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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
DEVILS LAKE YOUTH ACTIVITIES ASSN
 
Employer identification number
45-0454056
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) DEVILS LAKE PARK BOARD
PO BOX 446
DEVILS LAKE,ND58301 		45-6002051   11,000       ACTIVITIES & EQUIPME
(2) ST JOSEPH SCHOOL
824 10TH AVE NE
DEVILS LAKE,ND58301 		45-0251375   12,000       ACTIVITIES & EQUIPME
(3) DEVILS LAKE PUBLIC SCHOOLS
1601 COLLEGE DRIVE
DEVILS LAKE,ND58301 		45-6001342   26,250       ACTIVITIES & EQUIPME
(4) LAKE REGION STATE COLLEGE
1801 COLLEGE DRIVE
DEVILS LAKE,ND58301 		45-0281889   14,400       ACTIVITIES & EQUIPME
(5) DEVILS LAKE YOUTH FOOTBALL
114 - 19TH ST NE
DEVILS LAKE,ND58301 		91-1825561   6,000       EQUIPMENT & SUPPLIES
(6) SAMARITANS FEET
1836 CENTER PARK DR
CHARLOTTE,NC28217 		14-1880905 501C3 10,800       NONPROFIT DONATION
(7) FOUR WINDS HIGH SCHOOL
BOX 239 INDIAN CIRCLE DRIVE HWY 57
FT TOTTEN,ND58335 		45-6000113   9,000       ACTIVITIES & EQUIPME
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
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
SCHEDULE I, PAGE 1, PART I, LINE 2 CHARITABLE GAMING AND THE DISBURSEMENT OF PROCEEDS TO ELIGIBLE ORGANIZATIONS ARE REGULATED BY THE NORTH DAKOTA ATTORNEY GENERAL.
Schedule I (Form 990) 2018



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