return of private foundation 2004 -...

Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust

Treated as a Private Foundation Note : The organization may be able to use a copy of this return to satisfy state repor tax vear beainnina . and ending

OMB No 1545.0052

2004 Department of the Treasury Internal Revenue Service

For calendar vear

Use the IRS Name of organization

label. Otherwise, ILDRED H . MCEVOY FOUNDATION

print Number and street (a P 0 box number if mail is not delivered to street address)

or type : 370 MAIN STREET 12TH FLOOR See Specific City or town, state, and ZIP code Instructions . WORCESTER,- MA 01608-1779 H Check type of organization : W Section 501(c)(3) exempt private foundation

Section 4947(a)(1) nonexempt charitable trust 0 Other taxable private foundation I Fair market value of all assets at end of year J Accounting method: M Cash [ (from Part 11, coil, (c), line 16) 0 Other (specify)

25 , 242 , 22 111104 7 . (part 1, column (d) must be on cash bass

B Telephone number 508-798-8621

C If exemption application is pending, check here ,

D 1 . Foreign organizations, check here Q, Foreign organizations meeting the 85% test, ,

check here and attach computation

E If private foundation status was terminated under section 507(b)(1)(A), check here "D

F If the foundation is in a 60-month termination under section 507 b 1 B check here

(c) Adjusted net (d) Disbursements for charitable purposes income ,� _ .,, ,,__, . . ... ..,,

Accrual

Part I Analysis of Revenue and Expenses Rna total of amounts in columns (b), (c), and (~ may not (a) Revenue and (b) Net investment necessarily equal the amounts in column (a> > expenses per books income

1 Contributions, gifts, grants, etc., received Q Check 100~ Ell If the founAaBon Is not required to attach Sch B

sh on savings and temporary Interest

lnvastments 3 ca 29 , 526 . 4 Dividends and interest from securities 540 , 636 . 5a Gross rents b Net rental income a (loss)

6 a Net gain or goss) from sale of assets not on

line 10 1,118,619 . Gross sales price for all C' b assets on line 6a 1-0,670,568 .

7 Capital pain net income (from Part IV, line 2) LIJ cc 8 Net short-term capital gain

9 Income modifications _ , Gross sales less returns

108 and allowances

b less cost of goods sold c Gross profit or (loss)

11 Other income 5 , 500 . 1 2 Total . Add lines I through 11 1 , 694 , 281 . 13 Compensation of officers, directors, trustees, etc 51 ,000 . 14 Other employee salaries and wages

y 15 Pension plans, employee benefits isa Legal fees STMT 4 145 , 000 .

b Accounting fees $TMT 5 2 , 684 . CIL c Other professional fees $TNT 6 39 , 201 .

> 17 Interest e Taxes STMT ? 50 , 120 .

~ 19 Depreciation and depletion '' E 20 Occupancy

a 21 Travel, conferences, and meetings 22 Printing and publications

~ 23 Other expenses $TMT 8 3 , 969 . 24 Total operating and administrative

expenses . Add lines 13 through 23 291 , 974 . X 25 Contributions, gifts, grants paid 1 049 , 859 .

26 Total expenses and disbursements. Add lines 24 and 25 1 341 , 833 .

27 Subtract line 26 from line 12 : --8 Excess of revenue over expenses and disbursements 352 , 449 . b Net investment income cr negative, enter -o-) C Ad ~U8t8d net income of negative, enter-o-)

LHA For Privacy Act and Paperwork Reduction Act Notice, see the instructions . 423501 01-03-05

.9 , 526 . STATEMENT 1 0 , 636 . STATEMENT 2

8 1 619 .

.5 , 500 . STATEMENT 3 4 , 281 .

0 . 51 , 000 .

6 , 250 . 108 750 . 2 6 0 . 9 2 I . B 0 .

Ow, 2

NIF r r

2 1 655 . '` 1 , 274 .

0 , 790 . 161 024 . 1 , 049 , 859 .

0 1 790 . 1 , 210 , 883 .

3 , 491 . 1 ` ^ ~~ N/A

Form 990-PF (2004) I"

i

. ;y

.`

Form ; 990=PF

Room/suite

Employer identification number

04-6069958 End of year

Book Value (c) Fair Market Value Beginning of year lal Book Value

536 797 . 536 797 . 523 360 . 15 191 360 . 15 478 022 . 18 113 709 . 2 , 022 , 135 . 1 , 783 , 615 . 1 , 859 , 228 .

407 053 . 405 469 . 405 469 .

22 173 943 . 22 , 544 , 364 . 25 242 227 .

1 , 246 , 250 . 1 , 077 , 000 .

1 , 246 , 250 . 1 , 077 , 000 .

20 007 734 . 20 927 693 . 0 . 0 .

919 959 . 539 671 . 20 927 693 . 21 467 364 .

22 173 943 . 22 544 364 .

Organizations that follow SFAS 117, check here " U and complete lines 24 through 26 and lines 30 and 31 .

24 Unrestricted 25 Temporarily restricted

m 26 Permanently restricted Organizations that do not follow SFAS 117, check here and complete lines 27 through 31 . L

~° 27 Capital stock, trust principal, or current funds 28 Paid-in or capital surplus, or land, bldg ., and equipment fund

a 29 Retained earnings, accumulated income, endowment, or other funds ." Z 30 Total net assets or fund balances

2,4

Form 990-PF (2004) 423511 01-03-05

.'

Form 990-PF (2004) MILDRED H . MCEVOY FOU]

Part II Balance Sheets Attached schedules anuamounts lnmedescription column should he for end-of-year amounts only

1 Cash - non-interest-bearing 2 Savings and temporary cash investments 8 Accounts receivable " 8,177

Less: allowance for doubtful accounts 4 Pledges receivable 1

Less: allowance for doubtful accounts 01 5 Grants receivable 6 Receivables due from officers, directors, trustees, and other

disqualified persons 7 Other notes and loans receivable

Less: allowance for doubtful accounts 8 Inventories for sale or use

d 9 Prepaid expenses and deferred charges 10a Investments -U.S. and state government obligations STMT 11

b Investments - corporate stock $TMT 12 c Investments - corporate bonds STMT 13

11 investments -land, buildings, and equipment basis 00. Less accumulated depreciation 111111.

12 Investments - mortgage loans

13 Investments - other 14 Land, buildings, and equipment basis

less accumulated depreciation 11111.

15 Other assets (describe 0- STATEMENT 14)

17 Accounts payable and accrued expenses 18 Grants payable

d 19 Deferred revenue 20 Loans from omcers, directors, trustees, end other disqualified persons

m 21 Mortgages and other notes payable J 22 Other liabilities (describe Poo.

[Part lll Analysis of Changes in Net Assets or Fund Balances

1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return)

2 Enter amount from Part 1, line 27a 3 Other increases not included in line 2 (itemize) " SEE STATEMENT 9 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) " SEE STATEMENT 10 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 30

Iv ( c:apitai Uains ana posses ror i ax on investment income (a) List and describe the kind(s) of property sold (e .g ., real estate, 2-story brick warehouse ; or common stock, 200 shs. MLC Co.)

SEE ATTACHED STATEMENTS

(e) Gross sales price (f) Depreciation allowed (p) Cost or other basis (or allowable) plus expense of sale

in column (h) and owned by the foundation on 12/31/69 (j) Adjusted basis (k) Excess of col. (Q as of 12/31/69 over col. (j), if any

(I) Gains (Col. (h) gain minus col. (k), but not less than -0-) or

Losses (from col . (h)) (i) F.M .V. as of 12/31/69

2 Total of line 1, column (d) 3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years

the foundation has been in existence if less than 5 years

7 Add lines 5 and 6

8 Enter qualifying distributions from Part XII, line 4 I 8 I 1 , :& 1 U , tS tf 3 .

If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate . See the Part VI instructions .

423521/01-03-05 Form 990-PF (2004)

Form 990-PF

for assets sh

mow acquires (cDate acquired I (d) Date sold - Purchase I (c) Date

day, yr .) (mo., day, yr.)

(h) Gain or (loss) (e) plus (f) minus (g)

2 Capital am net income or net capital loss). If sin, also enter in Part I, line 7

9 ( ~ If loss), enter -0- in Part I, line 7

3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part 1, line 8, column (c) . If (loss), enter -0- in Part I, line 8

Part V Qualification Under Section 4940(e) for Reduced Tax on Net Inve (For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income .)

If section 4940(4)(2) applies, leave this part blank.

Was the organization liable for the section 4942 tax on the distributable amount of any year in the base period? EJ Yes EK] No If 'Yes.' the organization does not qualify under section 4940(e) . Do not complete this part. 1 Enter the appropriate amount in each column for each year; see instructions before making any entries.

Base peraod years Adjusted (distributions Net value of nonchaniable-use assets Distribution ratio Calendar year (or tax year 6eamnina m1 qualifying (col . (b) divided by c01. (c1)

4,216 1

4 Enter the net value of nonchantable-use assets for 2004 from Part X, line 5

5 Multiply line 4 by line 3

6 Enter 1% of net investment income (1% of Part I, line 27b)

to Exempt operating foundations described m section 4940(d)(2), check here 1 U and enter 'N/A' on line 1 . Date of ruling letter : (attach copy of ruling letter it necessary-see instructions)

b Domestic organizations that meet the section 4940(e) requirements in Part V, check here " Eland enter 1% 1 32 , 270 . of Part I, line 27b

c All other domestic organizations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b) 2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only . Others enter -0-) 2 0 .

