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
SIERRA HEALTH FOUNDATION
CENTER FOR HEALTH PROGRAM MANAGEMENT
Employer identification number
45-5282243
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) CENTER FOR YOUNG WOMEN'S DEVELOPMENT
832 FOLSOM STREET SUITE 700
SAN FRANCISCO,CA94112
94-3227681 PUBLIC CHARITY 100,000       MENTAL HEALTH RESPITE SERVICES
(2) CHARITABLE VENTURES OF ORANGE COUNTY
1505 E 17TH STREET SUITE 101
SANTA ANA,CA92705
20-8756660 PUBLIC CHARITY 5,000       MENTAL HEALTH RESPITE SERVICES
(3) COMMUNITIES UNITED FOR RESTORATIVE YOUTH JUSTICE
490 LAKE PARK AVENUE 16086
OAKLAND,CA94610
27-5008441 PUBLIC CHARITY 125,000       MENTAL HEALTH RESPITE SERVICES
(4) FATHERS AND FAMILIES OF SAN JOAQUIN
338 E MARKET STREET
STOCKTON,CA95202
32-0171398 PUBLIC CHARITY 100,000       MENTAL HEALTH RESPITE SERVICES
(5) FRESNO BARRIOS UNIDOS
4415 E TULARE AVENUE
FRESNO,CA93702
77-0363955 PUBLIC CHARITY 35,000       MENTAL HEALTH RESPITE SERVICES
(6) RYSE INC
205 41ST STREET
RICHMOND,CA94805
26-0692904 PUBLIC CHARITY 125,000       MENTAL HEALTH RESPITE SERVICES
(7) SACRAMENTO ACT
9249 FOLSOM BLVD
SACRAMENTO,CA95826
94-3146791 PUBLIC CHARITY 125,000       MENTAL HEALTH RESPITE SERVICES
(8) SIGMA BETA XI INC
14340 ELSWORTH STREET SUITE B
112/113
MORENO VALLEY,CA92553
30-0779014 PRIVATE FOUNDATION 117,750       MENTAL HEALTH RESPITE SERVICES
(9) SILICON VALLEY DE-BUG
701 LENZEN AVENUE
SAN JOSE,CA95126
46-4274158 PUBLIC CHARITY 5,000       MENTAL HEALTH RESPITE SERVICES
(10) YOUTH JUSTICE COALITION
PO BOX 73668
LOS ANGELES,CA90003
83-0466818 PUBLIC CHARITY 150,000       MENTAL HEALTH RESPITE SERVICES
(11) AMERICAN CIVIL LIBERTIES UNION FOUNDATION OF NORTHERN CALIFORNIA
125 BROAD STREET 18TH FLOOR
NEW YORK,NY10004
94-0279770 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(12) LITTLE MANILA FOUNDATION
PO BOX 1356
STOCKTON,CA95201
20-2661354 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(13) SAN JOAQUIN PRIDE CENTER
115 N SUTTER STREET SECOND FLOOR
STOCKTON,CA95202
46-4844960 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(14) SOUTHEAST ASIA RESOURCE ACTION CENTER
1225 8TH STREET SUITE 590
SACRAMENTO,CA95814
52-1161473 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(15) STONE SOUP FRESNO
1345 E BULLDOG LANE
FRESNO,CA93710
77-0430680 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(16) URBAN STRATEGIES COUNCIL
1720 BROADWAY 2ND FLOOR
OAKLAND,CA94612
94-3044453 PUBLIC CHARITY 50,000       MENTAL HEALTH RESPITE SERVICES
(17) FOCUS ON FAMILY FOUNDATION
8205 JOSE BENTO WAY
SACRAMENTO,CA95829
80-0968840 PUBLIC CHARITY 360,000       MENTAL HEALTH RESPITE SERVICES
(18) LA FAMILIA COUNSELING CENTER INC
5523 34TH STREET
SACRAMENTO,CA95820
94-2270786 PUBLIC CHARITY 6,500       MENTAL HEALTH RESPITE SERVICES
(19) FRESNO COUNTY ECONOMIC OPPORTUNITIES COMMISSION
1920 MARIPOSA MALL SUITE 300
FRESNO,CA93721
94-1606519 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(20) CENTER FOR COMMUNITY HEALTH AND WELL-BEING INC
4625 44TH STREET ROOM 13
SACRAMENTO,CA95820
68-0248303 PUBLIC CHARITY 360,000       MENTAL HEALTH RESPITE SERVICES
(21) GREATER SACRAMENTO URBAN LEAGUE
3725 MARYSVILLE BLVD
SACRAMENTO,CA95838
94-1686314 PUBLIC CHARITY 360,000       MENTAL HEALTH RESPITE SERVICES
(22) CALIFORNIANS FOR JUSTICE EDUCATION FUND INC
520 3RD STREET 204
OAKLAND,CA94607
94-3256009 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(23) CENTER FOR COMMUNITY HEALTH AND WELL-BEING INC
4625 44TH STREET ROOM 13
SACRAMENTO,CA95820
68-0248303 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(24) FATHERS AND FAMILIES OF SAN JOAQUIN
338 E MARKET STREET
STOCKTON,CA95202
32-0171398 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(25) FOCUS FORWARD
3333 EAST AMERICAN AVENUE SUITE B
FRESNO,CA93725
