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
2016
Open to Public
Inspection
Name of the organization
Greater Lee's Summit Healthcare Foundation
 
Employer identification number
43-1341459
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
noncash assistance		 (h) Purpose of grant
or assistance
(1) HOPE HOUSE INC
PO BOX 577
LEES SUMMIT,MO64063 		43-1265685 501(c)(3) 7,500       HUMAN SERVICES
(2) JOHN KNOX VILLAGE
400 NW MURRAY ROAD
LEES SUMMIT,MO64081 		23-7365138 501(C)(3) 10,000       HUMAN SERVICES
(3) METROCARE OF GREATER KANSAS CITY
315 NICHOLS ROAD SUITE 250
KC,MO64112 		26-0434271 501(c)(3) 10,000       HEALTH CARE
(4) PEACE PARTNERSHIP
605 NE WOODS CHAPEL RD
LEES SMT,MO64064 		46-2287864 501(c)(3) 7,500       PHILANTHROPY
(5) PRO DEO YOUTH CENTER
206 NE CHIPMAN ROAD
LEES SUMMIT,MO64063 		27-1834872 501(c)(3) 7,000       YOUTH DEVELOPMENT
(6) DEVELOPING POTENTIAL
120 W WALNUT STREET
INDEPENDENCE,MO64050 		43-1661167 501(C)(3) 7,000       HUMAN SERVICES
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
6
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) 2016
Page 2

Schedule I (Form 990) 2016
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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) SCHOLARSHIP: KANSAS CITY UNIVERSITY OF MEDICINE 1 5,000      
(2) SCHOLARSHIP: UNIVERSITY OF MISSOURI - COLUMBIA 4 20,000      
(3) SCHOLARSHIP: STEPHENS COLLEGE 1 5,000      
(4) SCHOLARSHIP: UNIVERSITY OF MISSOURI - KANSAS CITY 1 5,000      
(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 Grant Applications are reviewed and approved by the board.
Schedule I (Form 990) 2016



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