DOUBLE THE DONATION | CORPORATE MATCHING GIFTS PROGRAM IN 2019

Chandler Michelle Daffern Memorial Scholarship

Philanthropy means the love of humanity. When giving to your favorite non-profit or 501(c) (3) organization, which is tax-exempt under the internal revenue code, be sure to check with your employer if they have a Matching Gift Program where you can double the donation. For example, we lost my granddaughter at birth in 2017 due to Congenital Diaphragmatic Hernia, a diaphram birth defect that occurs before birth. We were traumatized. In order to help alleviate the pain of our loss, my daughter who was a student at University of Arkansas Community College Hope-Texarkana established The Chandler Michelle Daffern Memorial Scholarship giving preference to single mothers seeking a degree in the health professions field. To honor her memory, I donated $3,500. After checking online, I found my employer at the time (Firestone Building Products a subsidiary of Bridgestone Americas) had a Matching Gift Program. I found the form online, filled out Part I of the form, attached a copy of my donation check and sent it the UACCH-T Executive Director. The school officer fills out Part II then sends the form electronically with a copy of the check donation to the company Trust Fund. In just a few months I doubled my donation to $7,000. Along with other donations we were able to fully endow the scholarship ($10,000) within 2 years. The scholarship will now help a single mother in the health professions field each year to ensure Chandlers legacy will live on forever. Please check with your employer their policy on Matching Gift Program before giving to your favorite organization and double the donation. You may can get a copy of your company employers Matching Gift Program form online or see your company Human Resource Manager. See a generic copy of the Matching Gift Program purpose and form below:

PURPOSE

The Matching Gift Program of (your company and its subsidiaries) ​has been established for the purpose of providing financial assistance in cooperation with company teammates to colleges or universities throughout the country. Through the matching of gifts by your company Trust Fund, voluntary giving is effectively doubled. Support of education is an essential element in national, corporate and personal progress. The Matching Gift Program adds to the potential worth and value of the nation’s total education system. The fund will match eligible gifts on a dollar-for-dollar basis.

ELIGIBLE GIVERS

Full -time salaried and hourly teammates of (your company and its subsidiaries) who have at least six months continuous service. Former teammates who have retired and are eligible to receive a Normal, an Early or a Disability pension under the Company’s Retirement Plan. Former teammates who have earned a Deferred Vested Pension are not eligible.

ELIGBLE RECIPIENTS

Accredited universities and colleges, including junior and community colleges, in the United States. Gifts to independent college funds or separately organized funds, if certified as organizations that will transmit gifts to eligible universities or colleges. The college, university or fund must meet the requirements of the Internal Revenue Service as an organization to which deductible charitable contributions may be made. Gifts are not eligible if either the gift or matching gift constitutes payment for tuition, books, fees, dues, athletic programs (equipment, uniforms, etc.), booster clubs, church subsidies for private schools or other similar items at the recipient institution or fund, or for the benefit of any specific individual including the donor. However, athletic scholarships do qualify. Where benefits (preferred tickets to athletic events, etc.) are derived by the donor, only the deductible portion of the gift is eligible for matching purposes.

ELIGIBLE GIFTS

Only gifts of at least $50 made by check, charge or securities (average value on day of gift made), as distinguished from real or other forms of personal property, are eligible for matching. Pledges as such will not be matched until payment is made. Gifts made in a calendar year will be matched in that calendar year or in the first calendar half of the next calendar year if made in the last calendar quarter of the previous year. Gifts must be the personal contribution of the donor, not a gift made with funds provided in whole or in part by others or from the donor’s business account. Proof of payment must be retained by the giver for two years. Gifts of spouses are not eligible for matching.

MATCHING LIMITS

The (Your Company Trust Fund) will match gifts on a dollar-for-dollar basis of $50 or more to an aggregate maximum of $5,000 per eligible giver, per year. Subject to these limits, a qualified giver may make as many gifts to as many eligible recipients as he or she chooses. If this gift is matched by another organization, it does not qualify

ADMINISTRATION

The Trust Fund’s Matching Gifts will be paid quarterly to each eligible college, university or fund. Gifts will be considered for matching if properly completed applications are received in the (Your Companies Trust Fund) office within six months from the date of the donor’s gift. Each gift must be accompanied by this complete form.

