next $3,000, % Amunts abve $5,000, % A nte abut administrative fees: The Administrative Fee fr endwed and nn-endwed funds are subject t reasnable mdificatin by the Bard f Trustees. Fees nt nly supprt administrative peratins, but als fund a prtin f the Fundatin's wrk in the cmmunity. Shrt-Term Fund Administrative Fees Shrt Term Fund fees are assessed mnthly n the fund balance at a 1% annual rate. If the fund has duratin f less than ne year, the minimum fee is 1% f the average mnthly balance during the time the Fundatin hlds the funds. Investment Management Fees The Investment Management Fee is based n a graduated scale depending n the amunt f funds the Fundatin has invested. The fee is calculated by taking the investments market value at the end f the mnth multiplied by the current annual rate and then dividing by 12. Investment Management fee rate fr the Shrt Term fund was 0.32% annually as f 12/31/14. This fee/expense percentage varies slightly ver time as the mix f investment funds utilized changes. Investment Management fee rate fr the Medium Term and Lng Term funds was 0.54% annually as f 8/31/15. This fee/expense percentage varies slightly ver time as the mix f investment funds utilized changes. All investment perfrmance reprts shw investment returns net f fees. Signature: Date:

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