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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 BAY MEDICAL FOUNDATION
 
Employer identification number
94-1156581
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) Sutter Bay Hospitals
2200 RIVER PLAZA DR
SACRAMENTO,CA95833 		94-0562680 501(C)(3) 572,846       PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PROGRAM SUPPORT PATIENT NEEDS Scholarship NURSING SCHOLARSHIP
(2) SOUTH COUNTY COMM HLTH CTR INC
1885 BAY RD
E PALO ALTO,CA94303 		94-3372130 501(C)(3) 200,000       PROGRAM SUPPORT
(3) TRI CITY HEALTH CENTER
39500 LIBERTY ST
FREMONT,CA94538 		23-7255435 501(C)(3) 185,000       PROGRAM SUPPORT
(4) ASIAN AMERICANS FOR COMMUNITY INVOLVEMENT
2400 MOORPARK AVE STE 300
SAN JOSE,CA95128 		94-2292491 501(C)(3) 100,000       PROGRAM SUPPORT
(5) AXIS COMMUNITY HEALTH
4361 RAILROAD AVE
PLEASANTON,CA94566 		94-2232394 501(C)(3) 100,000       PROGRAM SUPPORT
(6) HEALTHIER KIDS FDN SANTA CLARA COUNTY
4010 MOORPARK AVE STE 118
SAN JOSE,CA95117 		77-0545774 501(C)(3) 100,000       PROGRAM SUPPORT
(7) INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
1333 MERIDIAN AVE
SAN JOSE,CA95125 		94-2476242 501(C)(3) 100,000       PROGRAM SUPPORT
(8) MAYVIEW COMMUNITY HEALTH CTR
270 GRANT AVE
PALO ALTO,CA94306 		94-2239648 501(C)(3) 100,000       PROGRAM SUPPORT
(9) HEALTH IMPROVEMENT PARTNERSHIP
1800 GREEN HILLS RD
SCOTTS VALLEY,CA95066 		01-0826156 501(C)(3) 36,250       PROGRAM SUPPORT
(10) YMCA OF SILICON VALLEY
3412 ROSS RD
PALO ALTO,CA94303 		94-1156318 501(C)(3) 27,500       PROGRAM SUPPORT
(11) DOMINICAN HOSPITAL FOUNDATION
1555 SOQUEL DR
SANTA CRUZ,CA95065 		94-2450442 501(C)(3) 25,000       PROGRAM SUPPORT
(12) SUNNYVALE COMMUNITY SERVICES
725 KIFER RD
SUNNYVALE,CA94086 		94-1713897 501(C)(3) 25,000       PROGRAM SUPPORT
(13) FAMILY SERVICE AGENCY OF THE CENTRAL COAST
104 WALNUT AVE STE 208
SANTA CRUZ,CA95060 		94-1716354 501(C)(3) 23,875       PROGRAM SUPPORT
(14) ADOLESCENT COUNSELING SERVICES
1717 EMBARCADERO RD 4000
PALO ALTO,CA94303 		51-0192551 501(C)(3) 20,000       PROGRAM SUPPORT
(15) SOCIAL GOOD FUND
12651 SAN PABLO AVE 5473
RICHMOND,CA94805 		46-1323531 501(C)(3) 19,500       PROGRAM SUPPORT
(16) ACTERRA ACTION FOR A HEALTHY PLANET
3921 E BAYSHORE RD
PALO ALTO,CA94303 		23-7064937 501(C)(3) 18,000       PROGRAM SUPPORT
(17) CABRILLO COLLEGE FOUNDATION
6500 SOQUEL DR
APTOS,CA95003 		94-6121953 501(C)(3) 15,000       PROGRAM SUPPORT
(18) CHILD ADVOCATES OF SILICON VALLEY
509 VALLEY WY BLDG 2
MILPITAS,CA95035 		77-0250773 501(C)(3) 15,000       PROGRAM SUPPORT
(19) HEALTH TRUST
3180 NEWBERRY DR STE 200
