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
Lutheran Community Services Northwest
 
Employer identification number
93-0386860
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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
 
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) Crisis/Emergency 64 5,311 37,244 COST Payments for Emergency Needs
(2) Foster Care/Respite Care 77 168,193 370,023 COST Payments to Foster Parents
(3) Childcare 4   687 COST Payments to Child care providers
(4) Housing/Utilities 572 1,359,851 727,406 COST Payments to landlord/utilities
(5) Food 193 1,350 27,428 COST Food and Meals for Program Participants
(6) Medical 57 2,463 17,466 COST Payments for Medical Care
(7) Transportation 184 8,812 21,473 COST Transportation Passes and Assistance
(8) Education 64 24,676 186,172 COST Payments to school/tutors & assistance
(9) Cultural/Recreation 59   157,665 COST Payments for Youth Recreation Activities
(10) Refugee Services 1439 73,521 1,255,878 COST Payments to Landlords/Utilities and Assistance
(11) Senior & Disabled Visitation 26   116,557 COST Volunteer Reimbursements for Visitation
(12) Other Assistance 23 5,452 59,512 COST Misc
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
Part I, Line 2: Program staff monitors grantee funds through routine reporting to grantors, monitoring program performance, and oversight through our quality management processes.
Schedule I (Form 990) 2021



Additional Data


Software ID:  
Software Version: