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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
SUTTER VALLEY HOSPITALS
 
Employer identification number
94-1156621
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) WELLSPACE HEALTH
777 12TH ST STE 250
SACRAMENTO,CA95814
94-1713704 501(C)(3) 4,081,389       GENERAL SUPPORT
(2) HEALTHY COMM FORUM FOR THE GREATER SAC REG
819 19TH ST
SACRAMENTO,CA95811
68-0377256 501(C)(3) 1,270,000       GENERAL SUPPORT
(3) CITY OF VALLEJO UNITY DAY
555 SANTA CLARA ST
VALLEJO,CA94590
94-6000448 GOVT 1,000,000       GENERAL SUPPORT
(4) CITY OF SACRAMENTO
915 I ST STE 104
SACRAMENTO,CA95814
94-6000410 GOVT 590,000       GENERAL SUPPORT
(5) COMMUNICARE HEALTH CENTERS
PO BOX 1260
DAVIS,CA95617
94-2188574 501(C)(3) 525,000       GENERAL SUPPORT
(6) MIDTOWN SACRAMENTO PBID CORP
1401 21ST ST STE A
SACRAMENTO,CA95811
46-1549378 501(C)(6) 470,000       GENERAL SUPPORT
(7) LA CLINICA DE LA RAZA
1515 FRUITVALE AVE
OAKLAND,CA94601
94-1744108 501(C)(3) 371,894       GENERAL SUPPORT
(8) SALVATION ARMY
180 E OCEAN BLVD
LONG BEACH,CA90802
94-1156347 501(C)(3) 339,831       GENERAL SUPPORT
(9) COMMUNITY MEDICAL CENTERS INC
7210 MURRAY DR
STOCKTON,CA95210
94-2437106 501(C)(3) 300,000       GENERAL SUPPORT
(10) SHADY CREEK OUTDOOR EDUCATION FOUNDATION
970 KLAMATH LN
YUBA CITY,CA95993
68-0239809 501(C)(3) 282,035       GENERAL SUPPORT
(11) VALLEY CONSORTIUM FOR MEDICAL EDUCATION
1400 FLORIDA AVE STE 200
MODESTO,CA95350
27-0506209 501(C)(3) 221,690       GENERAL SUPPORT
(12) COMMUNITY PARTNERSHIP FOR FAMILIES
PO BOX 1569
STOCKTON,CA95201
68-0475602 501(C)(3) 219,999       GENERAL SUPPORT
(13) GOLDEN VALLEY HEALTH CENTERS
737 W CHILDS AVE
MERCED,CA95340
94-2196086 501(C)(3) 204,170       GENERAL SUPPORT
(14) GLOBAL DEVELOPMENT INCUBATOR
1401 K ST NW STE 900
WASHINGTON,DC20005
14-1945286 501(C)(3) 200,000       GENERAL SUPPORT
(15) AMERICAN HEART ASSOCIATION INC
7272 GREENVILLE AVE
DALLAS,TX75231
13-5613797 501(C)(3) 197,338       GENERAL SUPPORT
(16) SACRAMENTO LGBT COMMUNITY CTR
2012 K ST
SACRAMENTO,CA95811
94-2502229 501(C)(3) 176,667       GENERAL SUPPORT
(17) SENIORS FIRST
12183 LOCKSLEY LN STE 205
AUBURN,CA95602
68-0430154 501(C)(3) 176,000       GENERAL SUPPORT
(18) COUNTY OF YOLO CHILDRENS ALLIANCE
600 A ST STE Y
DAVIS,CA95616
68-0526185 GOVT 167,000       GENERAL SUPPORT
(19) VALLEY VISION INC
3400 3RD AVE
SACRAMENTO,CA95817
94-3214572 501(C)(3) 158,000       GENERAL SUPPORT
(20) SACRAMENTO CONVENTION AND VISITORS BUREAU
1608 I ST
SACRAMENTO,CA95814
94-0824640 501(C)(6) 141,000       GENERAL SUPPORT
(21) GATHERING INN
201 BERKELEY AVE
ROSEVILLE,CA95678
84-1657746 501(C)(3) 134,940       GENERAL SUPPORT
(22) STANFORD YOUTH SOLUTIONS
8912 VOLUNTEER LN
SACRAMENTO,CA95826
68-0065690 501(C)(3) 126,500       GENERAL SUPPORT
(23) CITY OF ROSEVILLE
