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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
2019
Open to Public
Inspection
Name of the organization
NORTHEAST VALLEY HEALTH CORPORATION
 
Employer identification number
23-7120632
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) ANTELOPE VALLEY COMMUNITY CLINICJWCH-AV REGION
45104 10TH STREET
WEST LANCASTER,CA93534
26-0574826 501(C)(3) 204,000   BOOK   HOMELESS HEALTH CARE
(2) CHILDREN HOSPITAL LOS ANGELES
4650 SUNSET BLVD MAIL STOP 84
LOS ANGELES,CA90027
95-1690977 501(C)(3) 432,205   BOOK   HOMELESS HEALTH CARE
(3) CLINICA MSR ALVARADO
123 S ALVARADO ST
LOS ANGELES,CA90057
95-3881333 501(C)(3) 148,082   BOOK   HOMELESS HEALTH CARE
(4) CLINICA MSR OSCAR A ROMERO NE
2032 MARENGO ST
LOS ANGELES,CA90033
95-3881333 501(C)(3) 151,601   BOOK   HOMELESS HEALTH CARE
(5) COMMUNITY HEALTH ALLIANCE OF PASADENA
1855 N FAIROAKS AVE STE 200
PASADENA,CA91103
95-4536824 501(C)(3) 70,528   BOOK   HOMELESS HEALTH CARE
(6) EAST VALLEY COMMUNITY HEALTH
420 S GLENDORA AVENUE
WEST COVINA,CA91790
93-7068586 501(C)(3) 117,054   BOOK   HOMELESS HEALTH CARE
(7) HOMELESS HEALTH CARE LA
2330 BEVERLY BLVD
LOS ANGELES,CA90057
95-4074970 501(C)(3) 230,757   BOOK   HOMELESS HEALTH CARE
(8) JWCH INSTITUTE INC
5650 JILLSON STREET
COMMERCE,CA90026
95-2289916 501(C)(3) 244,606   BOOK   HOMELESS HEALTH CARE
(9) SABAN FREE CLINIC
8405 BEVERLY BLVD
LOS ANGELES,CA90048
95-2539105 501(C)(3) 159,704   BOOK   HOMELESS HEALTH CARE
(10) THE CHILDREN'S CLINIC
2801 ATLANTIC AVE
LOS ANGELES,CA90806
95-1643332 501(C)(3) 251,941   BOOK   HOMELESS HEALTH CARE
(11) UCLA SCHOOL OF NURSING
405 HILGARD AVE
LOS ANGELES,CA90095
09-2530369 GOVERNMENT 376,377   BOOK   HOMELESS HEALTH CARE
(12) USC SCHOOL OF DENTISTRY
1149 S HILL ST STE H550
LOS ANGELES,CA90015
95-1642394 501(C)(3) 426,363   BOOK   HOMELESS HEALTH CARE
(13) VENICE FAMILY CLINIC
604 ROSE AVENUE
VENICE,CA90291
95-2769432 501(C)(3) 541,960   BOOK   HOMELESS HEALTH CARE
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) 2019
Page 2

Schedule I (Form 990) 2019
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
PART I, LINE 2: THE COOPERATIVE HEALTH CARE FOR THE HOMELESS NETWORK (CHCHN) ADMINISTRATOR ENSURES COMPLIANCE WITH THE CHCHN CONTRACT AND FEDERAL REQUIREMENTS RELATED TO THE HEALTH CARE FOR THE HOMELESS (HCH) PROGRAM. ALL SUB-RECIPIENTS RECEIVING HCH FUNDS ARE REQUIRED TO SUBMIT DOCUMENTS TO DEMONSTRATE PROPER USAGE OF FUNDS AND SATISFACTORY PROVISION OF HOMELESS HEALTH CARE SERVICES. THE CHCHN ADMINISTRATOR REVIEWS ALL SUB-RECIPIENT SUBMISSIONS, INCLUDING, BUT NOT LIMITED TO, PERIODIC QUALITY IMPROVEMENT AND UTILIZATION REPORTS, INVOICES AND BUDGETS. SUB-RECIPIENTS ARE REQUIRED TO ATTEND PERIODIC MEETINGS/TRAININGS AND PROVIDE ANNUAL FINANCIAL AUDITS WHICH WAS REVIEWED BY ACCOUNTING AND APPROVED BY THE CFO, AND PROOF OF PROFESSIONAL LIABILITY/MEDICAL MALPRACTICE INSURANCE CERTIFICATES. SUB-RECIPIENT'S ELIGIBILITY OF CONTINUED HCH FUNDS IS PREDICATED ON THE SUB-RECIPIENT'S SATISFACTORY PERFORMANCE AND COMPLIANCE WITH ALL CHCHN AND FEDERAL REQUIREMENTS. ALL HCH FUNDS ARE UTILIZED FOR THE SOLE PURPOSE OF PROVIDING COMPREHENSIVE HOMELESS HEALTH CARE SERVICES (I.E., STAFF SALARIES AND HCH-RELATED EXPENDITURES). TECHNICAL ASSISTANCE IS PROVIDED WHEN NECESSARY.
Schedule I (Form 990) 2019



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