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.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
 
 
Employer identification number
39-1091469
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 Domestic Organizations and Domestic Governments. 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 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)  
1531 HUGHITT AVENUE
SUPERIOR,WI54880 		39-1840533 3 13,237       SHELTER OPERATIONS
(2)  
2231 CATLIN AVENUE
SUPERIOR,WI54880 		39-1478768 3 5,526       SHELTER OPERATIONS
(3)  
1900 3RD STREET W
ASHLAND,WI54806 		39-1364912 3 9,283       SHELTER OPERATIONS


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
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) 2014
Page 2

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. 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
(1) FOOD - COMMODITIES 212646   206,497 GOV'T COST FOOD
(2) FOOD - MEALS 132349   161,825 MEALS/LB FOOD
(3) HOMELESS PREVENTION 210 44,536      
(4) EMPLOYMENT SKILLS DEVEL. 5 6,436      
(5) GAS AND BUS VOUCHERS 47 2,850      
(6) PRENATAL CARE ASSISTANCE 136 4,310      
(7) HOTEL VOUCHERS 52 2,617      
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
SCHEDULE I, PAGE 1, PART I, LINE 2 ASSISTANCE IS MONITORED PRIMARILY THROUGH SITE VISITS AND MONTHLY OR QUARTERLY REPORTS.
SCHEDULE I, PAGE 4, PART IV FOOD ASSISTANCE - COMMODITIES RECEIPIENTS IS BASED ON THE NUMBER OF MEALS GIVEN OUT TO ELIGIBLE HOUSEHOLDS DURING THE YEAR THROUGH ALL SITES, EXCEPT FOR THE DOUGLAS COUNTY FOOD SHELF AND SOUP KITCHEN WHICH IS DETAILED IN LINE 2. FOOD ASSISTANCE - MEALS RECIPIENTS IS BASED ON THE CUMULATIVE TOTAL OF THE MONTHLY INDIVIDUALS SERVED THROUGH THE DOUGLAS COUNTY FOOD SHELF AND SOUP KITCHEN. ALL OTHER ASSISTANCE RECIPIENTS IS BASED ON NUMBER OF HOUSEHOLDS/INDIVIDUALS SERVED.
Schedule I (Form 990) 2014



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