311 VERNON ST
ROSEVILLE,CA95678
94-6000409 GOVT 125,000       GENERAL SUPPORT
(24) AMERICAN CANCER SOCIETY INC
250 WILLIAMS ST NW STE400
ATLANTA,GA30303
13-1788491 501(C)(3) 117,500       GENERAL SUPPORT
(25) TOURO UNIVERSITY
1310 CLUB DR
VALLEJO,CA94592
13-3838740 501(C)(3) 110,500       GENERAL SUPPORT
(26) BOYS AND GIRLS CLUB OF MERCED COUNTY
615 W 15TH ST
MERCED,CA95340
77-0357487 501(C)(3) 105,798       GENERAL SUPPORT
(27) MODESTO GOSPEL MISSION INC
PO BOX 1203
MODESTO,CA95353
94-6102833 501(C)(3) 100,500       GENERAL SUPPORT
(28) COUNTY OF SOLANO
675 TEXAS ST STE 2800
FAIRFIELD,CA94533
94-6000538 GOVT 100,000       GENERAL SUPPORT
(29) WEAVE INC
1900 K ST
SACRAMENTO,CA95811
94-2493158 501(C)(3) 96,000       GENERAL SUPPORT
(30) RONALD MCDONALD HOUSE CHARITIES NORTHERN CA
2555 49TH ST
SACRAMENTO,CA95817
68-0147193 501(C)(3) 92,500       GENERAL SUPPORT
(31) CATH CHARITIES OF THE DIOCESE OF STOCKTON
1106 NO EL DORADO ST
STOCKTON,CA95202
94-1629114 501(C)(3) 91,200       GENERAL SUPPORT
(32) WOMENS CENTER YOUTH AND FAMILY SERVICES
620 NO CALIFORNIA ST
STOCKTON,CA95202
94-2341360 501(C)(3) 91,000       GENERAL SUPPORT
(33) TRACY COMMUNITY CONNECTIONS CENTER INC
PO BOX 1215
TRACY,CA95378
47-5483883 501(C)(3) 89,500       GENERAL SUPPORT
(34) LATINO LEADERSHIP COUNCIL INC
2945 BELL RD STE 274
AUBURN,CA95603
27-0970476 501(C)(3) 85,019       GENERAL SUPPORT
(35) BOYS AND GIRLS CLUB OF TRACY
753 W LOWELL AVE
TRACY,CA95376
68-0028682 501(C)(3) 85,000       GENERAL SUPPORT
(36) SACRAMENTO FOOD BANK SERVICES
3333 3RD AVE
SACRAMENTO,CA95817
94-3315566 501(C)(3) 83,000       GENERAL SUPPORT
(37) H3O FOUNDATION
PO BOX 1816
ESCONDIDO,CA92033
45-3719707 501(C)(3) 82,500       GENERAL SUPPORT
(38) SACRAMENTO STEPS FORWARD
1331 GARDEN HWY STE100
SACRAMENTO,CA95833
27-4907397 501(C)(3) 74,150       GENERAL SUPPORT
(39) DOWNTOWN SACTO PARTNERSHIP
980 NINTH ST STE 400
SACRAMENTO,CA95814
68-0270320 501(C)(3) 72,500       GENERAL SUPPORT
(40) AMBULATORY SURGERY ACCESS
1119 MARKET ST 400
SAN FRANCISCO,CA94103
94-3180356 501(C)(3) 70,000       GENERAL SUPPORT
(41) SACRAMENTO METRO CHAMBER FNDT
1 CAPITOL MALL STE 700
SACRAMENTO,CA95814
20-2381828 501(C)(3) 62,500       GENERAL SUPPORT
(42) YOLO COMMUNITY CARE CONTINUUM
PO BOX 1101
DAVIS,CA95617
94-2623205 501(C)(3) 61,500       GENERAL SUPPORT
(43) HAVEN WOMENS CENTER
619 13TH ST STE 1
MODESTO,CA95354
94-2499361 501(C)(3) 60,000       GENERAL SUPPORT
(44) MERCED RESCUE MISSION
PO BOX 3319
MERCED,CA95344
77-0284849 501(C)(3) 60,000       GENERAL SUPPORT
(45) UNITED WAY OF SAN JOAQUIN CNTY
777 NO PERSHING AVE 2B
STOCKTON,CA95203
94-1279805 501(C)(3) 60,000       GENERAL SUPPORT
(46) MENTAL HEALTH AMERICA INC
500 MONTGOMERY ST 820
ALEXANDRIA,VA22314
13-1614906 501(C)(3) 56,500       GENERAL SUPPORT
(47) SAC ASIAN PACIFIC CHAMBER OF COMMERCE