81-0579812 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(26) THE FREEDOM BOUND CENTER
2574 21ST STREET
SACRAMENTO,CA95818
68-0477373 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(27) IU-MIEN COMMUNITY SERVICES
PO BOX 245693
SACRAMENTO,CA95824
68-0364879 PUBLIC CHARITY 9,948       MENTAL HEALTH RESPITE SERVICES
(28) LITTLE MANILA FOUNDATION
PO BOX 1356
STOCKTON,CA95201
20-2661354 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(29) MI FAMILIA VOTA EDUCATION FUND
1710 E INDIAN SCHOOL ROAD
PHOENIX,AZ85016
20-0182824 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(30) ROBERTS FAMILY DEVELOPMENT CENTER
770 DARINA AVENUE
SACRAMENTO,CA95815
68-0470557 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(31) SACRAMENTO ACT
9249 FOLSOM BLVD
SACRAMENTO,CA95826
94-3146791 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(32) THE TARGET EXCELLENCE PROGRAM INC
7442 INGALLS WAY
SACRAMENTO,CA95831
68-0468717 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(33) VALLEY MINISTRIES MCC
4118 CORONADO AVENUE
STOCKTON,CA95204
68-0431219 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(34) THE CHURCH OF THE NAZARENE INC
5132 ELKHORN BLVD
SACRAMENTO,CA95842
44-0552034 PUBLIC CHARITY 360,000       MENTAL HEALTH RESPITE SERVICES
(35) MUTUAL ASSISTANCE NETWORK OF DEL PASO HEIGHTS
2427 MARCONI AVENUE
SACRAMENTO,CA95821
68-0332694 PUBLIC CHARITY 360,000       MENTAL HEALTH RESPITE SERVICES
(36) ROBERTS FAMILY DEVELOPMENT CENTER
770 DARINA AVENUE
SACRAMENTO,CA95815
68-0470557 PUBLIC CHARITY 360,000       MENTAL HEALTH RESPITE SERVICES
(37) SOUTH SACRAMENTO CHRISTIAN CENTER CHURCH
7710 STOCKTON BLVD
SACRAMENTO,CA95823
68-0186235 PUBLIC CHARITY 360,000       MENTAL HEALTH RESPITE SERVICES
(38) CENTER FOR MULTICULTURAL COOPERATION
PO BOX 1389
FRESNO,CA93716
77-0305544 PUBLIC CHARITY 50,000       MENTAL HEALTH RESPITE SERVICES
(39) COMMUNITIES UNITED FOR RESTORATIVE YOUTH JUSTICE
490 LAKE PARK AVENUE 16086
OAKLAND,CA94610
27-5008441 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(40) HUMAN IMPACT PARTNERS
304 12TH STREET SUITE 2B
OAKLAND,CA94607
27-0193587 PUBLIC CHARITY 25,000       MENTAL HEALTH RESPITE SERVICES
(41) HEALTH EDUCATION COUNCIL SERVING POPULATIONS AT RISK
3950 INDUSTRIAL BLVD SUITE 600
WEST SACRAMENTO,CA95691
68-0249296 PUBLIC CHARITY 25,000       MENTAL HEALTH RESPITE SERVICES
(42) ACT FOR WOMEN AND GIRLS
PO BOX 536
VISALIA,CA93279
26-0287450 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(43) ALLIANCE FOR COMMUNITY TRANSFORMATIONS
PO BOX 2075
MARIPOSA,CA95338
77-0272319 PUBLIC CHARITY 15,000       MENTAL HEALTH RESPITE SERVICES
(44) CALIFORNIA COALITION FOR RURAL HOUSING PROJECT
717 K STREET SUITE 400
SACRAMENTO,CA95814
94-2832634 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(45) CALIFORNIA RURAL LEGAL ASSISTANCE
1430 FRANKLIN STREET SUITE 103
OAKLAND,CA94612
95-2428657 PUBLIC CHARITY 15,000       MENTAL HEALTH RESPITE SERVICES
(46) CATHOLIC CHARITIES OF STOCKTON
1106 NORTH EL DORADO STREET
STOCKTON,CA95202
94-1629114 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(47) THE CENTER ON RACE POVERTY & ENVIRONMENT
1012 JEFFERSON STREET
DELANO,CA93215
05-0557231 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(48) CENTRAL CALIFORNIA ASIAN PACIFIC WOMEN
PO BOX 26803
FRESNO,CA93729
94-2630067 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(49) CENTRO BINACIONAL PARA EL DESARROLLO INDIGENA
744 N ABBY STREET
FRESNO,CA93701
77-0337939 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(50) CHILDREN NOW
1404 FRANKLIN STREET SUITE 700
OAKLAND,CA94612
94-3059243 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(51) COMMUNITY FOUNDATION OF SAN JOAQUIN
PO BOX 286
STOCKTON,CA95201
26-1476916 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(52) COMMUNITY PARTNERSHIP FOR FAMILIES OF SAN JOAQUIN