6 Credits/Payments: a 2004 estimated tax payments and 2003 overpayment credited to 2004 6a 41 , 273 b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) 6c 7 , 50 0 d Backup withholding erroneously withheld ~ 6d 7 Total credits and payments. Add lines 6a through 6d 8 Enter any penalty for underpayment of estimated tax Check here ff] if Form 2220 is attached 9 Tax due . If the total of lines 5 and 8 is more than line 7, enter amount owed

10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid 11 Enter the amount of line 10 to be: Credited to 2005 estimated tax ~ 16 , 3 9 2 .

1 I Refunded 0.

6,392

" By language in the governing instrument, or " By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law

remain in the governing instrument? 6 X 1 Did the organization have at least $5,000 in assets at any time during the year? 7 X

N "Yes," complete Part 11, col. (c), and Part XV. 8a Enter the states to which the foundation reports or with which it is registered (see instructions)

COMMONWEALTH OF MASSACHUSETTS b If the answer is 'Yes'to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General (or designate) -

of each state as required by General Instruction G? If "No," attach explanation 8b X 9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar

year 2004 or the taxable year beginning in 2004 (see instructions for Part XIV)71f "Yes, " complete Part XIV 9 X 10 Did any persons become substantial contributors during the tax year? lr ^ves,^ attach a schedule listing their names and addresses 10 X 11 Did the organization comply with the public inspection requirements for its annual returns and exemption application? ~ 11 ~ X T

Web site address " N/A 12 The books are in care of " FLETCHER, TILTON & WHIPPLE P . C . Telephone no . " (5 0 8 ) 798-8621

located at " 370 MAIN STREET 12TH FLOOR, WORCESTER, MA zIP+4 .01608-1779 13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041- Check here " U

and enter the amount of tax-exempt interest received or accrued during the year 10. 1 13 ~ N/A oi3o3 os Form 990-PF (2004)

Form 990-PF (2004) MILDRED H . MCEVOY FOUNDATION 04 - 606 Pa VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see

3 Add lines 1 and 2 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 3 Tax based on investment income . Subtract line 4 from line 3. If zero or less, enter -0-

1a During the tax year, did the organization attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign?

b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? 1f the answer is "Yes" to f a or 1b, attach a detailed description of the activities and copies of any materials published or distributed by the organization in connection with the activities .

c Did the organization file Form 1120-POL for this year? d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the organization. " $ 0 . (2) On organization managers . l$ 0 . e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization

managers. " $ 0 . 2 Has the organization engaged m any activities that have not previously been reported to the IRS?

If 'Yes," attach a detailed description of the activities. 3 Has the organization made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or

bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes 4a Did the organization have unrelated business gross income of $1,000 or more during the year? b If 'Yes,' has it filed a tax return on Form 990-T for this year?

5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? 11 "Yes," attach the statement required by General Instruction T.

6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

X

expenditure responsibility for the grant? N/A F7 Yes ~ No 1/ "Yes," attach the statement required by Regulations section 53.4945-5(d).

8a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~ Yea ~ No

b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? N you answered 'Yes' to 6b, also file Form 8870.

Form 990-PF (2004)

423541 01-03-05

Form 990-PF(2004)

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. 1a During the year did the organization (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? 0 Yes ~X] No (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person? ~ Yes ~ No (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ~ Yes ~] No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? [X~, Yea E:1 No (5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? [] Yea M No (6) Agree to pay money or property to a government official? (Exception . Check 'No'

if the organization agreed to make a grant to or to employ the official for a period after termination of government service, if terminating within 90 days .) 0 Yes M No

b If any answer is 'Yes'to 1a(1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions) Organizations relying on a current notice regarding disaster assistance check here " 0

c Did the organization engage in a prior year m any of the acts described in 1a, other than excepted acts, that were not corrected before the first day of the tax year beginning m 20047

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

a At the end of tax year 2004, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2004? [] Yes EK] No If "Yes," list the years job.- ,

b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2) to all years listed, answer "No' and attach statement-see instructions .) N/A

c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here .

3a Did the organization hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? 0 Yes EK] No

b If 'Yes; did it have excess business holdings in 2004 as a result of (1) any purchase by the organization or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the organization had excess business holdings in 2004 .) N/A

4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes? b Did the organization make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2004

5a During the year did the organization pay or incur any amount to: (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? Yes [Y] No (2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly,

any voter registration drive? [] Yes E50 No (3) Provide a grant to an individual for travel, study, or other similar purposes? = Yes M No (4) Provide a grant to an organization other than a charitable, etc ., organization described m section

509(a)(1), (2), or (3), or section 4940(4)(2)7 = Yes FXI No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for

the prevention of cruelty to children or animals? = Yes M No b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in Regulations

section 53.4945 or in a current notice regarding disaster assistance (see instructions)? . . N/A . Organizations relying on a current notice regarding disaster assistance check here . . 1

c If the answer is 'Yes' to question 5a(4), does the organization claim exemption from the tax because it maintained

No

USTEE

USTEE . TILTON, JR . STREET

Q Mn nlszna_l

MILDRED H . MCEVOY FOUNDATION 04-6069958

Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Page s 0 Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation .

(a) Name and address (b) Title, and average (c) Compensation (d~canuiounonsto (e) Ex ense

hours per week devoted (It not paid , employee benefit plans account other to position enter-0- compensation allowances

GEORGE H . MCEVOY TRUSTEE

2 Compensation of five highest-paid employees (other than those included on line 1). Ii none, enter "NONE." (b) Title and average (d~ contnoueons co (e) Expense

(a) Name and address of each employee paid more than $50,000 lours per week I (c) Compensation I imp ana°ueienea~~ns + account, other devoted to uosition comoensason allowances

Total number of other employees paid over $50,000 3 Five highest-paid independent contractors for professional services . If none, enter "NONE."

(a) Name and address of each person paid more than $50,000 (b) Type of service FLETCHER, TILTON & WHIPPLE PC LEGAL AND OTHER

Total number of others receiving over $50,000 for professional services Part IX-A Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the Expenses number of organizations and other beneficiaries served, conferences convened, research papers produced, etc .

N/A

2

3

4

Form 990-PF (2004)

Form 990-PF (2004) MI LDRED H . MCEVOY FOUNDATION 04-6069958 Page ?

Part IX-B Summary of Program-Related Investments

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. T Amount t N/A

2

A!1 other program-related investments. See instructions. 3

Total . Add lines 1 through 3 _ . . _ . 1

Part X Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations, see instructions .)

1c (attach detailed explanation) 2 Acquisition indebtedness applicable to line 1 assets 3 Subtract line 2 from line id 2

1 Minimum investment return from Part X, line 6 2a Tax on investment income for 2004 from Part VI, line 5 b Income tax for 2004 . (This does not include the tax from Part VI.) c Add lines 2a and 2b

1,1 3 Distnbutable amount before adjustments. Subtract line 2c from line 1 4 Recoveries of amounts treated as qualifying distributions 5 Add lines 3 and 4 6 Deduction from distnbutable amount (see instructions) 7 Distributable amount as adjusted. Subtract line 6 from line 5 . Enter here and on Part XIII, line 1

Part;Xll . Qualifying Distributions see instructions)

423581 D1-03-05

1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes: a Average monthly fair market value of securities b Average of monthly cash balances c Fair market value of all other assets d Total (add lines la, b, and c) e Reduction claimed for blockage or other factors reported on lines is and

4 Cash deemed held for charitable activities. Enter 1 112% of line 3 (for greater amount, see instructions) 4 5 Net value of nancharitable-use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4 5 6 Minimum investment return . Enter 5% of line 5

Part XI DiStributable Amount (see instructions) (Section 49420)(3) and (1)(5) private operating foundations and certain foreign organizations check here 1 F-1 and do not complete this part .)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes : a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26 1a 1 , 210 , 8 83 . b Program-related investments - total from Part IX-B 1b 0 .

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes 2 3 Amounts set aside for specific charitable projects that satisfy the : a Suitability test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b

4 Qualifying distributions . Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4 1 , 210 , 88 3 . 5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment

income . Enter 1% of Part I, line 27b 5 0 . 6 Adjusted qualifying distributions . Subtract line 5 from line 4 ~ 6 ~ 1,210,883 .

Note : The amount on line 6 will be used m Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years.

Form 990-PF (2004)

Form 990-PF (2004) MILDRED H . MCEVOY FOUNDATION 04-6069958 Page e

Part XIII Undistributed Income (see instructions)

(a) Corpus

2

0 .

.8,739 .

16,844 .

Form 990-PF (2004) 423571 01-03-05

1 Distributable amount for 2004 from Part XI, line 7

2 Undistributed Income, ii any, as of the end of 2003

a Enter amount for 2003 only b Total for prior years:

, 3 Excess distributions carryover, if any, to 2004: a From 1999 18 , 739 b From 2000 c From 2001 d From 2002 478 , 374 e From 2003 44 , 879 ( Total of lines 3a through e

4 Qualifying distributions for 2004 from Part XII, line 4: " $ 1,21 0 ,883

a Applied to 2003, but not mare than line 2a b Applied to undistributed income of prior years (Election required - see instructions)

c Treated as distributions out of corpus (Election required - see instructions)

d Applied to 2004 distnbutable amount e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2004 of an amount appears m column (d), the same amount must be shown In column (a) )

6 Enter the net total of each column as indicated below:

8 Corpus Add lines 3f, 4c, and 4e Subtract line 5

b Prior years' undistributed income . Subtract line 4b from line 2b

c Enter the amount of prior years' undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed

d Subtract line 6c from line 6b . Taxable amount - see instructions

e Undistributed income for 2003. Subtract line 4a from line 2a . Taxable amount - see instr .

t Undistributed income for 2004. Subtract lines 4d and 5 from line 1 . This amount must be distributed in 2005

7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(E) or 4942(8)(3)

8 Excess distributions carryover from 1999 not applied on line 5 or line 7

9 Excess distributions carryover to 2005 . Subtract lines 7 and 8 from line 6a

10 Analysis of line 9 : a Excess nom 2000 b Excess from 2001 c Excess from 2002 478 , 374, d Excess from 2003 44 , 879

(b) (c) (d) Years prior to 2003 2003 2004

1 , 177 , 292 .