SAN JOSE,CA95118 		94-6050231 501(C)(3) 15,000       PROGRAM SUPPORT
(20) WEST VALLEY COMMUNITY SERVICES
10104 VISTA DR
CUPERTINO,CA95014 		94-2211685 501(C)(3) 15,000       PROGRAM SUPPORT
(21) MONTEREY BAY ECONOMIC PARTNERSHIP INC
PO BOX 1445
MONTEREY,CA93942 		47-1379810 501(C)(3) 13,000       PROGRAM SUPPORT
(22) BAY AREA WOMENS SPORTS INITIATIVE
1922 THE ALAMEDA STE 420
SAN JOSE,CA95126 		55-0897084 501(C)(3) 12,500       PROGRAM SUPPORT
(23) COASTAL KIDS HOME CARE
1172 SO MAIN ST STE 125
SALINAS,CA93901 		20-2549984 501(C)(3) 12,500       PROGRAM SUPPORT
(24) REGENTS OF THE UNIV OF CA
1156 HIGH ST
SANTA CRUZ,CA95064 		94-1539563 GOVT 10,638       PROGRAM SUPPORT
(25) AVENIDAS
450 BRYANT ST
PALO ALTO,CA94301 		94-1480548 501(C)(3) 10,000       PROGRAM SUPPORT
(26) BOYS AND GIRLS CLUBS OF THE PENINSULA
401 PIERCE RD
MENLO PARK,CA94025 		94-1552134 501(C)(3) 10,000       PROGRAM SUPPORT
(27) BRING CHANGE 2 MIND
155 SANSOME ST STE 530
SAN FRANCISCO,CA94104 		01-0974537 501(C)(3) 10,000       PROGRAM SUPPORT
(28) CARDIAC THERAPY FDN OF THE MIDPENINSULA
4000 MIDDLEFIELD RD STE G8
PALO ALTO,CA94303 		77-0336212 501(C)(3) 10,000       PROGRAM SUPPORT
(29) CHINESE AMERICAN COALITION FOR COMPATE CARE
4070 CACTUS RD
SHINGLE SPRINGS,CA95682 		26-0895114 501(C)(3) 10,000       PROGRAM SUPPORT
(30) COMMUNITY HEALTH AWARENESS COUNCIL
PO BOX 335
MOUTAIN VIEW,CA94042 		94-2223670 501(C)(3) 10,000       PROGRAM SUPPORT
(31) COSTANOA COMMONS
335 GOLF CLUB DR
SANTA CRUZ,CA95060 		47-1590387 501(C)(3) 10,000       PROGRAM SUPPORT
(32) HEALTH CONNECTED
763 GREEN ST
EAST PALO ALTO,CA94303 		94-3227947 501(C)(3) 10,000       PROGRAM SUPPORT
(33) JDRF INTERNATIONAL
200 VESEY ST 28TH FLR
NEW YORK,NY10281 		23-1907729 501(C)(3) 10,000       PROGRAM SUPPORT
(34) JEWISH VOCATIONAL & CAREER COUNSELING SVCS
17 GEARY ST STE 401
SAN FRANCISCO,CA94108 		94-2213100 501(C)(3) 10,000       PROGRAM SUPPORT
(35) NTL ALLIANCE ON MENTAL ILLNESS SANTA CRUZ
PO BOX 360
SANTA CRUZ,CA95061 		77-0002878 501(C)(3) 10,000       PROGRAM SUPPORT
(36) PATHWAYS HOSPICE FOUNDATION
201 SAN ANTONIO CIR
MOUNTAIN VIEW,CA94040 		77-0280660 501(C)(3) 10,000       PROGRAM SUPPORT
(37) SAFESPACE CENTER INC
1155 SAXON WY
MENLO PARK,CA94025 		81-3898296 501(C)(3) 10,000       PROGRAM SUPPORT
(38) SANTA CLARA UNIVERSITY
500 EL CAMINO REAL
SANTA CLARA,CA95053 		94-1156617 501(C)(3) 10,000       PROGRAM SUPPORT
(39) SENIOR NETWORK SERVICES
1777-A CAPITOLA RD
SANTA CRUZ,CA95062 		94-2259716 501(C)(3) 10,000       PROGRAM SUPPORT
(40) STARVISTA
610 ELM ST STE 212
SAN CARLOS,CA94070 		94-3094966 501(C)(3) 10,000       PROGRAM SUPPORT