PO BOX 1569
STOCKTON,CA95201
68-0475602 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(53) COMMUNITY WATER CENTER
311 W MURRAY AVENUE
VISALIA,CA93291
80-0267674 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(54) CONGREGATIONS BUILDING COMMUNITY MODESTO
511 VINE STREET
MODESTO,CA95351
81-0576641 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(55) CRLA FOUNDATION
2210 K STREET SUITE 201
SACRAMENTO,CA95816
94-2800442 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(56) CULTURAL BROKERS INC
2115 KERN STREET SUITE 330
FRESNO,CA93721
45-5495386 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(57) DOLORES C HUERTA FOUNDATION
PO BOX 2087
BAKERSFIELD,CA93303
91-2145992 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(58) EAST BAY ASIAN YOUTH CENTER
2025 EAST 12TH STREET
OAKLAND,CA94606
94-2925799 PUBLIC CHARITY 17,737       MENTAL HEALTH RESPITE SERVICES
(59) EDUCATION AND LEADERSHIP FOUNDATION
4290 E ASHLAN AVENUE
FRESNO,CA93726
26-0417563 PUBLIC CHARITY 30,000       MENTAL HEALTH RESPITE SERVICES
(60) THE ENVIRONMENTAL JUSTICE COALITION FOR WATER
PO BOX 188911
SACRAMENTO,CA95818
20-2539559 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(61) FAITH IN COMMUNITY
546 N FULTON STREET
FRESNO,CA93728
77-0635938 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(62) FAMILY RESOURCE AND REFERRAL CENTER OF SAN JOAQUIN
509 W WEBER AVENUE SUITE 101
STOCKTON,CA95203
94-1691503 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(63) FATHERS AND FAMILIES OF SAN JOAQUIN
338 E MARKET STREET
STOCKTON,CA95202
32-0171398 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(64) FOCUS FORWARD
3333 EAST AMERICAN AVENUE SUITE B
FRESNO,CA93725
81-0579812 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(65) FOODLINK FOR TULARE COUNTY
PO BOX 1544
VISALIA,CA93279
94-2558802 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(66) FRESNO FOOD COMMONS TRUST
504 E BELMONT AVENUE
FRESNO,CA93701
46-4357998 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(67) FRESNO INTERDENOMINATIONAL REFUGEE MINISTRIES
1940 N FRESNO STREET
FRESNO,CA93703
77-0357297 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(68) GOLDEN VALLEY HEALTH CENTERS INC
737 WEST CHILDS AVENUE
MERCED,CA95340
94-2196086 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(69) GREENACTION FOR HEALTH AND ENVIRONMENTAL JUSTICE
559 ELLIS STREET
SAN FRANCISCO,CA94109
43-2050242 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(70) GREENLINING INSTITUTE
1918 UNIVERSITY AVENUE 2ND FLOOR
BERKELEY,CA94704
94-3173571 PUBLIC CHARITY 15,000       MENTAL HEALTH RESPITE SERVICES
(71) HAVEN WOMEN'S CENTER OF STANISLAUS
618 13TH STREET
MODESTO,CA95354
94-2499361 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(72) IMMIGRANT LEGAL RESOURCE CENTER
1663 MISSION STREET SUITE 602
SAN FRANCISCO,CA94103
94-2939540 PUBLIC CHARITY 5,000       MENTAL HEALTH RESPITE SERVICES
(73) KINGS COMMUNITY ACTION ORGANIZATION
1130 N 11TH AVENUE
HANFORD,CA93230
94-1604455 PUBLIC CHARITY 7,700       MENTAL HEALTH RESPITE SERVICES
(74) KINGS PARTNERSHIP FOR PREVENTION
450 KINGS COUNTY DRIVE SUITE 104
HANFORD,CA93230
26-0130022 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(75) LITTLE MANILA FOUNDATION
PO BOX 1356
STOCKTON,CA95201
20-2661354 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(76) MADERA COALITION FOR COMMUNITY JUSTICE
126 N B STREET
MADERA,CA93638
77-0391942 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(77) MERCED ORGANIZING PROJECT INC
415 W 18TH STREET SUITE 123
MERCED,CA95340
27-1298934 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(78) MEXICAN AMERICAN LEGAL DEFENSE AND EDUCATIONAL FUND
634 S SPRING STREET
LOS ANGELES,CA90014
