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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
THE SOUTHEAST ALABAMA MEDICAL
CENTER FOUNDATION INC
Employer identification number
20-8726030
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) ALABAMA COLLEGE OF OSTEOPATHIC MEDI
445 HEALTH SCIENCES BLVD
DOTHAN,AL36303
27-3339185 C3 413,939       FINANCIAL SUPPORT
(2) HOUSTON COUNTY HEALTH CARE AUTHORIT
SOUTHEAST HEALTH MEDICAL CENTER
1922 FAIRVIEW AVENUE
DOTHAN,AL36301
63-6004476 GOV 484,412       FINANCIAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
2
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) SCHOLARSHIP 3 6,302      
(2) SCHOLARSHIP 3 10,070      
(3) BENEVOLENCE 57 21,155      
(4) PERINATAL BEREAVEMENT 3 750      
(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 THE ORGANIZATION OFFERS GRANTS TO SUPPORT INITIATIVES SUPPORTED BY THE HOUSTON COUNTY HEALTH CARE AUTHORITY (DBA SOUTHEAST HEALTH MEDICAL CENTER) OR TO THE ALABAMA COLLEGE OF OSTEOPATHIC MEDICINE. GRANTS ARE NOT MADE TO ANY OTHER ORGANIZATIONS. ALL REQUESTS FOR GRANTS ARE EVALUATED BY INTERNAL PERSONNEL AND ORGANIZATION LEADERSHIP FOR APPROVAL AND, IF APPROVED, FOR POST-AWARD ADMINISTRATION. THE BLUMBERG FAMILY JEWISH COMMUNITY SERVICES OF DOTHAN ACOM SCHOLARSHIP PROGRAM AWARDS SCHOLARSHIPS TO OUTSTANDING JEWISH STUDENTS ATTENDING THE ALABAMA COLLEGE OF OSTEOPATHIC MEDICINE. BLUMBERG SCHOLARS ARE MEDICAL STUDENTS WHO DEMONSTRATE THE HIGHEST LEVELS OF ACADEMIC EXCELLENCE AND PERSONAL CHARACTER, AND COMMIT TO SERVE DOTHAN'S JEWISH AND GREATER COMMUNITY. THE SCHOLARSHIP PROGRAM IS ADMINISTERED BY SOUTHEAST ALABAMA MEDICAL CENTER FOUNDATION. APPLICANTS ARE REQUIRED TO COMPLETE AN APPLICATION, A CURRICULUM VITAE, A 500-WORD ESSAY, PROVIDE LETTERS OF RECOMMENDATION AND COMPLETE AN INTERVIEW WITH THE FOUNDATION'S SCHOLARSHIP COMMITTEE. NO SCHOLARSHIPS WERE AWARDED DURING YEAR ENDED SEPTEMBER 30, 2019. THE TEENAGE VOLUNTEER (TAV) SCHOLARSHIP IS AVAILABLE TO HIGH SCHOOL SENIORS WHO PARTICIPATE IN THE TEENAGE VOLUNTEER PROGRAM AT SOUTHEAST HEALTH MEDICAL CENTER. THE TAV ADVISORY BOARD REQUIRES APPLICANTS TO SUBMIT AN APPLICATION PACKAGE. ELIGIBILITY IS BASED ON AN ASSESSMENT BY THE VOLUNTEER COORDINATOR, TAV SERVICE HOURS, QUALITY OF SERVICE, INTERVIEW, CONDUCT, PROJECT PARTICIPATION AND LEADERSHIP SKILLS. THE TAV ADVISORY BOARD CONDUCTS THE INTERVIEWS AND RATES EACH APPLICANT BASED ON THE ABOVE CRITERIA. THE WALTER SCOTT NURSING TUITION SCHOLARSHIP IS AVAILABLE TO EMPLOYEES OF SOUTHEAST HEALTH MEDICAL CENTER WHO ARE INTERESTED IN A CAREER IN THE FIELD OF NURSING. APPLICANTS MUST BE IN GOOD STANDING WITH THE MEDICAL CENTER AND COMPLETE A PACKAGE, WHICH INCLUDES A WRITTEN ESSAY. THE SCHOLARSHIP COMMITTEE, WHICH IS COMPRISED OF SOUTHEAST HEALTH NURSING LEADERSHIP AND SOUTHEAST HEALTH FOUNDATION BOARD MEMBERS, EVALUATES AND RANKS THE APPLICANTS AND SELECTS ONE OR MORE APPLICANTS BASED ON AVAILABLE FUNDS. AS A RESULT OF HURRICANE MICHAEL, THE FOUNDATION BEGAN A BENEVOLENCE FUND TO SUPPORT EMPLOYEES OF SOUTHEAST HEALTH EXPERIENCING FINANCIAL DIFFICULTIES RESULTING FROM THE DEVASTATION OF THE HURRICANE OR OTHER FINANCIAL PROBLEMS. THIS FUND IS SUPPORTED BY CONTRIBUTIONS FROM EMPLOYEES OF THE MEDICAL CENTER. EMPLOYEES IN FINANCIAL NEED SUBMIT AN APPLICATION TO THE FOUNDATION REQUESTING SPECIFIC SUPPORT FOR SPECIFIC ITEMS. IF APPROVED BY THE FOUNDATION'S ALLOCATION COMMITTEE, PAYMENT IS MADE DIRECTLY TO A VENDOR FOR RENT, UTILITY OR OTHER SERVICE PROVIDER. ALSO, THE FOUNDATION BEGAN A PERINATAL BEREAVEMENT FUND FOR FAMILIES SUFFERING FROM THE LOSS OF A CHILD DURING PREGNANCY, BIRTH OR SHORTLY AFTER BIRTH. THE FUNDING, APPLICATION AND APPROVAL ARE THE SAME AS FOR THE BENEVOLENCE FUND.
Schedule I (Form 990) 2018



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