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
Lutheran Community Services Northwest
 
Employer identification number
93-0386860
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) University of Washington
4333 Brooklyn Ave NE Box 359472
Seattle,WA981959472 		93-0784800 GOVERNMENT 129,501       SUPPORT PROGRAM
(2) Relief Nursery
1720 West 25th Ave
Eugene,OR97405 		93-0784800 501(C)(3) 65,000       SUPPORT PROGRAM
(3) Hood River County
309 State Street
Hood River,OR97031 		93-6002297 GOVERNMENT 28,000       SUPPORT PROGRAM
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
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) Crisis/Emergency 25 0 3,068 Cost Payments for Emergency Needs
(2) FosterCare 109 0 662,712 Cost Payments to Foster Parents
(3) Childcare 15 0 5,679 Cost Payments to Child care providers
(4) Housing/Utilities 275 228,085 175,917 Cost Payments to landlord/utilities
(5) Food 225 4,229 7,201 Cost Food and Meals for Program Participants
(6) Medical 100 0 26,721 Cost Payments for Medical Care
(7) Transportation 300 17,698 26,766 Cost Transportation Passes and Assistance
(8) Education 2750 10,292 85,022 Cost Payments to school/tutors & assistance
(9) Cultural/Recreation 300 80 36,453 Cost Payments for Youth Recreation Activities
(10) Refugee Services 1700 1,244,566 709,750 Cost Payments to Landlords/Utilities and Assistance
(11) Cash Assistance 1 467      
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: Program staff checks in with the grantees on a regular basis in person or via telephone.
Schedule I (Form 990) 2016



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