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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.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
WASHINGTON COUNTY MENTAL HEALTH
AUTHORITY INC
Employer identification number
52-1689627
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) CORRECT CARE SOLUTIONS LLC
7250 PARKWAY DRIVE SUITE 400
HANOVER,MD21076 		52-1530272   88,000       MENTAL HEALTH SERVIC
(2) DR CORVIN ROBINSON
10001 PEBBLE BEACH TERRACE
IJAMSVILLE,MD21754 		82-0553087   27,888       MENTAL HEALTH SERVIC
(3) INSTITUTE FOR FAMILY CENTERED
SERVICE
5720 EXECUTIVE DRIVE
CATONSVILLE,MD21228 		54-1503721 501C3 105,080       MENTAL HEALTH SERVIC
(4) JASON BURNS
2409 HILLFORD DRIVE
BALTIMORE,MD21234 		21-7159044   7,000       TECH SUPPORT
(5) MARYLAND COALITION OF FAMILIES
10632 LITTLE PATUXENT PARKWAY 119
COLUMBIA,MD21044 		52-2211436 501C3 16,000       MENTAL HEALTH SERVIC
(6) OFFICE OF CONSUMER ADVOCATES
119 EAST ANTIETAM STREET
HAGERSTOWN,MD21740 		52-2116525 501C3 585,168       MENTAL HEALTH SERVIC
(7) POTOMAC CASE MANAGEMENT
324 EAST ANTIETAM STREET
HAGERSTOWN,MD21740 		52-2118801 501C3 290,751       MENTAL HEALTH SERVIC
(8) ROSA SOURS
16923 SHINHAM ROAD
HAGERSTOWN,MD21740 		21-8503732   26,155       MENTAL HEALTH SERVIC
(9) THE ARC OF WASHINGTON COUNTY INC
820 FLORIDA AVENUE
HAGERSTOWN,MD21740 		52-0696197 501C3 9,942       MENTAL HEALTH SERVIC
(10) WASHINGTON CO COMMISSION ON AGING
535 EAST FRANKLIN STREET
HAGERSTOWN,MD21740 		52-0899001 501C3 28,210       MENTAL HEALTH SERVIC
(11) WASHINGTON COUNTY HEALTH DEPARTMENT
1302 PENNSYLVANIA AVENUE
HAGERSTOWN,MD21742 		52-1842599 GOV 59,500       MENTAL HEALTH SERVIC
(12) WAY STATION INC
PO BOX 3826
FREDERICK,MD21705 		52-1162749 501C3 425,663       MENTAL HEALTH SERVIC
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
8
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
4
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2017
Page 2

Schedule I (Form 990) 2017
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) CONSUMER SUPPORT FUNDS 74 29,853      
(2) HOUSING ASSISTANCE 39 242,821      
(3) CARE HOME PLACEMENT 14 60,066      
(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, PAGE 1, PART I, LINE 2 VENDORS ARE REQUIRED TO SIGN A CONTRACT DETAILING GRANT REQUIREMENTS. THE VENDORS ARE MONITORED ON A REGULAR BASIS VIA WRITTEN REPORTS. ADDITIONALLY, ANNUAL ON-SITE MONITORING OF THE VENDORS VERIFIES ALL CONTRACT REQUIREMENTS ARE MET.
Schedule I (Form 990) 2017



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