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
PALO ALTO MEDICAL FOUNDATION
 
Employer identification number
94-1156581
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) SOUTH COUNTY COMM HLTH CTR INC
1885 BAY RD
E PALO ALTO,CA94303
94-3372130 501(C)(3) 400,000       GENERAL SUPPORT
(2) EL CAMINO HOSPITAL FOUNDATION
2500 GRANT RD WIL210
MOUNTAIN VIEW,CA94040
94-2823235 501(C)(3) 188,880       GENERAL SUPPORT
(3) AXIS COMMUNITY HEALTH
4361 RAILROAD AVE
PLEASANTON,CA94566
94-2232394 501(C)(3) 150,000       GENERAL SUPPORT
(4) TRI CITY HEALTH CENTER
39500 LIBERTY ST
FREMONT,CA94538
23-7255435 501(C)(3) 150,000       GENERAL SUPPORT
(5) ASIAN AMERICANS FOR COM INVOLVEMENT
2400 MOORPARK AVE STE 300
SAN JOSE,CA95128
94-2292491 501(C)(3) 102,000       GENERAL SUPPORT
(6) MAYVIEW COMMUNITY HEALTH CTR
270 GRANT AVE
PALO ALTO,CA94306
94-2239648 501(C)(3) 100,000       GENERAL SUPPORT
(7) HEALTHIER KIDS FOUNDATION SANTA CLARA CO
4010 MOORPARK AVE STE 118
SAN JOSE,CA95117
77-0545774 501(C)(3) 60,000       GENERAL SUPPORT
(8) INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
1333 MERIDIAN AVE
SAN JOSE,CA95125
94-2476242 501(C)(3) 50,000       GENERAL SUPPORT
(9) PENINSULA HEALTHCARE CONNECTION INC
33 ENCINA AVE STE 103
PALO ALTO,CA94301
20-2886131 501(C)(3) 32,000       GENERAL SUPPORT
(10) CRISTO REY SAN JOSE WORK STUDY CORPORATION
1390 FIVE WOUNDS LN
SAN JOSE,CA95116
46-2605900 501(C)(3) 31,000       GENERAL SUPPORT
(11) CALIFORNIA DRAGON BOAT ASSOCIATION
268 BUSH ST STE 888
SAN FRANCISCO,CA94118
52-2153488 501(C)(3) 30,000       GENERAL SUPPORT
(12) AVENIDAS
450 BRYANT ST
PALO ALTO,CA94301
94-1480548 501(C)(3) 25,000       GENERAL SUPPORT
(13) AMERICAN RED CROSS CAPITAL REGION CHAPTER
PO BOX 100805
PASADENA,CA91189
53-0196605 501(C)(3) 25,000       GENERAL SUPPORT
(14) NORTH COAST OPPORTUNITIES
413 NO STATE ST
UKIAH,CA95482
94-1671958 501(C)(3) 25,000       GENERAL SUPPORT
(15) RONALD MCDONALD HOUSE AT STANFORD
520 SAND HILL RD
PALO ALTO,CA94304
94-2538615 501(C)(3) 25,000       GENERAL SUPPORT
(16) ABODE SERVICES
40849 FREMONT BLVD
FREMONT,CA94538
94-3087060 501(C)(3) 22,500       GENERAL SUPPORT
(17) HEALTH IMPROVEMENT PSHIP OF SANTA CRUZ CO
1800 GREEN HILLS RD STE 100
SCOTTS VALLEY,CA95066
10-0826156 501(C)(3) 22,500       GENERAL SUPPORT
(18) BURLINGAME COMMUNITY FOR EDUCATION FDN
PO BOX 117730
BURLINGAME,CA94010
94-2722072 501(C)(3) 20,000       GENERAL SUPPORT
