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," on 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
2015
Open to Public
Inspection
Name of the organization
LONGMONT UNITED HOSPITAL
 
Employer identification number
84-0460697
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" on 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) SALUD FAMILY HEALTH
203 SOUTH ROLLIE AVE
FORT LUPTON,CO80621
84-0613590 501(C)(3) 150,303       PROGRAM SUPPORT
(2) VIA MOBILITY SERVICES
2855 N 63RD ST
BOULDER,CO80301
84-0777296 501(C)(3) 30,000       PROGRAM SUPPORT
(3) A WOMAN'S WORK
PO BOX 817
LONGMONT,CO80502
20-8078513 501(C)(3) 30,000       PROGRAM SUPPORT
(4) LONGMONT COMMUNITY FOUNDATION
636 COFFMAN STREET SUITE 203
LONGMONT,CO80501
46-3894713 501(C)(3) 25,000       PROGRAM SUPPORT
(5) OUR CENTER
303 COLLYER STREET
LONGMONT,CO80501
74-2448346 501(C)(3) 27,200       PROGRAM SUPPORT
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) 2015
Page 2

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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)
(2)
(3)
(4)
(5)
(6)
(7)
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
PART I, LINE 2: ALL DONATIONS ARE BASED ON COMMUNITY NEED. IN ORDER TO ASSESS THE COMMUNITY NEEDS, MEMBERS OF THE LEADERSHIP COUNCIL HAVE FORMED LONG-TERM PROFESSIONAL RELATIONSHIPS WITH THE RECIPIENT ORGANIZATIONS. NO DONATIONS ARE MADE WITHOUT THIS LONG-TERM RELATIONSHIP BEING IN PLACE.
Schedule I (Form 990) 2015



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