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HMSA <br /> Foundation <br /> Pursuing.Quality in Health Care <br /> IRS Guidelines—Acknowledgement of receipt <br /> for contributions of$250 or more <br /> Grantees should provide HMSA Foundation with a written acknowledgement <br /> containing the following: <br /> 1. Acknowledgement dated AFTER funds are distributed; <br /> 2. Date of receipt of funds; <br /> 3. Amount of cash received; <br /> 4. An indication of whether the organization provided goods or services in <br /> consideration for the cash (in almost all cases with the HMSA <br /> Foundation, there will be no exchange of goods or services). If goods <br /> or services have been provided by the organization, a description and <br /> good faith estimate of the value of those goods/services are required; <br /> 5. Printed name, signature and title of the Individual authorized to sign <br /> recipient organization's letter. <br /> At a minimum, your letter should look something like this: <br /> [DATE(Please be sure to date after funds were received)] <br /> Dear HMSA Foundation, <br /> ABC Organization would like to acknowledge the HMSA Foundation for its grant <br /> of AMOUNT RECEIVED(Please indicate the actual amount received in this payment)] which we received on <br /> [DATE FUNDS wERE RECEIVED]. No goods or services were provided to the HMSA <br /> Foundation in exchange for this cash. <br /> [SIGNATURE] <br /> Jane Doe <br /> President <br /> ABC Organization <br /> If you have any questions, please call HMSA Foundation staff at 948-5585. <br />