Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
SWEDISHAMERICAN FOUNDATION
 
Employer identification number
36-3097493
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC Code section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) SWEDISHAMERICAN HOSPITAL
1401 EAST STATE ST
ROCKFORD,IL61104
36-2222696 501(C)(3) 178,667       EQUIP REGIONAL CANCER CENTER
(2) UNIVERSITY OF ILLINOIS FOUNDATION
1305 W GREEN ST
URBANA,IL61801
37-6006007 501(C)(3) 80,000       CAPITAL CONSTRUCTION
(3) YMCA OF ROCK RIVER VALLEY
200 Y BLVD
ROCKFORD,IL61107
36-2174838 501(C)(3) 15,000       COMMUNITY PROGRAMS
(4) HABITAT FOR HUMANITY INTERNATIONAL INC
322 W LAMAR ST
AMERICUS,GA31709
91-1914868 501(C)(3) 10,000       GRANT FOR BUILDING HOMES
(5) LIV LIFE FOUNDATION
11098 LEMON GRASS LANE
ROSCOE,IL61073
27-2167648 501(C)(3) 5,000       RESEARCH FUNDING














2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
5
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012
Page 2

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE AMOUNTS ARE GENERAL ASSISTANCE AND NO ONGOING GRANT MONITORING IS REQUIRED. GENERAL ASISTANCE GRANT REQUEST ARE SUBMITTED TO SAF BOARD OF DIRECTORS FOR REVIEW AND CONSIDERATION. THE GRANT COMMITTEE PRESENTS THEM TO THE FULL BOARD FOR DISCUSSION & APPROVAL.
Schedule I (Form 990) 2012


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