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
Sutter Health
 
Employer identification number
94-2788907
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) AMERICAN RED CROSS
PO Box 100805
Pasadena,CA911890805 		53-0196605 501(C)(3) 505,000       GENERAL SUPPORT
(2) ACRES OF HOPE
PO Box 238
Auburn,CA95604 		47-0958489 501(C)(3) 25,000       GENERAL SUPPORT
(3) ALAMEDA COUNTY FOOD BANK
7900 Edgewater Drive
Oakland,CA94614 		94-2960297 501(C)(3) 25,000       GENERAL SUPPORT
(4) CALIFORNIA PRIMARY CARE ASSOCIATION
1215 K Street STE 700
Sacramento,CA95814 		94-3215565 501(C)(3) 15,000       GENERAL SUPPORT
(5) CENTER FOR HEALTHCARE DECISIONS INC
3400 Data Drive
Rancho Cordova,CA95670 		68-0441958 501(C)(3) 15,000       GENERAL SUPPORT
(6) CERES COMMUNITY PROJECT
PO Box 1562
Sebastopol,CA95473 		26-2250997 501(C)(3) 6,250       GENERAL SUPPORT
(7) COALITION FOR COMPASSIONATE CARE
1331 Garden Hwy STE 100
Sacramento,CA95833 		27-0419836 501(C)(3) 45,000       GENERAL SUPPORT
(8) ELK GROVE FOOD BANK
PO Box 1447
Elk Grove,CA95759 		38-3664737 501(C)(3) 6,000       GENERAL SUPPORT
(9) FISHER HOUSE FOUNDATION INC
111 Rockville Pike STE 420
Rockville,MD20850 		11-3158401 501(C)(3) 26,500       GENERAL SUPPORT
(10) FOOD BANK OF SOLANO and CONTRA COSTA COUNTY
PO Box 6324
Concord,CA95424 		94-2418054 501(C)(3) 20,000       GENERAL SUPPORT
(11) FOOD PANTRY OF DAVIS STREET
3081 Teagarden
San Leandro,CA94577 		94-3121699 501(C)(3) 12,500       GENERAL SUPPORT
(12) INTERNATIONAL MEDICAL CORPS
1919 Santa Monica Blvd Ste 400
Santa Monica,CA90404 		95-3949646 501(C)(3) 250,000       GENERAL SUPPORT
(13) Kahi Mohala Hospital
91-2301 Fort Weaver RD
Ewa Beach,HI96706 		99-0298651 501(c)(3) 10,000       GENERAL SUPPORT
(14) MARCH OF DIMES
1050 Sansome St 4th FLOOR
San Francisco,CA94111 		13-1846366 501(C)(3) 136,500       GENERAL SUPPORT
(15) MEDSHARE INTERNATIONAL
3240 Clifton Springs Rd
Decatur,GA30034 		58-2433968 501(C)(3) 155,000       GENERAL SUPPORT
(16) MILLS PENINSULA HEALTH SERVICES
C/O SUTTER HEALTH TAX
2200 RIVER PLAZA DRIVE
SACRAMENTO,CA95833 		94-1156265 501(C)(3) 50,830       GENERAL SUPPORT
(17) NATUREBRIDGE
28 Geary St Ste 650
San Francisco,CA94108 		94-2145930 501(C)(3) 10,000       GENERAL SUPPORT
(18) NEXUS YOUTH & FAMILY SERVICES
621 New York Ranch Rd
Jackson,CA95642 		45-3594607 501(C)(3) 25,000       GENERAL SUPPORT
(19) OKIZU FOUNDATION
16 Digital Dr STE 100
Novato,CA94949 		68-0291178 501(C)(3) 25,000       GENERAL SUPPORT
(20) OPERATION ACCESS
1119 Market St Ste 400
San Francisco,CA94103 		94-3180356 501(C)(3) 105,000       GENERAL SUPPORT
(21) PLACER FOOD BANK
133 Church Street
Roseville,CA95678 		94-1740316 501(C)(3) 9,000       GENERAL SUPPORT
(22) REDWOOD EMPIRE FOOD BANK
3320 Industrial Drive
Santa Rosa,CA95403 		68-0121855 501(C)(3) 6,250       GENERAL SUPPORT
(23) RIVER CITY FOOD BANK
1322 27th Street
Sacramento,CA95816 		91-1851398 501(C)(3) 15,000       GENERAL SUPPORT
(24) SALVATION ARMY - THE MODESTO CITADEL
PO Box 1663
Modesto,CA95353 		94-1156347 501(C)(3) 20,000       GENERAL SUPPORT
(25) SAN FRANCISCO FOOD BANK
900 Pennsylvania AVE
San Francisco,CA94107 		94-3041517 501(c)(3) 32,500       GENERAL SUPPORT
(26) SF PUBLIC HLTH FDN PROJECT HOMELESS CONNECT
1450 Sutter Street Ste 101
San Francisco,CA94109 		94-3117093 501(C)(3) 10,000       GENERAL SUPPORT
(27) SECOND HARVEST FOOD BANK-SANTA CLARA
750 Curtner Avenue
San Jose,CA95125 		94-2614101 501(c)(3) 48,500       GENERAL SUPPORT
(28) SECOND HARVEST FOOD BANK-SANTA CRUZ COUNTY
800 Ohlone Parkway
Watsonville,CA95076 		77-0326685 501(C)(3) 16,500       GENERAL SUPPORT
(29) SEROTONIN SURGE CHARITIES
1955 Cowell Blvd
Davis,CA95616 		68-0411254 501(C)(3) 50,000       GENERAL SUPPORT
(30) SPECIAL OLYMPICS
633 W 5TH St Ste 4000
Los Angeles,CA90071 		45-2853870 501(C)(3) 10,000       GENERAL SUPPORT
(31) SUTTER VNA AND HOSPICE
C/O SUTTER HEALTH TAX
2200 RIVER PLAZA DRIVE
SACRAMENTO,CA95833 		94-6068843 501(C)(3) 15,000       GENERAL SUPPORT
(32) TRACY INTERFAITH MINISTRIES
3111 W Donation Line Road
Tracy,CA95376 		94-3150638 501(C)(3) 10,000       GENERAL SUPPORT
(33) UNITED SERVICE ORGANIZATIONs INC
PO Box 96860
Washington,DC20077 		13-1610451 501(C)(3) 15,000       GENERAL SUPPORT
(34) YOLO FOOD BANK
1244 Fortna Ave
Woodland,CA95776 		23-7111782 501(C)(3) 6,000       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
34
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) 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)
(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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