Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
WILLAMETTE HEALTH COUNCIL
 
Employer identification number
84-2658002
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) ADVANTAGE DENTAL SERVICES
PO BOX 11470
EUGENE,OR97440
  100,069 0     COMMUNITY IMPACT-VARIOUS HEALTH
(2) ADVENTURES WITH AUTISM
4300 CHERRY AVE NE
KEIZER,OR97303
  20,478 0     COMMUNITY IMPACT-VARIOUS HEALTH
(3) AMAZING TREATMENT - SUD
525 FERRY ST SE STE 203
SALEM,OR97302
  12,261 0     COMMUNITY IMPACT-VARIOUS HEALTH
(4) ARMSTRONG WELLNESS
1655 STATE ST
SALEM,OR97302
  36,975 0     COMMUNITY IMPACT-VARIOUS HEALTH
(5) BRAD DEHLER BS
185 13TH ST NE
SALEM,OR97301
  6,360 0     COMMUNITY IMPACT-VARIOUS HEALTH
(6) BRIDGEWAY RECOVERY SERVICES
PO BOX 17818
SALEM,OR97305
  115,661 0     COMMUNITY IMPACT-VARIOUS HEALTH
(7) CANYON FAMILY HEALTH INC
1095 N 1ST ST
STAYTON,OR97383
  11,454 0     COMMUNITY IMPACT-VARIOUS HEALTH
(8) CAPITOL DENTAL CARE
3000 MARKET ST NE 228
SALEM,OR97301
  195,797 0     COMMUNITY IMPACT-VARIOUS HEALTH
(9) CASTILLO JUAN L
PO BOX 23249
BELFAST,ME04915
  9,935 0     COMMUNITY IMPACT-VARIOUS HEALTH
(10) CATHOLIC COMMUNITY SERVICES
3737 PORTLAND RD
SALEM,OR97301
  18,231 0     COMMUNITY IMPACT-VARIOUS HEALTH
(11) CENTER FOR ADDICTION AND COUN
460 LANCASTER DR NE
SALEM,OR97301
  7,420 0     COMMUNITY IMPACT-VARIOUS HEALTH
(12) CENTER FOR AUTISM AND RELATED
21600 OXNARD ST STE 1800
WOODLAND HILLS,CA91367
  49,793 0     COMMUNITY IMPACT-VARIOUS HEALTH
(13) CHILDHOOD HEALTH ASSOCIATES
891 23RD ST NE
SALEM,OR97301
  299,076 0     COMMUNITY IMPACT-VARIOUS HEALTH
(14) CLEAR PATHS
3793 RIVER ROAD N
SALEM,OR97303
  27,864 0     COMMUNITY IMPACT-VARIOUS HEALTH
(15) CONNECTIONS 365
4890 32ND AVE SE
SALEM,OR97317
  12,160 0     COMMUNITY IMPACT-VARIOUS HEALTH
(16) COORDINATED COUNSELING FOR CH
295 CHURCH ST SE 305
SALEM,OR97301
  6,843 0     COMMUNITY IMPACT-VARIOUS HEALTH
(17) CORPORATION FOR SUPPORT HOUSE
2441 GREAR ST NE
SALEM,OR97301
  115,000 0     COMMUNITY IMPACT-VARIOUS HEALTH
(18) CREATING PATHWAYS PEDIATRIC T
3871 FAIRVIEW INDUSTRIAL DR S
SALEM,OR97302
  18,121 0     COMMUNITY IMPACT-VARIOUS HEALTH
(19) CREEKSIDE COUNSELING INC
PO BOX 4169
SALEM,OR97302
  8,318 0     COMMUNITY IMPACT-VARIOUS HEALTH
(20) CROSSING BRIDGES COUNSELING C
PO BOX 873
TUALATIN,OR97062
  13,847 0     COMMUNITY IMPACT-VARIOUS HEALTH
(21) DR TIMOTHY PETERS
605 WELCH ST
SILVERTON,OR97381
  16,050 0     COMMUNITY IMPACT-VARIOUS HEALTH