0 .

0 .

0 .

1 , 177 , 292 .

0 .

0 .

0 .

0 .

0 .

Form 990-PF

1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2004, enter the date of the ruling

Prior 3 years (b) 2003 (c) 2002 (d) 2001 (e) Total

c Qualifying distributions from Part XII, line 4 for each year listed

d Amounts included in line 2c not used directly for active conduct of exempt activities

e Qualifying distributions made directly for active conduct of exempt activities . Subtract line 2d from !me 2c Complete 3a, b, or c for the alternative test relied upon:

a 'Assets' alternative test - enter: (t) Value of all assets

(2) Value of assets qualifying under section 4942(j)(3)(B)(i)

b 'Endowment" alternative test - enter 2l3 of minimum investment return shown in Part X, line 6 for each year listed

c 'Support alternative test - enter: (1) Total support other than gross

investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties)

(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(ni)

(3) Largest amount of support from an exempt organization

(see instructions and Part VII-A, question 9)

b Check box to indicate whether the orgarnzation is a rival 2 a Enter the lesser of the adjusted net Tax year

income from Part I or the minimum (a) 2004

investment return from Part X for each year listed

b 85% of line 2a

Part Supplementary Information (Complete this part only if the organization had $5,000 or more in assets at any time during the year-see page 26 of the instructions .)

1 Information Regarding Foundation Managers : a List any managers of the foundation who have contributed mare than 2% of the total contributions received by the foundation before the close of any tax

year (but only if they have contributed mare than $5,000). (See section 507(d)(2).)

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest .

2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs : Check here " E] if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the organization makes gifts, grants, etc . (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d.

a The name, address, and telephone number of the person to whom applications should be addressed: SiTNNER B . TILTON, JR, 370 MAIN STREET, 12TH FLOOR, WORCESTER, MA 01608

b The form in which applications should be submitted and information and materials they should include : SEE STATEMENT 15

c Any submission deadlines: REQUESTS SHOULD BE RECEIVED PRIOR TO JUNE 1ST OF A GIVEN TAX YEAR .

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors: GRANTS ARE PROVIDED TO HEALTH, EDUCATIONAL, CULTURAL AND HUMAN SERVICE ORGANIZATIONS BASED IN BOOTHBAY ME AND WORCESTER MA . azsse1ro,-oa-os Form 990-PF (2004)

10

,049,500 .

359 .

Total 423e01ro1-03-05

31) 1 0 . Form 990-PF (2004)

Form 990-PF (2004) MILDRED H. MCEVOY FOUNDATION 04-60 Part XV Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment

Recipient If recipient is an individual, show any relationship to Foundation Purpose of grant or

Name and address (home or business) any foundation manager status of contribution or substantial contributor recipient

a Paid during the year

SEE SCHEDULE ATTACHED ONE PUBLIC SEE SCHEDULE

ONGOING WESTPORT ADVISORS LP NONE PUBLIC OPERATIONS

Total " 3a b Approved for future payment

SEE SCHEDULE ATTACHED ONE 1PUBLIC ISEE SCHEDULE

Amount

:x Enter gross amounts unless otherwise indicated. U11juldIVU UUbillubb 11JUVIIJU

(

r

C

riuava vys=ion oiz. oij, or ai4

W (b) Exl_ (d) Related or exempt Business Amount sion Amount function income I Program service revenue : code code

C

d e f

g Fees and contracts from government agencies 2 Membership dues and assessments 3 Interest on savings and temporary cash

investments 14 29,526 . 4 Dividends and interest from securities 14 540,636 . 5 Net rental income or (loss) from real estate:

a Debt-financed property

b Not debt-financed property 6 Net rental income or (loss) from personal

property 7 Other investment income 14 5,500 . 8 Gain or (loss) from sales of assets other

than inventory 18 . 1,118,619 . 9 Net income or (loss) from special events 10 Gross profit or (loss) from sales of inventory 111 Other revenue:

a b C d e

12 Subtotal. Add columns (b), (d), and (e) 0 . 1,694,281 .1 0 . 13 Total . Add line 12, columns (b), (d), and (e) 13 1,694,281 . (See worksheet in line 13 instructions to verify calculations .)

I Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes

423811 01-03-05 Form 990-PF (2004)

I

Form 990-PF (2004) MILDRED H . MCEVOY FOUNDATION 04-6069958 Pagell

Analysis of Income-Producing Activities

H . )UNDATION 04-6069958 Form 990-PF Noncharitable To and Transactions

1 Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of Ye the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

a Transfers from the reporting organization to a noncharitable exempt organization of. (1) Cash 11110) (2) Other assets I a(2)

b Other transactions: (1) Sales of assets to a nonchantable exempt organization lb(l) (2) Purchases of assets from a nonchantable exempt organization lb(2) (3) Rental of facilities, equipment, or other assets lb(3) (4) Reimbursement arrangements lb(4) (5) Loans or loan guarantees 1b 5 (6) Performance of services or membership or fundraising solicitations 1116

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 5 1C d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair market value of the goods, other assets,

or services given by the reporting organization. It the organization received less than fair market value in any transaction or sharing arrangement, show in

No

2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) orin section 5277 El Yes EXI No

of of

including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, y) is based on all information of which preparer has any knowledge

Under penalties df perjury, I clqlara~pst I have and comVete eclaration of pre

423621 01-03-05

Name of

ignature 9P&fi-ce_t/or trustee Preparer's

.9 -E signatu co 15 ASO Q 4Dej, nrm-s name (or yours FLETCHER, TILTON WHIP 00 If self -employed), 370 MAIN STREET 12TH FL

address, and ZIP code ~WnD0VQMWV mh nignp

FORM 990-PF OTHER INCOME STATEMENT 3

TOTAL TO FORM 990-PF, PART I, LINE 11, COLUMN A

STATEMENT(S) 1, 2, 3


FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 1

SOURCE AMOUNT

FLAGSHIP BANK FOR WORCESTER FUND 199 . STATE STREET BANK MA BANK INTEREST 29,327 .

TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A 29,526 .

FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 2

CAPITAL GAINS COLUMN (A) SOURCE GROSS AMOUNT DIVIDENDS AMOUNT

BANK OF AMERICA/FRONTIER CORP INT 4,825 . 0 . 4,825 . BANK OF AMERICA/FRONTIER DIV 4,685 . 0 . 4,685 . CENTPHARM LLC 9 . 0 . 9 . FRANKLIN ST . PROP'S REIT 70,227 . 0 . 70,227 . NATURAL RESOURCES LP 139 . 0 . 139 . STATE STREET BANK CORP NOTES 154,094 . 0 . 154,094 . STATE STREET BANK DIVIDENDS 2950 306,601 . 0 . 306,601 . WESTPORT ADVISORS LP 56 . 0 . 56 .

TOTAL TO FM 990-PF, PART I, LN 4 540,636 . 0 . 540,636 .

DESCRIPTION

NATURAL RESOURCE LP NATURAL RESOURCE LP OTHER PORTFOLIO INCOME

AMOUNT

4,509 . 991 .

5,500 .

MILDRED H. MCEVOY FOUNDATION 04-6069958

FORM 990-PF LEGAL FEES STATEMENT 4

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE PER BOOKS MENT INCOME NET INCOME PURPOSES

145,000 . 36,250 . 108,750 .

145,000 . 36,250 . 108,750 . TO FM 990-PF, PG 1, LN 16A

DESCRIPTION

FLETCHER TILTON & WHIPPLE

FORM 990-PF ACCOUNTING FEES STATEMENT 5

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

STATE STREET BANK 2,6814 . 2,684 . 0 .

TO FORM 990-PF, PG 1, LN 16B 2,684 . 2,684 . 0 .

FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 6

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

FRONTIER CAPITAL MANAGEMENT/SSB 33,396 . 33,396 . 0 . FRONTIER CAPITAL MANAGEMENT 5,805 . 5,805 . 0 .

TO FORM 990-PF, PG 1, LN 16C 39,201 . 39,201 . 0 .


MILDRED H. MCEVOY FOUNDATION 04-6069958

FORM 990-PF TAXES STATEMENT 7

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE PER BOOKS MENT INCOME NET INCOME PURPOSES

50,000 . 0 . 0 . 120 . 0 . 0 .

50,120 . 0 . 0 . TO FORM 990-PF, PG 1, LN 18

I FORM 990-PF OTHER EXPENSES STATEMENT 8

(D) CHARITABLE PURPOSES

250 .

1,024 .

0 .

0 .

0 .

0 .

1,274 .

(C) ADJUSTED NET INCOME

TO FORM 990-PF, PG 1, LN 23 3,969 . 2,655 .

FORM 990-PF OTHER INCREASES IN NET ASSETS OR FUND BALANCES STATEMENT 9

TOTAL TO FORM 990-PF, PART III, LINE 3


DESCRIPTION

FEDERAL TAX FOREIGN TAXES

(A) (B) EXPENSES NET INVEST-

DESCRIPTION PER BOOKS MENT INCOME

COMMONWEALTH OF MASSACHUSETTS PC 250 . 0 . STATE STREET BANK ADMINISTRATIVE EXPENSE 1,024 . 0 . CENTPHARM LLC INV INTEREST EXPENSE 258 . 258 . NATURAL RESOURCE LP INV INTEREST EXPENSE 2,397 . 2,397 . NATURAL RESOURCE LP NON-DED EXPENSE 18 . 0 . NATURAL RESOURCE LP CASH CONTRIBUTION 22 . 0 .