(19) CABRILLO COLLEGE FOUNDATION
6500 SOQUEL DR
APTOS,CA95003
94-6121953 501(C)(3) 20,000       GENERAL SUPPORT
(20) PEOPLE ACTING IN COMMUNITY TOGETHER INC
1100 SHASTA AVE
SAN JOSE,CA95126
77-0090129 501(C)(3) 20,000       GENERAL SUPPORT
(21) NATIONAL COMPREHENSIVE CANCER NETWORK INC
275 COMMERCE DR STE 300
FORT WASHINGTON,PA19034
23-2818395 501(C)(3) 15,000       GENERAL SUPPORT
(22) MILLS PENINSULA HOSPITAL FND
2200 RIVER PLAZA DRIVE
SACRAMENTO,CA95833
23-7288765 501(C)(3) 14,000       GENERAL SUPPORT
(23) BOYS AND GIRLS CLUBS OF THE PENINSULA
401 PIERCE RD
MENLO PARK,CA94025
94-1552134 501(C)(3) 13,000       GENERAL SUPPORT
(24) YMCA OF SILICON VALLEY
3412 ROSS RD
PALO ALTO,CA94303
94-1156318 501(C)(3) 13,000       GENERAL SUPPORT
(25) CHILDRENS HEALTH COUNCIL DBA CHC
650 CLARK WY
PALO ALTO,CA94304
94-1312311 501(C)(3) 12,500       GENERAL SUPPORT
(26) SANTA CLARA UNVRSTY WOMENS GOLF & ATHLETICS
500 EL CAMINO REAL
SANTA CLARA,CA95053
94-1156617 501(C)(3) 11,100       GENERAL SUPPORT
(27) YOUTH COMMUNITY SERVICE INC
4120 MIDDLEFIELD RD STE P8
PALO ALTO,CA94303
20-8099150 501(C)(3) 10,325       GENERAL SUPPORT
(28) ADOLESCENT COUNSELING SERVICES
1717 EMBARCADERO RD STE 4000
PALO ALTO,CA94303
51-0192551 501(C)(3) 10,000       GENERAL SUPPORT
(29) ART RESEARCH & CURRICULUM ASSOC INC
410 7TH ST STE 204B
OAKLAND,CA94607
94-2466542 501(C)(3) 10,000       GENERAL SUPPORT
(30) CARDIAC THERAPY FDN OF THE MIDPENINSULA
4000 MIDDLEFIELD RD STE G8
PALO ALTO,CA94303
77-0336212 501(C)(3) 10,000       GENERAL SUPPORT
(31) CHINESE AMERICN COALITION-COMPATIONATE CARE
4070 CACTUS RD
SHINGLE SPRINGS,CA95682
26-0895114 501(C)(3) 10,000       GENERAL SUPPORT
(32) COASTAL KIDS HOME CARE
1172 SO MAIN ST STE 125
SALINAS,CA93901
20-2549984 501(C)(3) 10,000       GENERAL SUPPORT
(33) COUNSELING AND SUPPORT SERVICES FOR YOUTH
555 BRYANT ST STE 126
PALO ALTO,CA94301
26-4655116 501(C)(3) 10,000       GENERAL SUPPORT
(34) FRIENDS OF CHILDREN WITH SPECIAL NEEDS
2300 PERALTA BLVD
FREMONT,CA94536
77-0446853 501(C)(3) 10,000       GENERAL SUPPORT
(35) HEALTH CONNECTED
480 JAMES AVE
REDWOOD CITY,CA94062
94-3227947 501(C)(3) 10,000       GENERAL SUPPORT
(36) HOMELESS SERVICES CENTER
115 B CORAL ST
SANTA CRUZ,CA95060
77-0126783 501(C)(3) 10,000       GENERAL SUPPORT
(37) IMAGINE SUPPORTED LIVING SVC
1395 41ST AVE STE A
CAPITOLA,CA95010
61-1418745 501(C)(3) 10,000       GENERAL SUPPORT
