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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
Harrison Medical Center Foundation
 
Employer identification number
91-1197626
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) Harrison Medical Center
2520 CHERRY STREET
BREMERTON,WA98310 		91-0565546 501(C)(3) 2,488,389       GENERAL SUPPORT
(2) PENINSULA COMMUNITY HEALTH SERVICES
PO Box 960
Bremerton,WA98337 		94-3079770 501(c)(3) 20,599       Harrison Respite Care Program Support
(3) ROTARY OF BAINBRIDGE ISLAND TRUST
PO Box 11286
Bainbridge Island,WA98110 		94-3184519 501(c)(3) 13,375       Touching Hearts, Saving Lives SUPPORT
(4) Olympic College
1600 Chester Ave
Bremerton,WA98337 		91-0823201 501(c)(3) 6,714       RME Nursing Scholarship Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
4
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
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) Helping hand fund 54 0 13,856 FMV EMPLOYEE Assistance fund. HELPING HAND FUND GRANTS ARE PAID DIRECTLY TO THE VENDORS OF MORTGAGE/RENT, UTILITY OR OTHER NEEDS OF HARRISON MEDICAL CENTER EMPLOYEES, AND NOT PAID DIRECTLY TO THE REQUESTING APPLICANT.
(2) Patient Assistance Fund (fka SMALL FAVORS GRANTS) 810 0 4,125 FMV The fund provides our most needy patients with clothing, transportation, personal care items, and/or food to ease their transition from Harrison to home. Funds provided clothes, bus tokens, and gas cards for patients.
(3) WOMEN'S HEALTH SCREENINGS Fund 2 0 1,191 FMV For under insured or un-insured women to cover the cost of all women's health screening exams and needed diagnostic testing. Funds covered diagnostic and imaging services for patients.
(4) SCHOLARSHIPS 12 0 29,430 FMV SCHOLARSHIP FUNDING
(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, Part I, Line 2 Procedures for monitoring use of grant funds. All requests seeking to use Foundation Funds are submitted using a Restricted Fund Request Form and are reviewed and approved by the Foundation Director and/or the Foundation Board of Directors. Fund balances are closely monitored on a regular basis.
Schedule I (Form 990) 2018



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