DESCRIPTION

FRONTIER REPFORMANCE BASIS ADJUSTMENT WESTPORT ADVISORS LP TAX EXEMPT INCOME WESTPORT ADVISORS LP TRADE/BUSINESS INCILOSS DECREASE IN GRANTS PAYABLE

AMOUNT

264 . 4,338 .

14,008 . 169,250 .

187,860 .

04-6069958 MILDRED H . MCEVOY FOUNDATION

FORM 990-PF OTHER DECREASES IN NET ASSETS OR FUND BALANCES STATEMENT 10

AMOUNT

TOTAL TO FORM 990-PF, PART III, LINE 5 637 .

U .S . OTHER FAIR MARKET DESCRIPTION GOV'T GOV'T BOOK VALUE VALUE

STATE STREET BANK US TSY & AGENCY x 536,797 . 523,360 .

STATEMENT 12

BOOK VALUE

13,924,990 . 1,171,684 .

0 . 381,348 .

0 . 0 . 0 . 0 . 0 .

15,478,022 . 18,113,709 . TOTAL TO FORM 990-PF, PART II, LINE 10B


DESCRIPTION

CENTPHARM LLC TRADE OR BUSINESS INC/LOSS 637 .

FORM 990-PF U .S . AND STATE/CITY GOVERNMENT OBLIGATIONS STATEMENT 11

TOTAL U .S . GOVERNMENT OBLIGATIONS

TOTAL STATE AND MUNICIPAL GOVERNMENT OBLIGATIONS

TOTAL TO FORM 990-PF, PART II, LINE 10A

FORM 990-PF CORPORATE STOCK

DESCRIPTION

STATE STREET BANK CORP STOCK STATE STREET BANK EATON VANCE FD OF BOSTON A FRONTIER PERFORMANCE ADVISERS STATE STREET BANK FRANKLIN ST . PROP'S REIT 6215 SH PHYTERA B CONV PFD (C'WEALTH BIOV V) 2654 SH PHYTERA C CONV PFD (C'WEALTH BIOV V) 3421 SH PHYTERA B CONV PFD (C'WEALTH BIOV IV) 8300 SH PHYTERA A CONV PFD (C'WEALTH BIOV IV) 497 SH RENOVIS

536,797 . 523,360 .

536,797 . 523,360 .

FAIR MARKET VALUE

16,028,820 . 1,146,136 .

0 . 931,646 .

0 . 0 . 0 . 0 .

7,107 .

FORM 990-PF OTHER ASSETS STATEMENT 14

FAIR MARKET DESCRIPTION BOOK VALUE VALUE

WESTPORT ADVISORS LTD 32,015 . 32,015 . CENTPHARM LLC 0 . 0 . NATURAL RESOURCE PARTNERS LP 373,454 . 373,454 .

405,469 . 405,469 . TOTAL TO FORM 990-PF, PART II, LINE 15



FORM 990-PF CORPORATE BONDS STATEMENT 13

FAIR MARKET DESCRIPTION BOOK VALUE VALUE

STATE STREET BANK CORP BONDS 1,783,615 . 1,859,228 .

TOTAL TO FORM 990-PF, PART II, LINE 10C 1,783,615 . 1,859,228 .

FORM 990-PF PART XV, LINE 2B STATEMENT 15 APPLICATION REQUIREMENTS

DESCRIPTION

PROPOSALS SHOULD BE IN LETTER FORM OUTLINING GOALS AND OBJECTIVES ALONG WITH A PROJECT PLAN AND BUDGET . INCLUDE EVIDENCE OF 501(C)(3) TAX EXEMPT STATUS .

Form MO Oepwtment of the Treasury Internal Revenue Service

Name

OMB No 1545-0142 Underpayment of Estimated Tax by Corporations III. See separate instructions .

No- Attach to the corporation's tax return . qqo-T 2004 Employer identification number

nA-rnroolza H . Note : In most cases, the corporation is not required to file Form 2220. (see Part I below for exceptions) because the IRS will figure any penalty owed and bill the

corporation . Even if Form 2220 is not required, the corporation may still use it to figure the penalty. In such a case, enter the amount from page 2, line 38 on the estimated tax penalty line of the corporation's income tax return, but do not attach Form 2220 .

part I I Reasons for Filing - Check the boxes below that apply. If any boxes are checked, and line 6, below, is $500 or more, the corporation must file Form 2220, even if it aces not owe a penalty.

1 [:J The corporation is using the adjusted seasonal installment method. 2 El The corporation is using the annualized income installment method .

Part III Figuring th 4 Total tax (see instructions)

c Credit for Federal tax paid on fuels (see instructions) 1 60 d Total. Add lines 5a through 5c

6 Subtract line 5d from line 4 . If the result is less than $500, do not complete or file this form . The corporation does not owe the penalty

7 Enter the tax shown on the corporation's 2003 income tax return . Caution: If the tax is zero or the tax year was for less than 12 months, skip this line and enter the amount from line 6 on line 8

7.

0

18 .684 .1 17 .070

16 If the amount on line 15 is zero, subtract

line 13 from line 14 Otherwise, enter -0-

17 Underpayment. If line 15 Is less than or equal to line 10, subtract line 15 from line 10 Then go to line 12 of the next column Otherwise, go to line 18

18 Overpayment . If fine 10 Is less than line 15, subtract line 10 from line 15

Go to Part III on pace 2 to ficure the penalty. Do not no to Part III if there are no entries on line 17 - no penalty is owed. 412801 ol-03.05 JWA For Paperwork Reduction Act Notice, see separate instructions . Form 2220 (2004)

C

5 a Personal holding company tax (Schedule PH (Form 1 120), line 26) included on line 4 b Look-back interest included on line 4 under section 460(b)(2) for completed long-term contracts or of section 167(g) for depreciation under the income forecast method

8 Enter the smallerof line 6 or line 7. It

9 Installment due date$. Enter in ool (a) through (d) the 15th day of the 4th (Form 990-PF filers: Use 5th month), Oth, gth . and 112th mos of the corporation's tax yew Exception . if one of your installment due dates is Sept 15, 2004, see the Instructions

10 Required installments . if the box on line I and(or line 2 above Is checked, entei the amounts from Schedule A, line 38 If the box on In 3 (but not I or 2) Is checked, see Instructions for the amounts to enter If none of these boxes are checked, enter 25% of In 8 above In each column

I I Estimated tax paid or credited for each period (see instructions). For column (a) only, enter the amount from line 11 on line 15 Complete lines 12 through 18 of one column before going to the next column .

12 Enter amount, it any, from line 18 of the preceding column

13 Add lines 11 and 12 14 Add amounts on lines 16 and 17

of the preceding column 15 Subtract line 14 from line 13 . If

zero or less, enter -0-

FORM 990-PF Form 2220 (2004) MILDRED H . MCEVOY FOUNDATION 04-6069958 Paue 2

Figuring the Penalty

19 Enter the date of payment or the 15th day of the 3rd month after the close of the tax

A - hichevw Is earlier (see Instructions) I,eFwoiw 990 PF and Form 990-T I

e rs : Use 5th month Instead of 3rd month )

Number of days from due date of Install-20 mentoningtothadateshowrion line 19

37 Addlines22,24,26,28,30,32,34,&36

4112802 01-24-05

Number of days on line 20 after 21 4/15/2004 and before 7/11/2004

22 Underpayment on line 17 x

Number of days on line 21 x 5% 386









Number of days on line 27 X 5% 385



Number of days an line 29 x 'A 385



Number of days on line 31 x lh 385

Number of days on line 20 after 33 9/30/2005 and before 11112008


Number of days an line 33 x 385



Number of days an line 35 x *% 365

36 Penalty . Add columns (a) through (e), of line 37. Enter the total here and on Form 1120 ; line 33, Form 1120-A, line 29; or the comparable line for other income tax returns 1 381$ 111

For underpayments paid after March 31, 2005: For lines 30, 32, 34, and 36, use the penalty interest rate for each calendar quarter, which the IRS will determine during the first month in the preceding quarter . These rates are published quarterly in an IRS News Release and in a revenue ruling in the Internal Revenue Bulletin . To obtain this information on the Internet access the IRS website at www.irs .gov. You can also call 1-800-829-1040 to get interest rate information.

JWA Form 2220 (2004)

412511 05_01-04

FORM 990-PF UNDERPAYMENT OF ESTIMATED TAX WORKSHEET

Name(s) Identifying Number

MILDRED H . MCEVOY FOUNDATION 04-6069958 (A) (B) (C) (D) (E) (F)

Adjusted Number Days Daily Tate Amount Balance Due Balance Due Penalty Rate Penalty

-0-

05/15/04 8,068 . 8,068 .

05/15/04 <6,273 .> 1,795 . 31 .000136612 8 .

06/15/04 8,067 . 9,862 . is .000136612 20 .

06/30/04 0 . 9,862 . 77 .000109290 83 .

09/15/04 6,454 . 16,316 .

09/15/04 <35,000 .> <18,684 .>

09/30/04 0 . <18,684 .> 1 .000136612

10/01/04 1,614 . <17,070 .>

12/15/04 8,067 . <9,003 .>

12/31/04 0 . <9,003 .> 90 .000136986

03/31/05 0 . <9,003 .> 45 .000164384

Penalty Due (Sum of Column F) .

