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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.
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
PHS Commissioned Officers Foundation for the
 
Employer identification number
52-2258463
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) Chatham County Safety Net Planning
400 Mall Blvd
Savannah,GA31406
26-1119132 501c3 10,000        
(2) KinderSmile Foundation
10 Broad Street
Bloomfield,NJ07003
56-2635166 501c3 10,000        
(3) Michael Glynn Memorial Coalition
PO Box 11
White River,SD57579
26-3152733 501c3 10,000        
(4) Patient Assistance Foundation
2100 Webster Street
San Francisco,CA94115
94-2944137 501c3 10,000        
(5) African Family Health Organization
5400 Grays Avenue 2nd Floor
Philadelphia,PA19142
73-1670436 501c3 10,000        
(6) San Mateo County Health Foundation
222 W 39th Avenue
San Mateo,CA94403
94-3116070 501c3 10,000        
(7) Tuggle Elementary School
412 12th Court North
Birmingham,AL35204
63-6000767 501c3 10,000        
(8) Refugee Dream Center
747 Broad Street
Providence,RI02907
47-3515841 501c3 10,000        
(9) Cahaba Medical Care Fdn
405 Belcher Street
Centreville,AL35042
27-3605364 501c3 10,000        
(10) Siouxland Community Health Center
1021 Nebraska Street
Sioux City,IA51105
42-1374894 501c3 9,861        
(11) Seven Valleys Health Coalition Inc
10 Kennedy Parkway
Cortland,NY13045
16-1600893 501c3 10,000        
(12) Rosa es Rojo Inc
PO Box 250435
Plano,TX75025
81-3557997 501c3 10,000        
(13) The Northampton Recovery Center
25 Armory Street
Northampton,MA01060
23-7450656 501c3 10,000        
(14) Oklahoma City Indian Clinic
4913 W Reno Ave
Oklahoma City,OK73107
73-0955756 501c3 9,898        
(15) Health Outreach Prevention Educatio
3540 E 31st St Ste 3
Tulsa,OK74135
73-1537952 501c3 9,400        
(16) Klamath County Public Health
3314 Vandenberg Rd
Klamath Falls,OR97603
93-1230223 501c3 10,000        
(17) Maryland Primary Care Program
4201 Patterson Avenue
Baltimore,MD21215
52-6002033 501c3 10,000        
(18) Not 1 More Project
1389 W 86th Street Suite 205
Indianapolis,IN46268
87-2080128 501c3 10,000        
(19) PA Coalition for Oral Health
PO Box 242
Delmont,PA15626
81-3594885 501c3 10,000        
(20) ABLE-NH
2 12 Beacon St
Concord,NH03301
30-0508754 501c3 10,000        
(21) Boost Oregon
PO Box 8635
Portland,OR97207
47-4538646 501c3 10,000        
(22) Chaldean Community Foundation
3601 15 Mile Rd
Sterling Heights,MI48310
20-3963417 501c3 10,000        
(23) Cherokee County Health Services Cou
135 N Muskogee Ave
Tahlequah,OK74464
73-1574782 501c3 10,000        
(24) Coalition Rx
6400 University Drive S N CEC 219
Omaha,NE68182
84-2855854 501c3 9,977        
(25) Community Health Worker Coalition
24315 89TH PL W
Edmonds,WA98026
83-2266657 501c3 10,000        
(26) The Keya Foundation
PO BOX 1824
Eagle Butte,SD57625
46-0879346 501c3 10,000        
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
26
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) Scholarships       Cost NA
(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



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