2331 ALHAMBRA BLVD 100
SACRAMENTO,CA95817
68-0306606 501(C)(6) 55,000       GENERAL SUPPORT
(48) GENDER HEALTH CENTER
2020 29TH ST STE 201
SACRAMENTO,CA95817
26-3839452 501(C)(3) 50,000       GENERAL SUPPORT
(49) SEC HARV FB OF SAN JOAQUIN & STANISLAUS CO
704 E INDUSTRIAL PARK DR
MANTECA,CA95337
68-0376587 501(C)(3) 50,000       GENERAL SUPPORT
(50) SOCIETY FOR THE BLIND INC LOW VISION CLINIC
1238 S ST
SACRAMENTO,CA95811
94-1384666 501(C)(3) 50,000       GENERAL SUPPORT
(51) STANISLAUS BUSINESS ALLIANCE
1010 TENTH ST STE 1400
Modesto,CA95354
20-5186517 501(C)(3) 50,000       GENERAL SUPPORT
(52) UNITED WAY OF MERCED COUNTY
531 W MAIN ST
MERCED,CA95340
94-2633265 501(C)(3) 50,000       GENERAL SUPPORT
(53) WORLD RELIEF CO OF NTL ASSN OF EVANGELICALS
4616 ROSEVILLE RD 107
NO HIGHLANDS,CA95660
23-6393344 501(C)(3) 50,000       GENERAL SUPPORT
(54) ROSEVILLE AREA CHAMBER OF COMMERCE
650 DOUGLAS BLVD
ROSEVILLE,CA95678
94-1079379 501(C)(6) 49,000       GENERAL SUPPORT
(55) SUTTER YUBA HOMELESS CONSORTIUM
PO BOX 3642
YUBA CITY,CA95992
46-2438264 501(C)(3) 48,000       GENERAL SUPPORT
(56) PRO YOUTH AND FAMILIES
4625 44TH ST
SACRAMENTO,CA95820
94-2795430 501(C)(3) 45,000       GENERAL SUPPORT
(57) SOIL BORN FARMS URBAN AGRICULTURE PROJECT
PO BOX 661175
SACRAMENTO,CA95866
20-0774693 501(C)(3) 42,500       GENERAL SUPPORT
(58) MCHENRY HOUSE TRACY FAMILY SHELTER
757 A ST
TRACY,CA95376
68-0123612 501(C)(3) 40,600       GENERAL SUPPORT
(59) SHELTER SOLANO INC
PO BOX 5368
CONCORD,CA94524
83-2704105 501(C)(3) 37,500       GENERAL SUPPORT
(60) SACRAMENTO SOC MED IMPROVEMENT
5380 ELVAS AVE
SACRAMENTO,CA95819
94-1149667 501(C)(6) 36,500       GENERAL SUPPORT
(61) STANISLAUS COUNTY OFFICE OF EDUCATION
1100 H ST
MODESTO,CA95354
94-6002388 GOVT 35,000       GENERAL SUPPORT
(62) SOLANO COALITION FOR BETTER HEALTH
3720 BARRETT AVE
RICHMOND,CA94805
94-3189914 501(C)(3) 32,500       GENERAL SUPPORT
(63) PLACER COUNTY AIR POLUTION CONTROL DISTRICT
110 MAPLE ST
AUBURN,CA95603
94-6000527 GOVT 30,000       GENERAL SUPPORT
(64) SIERRA NEVADA JOURNEYS
190 E LIBERTY ST
RENO,NV89501
01-0881587 501(C)(3) 30,000       GENERAL SUPPORT
(65) CRISTO REY HIGH SCHOOL SAC WORK STUDY INC
6200 MCMAHON DR
SACRAMENTO,CA95824
41-2191660 501(C)(3) 28,000       GENERAL SUPPORT
(66) SHADOWCHASE RUNNING CLUB
1325 11TH ST
MODESTO,CA95354
94-2751030 501(C)(3) 27,000       GENERAL SUPPORT
(67) GIVE EVERY CHILD A CHANCE
322 SUN WEST PL
MANTECA,CA95337
68-0399384 501(C)(3) 26,385       GENERAL SUPPORT
(68) FAIRYTALE TOWN INC
3901 LAND PARK DR
SACRAMENTO,CA95822
94-1669088 501(C)(3) 25,000       GENERAL SUPPORT
(69) HELPING OTHS PROVIDE ENCORE MINISTRIES INC
PO BOX 841
MANTECA,CA95336
68-0235846 501(C)(3) 25,000       GENERAL SUPPORT
(70) KEATONS CHILD CANCER ALLIANCE
2260 DOUGLAS BLVD 140
ROSEVILLE,CA95661