Date of estimated tax payment, withholding credit date or installment due date.

THE FOLLOWING ARE THE DETAILS OF THE SALES REPORTED TO THE IRS ON THE 2004 FORM 1099-B .

Units Description Date Date Gross Sales Cost or Short-term

Acquired Sold Price Other Basis Gain/Loss

SHORT-TERM SALES REPORTED ON FORM 1099-B* -----------------------------------------

6,000 .000 AVERY DENNISON CORP C014 12/11/2003 01/20/2004 345,967 .75 336,582 .00 9,385 .75 5,000 .000 QUANEX CORP COM 12/11/2003 01/20/2004 221,337 .59 203,458 .00 17,879 .59 5,000 .000 SEAGATE TECHNOLOGY 12/11/2003 01/29/2004 80,796.17 91,500 .00 -10,703 .83

0 .966 EAGLE MATERIALS I14C 12/11/2003 02/11/2004 51 .49 51 .43 0 .06 0.057 EAGLE MATERIALS INC-B 12/11/2003 02/11/2004 3 .00 3.00

10,000.000 CONAGRA INC COM 12/11/2003 02/12/2004 258,587 .80 258,485.00 102.80 15,000.000 OLIN CORP COM 12/11/2003 02/12/2004 271,977 .63 296,050.50 -24,072 .87 5,800.000 GENERAL MILLS INC COM 02/12/2004 02/24/2004 261,697 .92 261,928.00 -230.08

132 .000 EAGLE MATERIALS INC 12/11/2003 08/18/2004 8,529 .64 7,027.73 1,501 .91 447 .000 EAGLE MATERIALS INC-B 12/11/2003 08/18/2004 27,848 .92 23,505.55 4,343.37

5,500.000 NEWMONT MINING CORP CAP COM 11/16/2003 06/18/2004 231,434 .55 249,502.05 -18,067.50 2,000.000 WASHINGTON MUT INC COM 12/11/2003 08/18/2004 77,358 .18 79,100.00 -1,741.82 3,900.000 CENTEX CORP COM 1211112003 12/07/2004 201,118 .27 185,374 .99 15,743.28 2,100.000 CENTEX CORP COM 12/11/2003 12/07/2004 108,420 .45 99,817 .30 8,603.15

10,000.000 COLGATE PALMOLIVE 12/11/2003 12/07/2004 496,988 .32 529,492.00 -32,503.68 5,350.000 DUKE POWER CO COM 12/11/2003 12/07/2004 130,055 .43 103,576.00 26, 479.43 300.000 DUKE POWER CO COM 12/11/2003 12/07/2004 7,295 .82 5,808.00 1,487 .82 300.000 DUKE POWER CO COM 12/11/2003 12/07/2004 7,298 .82 5,808 .00 1,490.82

4,050.000 DUKE POWER CO COM 12/11/2003 12/07/2004 98,574 .67 78,408 .00 20,166.67 15,100 .000 IVAX CORP COM 08/18/2004 12/07/2004 235,705 .41 290,828 .49 -55,123.08

300.000 IVAX CORP C014 08/18/2004 12/07/2004 4,694 .88 5,778 .05 -1,083.17 225 .000 IVAX CORP C014 08/18/2004 12/07/2004 3,525 .66 4,333 .54 -807 .88

4,700.000 MOSAlC CO 02/12/2004 12/07/2004 81,402 .07 54,369 .60 27,032 .47 20,300 .000 MOSAIC CO 02/12/2004 12/07/2004 353,211 .63 234,830 .40 118,381 .23 8rIO0.000 SCIENTIFIC ATLANTA INC COM 04/14/2004 12/07/2004 235,461 .45 266,784 .84 -31,323 .39 1,900 .000 SCIE14TIFIC ATIJkNTA INC COM 04/14/2004 12/07/2004 55,364 .69 62,579 .16 -7,214 .47

------------- ------------- -------------

TOTAL SHORT-TERM SALES REPORTED ON 1099-B 3fBO4,708 .21 3,734,981 .63 69r726 .58

EXe94 1000 Important Tax Return Document Enclosed

10 -

Account-ritle:. MCEVOY MILDRED H FOUNDATION State Street Account Number: AN29 .50

Tax I.D . Number: 04-6069958

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All Saints Church SBT matching gift

American Antiquarian Capital campaign Society

Assumption College New Lt Joseph P Kennedy, Jr. Science

Building

BOOTHBAY REGION Capital Campaign LAND TRUST INC

Bancroft School Support of the City Scholar's initiative

Barton Center for Diabetes Education Education, Inc .

Boothbay Railway Village 2003 Challenge Grant met, Museum payment 2004

Boothbay Railway Village operations Museum




Boothbay Railway Village GHM matching gift Museum

Boothbay Region Purchase of Fireproof File Historical Society

Boothbay Region YMCA usualannual

Boys & Girls Club of Gardner/Hammond Project Worcester

CAROLINA COASTAL Sails for "Ada Mae" CLASSROOMS INC

COASTAL MAINE Purchase of "people-BOTANICAL GARDENS mover"vehicle INC

COASTAL MAINE Purchase of "people-BOTANICAL GARDENS mover"vehicle INC

Central MA Symphony 2004 capital campaign Orchestra

Children's Friend, Inc Capital Campaign

Children's Hospital, usualannual Boston Axion

Clark University Traina Center for the Arts

Clark University SBT matching gift

EcoTanum educational programs and operations for 2004

732401 $5,00000 12/15/04

724177 $10,00000 12/15/04

729462 $5,00000 `12/15/04

732391 $25,00000 12/01104

812955 $5,00000 12/27/04

724105 $5,00000 12/15/04

Page 2 of 5 May 16,2005

Data contained in this report was Filtered on Request Disposition of 'Approved, Payment Status of 'Paid', Budget Year of '2004', Proposal Type of 'Mildred H McEvoy Foundation'

McEvoy Foundation Pledges Paid in 2004

Organization Legal Name Project Title Request ID Payment Amount Check/Requested Check Date

812954 $1,000.00 12/27/04

732481 $5,00000 12/15/04

731333 $18,00000 12/01/04

793874 $5,00000 12/15/04

725314 $6,00000 12/15/04

730088 $7,00000 12101104

723814 $20,000.00 02/19/04

725060 $50,00000 03/01/04

725060 $50,00000 09/01/04

725060 $50,00000 06/01104

725060 $50,00000 12/01/04

812731 $4,000.00 12/15/04

793868 $2,50000 12/15/04

729423 $10,00000 12/15/04

725057 $60,000 .00 12/15/04

793773 $4,300.00 12/15/04

756303 $5,00000 12/15/04

799390 $4,20000 12/15/04

Friends of the Rogers- restoration of the 723649 $5,000.00 12115/04 Kennedy Memorial monument

GREAT BROOK VALLEY Phase Three of the Capital 728998 $5,00000 11/29/04 HEALTH CENTER, INC Campaign

Good Will-Hinckley usual annual, operations 729505 $2,00000 12/15/04

Grand Banks Schooner operations 724929 $25,25000 03/01/04 Museum Trust

Grand Banks Schooner Shipyard rehabilitation 724976 $25,00000 07/27/04 Museum Trust

Grand Banks Schooner line of credit 725017 $25,00000 12/01/04 Museum Trust

Grand Banks Schooner Shipyard rehabilitation 724976 $25,00000 03/01/04 Museum Trust



Grand Banks Schooner GHM matching gift (Ram 812734 $2,00000 12/15/04 Museum Trust Island Trust)

Grand Banks Schooner GHM matching gift 812732 $4,00000 12/15/04 Museum Trust

Grand Banks Schooner operations 724929 $25,250.00 09/01/04 Museum Trust

Greater Worcester PRR- matching gift Paul & 799303 $10,000.00 12/15/04 Community Foundation, Fay Rossley Fd . Inc

Joy of Music Program, Inc Endowment fund 725450 $15,00000 11/29/04

MAINE LIGHTHOUSE Relocation of Museum 793860 $5,00000 12/15/04 MUSEUMINC

MRGINC Restoration of Dining Rail 793780 $5,00000 12/15104 Car

Maine Farm Land Trust General Support 725366 $5,00000 12/15/04

Maine Maritime Museum capital campaign 727542 $30,00000 11/29/04

Maine Maritime Museum challenge grant 727588 $30,000.00 11/29/04

Maine Public Broadcasting capital campaign 723163 $25,00000 11/29/04 Corporation

Martin Luther King, Jr . incubator facilities for new 729041 $5,000 .00 111/30/04 Business Empowerment businesses Center, Inc

Massachusetts Audubon - costs associated with the 723605 $15,00000 11/30/04 Society Conservation Center

Massachusetts College of Creation of the new college 732739 $20,00000 11/30/04 Pharmacy and Health campus in Worcester Sciences

Massachusetts Cystic usualannual 729546 $10,000.00 12/15/04 Fibrosis Foundation

Page 3 of 5 May 16, 2005

Date contained in this report was filtered on Request Disposition of"Approved, Payment Status ofPaid', Budget Year of 2004', Proposal Type of'MildredH McEvoy Foundation'



(continued)

(continued)

Middlesex School SBT . matching gift

Music Worcester, Inc season proggrams 2004/05

New Hampton School usual annual operations

Opportunity Farm 2004 support

Pine Manor College Annual Scholarship Fund . Students from Maine

Pride Productions, Inc building growth and programs

QUODDY TIDES Capital Campaign FOUNDATION

Rangeley Region Health Matching grant Physical Center medicine

SOCIETY FOR THE Painting of Nickels-PRESERVATION OF NEW Sortwell House, Wiscasset, ENGLAND ANTIQUITIES ME

