Agency Fund Agreement Worksheet

Agency Funds are established by nonprofits to support their charitable needs. NCCF handles the management and stewardship of their charitable assets to enable a stable source of revenue for the nonprofit at a low cost. This frees the nonprofit and its board of directors to concentrate on the pursuit of the nonprofit’s charitable mission.

The Agency Fund Worksheet is used to create the Agreement establishing the Fund with NCCF. Please fill out the information below. Questions? Call our Philanthropic Services staff at (860) 626-1245.

General Information

Nonprofit Profile

EIN *

Full Name of Organization *

Mailing Address *

Mailing Address Line 2

City *

State *

Zip Code *

Website *

Phone Number *

Mission Statement *

Fund Information

Fund Name * 🛈

Fund Use Restrictions (if any): *

Fund Type: Endowed or Non-Endowed (expendable)

Endowments/Endowed funds are permanent funds established to carry out your organization's philanthropic intentions in perpetuity. The fund is invested for growth, and the amount available for grants each year is based on NCCF's Board approved annual Community Distribution Policy (usually around 5% net of fees of the fund's 3 year average market value). This fund is intended to make distributions to your organization in perpetuity.

Non-Endowed funds are expendable. These funds permit grant distributions in any amount (minimum of $250 per grant) at any time. A non-endowed fund may be converted to an endowed fund, but an endowed fund may not be converted to a non-endowed fund. There us no annual distribution limit. If the fund assets are exhausted, the fund will terminate.

Pass-Through funds–because they are temporary and short in duration–are held in a Money Market account. These funds are for the short term, with the entire fund likely to be distributed within 12 months.

Select Your Fund Type: *

Endowed

Non-Endowed

Pass-Through

Fund Statements

Fund Statements are posted to the Fund Advisor Portal quarterly. Individuals designated by your nonprofit's Board will receive an email notification when quarterly statements are posted–usually about four weeks after the quarter's end.

Please indicate the name, address and email of up to three individuals whom your Board will designate to receive quarterly statement notifications.

Note: Any changes to the distribution list must be approved by your Board with proper supporting evidence- (minutes or Board resolution).

Fund Statement Recipients

First Name *

Last Name *

Title *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Add another Fund Advisor

First Name *

Last Name *

Title

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

add another Fund Advisor

First Name *

Last Name *

Title

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

add another Fund Advisor

First Name *

Last Name *

Title

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Gift Information

A. Fund Creation

Type of Gift: *

Cash/Check

Securities/ Stock

Other

For "Other," please explain: *

Gift Amount (approx.): *

Please make checks payable to The Northwest CT Community Foundation, Inc. with your fund name in the memo line. For the transfer of funds by wire, or for gifts of securities or complex assets please review Methods to Give to your Fund.

Professional Advisor (optional)

Professional Advisor Information
We can work with your accountant in providing fund information for accurate 990 filings, and/or with your attorney should there be any legal questions regarding our fund relationship. Contact information will not be shared outside of NCCF.

Advisor Information (optional):

Attorney

CPA

Financial Planner

Other

For "Other," please explain:

Name *

Name of Firm *

Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Home Phone

Mobile Phone

add another Professional Advisor

Advisor Information (optional):

Attorney

CPA

Financial Planner

Other

For "Other," please explain:

Name *

Name of Firm *

Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Home Phone

Mobile Phone

Distribution Authorizations

Names of individuals who you have authorized to request a distribution from your fund:

(Please Note: All distribution requests must be accompanied by executed Board Minutes or a standing Board Resolution.)

First Name *

M.I.

Last Name *

Organization *

Title *

add another authorized individual

First Name *

M.I.

Last Name *

Organization *

Title *

add another authorized individual

First Name *

M.I.

Last Name *

Organization *

Title *

Signatures

Executive Director Name

Executive Director Signature

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Board Chair Name

Board Chair Signature

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