(38) LEGAL AID SOCIETY OF SAN MATEO COUNTY
521 E 5TH AVE
SAN MATEO,CA94402
94-1451894 501(C)(3) 10,000       GENERAL SUPPORT
(39) NAT ALLIANCE ON MENTAL ILL SANTA CRUZ CO
PO BOX 360
SANTA CRUZ,CA95061
77-0002878 501(C)(3) 10,000       GENERAL SUPPORT
(40) NEW HOPE CHINESE CANCER
500 E CALAVERAS BLVD STE 307
MILPITAS,CA95035
46-2490094 501(C)(3) 10,000       GENERAL SUPPORT
(41) NEXT DOOR SOLUTIONS TO DOMESTIC VIOLENCE
234 E GISH RD STE 200
SAN JOSE,CA95112
94-2420708 501(C)(3) 10,000       GENERAL SUPPORT
(42) PENINSULA HUMANE SOCIETY AND SPCA
1450 ROLLINS RD
BURLINGAME,CA94010
94-1243665 501(C)(3) 10,000       GENERAL SUPPORT
(43) RAPE TRAUMA SERVICES
1860 EL CAMINO REAL STE 406
BURLINGAME,CA94010
94-3215045 501(C)(3) 10,000       GENERAL SUPPORT
(44) SENIOR NETWORK SERVICES
1777-A CAPITOLA RD
SANTA CRUZ,CA95062
94-2259716 501(C)(3) 10,000       GENERAL SUPPORT
(45) ACTERRA ACTION FOR A SUSTAINABLE EARTH
3921 E BAYSHORE RD
PALO ALTO,CA94303
23-7064937 501(C)(3) 10,000       GENERAL SUPPORT
(46) CALIFORNIA UNIVERSITY OF SAN FRANCISCO FDN
220 MONTGOMERY ST 5TH FLR
SAN FRANCISCO,CA94104
94-2829914 501(C)(3) 10,000       GENERAL SUPPORT
(47) COMMUNITY HEALTH AWARENESS COUNCIL
PO BOX 335
MOUTAIN VIEW,CA94042
94-2223670 501(C)(3) 10,000       GENERAL SUPPORT
(48) COMPUTER HISTORY MUSEUM
1401 NO SHORELINE BLVD
MOUNTAIN VIEW,CA94043
77-0507525 501(C)(3) 10,000       GENERAL SUPPORT
(49) FAMILY SERVICE AGENCY SANTA CRUZ
2003 104 WALNUT AVE STE 208
SANTA CRUZ,CA95060
94-1716354 501(C)(3) 10,000       GENERAL SUPPORT
(50) FRIENDS OF CHILDREN WITH SPECIAL NEEDS
2300 PERALTA BLVD
FREMONT,CA94536
77-0446853 501(C)(3) 10,000       GENERAL SUPPORT
(51) JUVENILE DIABETES RESEARCH FOUNDATION
425 UNIVERSITY AVE STE 106
SACRAMENTO,CA95825
23-1907729 501(C)(3) 10,000       GENERAL SUPPORT
(52) SAMARITAN HOUSE
4031 PACIFIC BLVD
SAN MATEO,CA94403
23-7416272 501(C)(3) 10,000       GENERAL SUPPORT
(53) SILICON VALLEY COUNCIL OF NONPROFITS
1400 PARKMOOR AVE STE 130
SAN JOSE,CA95126
77-0524747 501(C)(3) 10,000       GENERAL SUPPORT
(54) SUNNYVALE COMMUNITY SERVICES
725 KIFER RD
SUNNYVALE,CA94086
94-1713897 501(C)(3) 10,000       GENERAL SUPPORT
(55) WASHINGTON HOSPITAL HEALTHCARE FOUNDATION
2000 MOWRY AVE
FREMONT,CA94538
94-2886219 501(C)(3) 10,000       GENERAL SUPPORT
(56) CAMP OPPORTUNITY INC
34050 PASEO PADRE PKWY
FREMONT,CA94555
77-0219669 501(C)(3) 7,500       GENERAL SUPPORT
(57) FOUNDATION FOR A COLLEGE EDUCATION