Decisions concerning any request under this program shall be final and the company reserves the right to revise or terminate this program at any time and to refuse a request to any organization. No mechanical reproductions of this form will be accepted. You must use original forms.

HOW TO PARTICIPATE

· TEAMMATE OR RETIREE TO COMPLETE PART I, then send this form with your gift or copy of gift (check, charge transaction or security sale) directly to the college, university or fund.

· SCHOOL OFFICER TO COMPLETE PART II, then send this form along with copy of gift (check, transaction or security sale) electronically to MATCHINGGIFTS@YOURCOMPANY.COM or remit to:

YOUR COMPANY TRUST FUND

ATTN: MATCHING GIFTS

COMPANY ADDRESS

COMPANY CITY, COMPANY STATE COMPANY ZIP

Matching Gift Program to Educational Institutions

PART I    

TO BE COMPLETED BY EMPLOYEE OR RETIREE OR YOUR COMPANY INC. (AND ITS SUBSIDIARIES)

DATE __________

GIVERS NAME _____________________________________________

HOME ADDRESS ___________________________________________

CITY ________________________ STATE ______ ZIP ____________

PHONE ______________ EMAIL ______________________________

UID# ________________

( ) EMPLOYEE          SERVICE DATE ____________________

( ) RETIREE               RETIREMENT DATE _______________

COMPANY NAME _______________________________________________________

(RETIREES LIST COMPANY NAME FROM WHICH YOU RETIRED)

COMPANY LOCATION __________________________________________________

(RETIREES LIST COMPANY LOCATION FROM WHICH YOU RETIRED)

ENCLOSED WITH THIS FORM IS MY GIFT TO _________________________________________________

EDUCATIONAL INSTITUTION RECIPIENT _____________________________________________________

ADDRESS _______________________________________________________

CITY ________________________ STATE ______ ZIP ____________

IF GIFT IS MADE IN INSTALLMENTS, PROVIDE ALL DATES AND INDIVIDUAL AMOUNTS

_______________________________________________________

FORM OF GIFT

*COPY OF GIFT (CHECK, CHARGE TRANSACTION OR SECURITY SALE) MUST BE PROVIDED

CHECK               ( )         AMOUNT $ __________________________________

CHARGE            ( )         AMOUNT $ __________________________________

SECURITIES      ( )  NUMBER OF SHARES _______________ TOTAL VALUE $ ____________________

 (AVERAGE VALUE ON DATE GIFT MADE)

NAME OF SECURITY AND ISSUER _______________________________________________________

NONDEDUCTIBLE PORTION IF ANY $ ___________________________

I certify that the information submitted herewith is correct and I authorize the recipient college, university or affiliated organization named above to report this gift to (company name Inc.), in order to obtain a contribution under the provisions of the (company name ) Trust Fund Matching Gift Program

_______________________________________________________

SIGNATURE OF GIVER      

Matching Gift Program to Educational Institutions

PART II   

TO BE COMPLETED BY AUTHORIZED SCHOOL OFFICIAL

I certify this contribution does not constitute a duplicate match and was received from this institution from:

NAME OF DONOR ________________________________

DATE __________

And I further certify that this organization is recognized by the U.S. Treasury Department as one to which contributions are deductible by the donor for Federal Income Tax purposes and which is not a private foundation within the meaning of section 509(a) of the Internal Revenue Code.

Also, I understand that this gift and the matching gift will not constitute payment for tuition, books, fees, dues, athletic programs (i.e. equipment, uniforms, etc.) booster clubs, church subsidies for private schools or other similar items at this college, university or organization, nor is it for the benefit of any special individual.

NAME   OF AUTHORIZED OFFICIAL _____________________________________________

TITLE OF AUTHORIZED OFFICIAL ______________________________________________

NAME OF THIS INSTITUTION OR IT’S RECEIVING AGENT _____________________________________

ADDRESS ___________________________________________

CITY ________________________ STATE ______ ZIP ____________

PHONE ______________ EMAIL _____________________________

_______________________________________________________

SIGNATURE OF AUTHORIZED OFFICIAL