Seven Hills Foundation Strengthening the Foundation Capital

Campaign

$5,00000 723729 11/30/04

Unrestricted gift 732306 $15,00000 11130104

restoration 729791 $17,00000 12115/04

SBT matching gift 812958 $500.00 12/27/04

$60,00000 11/30/04 732357 2004(over 5 yrs)renovation &

expansion of EIR on Univercity Campus

capital grant

Further the goals & mission of the Academy

usual annual : scholarships for Maine students

Support of the Museum's $30M centennial canpaign

SBT matching gift

Unrestricted operating support for infrastructure &

facility needs

research & education

capital campaign

Why Me and Sherry's House

Worcester Academy

Worcester Academy

Worcester Art Museum

Worcester Art Museum

Worcester Historical Museum

Worcester Regional Research Bureau

Worcester Youth Center, Inc

723937 $5,00000 12/15/04

723678 $50,00000 11130/04

729632 $12,00000 12/15/04

732004 $35,00000 11/30/04

812957 $50000 12/27/04

731379 $15,00000 11/30/04

725839 $4,00000 12/15/04

723177 $10,00000 11/30/04

Mildred H . McEvoy Foundation Payment Amount Total : $1,049,500.00 Page 4 of 5 May 16, 2005

Data containedm this report was filteradon Request Disposition ofApproved, Payment Status ofFed, Budget Yearof'2004', Proposal Type ofUldredH McEvoy Foundation'



812956

723393

729586

728952

723926

725061

793931

725357

793863

$3,00000

$3,00000

$5,000.00

$1,00000

$10,00000

$5,00000

$5,00000

$7,50000

$5,00000

12/27/04

12/15/04

12115/04

12/15/04

11/30/04

12115/04

12/15/04

11/30/04

12/15/04

St Andrews Hospital

The Opera House at Boothbary Harbor

Tower Hill Botanic Garden (Worcester County Horticultural Society)

UMASS Memorial Foundation



(continued)

2004 Payment Amount Total : $1,049,SOO.00

Payment Amount Total : $1,049,500 .00

Page 5 of 5 May 16, 2005

Data contained in this report was filtered on Request Disposition of 'Approved, Payment Status of 'Paid, Budget Year of 2004', Proposal Type of 'Mildred H McEvoy Foundation'

Outstanding Multi-Year G UMPTION COLLEGE

Request ID : 731333 Request Date : 07124/01

$150,000.00 - New Lt . Joseph P . Kennedy, Jr. Science Building Funding Principle: (None)

Data contained in this report is for management reporting only and should not be used for financial purposes Not for disclosure outside of FTW Acting as Administrator for unless by wnlten authorization

Note Data in this report represents Approvedgrants with non-voided payments Other filters may apply

McEvoy Foundation Multi-Year Payments By Completion Status, Organization

Grant Amount - Payment Scheduledl Payment Request Payment Payment Project Title Status Payment Date Type Owner Notes Amount

Paid 12/01/01 Check eprovost (none) $30,00000 Paid 12/01/02 Check eprovost (none) $30,00000 Paid 12/01/03 Check eprovost (none) $18,00000 Paid 12/01104 Check eprovost (none) $18,00000

Scheduled 12/01/05 Check eprovost (none) $18,00000 Scheduled 12/01/06 Check eprovost (none) $18,000.00 Scheduled 12/01/07 Check eprovost (none) $18,00000

New Lt. Joseph P . Kennedy, Jr. Science Building Total : $150,000.00 New Lt. Joseph P . Kennedy, Jr. Science Building Paid : $96,000.00

New Lt . Joseph P . Kennedy, Jr. Science Building Outstanding Balance : $54,000.00 ASSUMPTION COLLEGE Total : $150,000.00 ASSUMPTION COLLEGE Paid : $96,000.00

ASSUMPTION COLLEGE Outstanding Balance: $54,000.00

BARTON CENTER FOR DIABETES EDUCATION, INC .

$35,000.00 - Education Request ID: 730088 Funding Principle : (None) Request Date : 07/24/01

Paid 12/01/01 Check eprovost (none) $7,00000 Paid 12/01/02 Check eprovost (none) $7,00000 Paid 12/01/03 Check eprovost (none) $7,00000 Paid 12/01/04 Check eprovost (none) $7,00000

Scheduled 12/01/05 Check eprovost (none) $7,00000

$35,000.00 Education Total: Education Paid : $28,000.00

Education Outstanding Balance: $7,000.00 BARTON CENTER FOR DIABETES EDUCATION, INC. Total: $35,000.00 BARTON CENTER FOR DIABETES EDUCATION, INC. Paid : $28,000.00

BARTON CENTER FOR DIABETES EDUCATION, INC. Outstanding Balance: $7,000.00

BOYS & GIRLS CLUB OF WORCESTER

$300,000.00 - Gardner/Hammond Project Request ID : 725057 Funding Principle : (None) RequestDate : 11/12/02

Paid 12/15/04 Check eprovost (none) $60,00000 Scheduled 12/15/05 Check eprovost' (none) $60,00000 Scheduled 12/15/06 Check eprovost (none) $60,00000 Scheduled 12/15107 Check eprovost (none) $60,00000 Scheduled 12/15/08 Check eprovost (none) $60,00000

Gardner/Hammond Project Total : $300,000.00 Gardner/Hammond Project Paid : $60,000.00

Gardner/Hammond Project Outstanding Balance : $240,000.00

BOYS & GIRLS CLUB OF WORCESTER Total : $300,000.00 BOYS & GIRLS CLUB OF WORCESTER Paid : $60,000.00

BOYS & GIRLS CLUB OF WORCESTER Outstanding Balance : $240,000.00

Page 2 May 1Z 2005

Outstanding Multi-Year Grants (contin I CHILDREN'S FRIEND, INC .

Request ID : 724177 Request Date : 10/25/99

$100,000.00 - Capital Campaign Funding Principle : (None)

Paid 12/15/00 Check eprovost (none) $20,00000 Paid 12/15/01 Check eprovost (none) $20.00000 Paid 12/15/02 Check eprovost (none) $20,00000 Paid 12/15/03 Check eprovost (none) $10,00000 Paid 12/15/04 Check eprovost (none) $10,00000

Scheduled 12/01/05 Check eprovost (none) $10,00000 Scheduled 12/01/06 Check eprovost (none) $10,00000

Capital Campaign Total : $100,000.00 Capital Campaign Paid : $80,000.00

Capital Campaign Outstanding Balance : $20,000.00

CHILDREN'S FRIEND, INC . Total : $100,000.00 CHILDREN'S FRIEND, INC . Paid : $80,000.00

CHILDREN'S FRIEND, INC . Outstanding Balance : $20,000.00


(none) $5,00000 (none) $5,00000

Check eprovost Check eprovost

JOY OF MUSIC PROGRAM, INC .

$100,000.00 - Endowment fund Funding Principle : (None)


Paid 12/01/01 Check eprovost (none) $20,00000 Paid 12/01102 Check eprovost (none) $20,000.00 Paid 12/01/03 Check eprovost (none) $15,00000 Paid 11/29/04 Check eprovost (none) $15,00000


$100,000.00 $70,000.00 $30,000.00

$100,000.00 $70,000.00 $30,000.00

Data contained in this report is for management reporting only and should not be used for financial purposes Not for disclosure outside of FTW Acting as Administrator for unless by wntten authorization

Note Data in this feport fepresents 'Approved'grants with non-voided payments Other filters may apply


Grant Amount - Payment Scheduled/ Payment Request Payment Payment Project Title Status Payment Date Type Owner Notes Amount

GREAT BROOK VALLEY HEALTH CENTER, INC . $10,000 .00 - Phase Three of the Capital Campaign Funding Principle : (None)

Paid 11/29/04 Scheduled 12/15/05

Phase Three of the Capital Campaign Total: $10,000.00 Phase Three of the Capital Campaign Paid : $5,000 .00

Phase Three of the Capital Campaign Outstanding Balance: $5,000 .00

GREAT BROOK VALLEY HEALTH CENTER, INC. Total: $10,000.00 GREAT BROOK VALLEY HEALTH CENTER, INC. Paid : $5,000 .00

GREAT BROOK VALLEY HEALTH CENTER, INC. Outstanding Balance: $5,000 .00

Endowment fund Total : Endowment fund Paid :

Endowment fund Outstandino Balance :

JOY OF MUSIC PROGRAM, INC. Total: JOY OF MUSIC PROGRAM, INC. Paid :

JOY OF MUSIC PROGRAM, INC. Outstanding Balance:

Page 3

May 1Z 2005

t



$250,000.00 - challenge grant Funding Principle : (None)

Paid Paid Paid Paid

Scheduled Scheduled Scheduled

challenge grant Total : $250,000.00 challenge grant Paid : $160,000.00

challenge grant Outstanding Balance : $90,000.00 MAINE MARITIME MUSEUM Total : $250,000.00 MAINE MARITIME MUSEUM Paid : $160,000.00

MAINE MARITIME MUSEUM Outstanding Balance : $90,000.00 MAINE PUBLIC BROADCASTING CORPORATION

$250,000.00 - capital campaign Funding Principle : (None)

Paid Paid Paid Paid Paid

Scheduled Scheduled

capital campaign Total : $260,000.00 capital campaign Paid : $200,000.00

capital campaign Outstanding Balance : $50,000.00

MAINE PUBLIC BROADCASTING CORPORATION Total : $250,000.00 MAINE PUBLIC BROADCASTING CORPORATION Paid : $200,000.00

MAINE PUBLIC BROADCASTING CORPORATION Outstanding Balance : $50,000.00

Data contained in this report is for management reporting only and should not be used for financial purposes Not for disclosure outside of FTW Acting as Administrator for unless by written authorization

Note Data in this report represents 'Approved'grants with non-voided payments Other filters may apply

Outstanding Multi-Year Gra FMAINE MARITIME MUSEUM

nued


12/15/01 Check eprovost (none) $50,00000 12/15/02 Check eprovost (none) $50,00000 12/15/03 Check eprovost (none) $30,00000 11/29/04 Check eprovost (none) $30,00000 12/15/05 Check eprovost (none) $30,00000 12/01/06 Check eprovost (none) $30,00000 12/01107 Check eprovost (none) $30,00000


12/15/00 Check eprovost (none) $50,00000 12/15/01 Check eprovost (none) $50,00000 12/15/02 Check eprovost (none) $50,00000 12/15/03 Check eprovost (none) $25,00000 11/29/04 Check eprovost (none) $25,00000 12/01/05 Check eprovost (none) $25,00000 12/01/06 Check eprovost (none) $25,00000

MARTIN LUTHER KING, JR . BUSINESS EMPOWERMENT CENTER, INC .