2160 EUCLID AVE
EAST PALO ALTO,CA94303
77-0401635 501(C)(3) 7,500       GENERAL SUPPORT
(58) WEST VALLEY COM SRVCS OF SANTA CLARA CO
10104 VISTA DR
CUPERTINO,CA95014
94-2211685 501(C)(3) 7,500       GENERAL SUPPORT
(59) HUMANE SOCIETY SILICON VALLEY
901 AMES AVE
MILPITAS,CA95035
94-1196215 501(C)(3) 6,000       GENERAL SUPPORT
(60) MEDSHARE INTERNATIONAL
3240 CLIFTON SPRINGS RD
DECATUR,GA30034
58-2433968 501(C)(3) 5,200       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
60
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) Patient Assistance 11 7,248      
(2) Scholarships 24 102,250      
(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
SCHEDULE I, PART I, LINE 2 IN ORDER TO CLOSELY MONITOR EFFICIENCY AND EFFECTIVENESS, THE COMMUNITY BENEFIT FUNCTION OUTLINES MEASURABLE REPORTING (QUARTERLY, SIX-MONTH AND/OR YEAR-END), PROGRAM AND FUNDING REQUIREMENTS IN A MEMORANDUM OF UNDERSTANDING (MOU), BUSINESS SERVICES AGREEMENT (BSA), OR JOINT VENTURE AGREEMENT FOR EACH INVESTMENT MADE WITH A COMMUNITY PARTNER. WHERE IT IS DETERMINED NECESSARY, ADDITIONAL EFFORTS ARE MADE TO MONITOR EFFECTIVENESS AND EFFICIENCY OF INVESTMENTS, WHICH COULD INCLUDE: - QUARTERLY MEETINGS WITH COMMUNITY PARTNERS - E-MAIL AND TELEPHONIC COMMUNICATIONS WITH COMMUNITY PARTNERS - CONTINUED DIALOGUE WITH INVOLVED HOSPITAL STAFF AND COMMUNITY PARTNERS THROUGHOUT DURATION OF PROGRAM - SITE VISITS WITH COMMUNITY PARTNERS - BI-ANNUAL "OUTCOMES" SURVEY (6-MONTH AND YEAR-END OUTCOMES) - REVIEW OF HOSPITAL USAGE AND PATIENT LEVEL DATA - COLLECTION OF PATIENT STORIES AND NARRATIVES - COLLABORATIVE DISCUSSIONS AROUND AD-HOC SUCCESSES AND CHALLENGES THAT ARISE - REPORTING TO INCLUDE YEAR-END FINANCIAL SUMMARY THAT COMPARES ACTUAL EXPENDITURES TO THE FUNDED PROJECTS BUDGET, INDICATING ANY UNUSED AMOUNT OF GRANT FUNDS. AT THE END OF EACH YEAR/REPORTING PERIOD, COMMUNITY BENEFIT ANALYZES FULL-YEAR DATA TO ENSURE COMMUNITY PARTNERS MET THE OBJECTIVES OUTLINED IN THE MOU OR BAA. IF THE COMMUNITY PARTNERS DID NOT REACH THE ANTICIPATED OUTCOMES, COMMUNITY BENEFIT WORKS TO UNDERSTAND WHAT CIRCUMSTANCES PREVENTED THE ORGANIZATION FROM NOT MEETING THE GOALS TO HELP IDENTIFY WAYS TO IMPROVE OR PERHAPS RE-EVALUATE WHAT SUCCESS OF THIS PROGRAM LOOKS LIKE, AND MAKES THE DETERMINATION TO CONTINUE OR TERMINATE FUNDING.
Schedule I (Form 990) 2015



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