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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
Mount Horeb Community Foundation Inc
 
Employer identification number
39-1626231
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) Mount Horeb Youth Center Inc
105 North Grove Street
Mount Horeb,WI53572 		45-5558011 501(c)(3)         Gen Op Fd
(2) Mount Horeb Middle School
900 East Garfield Street
Mt Horeb,WI53572 		39-1050370           STRETCH
(3) Mount Horeb Young Life
104 South Grove Street
Mount Horeb,WI53572 		84-0385934 501(c)(3)         Camp Transporation Fees
(4) Mount Horeb Food Pantry
P O Box 204
Mount Horeb,WI53572 		80-0306739           Kids summer lunch prog
(5) Mount Horeb Public Library
105 Perimeter St
Mount Horeb,WI53572 		39-6006326           Purchase Books
(6) Mt Horeb Historical Society Inc
P O Box 64
Mount Horeb,WI53572 		51-0180176           Grand Opening
(7) Friends of the Norsk Inc
2755 Golf Bowl Rd
Mount Horeb,WI53572 		81-1454296           Signage
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
Pt I Line 2 Charitable Organizations wishing to obtain a grant apply to the Mount Horeb Community Foundation, providing a project description of what the funds, if approved, would be used for. The Board chooses which applications to approve. The Board follows up as necessary with the grantee organizations/individuals related to the actual use of the grant funds.
Schedule I (Form 990) 2018



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