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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
SYMMES LIFE CARE INC
D/B/A BROOKHAVEN AT LEXINGTON
Employer identification number
04-2853296
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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
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) 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) EMPLOYEE SCHOLARSHIP GRANT 19 48,586   N/A N/A
(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
PART I, LINE 2: THE BROOKHAVEN RESIDENT'S ASSOCIATION HAS ESTABLISHED A SCHOLARSHIP PROGRAM FOR BROOKHAVEN EMPLOYEES WHO SEEK FINANCIAL ASSISTANCE FOR THEIR EDUCATIONAL ENDEAVORS. DONATIONS FOR THIS PROGRAM ARE DIRECTED TO THE EMPLOYEE SCHOLARSHIP FUND. ANY EMPLOYEE IN GOOD STANDING WHO HAS COMPLETED 6 MONTHS OF EMPLOYMENT AND IS NOT CLASSIFIED AS PER DIEM EMPLOYEE MAY APPLY FOR A SCHOLARSHIP. THE SCHOLARSHIP AMOUNT WAS RAISED ON 1/1/14 TO $2,000 FOR PROGRAMS LEADING TO A COLLEGE DEGREE AND $1,000 FOR CERTIFICATE PROGRAMS, TO BE USED TOWARDS TUITION, FEES, AND BOOKS. APPLICANTS MUST SUBMIT A SCHOLARSHIP PROGRAM APPLICATION, A LETTER OF RECOMMENDATION FROM THEIR SUPERVISOR, AND PROOF OF ENROLLMENT IN A CERTIFICATE OR DEGREE PROGRAM TO THE HUMAN RESOURCE DEPARTMENT. AFTER CONFIRMING THAT THE EMPLOYEE IS A QUALIFIED APPLICANT, HUMAN RESOURCES WILL NOTIFY THE SCHOLARSHIP PROGRAM COMMITTEE OF THE APPLICANT'S INTENT. THE COMMITTEE, CONSISTING OF THE DIRECTOR OF HUMAN RESOURCES, A MEMBER OF THE RESIDENTS' STAFF APPRECIATION COMMITTEE, AND A MEMBER OF THE RESIDENTS' ASSOCIATION EXECUTIVE COMMITTEE WILL REVIEW ALL SCHOLARSHIP PROGRAM APPLICATIONS. THE NUMBER OF AWARDS IS DETERMINED BY THE AVAILABILITY OF FUNDS. UPON COMPLETION OF COURSES WITH A GRADE OF "C OR BETTER, A GRADE REPORT AS WELL AS A COPY OF THE PAID RECEIPT FOR TUITION AND BOOKS IS SUBMITTED.
Schedule I (Form 990) 2017



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