(22) HOPE FAMILY MEDICINE
2410 TURNER RD SE
SALEM,OR97302
  6,697 0     COMMUNITY IMPACT-VARIOUS HEALTH
(23) INTERCULTURAL CENTER FOR PSYC
PO BOX 256
NEWBERG,OR97132
  11,066 0     COMMUNITY IMPACT-VARIOUS HEALTH
(24) JD HEALTH AND WELLNESS CENTER
PO BOX 2178
WILSONVILLE,OR97070
  6,364 0     COMMUNITY IMPACT-VARIOUS HEALTH
(25) JOHN H WELLER
1095 LIBERTY ST
SALEM,OR97301
  7,969 0     COMMUNITY IMPACT-VARIOUS HEALTH
(26) LEGACY MEDICAL GROUP
PO BOX 3417
PORTLAND,OR97208
  7,471 0     COMMUNITY IMPACT-VARIOUS HEALTH
(27) LEGACY MERIDIAN PARK HOSPITAL
PO BOX 4037
PORTLAND,OR97208
  9,866 0     COMMUNITY IMPACT-VARIOUS HEALTH
(28) LIBERTY HOUSE
2685 4TH ST NE
SALEM,OR97301
  11,727 0     COMMUNITY IMPACT-VARIOUS HEALTH
(29) MARION COUNTY PUBLIC HEALTH
3180 CENTER ST NE
SALEM,OR97301
  595,368 0     COMMUNITY IMPACT-VARIOUS HEALTH
(30) MID VALLEY PAIN CLINIC
3723 FAIRVIEW DR STE 170
SALEM,OR97302
  6,232 0     COMMUNITY IMPACT-VARIOUS HEALTH
(31) MILL CREEK FAMILY CLINIC
4285 COMMERCIAL ST SE 120
SALEM,OR97302
  13,354 0     COMMUNITY IMPACT-VARIOUS HEALTH
(32) NEW PERSPECTIVES CENTER FOR C
PO BOX 7497
SALEM,OR97303
  75,832 0     COMMUNITY IMPACT-VARIOUS HEALTH
(33) NORTHWEST PERMANENTE
7201 NORTH INTERSTATE AVE
PORTLAND,OR97217
  35,928 0     COMMUNITY IMPACT-VARIOUS HEALTH
(34) NWHS-WEST SALEM CLINIC
1233 EDGEWATER ST NW
SALEM,OR97304
  249,937 0     COMMUNITY IMPACT-VARIOUS HEALTH
(35) OPTIONS COUNSELING FAMILY SVC
3270 LIBERTY RD S
SALEM,OR97302
  90,919 0     COMMUNITY IMPACT-VARIOUS HEALTH
(36) OPTIONS COUNSELING SVCS OF OR
3500 CHAD DR
EUGENE,OR97408
  64,588 0     COMMUNITY IMPACT-VARIOUS HEALTH
(37) OREGON DENTAL SERVICE
601 SW SECOND AVE
PORTLAND,OR97204
  89,904 0     COMMUNITY IMPACT-VARIOUS HEALTH
(38) OREGON FAMILY HEALTH
607 SE JEFFERSON ST
DALLAS,OR97338
  31,536 0     COMMUNITY IMPACT-VARIOUS HEALTH
(39) OREGON FAMILY SUPPORT
PO BOX 886
SALEM,OR97301
  78,000 0     COMMUNITY IMPACT-VARIOUS HEALTH
(40) OREGON RECOVERY BEHAVIORAL HE
PO BOX 20674
KEIZER,OR97307
  5,418 0     COMMUNITY IMPACT-VARIOUS HEALTH
(41) PHYSICIANS BUILDING GROUP
1234 COMMERCIAL ST SE
SALEM,OR97302
  18,079 0     COMMUNITY IMPACT-VARIOUS HEALTH
(42) POLK COUNTY HEALTH DEPARTMENT
182 ACADEMY SW
DALLAS,OR97338
  238,062 0     COMMUNITY IMPACT-VARIOUS HEALTH
(43) RODNEY E ORR MD PC
335 FAIRVIEW ST
SILVERTON,OR97381
  18,269 0     COMMUNITY IMPACT-VARIOUS HEALTH
(44) SALEM CLINIC PC
PO BOX 8100
SALEM,OR97303