74-1563270 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(79) ORGANIZACION EN CALIFORNIA DE LIDERES CAMPESINAS INC
PO BOX 20033
OXNARD,CA93034
95-4611282 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(80) PEOPLE AND CONGREGATIONS TOGETHER FOR STOCKTON INC
PO BOX 4102
STOCKTON,CA95204
94-3139144 PUBLIC CHARITY 5,000       MENTAL HEALTH RESPITE SERVICES
(81) PESTICIDE ACTION NETWORK NORTH AMERICA REGIONAL CENTER
1611 TELEGRAPH AVENUE SUITE 1200
OAKLAND,CA94612
94-2949686 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(82) PHYSICIANS FOR SOCIAL RESPONSIBILITY INC
617 SOUTH OLIVE STREET SUITE 200
LOS ANGELES,CA90014
95-3956136 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(83) PUBLIC HEALTH ADVOCATES
PO BOX 2309
DAVIS,CA95617
95-4723901 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(84) PUBLIC HEALTH INSTITUTE
555 12TH STREET 10TH FLOOR
OAKLAND,CA94607
94-1646278 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(85) RADIO BILINGUE INC
5005 E BELMONT AVENUE
FRESNO,CA93727
94-2472322 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(86) READING AND BEYOND
4670 E BUTLER AVENUE
FRESNO,CA93702
77-0508471 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(87) RURAL COMMUNITY ASSISTANCE CORPORATION
3120 FREEBOARD DRIVE SUITE 201
WEST SACRAMENTO,CA95691
94-2512284 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(88) SACRAMENTO INDEPENDENT LEARNING CENTER CORPORATION
340 MENARD CIRCLE
SACRAMENTO,CA95835
20-8394742 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(89) SAN JOAQUIN PRIDE CENTER
109 N SUTTER STREET
STOCKTON,CA95202
46-4844960 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(90) SEQUOIA RIVERLANDS TRUST
427 SOUTH GARDEN STREET
VISALIA,CA93277
77-0347417 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(91) SOUTHEAST ASIA RESOURCE ACTION CENTER
1225 8TH STREET SUITE 590
SACRAMENTO,CA95814
52-1161473 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(92) STANISLAUS FAMILY JUSTICE CENTER
1625 I STREET
MODESTO,CA95354
20-0128637 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(93) STONE SOUP FRESNO
1345 E BULLDOG LANE
FRESNO,CA93710
77-0430680 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(94) TIDES CENTER
PO BOX 29907
SAN FRANCISCO,CA94129
94-3213100 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(95) UNITED WAY OF MERCED COUNTY INC
658 WEST MAIN STREET
MERCED,CA95340
94-2633265 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(96) UTILITY REFORM NETWORK
785 MARKET STREET SUITE 1400
SAN FRANCISCO,CA94103
23-7351081 PUBLIC CHARITY 10,000       MENTAL HEALTH RESPITE SERVICES
(97) POLICYLINK
1438 WEBSTER STREET SUITE 303
OAKLAND,CA94612
94-3297479 PUBLIC CHARITY 11,570       MENTAL HEALTH RESPITE SERVICES
(98) CENTER ON JUVENILE AND CRIMINAL JUSTICE
40 BOARDMAN PLACE
SAN FRANCISCO,CA94103
94-3136811 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(99) CHILDREN NOW
1404 FRANKLIN STREET SUITE 700
OAKLAND,CA94612
94-3059243 PUBLIC CHARITY 20,000       MENTAL HEALTH RESPITE SERVICES
(100) COUNCIL FOR A STRONG AMERICA
211 SUTTER STREET 401
SAN FRANCISCO,CA94108
13-3840271 PUBLIC CHARITY 25,000       MENTAL HEALTH RESPITE SERVICES
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
102
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
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)
(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: EACH GRANTEE MUST COMPLY WITH THE MONITORING REQUIREMENTS SET FORTH IN THE AGREEMENT. THOSE REQUIREMENTS VARY DEPENDING ON THE PURPOSE OF THE GRANT. ALL GRANTEES ARE REQUIRED TO PROVIDE A FINAL NARRATIVE AND FINANCIAL REPORT. OTHER MONITORING REQUIREMENTS INCLUDE PROGRESS REPORTS, BOTH NARRATIVE AND FINANCIAL, AND SITE VISITS.
Schedule I (Form 990) 2016



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