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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.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
Security Health Plan of Wisconsin Inc
 
Employer identification number
39-1572880
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) Marshfield Clinic Inc
1000 N Oak Avenue
Marshfield,WI54449 		39-0452970 501(c)(3) 331,010       Precision Med. Initiative research study
(2) Marathon County Special Education
1200 Lakeview Drive Suite 350
Wausau,WI54403 		39-1655623 501(c)(3) 124,570       Drug abuse prevention ABCs for Healthy Communities
(3) Oneida County Health Department
100 W Keenan Street
Rhinelander,WI54501 		39-6005723 Government 46,000       Drug abuse prevention ABCs for Healthy Communities
(4) Eau Claire Area School District
500 Main Street
Eau Claire,WI54701 		39-6001817 Government 41,530       Drug abuse prevention ABCs for Healthy Communities
(5) School District of Phillips
990 Flambeau Avenue
Phillips,WI54555 		39-6008030 Government 40,000       Drug abuse prevention ABCs for Healthy Communities
(6) Community Connections To Prosperity of Barron Cnty
1107 Heart Island Parkway
Rice Lake,WI54868 		82-4231103 501(c)(3) 38,000       Drug abuse prevention ABCs for Healthy Communities
(7) Wisconsin Health Literacy
211 S Paterson Suite 260
Madison,WI54703 		39-1628898 501(c)(3) 30,000       Drug abuse prevention ABCs for Healthy Communities
(8) Wood County Health Department
111 W Jackson Street
Wisconsin Rapids,WI54495 		39-6005763 Government 30,000       Drug abuse prevention ABCs for Healthy Communities
(9) Wisconsin Institute for Healthy Aging
1414 MacArthur Road Suite B
Madison,WI53714 		27-3001041 501(c)(3) 28,000       Drug abuse prevention ABCs for Healthy Communities
(10) Feed My People Food Bank
2610 Alpine Road
Eau Claire,WI54703 		36-1488941 501(c)(3) 25,000       Pain medicine workshops ABCs for Healthy Communities
(11) Lincoln County Health Department
N607 N Sales Street Suite 101
Merrill,WI54452 		39-6005714 Government 25,000       General support ABCs for Healthy Communities
(12) Bayfield County Health Department
117 E 6th Street PO Box 403
Washburn,WI54891 		39-6005670 Government 21,213       BEST program ABCs for Healthy Communities
(13) Chippewa County Department of Public Health
711 North Bridge Street Room 121
Chippewa Falls,WI54729 		39-6005678 Government 15,000       General support ABCs for Healthy Communities
(14) Juneau County Health Department
200 Hickory Street
Mauston,WI53984 		39-6005706 Government 12,965       ABCs for Healthy Communities
(15) Newman Catholic Schools
619 Stark Street
Wausau,WI54403 		39-1556442 501(c)(3) 12,271       ABCs for Healthy Communities
(16) Big Brothers Big Sisters
2804 Rib Mountain Drive Suite G
Wausau,WI54401 		39-1258616 501(c)(3) 10,000       ABCs for Healthy Communities
(17) Clark County Public Health Department
517 Court Street Room 105
Neillsville,WI54456 		39-6005679 Government 10,000       ABCs for Healthy Communities
(18) Northwest Wisconsin CEP
422 3rd Street W Suite 200 PO Box
Ashland,WI54806 		39-1202378 501(c)(3) 7,500       ABCs for Healthy Communities
(19) School District of Tigerton
213 Spaulding Street
Tigerton,WI54486 		39-6008518 Government 5,605       ABCs for Healthy Communities
(20) Sawyer County Public Health
10610 Main Street Suite 224
Hayward,WI54843 		39-6005742 Government 5,181       ABCs for Healthy Communities
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
20
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
20
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2018
Page 2

Schedule I (Form 990) 2018
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
Form 990 Sch I Part I Line 2 SECURITY HEALTH PLAN (SHP) PROVIDES ASSISTANCE (PRIMARILY CONTRIBUTIONS) TO A VARIETY OF ORGANIZATIONS, ALL OF WHICH ARE 501(C)(3). SHP MAKES DETERMINATIONS ON GRANTS AND OTHER ASSISTANCE BASED ON THE RECIPIENT ORGANIZATION'S MISSION, REPUTATION AND THE ORGANIZATION'S INTENDED USE OF FUNDS. SHP REQUIRES GRANTEES TO SUBMIT A BUDGET TO SHOW HOW FUNDS WILL BE USED. IF THEIR BUDGET CHANGES DURING THE GRANT PERIOD THE GRANTEE MUST CONTACT SHP AND OBTAIN APPROVAL TO REAPPROPRIATE FUNDS. AT THE END OF THE GRANT PERIOD THE GRANTEE IS REQUIRED TO SUBMIT A REPORT TO SHP EXPLAINING THE OUTCOME OF THE GRANT AS WELL AS HOW FUNDS WERE USED.
Schedule I (Form 990) 2018



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