American College of Sports Medicine Regional Chapters
Year 2015 Activity Report (Non-Financial Report)
Due: February 1, 2016
Regional Chapter:
Report Completed By:
Date Completed:
Chapter Meetings - This information will be used to follow trends in attendance increases and/or decreases. Please provide fee structure so that other
chapters may use this information to adjust fees if necessary.
Date
Meeting Title
Location
# of Students
# of Professionals
Fee Breakdown:
1. Professional Member
2. Professional Non-Member
3. Student Member
4. Student Non-member
5. Professional Late Fee
6. Student Late Fee
7. Public Fee
Chapter Business Meetings
Please list the total number of Business Meetings and/or Board Meetings held in 2015 –
Other Chapter Activities
Please summarize any other chapter activities conducted in 2015 -
Chapter Publications
Please list the type and frequency of any chapter publications in 2015 -
Recognition Awards
List all recognition awards and / or student awards. Please include non-monetary awards as well.
Type of Award
Recipient
Stipend / Award Amount (If Applicable)
NOTE- The total financial amount listed on this
activity report must match the amount listed in the
“Awards” expense line item on the chapter’s
financial report.
Chapter Membership
Please complete the membership information below and send an electronic list of ALL chapter members as of 12/31/15 (including name, address & e-mail
address) to hturner@acsm.org.
Number of Members
CHAPTER MEMBERSHIP AS OF 12/31/15
Total Number of Student Members
Total Number of Professional Members
TOTAL 2014 MEMBERSHIP AS OF 12/31/15 (Total of two lines above)
Officer Information
Please complete the following information on your officers as of 12/31/2015.
Position
President
President-elect
Immediate Past President
Secretary / Treasurer
RCC Representative
Student Representative
Board Member
Board Member
Board Member
Board Member
Board Member
Executive Director
Name of Officer
E-mail
Dates of Term
Chapter Annual Meeting Information
Please provide information on your next two upcoming annual meetings (if available).
2016 Annual Meeting
2017 Annual Meeting
Title:
Dates:
Location:
Contact Person:
Contact Address, Phone, E-mail:
Title:
Dates:
Location:
Contact Person:
Contact Address, Phone, E-mail:
Chapter Support from National ACSM
Each year, chapters have access to marketing e-mail blasts, online survey services, online election services, Annual Meeting support, website design/webmaster
support, Strategic Planning Facilitation, Handouts for Meetings (e.g. Sample FIT Journals, ACSM Membership Applications), Teleconferencing services, Travel
Arrangement service for meeting presenters, letterhead printing, Workshops, Newsletter Support, Regional Chapter E-bulletins and more.
What services have you found particularly helpful in 2015?
What additional services would you find useful in 2016?
Financial Support from ACSM Foundation
In 2015, each chapter received funding from the ACSM Foundation ($500) and the Gatorade Sports Science Institute ($1000). Please indicate below what
recognition you provided for these funds. This information will be used to support cause for future partner agreements involving Regional Chapters. NOTE: All
2016 funding is subject to change per sponsorship agreements.
Foundation Grants – Please list recipients. The amount(s) should total at least $500.
Recipient’s Name
Amount of Award
Award Description
1.
2.
3.
4.
Gatorade Sports Science Institute (GSSI) - As part of the agreement with the Gatorade Sports Science Institute, $1000 must be used to cover education
expenses incurred during the annual meeting. GSSI also provided funding for one GSSI speaker to present at each chapter meeting. Please indicate the
recognition you provided (or plan to provide) for GSSI.
Information Required for IRS Group Tax ReturnPlease answer the following questions which are now necessary for ACSM to include on the Group Tax return that we file on behalf of the chapters. Note: Due to
the new 990 revisions, ACSM may request additional information later in the year as all implications of the new form become known.
During the year, did the chapter attempt to influence national, state, or local legislation, including any attempt to influence public opinion on a
legislative matter or referendum through the use of:
Yes
No
Volunteers
Paid staff or management
Media advertisements
Mailings to members, legislators of public
Publications or published broadcast statements
Grants to other organizations for lobbying purposes
Direct contact with legislators, their staffs, gov’t officials, legislative body
Rallies, demonstrations, seminars conventions, speeches, lectures
If you answered “yes” to any of the statements above, how much did you spend on each activity?
During the year, did the chapter, either directly or indirectly, engage in any of the following acts with any substantial contributors, trustees, directors,
officers, employees, or members of their families or any organizations that these people would be affiliated with?
Yes
Sale, exchange or leasing of property
Lending of money or extension of credit
Furnishing of goods, services or facilities
Payment of compensation (if more than $1000)
Transfer any part of its income or assets
No
Yes
No
Yes
No
Yes
No
Did the chapter maintain any donor advised funds (Definition is: A private fund administered by a third
party and created for the purpose of managing charitable donations on behalf of an organization, family, or
individual.)?
Did the chapter pay premiums, directly or indirectly, on a personal benefit contract?
Does the chapter have a written conflict of interest policy?
Did the chapter receive donated services or the use of materials, equipment or facilities at no charge or
substantially less than fair rent value?
If “yes”, indicate value:
Did the chapter solicit any contributions or gifts that were not tax deductible?
If “yes”, did you include a statement on solicitations that the gifts weren’t tax deductible?
Enter the total number of officer, directors and trustees permitted to vote on organization business at board meetings.
Reporting of Contributors and Acknowledgement of Receipts Provided
IRS guidelines require non-profits to issue receipts to individuals that make contributions (e.g. donations to foundations, donations to scholarship programs, etc.).
Registration for meetings or membership dues ARE NOT considered contributions. All contributors must receive a receipt from your chapter which acknowledges
the amount of the donation as well as a statement that no goods or services were provided for the donation). Please complete the following table for any
individuals that made donations to your chapter in 2015. You may attach a spreadsheet with the information if it is easier to do so. Sample text for receipt letterThe American College of Sports Medicine is an organization qualified to receive tax-deductible gifts under IRS code section 501 (c)(3).This letter acts as your
receipt for the donation, and verifies that no goods or services were rendered in exchange for this voluntary donation.
Name of Contributor
Amount of
Donation
Contribution Provided For: (e.g. scholarship fund, memorial, etc.)
Indicate with “X” below to confirm
that a receipt was provided
Regional Chapter Year-End Summary for ACSM Board of Trustees Report
The Regional Chapters Committee is responsible for reporting activities of all regional chapters to the ACSM Board of Trustees. Please detail how your chapter
furthered the Mission of the College in 2015. Note: This summary will be submitted to the Board of Trustees in its entirety to demonstrate the important role that
Chapters fulfill and showcase your chapter’s accomplishments throughout the year.
Please submit approximately 1 - 1 ½ paragraph(s) of narrative here (Continue text on next page as needed):
Thank you for completing this report. Please e-mail it by February 1, 2016 to Heather Turner at hturner@acsm.org.