  400,587 0     COMMUNITY IMPACT-VARIOUS HEALTH
(45) SALEM FAMILY MEDICINE
432 LANCASTER DR NE
SALEM,OR97301
  10,466 0     COMMUNITY IMPACT-VARIOUS HEALTH
(46) SALEM HEALTH
PO BOX 5969
PORTLAND,OR97228
  322,056 0     COMMUNITY IMPACT-VARIOUS HEALTH
(47) SALEM KEIZER COALITION
PO BOX 13129
SALEM,OR97309
  75,450 0     COMMUNITY IMPACT-VARIOUS HEALTH
(48) SALEM PEDIATRIC CLINIC
2478 13TH ST SE
SALEM,OR97302
  200,716 0     COMMUNITY IMPACT-VARIOUS HEALTH
(49) SANTIAM MEMORIAL HOSPITAL
PO BOX 19212
BELFAST,ME04915
  74,418 0     COMMUNITY IMPACT-VARIOUS HEALTH
(50) SAPPHIRE BLUE BEHAVIORAL HEAL
5200 SW MEADOWS RD STE 150
LAKE OSWEGO,OR97035
  5,664 0     COMMUNITY IMPACT-VARIOUS HEALTH
(51) SHANGRI LA
4080 REED RD SE STE 150
SALEM,OR97302
  25,320 0     COMMUNITY IMPACT-VARIOUS HEALTH
(52) SILVER CREEK FAMILY MEDICINE
111 W C ST
SILVERTON,OR97381
  9,678 0     COMMUNITY IMPACT-VARIOUS HEALTH
(53) SILVERTON HEALTH
PO BOX 3417
PORTLAND,OR97208
  170,045 0     COMMUNITY IMPACT-VARIOUS HEALTH
(54) STAYTON FAMILY PRACTICE
PO BOX 19517
BELFAST,ME04915
  19,706 0     COMMUNITY IMPACT-VARIOUS HEALTH
(55) VALLEY MENTAL HEALTH
821 SAGINAW ST STE S
SALEM,OR97302
  108,461 0     COMMUNITY IMPACT-VARIOUS HEALTH
(56) VIDA FAMILY MEDICINE
PO BOX 883
SALEM,OR97308
  16,398 0     COMMUNITY IMPACT-VARIOUS HEALTH
(57) WEST SALEM FAMILY PRACTICE
1275 WALLACE RD NW
SALEM,OR97304
  7,733 0     COMMUNITY IMPACT-VARIOUS HEALTH
(58) WEST VALLEY HOSPITAL
PO BOX 94269
SEATTLE,WA98124
  10,910 0     COMMUNITY IMPACT-VARIOUS HEALTH
(59) WFMC HEALTH
435 LANCASTER DR NE
SALEM,OR97301
  42,429 0     COMMUNITY IMPACT-VARIOUS HEALTH
(60) WILLAMETTE FAMILY MEDICAL CEN
435 LANCASTER DR NE
SALEM,OR97301
  165,738 0     COMMUNITY IMPACT-VARIOUS HEALTH
(61) WILLAMETTE VALLEY HOSPICE
2973 12TH ST SE
SALEM,OR97302
  7,228 0     COMMUNITY IMPACT-VARIOUS HEALTH
(62) WOODBURN PEDIATRIC CLINIC
2050 PROGRESS WAY
WOODBURN,OR97071
  99,850 0     COMMUNITY IMPACT-VARIOUS HEALTH
(63) YVFW
PO BOX 190
TOPPENISH,WA98948
  394,386 0     COMMUNITY IMPACT-VARIOUS HEALTH
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
0
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
63
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

Schedule I (Form 990) 2021
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)
(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 (Form 990) 2021



Additional Data


Software ID: 21013475
Software Version: 2021v4.0