(41) VILLAGES OF SAN MATEO COUNTY
809 LAUREL ST STE 813
SAN CARLOS,CA94070 		47-3571718 501(C)(3) 10,000       PROGRAM SUPPORT
(42) WASHINGTON HOSPITAL HEALTHCARE
FOUNDATION 2000 MOWRY AVE
FREMONT,CA94538 		94-2886219 501(C)(3) 10,000       PROGRAM SUPPORT
(43) RIEKES CENTER FOR HUMAN ENHANCEMENT
3455 EDISON WY
MENLO PARK,CA94025 		94-3224127 501(C)(3) 9,250       PROGRAM SUPPORT
(44) SILICON VALLEY LEADERSHIP GROUP FOUNDATION
2001 GATEWAY PL STE 101E
SAN JOSE,CA95110 		91-2140464 501(C)(3) 9,000       PROGRAM SUPPORT
(45) CASTRO VALLEY CHAMBER COMMERCE
3160 CASTRO VALLEY RD
CASTRO VALLEY,CA94546 		94-1321044 501(C)(6) 8,800       PROGRAM SUPPORT
(46) TEEN KITCHEN PROJECT
PO BOX 1853
SOQUEL,CA95073 		27-0524692 501(C)(3) 7,550       PROGRAM SUPPORT
(47) CAMP OPPORTUNITY INC
34050 PASEO PADRE PKWY
FREMONT,CA94555 		77-0219669 501(C)(3) 7,500       PROGRAM SUPPORT
(48) COMMUNITY BRIDGES
236 SANTA CRUZ AVE
APTOS,CA95003 		94-2460211 501(C)(3) 7,500       PROGRAM SUPPORT
(49) COUNSELING AND SUPPORT SERVICES FOR YOUTH
555 BRYANT ST STE 126
PALO ALTO,CA94301 		26-4655116 501(C)(3) 7,500       PROGRAM SUPPORT
(50) DEAF PLUS ADULT COMMUNITY
5437 CENTRAL AVE STE 4
NEWARK,CA94560 		47-3687686 501(C)(3) 7,500       PROGRAM SUPPORT
(51) DIENTES COMMUNITY DENTAL CARE
1830 COMMERCIAL WY
SANTA CRUZ,CA95065 		77-0311752 501(C)(3) 7,500       PROGRAM SUPPORT
(52) GEORGE MARK CHILDRENS FUND
2121 GEORGE MARK LN
SAN LEANDRO,CA94578 		94-3255845 501(C)(3) 7,500       PROGRAM SUPPORT
(53) LEGAL AID SOCIETY OF SAN MATEO COUNTY
521 E 5TH AVE
SAN MATEO,CA94402 		94-1451894 501(C)(3) 7,500       PROGRAM SUPPORT
(54) MAITRI
PO BOX 697
SANTA CLARA,CA95052 		94-3132087 501(C)(3) 7,500       PROGRAM SUPPORT
(55) NEXT DOOR SOLUTIONS TO DOMESTIC VIOLENCE
234 E GISH RD STE 200
SAN JOSE,CA95112 		94-2420708 501(C)(3) 7,500       PROGRAM SUPPORT
(56) YOUTH COMMUNITY SERVICE INC
705 ALESTER AVE STE 4
PALO ALTO,CA94303 		20-8099150 501(C)(3) 7,000       PROGRAM SUPPORT
(57) MILLS-PENINSULA HOSPITAL FOUNDATION
2200 RIVER PLAZA DR
SACRAMENTO,CA95833 		23-7288765 501(C)(3) 7,000        
(58) EAST PALO ALTO KIDS FNDT
PO BOX 50542
PALO ALTO,CA94303 		77-0359913 501(C)(3) 6,000        
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
57
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
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 28 47,392      
(2) PRE-MED SCHOLARSHIP 31 88,995      
(3) NURSING SCHOLARSHIP 9 16,500      
(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 PROJECTS 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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