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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
2020
Open to Public
Inspection
Name of the organization
HOLY NAME MEDICAL CENTER
 
Employer identification number
22-1487322
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) BERGEN CATHOLIC HIGH SCHOOL
1040 ORADELL AVENUE
ORADELL,NJ07649 		22-1599180 RELIGIOUS ORG 22,207       PROGRAM SUPPORT
(2) CAUCUS EDUCATIONAL CORP
75 MIDLAND AVE
MONTCLAIR,NJ07042 		22-3240680 501(C)(3) 125,000       PROGRAM SUPPORT
(3) HOLY NAME HEALTH CARE FOUNDATION INC
718 TEANECK ROAD
TEANECK,NJ07666 		22-2737143 501(C)(3) 15,000       PROGRAM SUPPORT
(4) SAVE LATIN AMERICA
138 39TH STREET
UNION CITY,NJ07087 		22-2942402 501(C)(3) 26,000       PROGRAM SUPPORT
(5) SINAI SPECIAL NEEDS INSTITUTE
1485 TEANECK RD STE 304
TEANECK,NJ07666 		13-4198529 501(C)(3) 125,000       PROGRAM SUPPORT
(6) TEMPLE EMANUEL OF THE PASCACK VALLEY
87 OVERLOOK DRIVE
WOODCLIFF LAKE,NJ07677 		22-6013926 RELIGIOUS ORG 10,000       PROGRAM SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
6
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) 2020
Page 2

Schedule I (Form 990) 2020
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) NURSING SCHOLARSHIPS 106 107,971      
(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
SCHEDULE I, PART I; QUESTION 2 GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS.
SCHEDULE I, PART II PLEASE NOTE THAT CERTAIN GIFTS, GRANTS AND CONTRIBUTIONS PROVIDED TO OTHER ORGANIZATIONS WERE LESS THAN OR EQUAL TO $5,000 EACH. THEREFORE, IN ACCORDANCE WITH FORM 990 RULES AND REGULATIONS THOSE CONTRIBUTIONS WOULD NOT BE INCLUDED WITHIN IN SCHEDULE I, PART II. THE TOTAL AMOUNTS PAID FOR CONTRIBUTIONS AND EVENT SPONSORSHIPS CAN BE FOUND WITHIN CORE FORM, PART IX, LINE 1.
Schedule I (Form 990) 2020



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