68-0406980 501(C)(3) 25,000       GENERAL SUPPORT
(71) MAKE A WISH FOUNDATION
1401 HALYARD DR 130
W SACRAMENTO,CA95691
68-0027351 501(C)(3) 25,000       GENERAL SUPPORT
(72) MENTAL HEALTH AMERICA OF CALIFORNIA
2035 HURLEY WY STE 290
SACRAMENTO,CA95825
94-1393424 501(C)(3) 25,000       GENERAL SUPPORT
(73) SACRAMENTO ASIAN SPORTS FNDT
9040 HIGH TECH CT
ELK GROVE,CA95758
94-3227001 501(C)(3) 25,000       GENERAL SUPPORT
(74) SOLANO ECONOMIC DEVCO CORP
360 CAMPUS LN STE 102
FAIRFIELD,CA94534
91-1790564 501(C)(3) 25,000       GENERAL SUPPORT
(75) SUICIDE PREVENTION OF YOLO COUNTY
1784 PICASSO AVE STE A
DAVIS,CA95618
94-2619492 501(C)(3) 25,000       GENERAL SUPPORT
(76) YUBA SUTTER CHAMBER OF COMMERCE
519 D ST
MARYSVILLE,CA95901
94-1731239 501(C)(6) 25,000       GENERAL SUPPORT
(77) ZAFIAS FAMILY HOUSE
326 NATTIER CT
EL DORADO HILLS,CA95762
27-3195178 501(C)(3) 25,000       GENERAL SUPPORT
(78) SHORT TERM EMERGENCY AID COMMITTEE
1712 PICASSO AVE STE D
DAVIS,CA95618
94-6138684 501(C)(3) 22,500       GENERAL SUPPORT
(79) LOVE OUR CITIES INC
1401 F ST
MODESTO,CA95354
47-1989572 501(C)(3) 20,000       GENERAL SUPPORT
(80) SACRAMENTO SELF HELP HOUSING
PO BOX 188445
SACRAMENTO,CA95818
68-0217383 501(C)(3) 20,000       GENERAL SUPPORT
(81) VALLEJO SENIOR CITIZENS COUNCIL INC
333 AMADOR ST
VALLEJO,CA94590
23-7367329 501(C)(3) 20,000       GENERAL SUPPORT
(82) COALITION OF TRACY CIT TO AST THE HOMELESS
21055 SO CORRAL HOLLOW ROAD
TRACY,CA95304
90-0532767 501(C)(3) 19,300       GENERAL SUPPORT
(83) FRIENDS OF SUTTERS FORT
2701 L ST
SACRAMENTO,CA95816
94-2608741 501(C)(3) 18,000       GENERAL SUPPORT
(84) LIGHTHOUSE COUNSELING AND FAMILY RES CTR
427 A ST STE 400
LINCOLN,CA95648
35-2252834 501(C)(3) 15,347       GENERAL SUPPORT
(85) CAPITAL AIRSHOW GROUP
10425 NORDEN AVE
MATHER,CA95655
74-3212900 501(C)(3) 15,000       GENERAL SUPPORT
(86) GOLD COUNTRY FAIR
PO BOX 5527
AUBURN,CA95604
94-6001553 501(C)(3) 15,000       GENERAL SUPPORT
(87) MODESTO CHAMBER OF COMMERCE
1114 J ST
MODESTO,CA95354
94-0689450 501(C)(6) 15,000       GENERAL SUPPORT
(88) VOLS OF AMER NORTHERN CA AND NORTHERN NV
1900 POINT W WY 270
SACRAMENTO,CA95815
94-6001984 501(C)(3) 15,000       GENERAL SUPPORT
(89) YOLO CRISIS NURSERY INC
1477 DREW AVE STE 103
DAVIS,CA95618
47-1006055 501(C)(3) 15,000       GENERAL SUPPORT
(90) SIERRA COLLEGE FOUNDATION
5100 SIERRA COLLEGE BLVD
ROCKLIN,CA95677
23-7241877 501(C)(3) 13,000       GENERAL SUPPORT
(91) NORTHERN CA CONF OF SEVENTH DAY ADVENTIST
12225 ROCK CREEK RD
AUBURN,CA95602
68-0260677 501(C)(3) 12,540       GENERAL SUPPORT
(92) AMER LDRSP FORUM MOUNTAIN VALLEY CHAPTER
1601 RESPONSE RD 350
SACRAMENTO,CA95815
91-1792774 501(C)(3) 12,500       GENERAL SUPPORT
(93) CALIFORNIA STATE UNIV SACTO
6000 J ST
SACRAMENTO,CA95819
68-0365325 GOVT 12,500       GENERAL SUPPORT
(94) LOS RIOS COMM COLLEGE FNDT