$10,000.00 - incubator facilities for new businesses Request ID : 729041 Funding Principle : (None) Request Date : 09/16/04

Paid 11/30/04 Check eprovost (none) $5,00000 Scheduled 12/15/05 Check eprovost (none) $5,00000

incubator facilities for new businesses Total : $10,000.00 Incubator facilities for now businesses Paid : $5,000 .00

incubator facilities for new businesses Outstanding Balance : $5,000.00

MARTIN LUTHER KING, JR. BUSINESS EMPOWERMENT CENTER, INC . Total : $10,000.00 MARTIN LUTHER KING, JR . BUSINESS EMPOWERMENT CENTER, INC . Paid : $6,000 .00

MARTIN LUTHER KING, JR . BUSINESS EMPOWERMENT CENTER, INC . Outstanding Balance : $5,000.00

Page 4

May t2,2005

Outstanding Multi-Year Grants Fm-AsSACHUSETTS AUDUBON SOCIETY

$25,000.00 - costs associated with the Conservation Center Funding Principle : (None)

(none) $15,00000 (none) $10,00000

Paid 11/30/04 Check eprovost Scheduled 12/15/05 Check eprovost

costs associated with the Conservation Center Total : $26,000.00 costs associated with the Conservation Center Paid : $15,000.00

costs associated with the Conservation Center Outstanding Balance : $10,000.00

MASSACHUSETTS AUDUBON SOCIETY Total : $25,000.00 MASSACHUSETTS AUDUBON SOCIETY Paid : $15,000.00

MASSACHUSETTS AUDUBON SOCIETY Outstanding Balance : $10,000.00

MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES

$200,000.00 - Creation of the new college campus in Worcester Funding Principle : (None)


PINE MANOR COLLEGE 723926 10/25199

$20,00000 $20,00000 $20,00000 $10,00000 $10,00000 $10,00000 $10,00000

$100,000.00 $80,000.00 $20,000.00

$100,000.00 $80,000.00 $20,000.00

Data contained in this report is for management reporting only and should not be used for financial purposes Not for disclosure outside of FTW Acting as Administrator for unless by written authorization

Note Data in this report represents Approved'grants with non-voided payments Other filters may apply

0




Paid 12/15/00 Check eprovost (none) $40,00000 Paid 12/15/01 Check eprovost (none) $40,00000 Paid 12/15/02 Check eprovost (none) $40,00000 Paid 12/15/03 Check eprovost (none) $20,00000 Paid 11/30/04 Check eprovost (none) $20,00000


Creation of the new college campus in Worcester Total : $200,000.00 Creation of the new college campus In Worcester Paid : $160,000.00

Creation of the now college campus in Worcester Outstanding Balance : $40,000.00 MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES Total : $200,000.00 MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES Paid : $160,000.00

MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES Outstanding Balance : $40,000.00

$100,000.00 - Annual Scholarship Fund : Students from Maine Request ID : Funding Principle: (None) Request Date :

Paid 12/15/00 Check eprovost (none) Paid 12/15/01 Check eprovost (none) Paid 12/15/02 Check eprovost- (none) Paid 12/15/03 Check eprovost (none) Paid 11/30/04 Check eprovost (none)

Scheduled 12/01/05 Check eprovost (none) Scheduled 12/01106 Check eprovost (none)

Annual Scholarship Fund : Students from Maine Total : Annual Scholarship Fund : Students from Maine Paid :

Annual Scholarship Fund : Students from Maine Outstanding Balance :

PINE MANOR COLLEGE Total : PINE MANOR COLLEGE Paid :

PINE MANOR COLLEGE Outstanding Balance :

Page 5

May 12, 2005

t )J~

Outstanding Multi-Year Grants (continued GELEY REGION HEALTH CENTER


$50,000.00 - Matching grant: Physical medicine Funding Principle : (None)

Data contained in this report is for management reporting only and should not be used for financial purposes Not for disclosure outside of FTW Acting as Administrator thr unless by written authorization




Paid 12/01/01 Check eprovost (none) $10,00000 Paid 12/01/02 Check eprovost (none) $10,00000 Paid 12/01103 Check eprovost (none) $7,50000 Paid 11/30/04 Check eprovost (none) $7,50000


Matching grant: Physical medicine Total : $50,000.00 Matching grant: Physical medicine Paid : $35,000.00

Matching grant: Physical medicine Outstanding Balance: $16,000.00 RANGELEY REGION HEALTH CENTER Total : $50,000.00 RANGELEY REGION HEALTH CENTER Paid : $36,000.00

RANGELEY REGION HEALTH CENTER Outstanding Balance: $16,000.00 SEVEN HILLS FOUNDATION

$20,000 .00 - Strengthening the Foundation Capital Campaign Request ID : 723729 Funding Principle : (None) Request Date : 06/15/04

Paid 11/30/04 Check eprovost (none) $5,00000 Scheduled 12/15105 Check eprovost (none) $5,00000 Scheduled 12/15/06 Check eprovost (none) $5,00000 Scheduled 12115/07 Check eprovost (none) $5,00000

Strengthening the Foundation Capital Campaign Total : $20,000.00 Strengthening the Foundation Capital Campaign Paid : $6,000 .00

Strengthening the Foundation Capital Campaign Outstanding Balance : $15,000.00 SEVEN HILLS FOUNDATION Total : $20,000.00 SEVEN HILLS FOUNDATION Paid : $5,000.00

SEVEN HILLS FOUNDATION Outstanding Balance: $15,000.00

ST. ANDREWS HOSPITAL

$100,000.00 - Unrestricted gift Request ID : 732306 Funding Principle : (None) Request Date : 09/24/01

Paid 12/01/01 Check eprovost (none) $20,00000 Paid 12/01/02 Check eprovost (none) $20,000.00 Paid 12/01103 Check eprovost (none) $15,00000 Paid 11130/04 Check eprovost (none) $15,00000

Scheduled 12101105 Check eprovost (none) $15,00000 Scheduled 12/01/06 Check eprovost (none) $15,00000

Unrestricted gift Total : $100,000.00 Unrestricted gift Paid : $70,000 .00

Unrestricted gift Outstanding Balance : $30,000 .00

ST. ANDREWS HOSPITAL Total : $100,000.00 ST . ANDREWS HOSPITAL Paid : $70,000.00

ST. ANDREWS HOSPITAL Outstanding Balance : $30,000 .00

Page 6 May 1Z 2005



Outstanding Multi-Year Grants (continued THE OPERA HOUSE AT BOOTHBARY HARBOR

$85,000.00 - restoration Funding Principle : (None)


UMASS MEMORIAL FOUNDATION Request ID : 732357 Request Date : 12/20/03 Funding Principle : (None)

2004(over 6 yrs)renovation & expansion of ER on Univercity Campus Total : $300,000.00 2004(over 5 yrs)renovation & expansion of ER on Univercity Campus Paid : $60,000.00

2004(over 5 yrs)renovation & expansion of ER on Univercity Campus Outstanding Balance : $240,000.00 UMASS MEMORIAL FOUNDATION Total : $300,000.00 UMASS MEMORIAL FOUNDATION Paid : $60,000.00

UMASS MEMORIAL FOUNDATION Outstanding Balance : $240,000.00 WHY ME AND SHERRY'S HOUSE

f300,OOO - .00 . 2004(over 6 yrs)renovation & expansion of ER on UnIvercity Campus Fu'inafin-g Orinciple :* (None)

Request ID: 723937 Request Date : 06/15/04

(none) $5,00000 (none) $5,00000

Paid 12/15/04 Check eprovost Scheduled 12115/05 Check eprovost

Data contained in this report is for management reporting only and should not be used for financial purposes Not for disclosure outside of F TIN Acting as Administrator for unless by written authonzation

Note Data in this report represents Approved'grants mth non-voided payments Other litters may apply

Paid 12/01/03 Check eprovost (none) $17,00000 Paid 12/15/04 Check eprovost (none) $17,00000

Scheduled 12/01/05 Check eprovost (none) $17,00000 Scheduled 12/01/06 Check eprovost (none) $17 .00000 Scheduled 12/01/07 Check eprovost (none) $17,00000

restoration Total : $85,000.00 restoration Paid : $34,000.00

restoration Outstanding Balance : $51,000.00 THE OPERA HOUSE AT BOOTHBARY HARBOR Total : $85,000.00 THE OPERA HOUSE AT BOOTHBARY HARBOR Paid : $34,000.00

