SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
SOUTHWESTERN MEDICAL CLINIC FOUNDATION
 
Employer identification number

38-3332816
Return Reference Explanation
Form 990-EZ, Part I, Line 4 - Other Investment Income Description: INTEREST INCOME. Amount: 19.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid Activity Classification: CHARITY SUPPORT. Grantee Name: Marten Zambia. Amount Given: 21,800.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid Activity Classification: cHARITY SUPPORT. Grantee Name: RYAN STRINGER. Amount Given: 500.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid Activity Classification: CHARITY SUPPORT. Grantee Name: Cert International. Amount Given: 1,000.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid Activity Classification: CHARITY SUPPORT. Grantee Name: PROJECT MEDSEND. Amount Given: 6,000.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid Activity Classification: CHARITY SUPPORT. Grantee Name: The chapel. Amount Given: 3,000.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid Activity Classification: FELLOWSHIP. Grantee Name: UGANDA. Amount Given: 2,000.
Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid Activity Classification: CHARITY SUPPORT. Grantee Name: TENWEK HOSPITAL. Amount Given: 4,378. Total included on Form 990-EZ, line 10: 38,678.
Form 990-EZ, Part I, Line 16 - Other Expenses Description: MISCELLANEOUS. Amount: 255.
Form 990-EZ, Part I, Line 20 - Other Changes in Net Assets Description: PRIOR YEAR VALUE OF LAKELAND INVESTMENT. Amount: 195,945. Description: UNREALIZED GAIN ON INVESTMENT. Amount: 9,036. Total to Form 990-EZ, line 20: 204,981.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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