1919 SPANOS CT
SACRAMENTO,CA95825
94-2506591 501(C)(3) 12,500       GENERAL SUPPORT
(95) ALL ABOUT SACRAMENTO COMMUNITY FUND
555 CAPITOL MALL 400
SACRAMENTO,CA95814
82-3048635 501(C)(3) 10,000       GENERAL SUPPORT
(96) CALIFORNIA PRIMARY CARE ASSOC
1215 K ST STE 700
SACRAMENTO,CA95814
94-3215565 501(C)(3) 10,000       GENERAL SUPPORT
(97) COMMUNITY HOSPICE INC
4368 SPYRES WY
MODESTO,CA95356
94-2638213 501(C)(3) 10,000       GENERAL SUPPORT
(98) EAST STANISLAUS RES CONSERVATION DISTRICT
3800 CORNUCOPIA WY STE E
MODESTO,CA95358
77-0451977 GOVT 10,000       GENERAL SUPPORT
(99) KVIE INC
2030 W EL CAMINO AVE
SACRAMENTO,CA95833
94-1421463 501(C)(3) 10,000       GENERAL SUPPORT
(100) COUNTY OF MERCED SPRING FAIR
403 F ST
LOS BANOS,CA93635
94-6000521 GOVT 10,000       GENERAL SUPPORT
(101) MUSIC ON A MISSION FOUNDATION
455 CAPITOL MALL 801
SACRAMENTO,CA95814
46-2969397 501(C)(3) 10,000       GENERAL SUPPORT
(102) RUN TO REMEMBER LOS ANGELES
1201 NO CATALINA AVE STE 848
REDONDO BEACH,CA90277
82-2990305 501(C)(3) 10,000       GENERAL SUPPORT
(103) SACRAMENTO COTTAGE HOUSING INC
1500 NO A ST
SACRAMENTO,CA95811
68-0322086 501(C)(3) 10,000       GENERAL SUPPORT
(104) STANISLAUS PARTNERS IN EDUC
PO BOX 4477
MODESTO,CA95352
77-0294263 501(C)(3) 10,000       GENERAL SUPPORT
(105) HEALING PASTURES INC
11685 LORENSON RD
AUBURN,CA95602
46-2449921 501(C)(3) 9,600       GENERAL SUPPORT
(106) YUBA SUTTER PINK OCTOBER
871 E ONSTOTT RD
YUBA CITY,CA95991
20-1530007 501(C)(3) 9,000       GENERAL SUPPORT
(107) CHAPA DE INDIAN HEALTH PROGRAM INC
11670 ATWOOD RD
AUBURN,CA85603
94-2583156 501(C)(3) 8,345       GENERAL SUPPORT
(108) CHILD ABUSE PREVENTION COUNCIL OF SAC
4700 ROSEVILLE RD 102
NO HIGHLANDS,CA95660
94-2833431 501(C)(3) 7,500       GENERAL SUPPORT
(109) GOLDEN VALLEY HEALTH CENTERS FOUNDATION
737 W CHILDS AVE
MERCED,CA95341
47-4773124 501(C)(3) 7,500       GENERAL SUPPORT
(110) LILLIPUT CHILDRENS SERVICES
1651 RESPONSE RD 300
SACRAMENTO,CA95815
94-2614102 501(C)(3) 7,500       GENERAL SUPPORT
(111) MODESTO CITY SCHOOLS
426 LOCUST ST
MODESTO,CA95351
77-0195326 GOVT 7,500       GENERAL SUPPORT
(112) SAC BLACK CHAMBER OF COMMERCE FOUNDATION
5770 FREEPORT BLVD 44
SACRAMENTO,CA95822
95-4818928 501(C)(3) 7,500       GENERAL SUPPORT
(113) SAINT JOHNS SHELTER FOR WOMEN AND CHILDREN
2443 FAIR OAKS BLVD 369
SACRAMENTO,CA95825
68-0132934 501(C)(3) 7,500       GENERAL SUPPORT
(114) TRACY SENIOR ADVOCACY ASSN
350 W GRANTLINE RD
TRACY,CA95376
46-1753137 501(C)(3) 7,500       GENERAL SUPPORT
(115) AMADOR TUOLUMNE COMMUNITY ACTION AGENCY
10590 HWY 88
JACKSON,CA95642
94-2765408 501(C)(3) 7,000       GENERAL SUPPORT
(116) HEALTH EDUCATION COUNCIL
3950 INDUSTRIAL BLVD STE 600
W SACRAMENTO,CA95691
68-0249296 501(C)(3) 5,823       GENERAL SUPPORT
(117) VALLEJO CHAMBER OF COMMERCE
427 YORK ST