THE OPERA HOUSE AT BOOTHBARY HARBOR Outstanding Balance : $51,000 .00

Paid 11/30/04 Check eprovost (none) $60,000.00 Scheduled 12/15/05 Check eprovost (none) $60,000.00 Scheduled 12/15/06 Check eprovost (none) $60,00000 Scheduled 12/15/07 Check eprovost (none) $60.00000 Scheduled 12/15/08 Check eprovost (none) $60,00000

capital grant Total : $10,000.00 capital grant Paid : $5,000 .00

capital grant Outstanding Balance : $5,000.00

WHY ME AND SHERRY'S HOUSE Total: $10,000.00 WHY ME AND SHERRY'S HOUSE Paid: $5,000.00

WHY ME AND SHERRY'S HOUSE Outstanding Balance: $5,000.00

Page 7 May 12,2005

Outstanding Multi-Year Grants (continued RCESTER ACADEMY


$500,000.00 - Further the goals & mission of the Academy Funding Principle : (None)

capital campaign Total : $30,000 .00 capital campaign Paid : $10,000.00

capital campaign Outstanding Balance : $20,000.00

WORCESTER YOUTH CENTER, INC . Total : $30,000 .00 WORCESTER YOUTH CENTER, INC . Paid : $10,000.00

WORCESTER YOUTH CENTER, INC . Outstanding Balance: $20,000.00

$2,725,000 .00

$1,648,000 .00

$1,077,000 .00

Date contained in this report is for management reporting only and should not be used for Financial purposes Not for disclosure outside of FTW Acting as Administrator for unless by written authorization




Paid 12/15/00 Check eprovost (none) $100,00000 Paid 12/15/01 Check eprovost (none) $100,00000 Paid 12/15/02 Check eprovost (none) $100,00000 Paid 12/15/03 Check eprovost (none) $50,00000 Paid 11/30/04 Check eprovost (none) $50,00000


Further the goals & mission of the Academy Total : $500,000.00 Further the goals & mission of the Academy Paid : $400,000.00

Further the goals & mission of the Academy Outstanding Balance : $100,000.00

WORCESTER ACADEMY Total : $500,000.00 WORCESTER ACADEMY Paid : $400,000.00

WORCESTER ACADEMY Outstanding Balance : $100,000.00

WORCESTER HISTORICAL MUSEUM $100,000 .00 - Unrestricted operating support for infrastructure & facility needs Request ID: 731379 Funding Principle: (None) Request Date : 12/18/01

Paid 12/15/01 Check eprovost (none) $20,00000 Paid 12/15/02 Check eprovost (none) $20,00000 Paid 12/15/03 Check eprovost (none) $15,000.00 Paid 11/30/04 Check eprovost (none) $15,00000


Unrestricted operating support for infrastructure & facility needs Total : $100,000 .00 Unrestricted operating support for Infrastructure & facility needs Paid : $70,000.00

Unrestricted operating support for infrastructure & facility needs Outstanding Balance: $30,000.00 WORCESTER HISTORICAL MUSEUM Total : $100,000.00 WORCESTER HISTORICAL MUSEUM Paid : $70,000.00

WORCESTER HISTORICAL MUSEUM Outstanding Balance: $30,000.00

WORCESTER YOUTH CENTER, INC. $30,000.00 - capital campaign Request ID : 723177 Funding Principle: (None) Request Date : 06/15/04

Paid 11/30/04 Check eprovost (none) $10,00000 Scheduled 12/15/05 Check eprovost (none) $10,000.00 Scheduled 12/15/06 Check eprovost (none) $10,00000

Outstanding Multi-Year Grants Total: Outstanding Multi-Year Grants Paid :

Outstanding Multi-Year Grants Outstanding Balance:

Report Total :

Report Paid :

Report Outstanding Balance:

Page 6

May 1Z 2005

$2,725,000 .00

$1,648,000 .00 $1,077,000 .00

CONTINUATION FOR 990-PF, PART IV 04-6069958 PAGE 1 OF 2

(b~~ow ac has P,', qui.redl (0) Date acquiredl (d) Date sold n - n-fin. (mo., day, yr.) (mo., day, yr.)

4

8


(f) Depreciation allowed (or allowable) (e) Gross sales price

aw , JWW .

14,570 . 972,077 . 734,982 . 238,520 . 133,250 . 125,016 . 172,673 . 79 .546 .

f

2 h i J. k

27 .624 .

(1) Losses (from col . (h)) Gains (excess of col. (h) gain over col. (k),

but not less than *-0-*)

<16,018 .> <50,387 .> <14, 569 .>

1,166,808 . 69,726 . 11,480 .

<77, 549 .> 2,608 .

16,181 . 7,577 .

1 . <905 .>

<11 . 632 .>

2 Capital gain net income or (net capital loss) If ain, also enter in Part 1, line 7 1 If ?loss), enter'-V in Part 1, line 7 1

3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) : If gain, also enter in Part 1, line 8, column (c) . If (loss), enter '-02 in Part 1, line 8

423591 05-01-04

f 2bu a 200

n

Gains and Losses for Tax on Investment Income (a) List and describe the kind(s) of property sold, e.g., real estate, 2-story brick warehouse; or common stock, 200 shs . MLC Co .

(g) Cost or other basis plus expense of sale

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (i) Adjusted basis (k) Excess of col. (i)

(I) FXV. as of 12/31/69 as of 12/31/69 over col . (1), if any

a

CONTINUATION FOR 990-PF, PART IV 04-6069958 PAGE 2 OF 2

(b~~ow acquired (c) Date acquired (d) Date sold Purchase (mo., day, yr.) (mo., day, yr.) D - Donation I I (a) List and describe the kind(s) of property sold, e.g ., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co .

(f) Depreciation allowed (g) Cost or other basis (or allowable) I plus expense of sale

h

(1) Losses (from col. (h)) Gains (excess of col. (h) gain over col . (k),

but not less than '-02)

32

2 Capital gain net income or (net capital loss) If ain, also enter in Part 1, line 7 If ~Ioss), enter *-02 in Part 1, line 7

3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6) : If gain, also enter in Part 1, line 8, column (c) . If (loss), enter '-02 in Part 1, line 8

423591 05-01-04

b

f

k I

0

(e) Gross sales price

a

n 0

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69

(1) F.M.V. as of 12/31/69 (j) Adjusted basis (k) Excess of col. (i) as of 12/31/69 1 over col. (1), if any

f

i

m


423831 01-10-05

Form 00%" Application for Extension of Time To File an (Rev . Ncember 2004) Exempt Organization Return OMB No . 1545-1709 Department of the Treasury Internal Revenue Service Ili- File a separate application for each return .

" If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box 10. " If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part 11 (on page 2 of this form). Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously filed Form 8868 .

Ep-art U Automatic 3-Month Extension of Time - Only submit original (no copies needed)

Form 9W-T corporations requesting an automatic 6-month extension - check this box and complete Part I only F-] All other corporations (including Form 990-C filets) must use Form 7004 to request an extension of time to Me income tax returns. Partnerships, PEWS, and trusts must use Form 8 736 to request an extension of time to file Form 1065, 1066, or 104 1.

Electronic Filing (e-file) . Form 8868 can be filed electronically it you want a 3-month automatic extension of time to file one of the returns noted below (6 months for corporate Form 990-T filers) . However, you cannot file it electronically If you want the additional (not automatic) 3-month extension, instead you must submit the fully completed signed page 2 (Part 11) of Form 8868 For more details on the electronic filing of this form, visit www.irs.gov/ef//e .

Type or Name of Exempt Organization Employer identification number print

MILDRED H. MCEVOY FOUNDATION 04-6069958 File by the due date for Number, street, and room or suite no . If a P.O. box, see instructions . filing your 370 MAIN STREET 12TH FLOOR return See Instructiorim City, town or post office, state, and ZIP code. For a foreign address, see instructions .

I WORCESTER, MA 01608-1779 Check type of return to be filed(fille a separate application for each return) :

ED Form 9W FlForm 99o-T (corporation) El Form 4720 0 Form 990-13L EJ Form 990-T (sec . 401 (a) or 408(a) trust) Form 5227 0 Form 990-EZ EJ Form 990-T (trust other than above) Form 6069 CE Form 9WPF F-IForm 1 o4i -A Form 8870

" The books are In the care of 1110,~ FLETCHER, TILTON & WHIPPLE P . C . TolephoneNo .10- (508) 798-8621 FAX No. Op.

" If the organization does not have an office or place of business in the United States, check this box . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Do- 1:J " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEM . If this Is for the whole group, check this box No- 0 . If It is for part of the group, check this box Om~ ED and attach a list with the names and EINs of all members the extension will cover .

I I request an automatic 3-month (6-months for a Form 990-T corporation) extension of time until AUGUST 15, 2005 to file the exempt organization return for the organization named above. The extension Is for the organization's return for 10- EE calendar year 2 0 0 4 or 0. EJ tax year beginning and ending

2 If this tax year is for less than 12 months, check reason : 0 Initial return Final return ED Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits . See instructions 1 $ 48,773 .

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit $ 41,273 .

Balance Due . Subtract line 3b from line 3a . Include your payment with this form, or, if required, deposit with FTD coupon or, ff required, by using EFTPS (Electronic Federal Tax Payment System) . See instructions . . . . . . $ 7,500 .

Caution . If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment Instructions .

LHA For Privacy Act and Paperwork Reduction Act Notice, see Instructions. Form 8868 (Rev. 12-2004)

return of private foundation 2004 -...

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