VALLEJO,CA94590
94-0949756 501(C)(6) 5,750       GENERAL SUPPORT
(118) JDRF INTERNATIONAL
200 VESEY ST 28TH FLR
NEW YORK,NY10281
23-1907729 501(C)(3) 5,500       GENERAL SUPPORT
(119) SACRAMENTO ZOOLOGICAL SOCIETY
3930 W LAND PARK DR
SACRAMENTO,CA95822
94-2861667 501(C)(3) 5,500       GENERAL SUPPORT
(120) WOMENS EMPOWERMENT
1400 NO C ST
SACRAMENTO,CA95814
30-0520643 501(C)(3) 5,500       GENERAL SUPPORT
(121) YUBA SUTTER UNITED WAY
1521 BUTTE HOUSE RD C
YUBA CITY,CA95993
94-1668459 501(C)(3) 5,500       GENERAL SUPPORT
(122) EDUCATION FOUNDATION OF STANISLAUS COUNTY
1100 H ST
MODESTO,CA95354
94-2906392 501(C)(3) 5,300       GENERAL SUPPORT
(123) NATIONAL MULTIPLE SCLEROSIS
SOC 733 THIRD AVE 3RD FL
NEW YORK,NY10017
13-5661935 501(C)(3) 5,250       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
115
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
8
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) PATIENT ASSISTANCE 6659   1,363,750 FMV MEDICATION/TRANSPORT
(2) Spirit Club Program 10 19,500      
(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
SCHEDULE I, PART I, LINE 2 In order to closely monitor efficiency and effectiveness, the Community Benefit function outlines measurable reporting (quarterly, six-month and/or year-end), program and funding requirements in a Memorandum of Understanding (MOU), Business Services Agreement (BSA), or Joint Venture Agreement for each investment made with a community partner. Where it is determined necessary, additional efforts are made to monitor effectiveness and efficiency of investments, which could include: - Quarterly meetings with community partners - E-mail and telephonic communications with community partners - Continued dialogue with involved hospital staff and community partners throughout duration of program - Site visits with community partners - Bi-annual "outcomes" survey (6-month and/or year-end outcomes) - Review of hospital usage and patient level data - Collection of patient stories and narratives - Collaborative discussions around ad-hoc successes and challenges that arise - Reporting to include year-end financial summary that compares actual expenditures to the funded project's budget, indicating any unused amount of grant funds. At the end of each year/reporting period, Community Benefit analyzes full-year data to ensure community partners met the objectives outlined in the MOU or BSA. If the community partners did not reach the anticipated outcomes, Community Benefit works to understand what circumstances prevented the organization from meeting the goals to help identify ways to improve or perhaps re-evaluate what success of this program looks like, and makes the determination to continue or terminate funding.
Schedule I (Form 990) 2019



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