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Fillable Printable Form 990 Schedule I

Fillable Printable Form 990 Schedule I

Form 990 Schedule I

Form 990 Schedule I

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.
Attach to Form 990.
Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
Employer identification number
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? .............................
Yes No
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” onForm
990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
1
(a) Name and address of organization
or government
(b) EIN (c) IRC section
(if applicable)
(d) Amount of cash
grant
(e) Amount of non-
cashassistance
(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..................
3 Enter total number of other organizations listed in the line 1 table...........................
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055PSchedule I (Form 990) (2016)
Schedule I (Form 990) (2016)
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.
Schedule I (Form 990) (2016)
Schedule I (Form 990) (2016)
Page 3
Section references are to the Internal Revenue
Code unless otherwise noted.
General Instructions
Future developments. For the latest
information about developments related to
Schedule I (Form 990), such as legislation
enacted after the schedule and its instructions
were published, go to www.irs.gov/form990.
Note: Terms in bold are defined in the
Glossary of the Instructions for Form990.
Purpose of Schedule
Schedule I (Form 990) is used by an
organization that files Form 990 to provide
information on grants and other assistance
made by the filing organization during the tax
year to domestic organizations, domestic
governments, and domestic individuals.
Report activities conducted by the
organization directly. Also, report activities
conducted by the organization indirectly
through a disregarded entity or a joint
venture treated as a partnership.
Grants and other assistance include
awards, prizes, contributions, noncash
assistance, cash allocations, stipends,
scholarships, fellowships, research grants,
and similarpayments and distributions made
by the organization during the tax year. For
purposes of Schedule I, grants and other
assistance don’t include:
• Salaries or other compensation to
employees, or payments to independent
contractors if the primary purpose of such
payments is to serve the direct and immediate
needs of the organization (such as legal,
accounting, or fundraising services).
• The payment of any benefit by a 501(c)(9)
voluntary employees’ beneficiary association
(VEBA) to employees of a sponsoring
organization or contributing employer, if such
payment is made under the terms of the
VEBA trust and in compliance with section
505.
• Grants to affiliates that aren’t organized as
legal entities separate from the filing
organization, or payments made to branch
offices, accounts, or employees of the
organization located in the United States.
A domestic organization includes a
corporation or partnership created or
organized in the United States or under the
law of the United States or of any state or
possession. A trust is a domestic organization
if a court within the United States or a U.S.
possession is able to exercise primary
supervision over the administration of the
trust, and one or more U.S. persons (or
persons in U.S. possessions) have the
authority to control all substantial decisions of
the trust.
A domestic government is a state, a U.S.
possession, a political subdivision of a state
or U.S. possession, the United States, or the
District of Columbia. A grant to a U.S.
government agency must be included on this
schedule regardless of where the agency is
located or operated.
A domestic individual is a person,
including a foreign citizen, who lives or
resides in the United States (or a U.S.
possession) and not outside of the United
States (or a U.S. possession).
Parts II and III of this schedule may be
duplicated to list additional grantees (Part II)
or types of grants/assistance (Part III) that
don’t fit on the first page of these parts.
Number each page of each part.
Don’t report on this schedule foreign grants
or assistance, including grants or assistance
provided to domestic organizations,
domestic governments, or domestic
individuals for the purpose of providing
grants or other assistance to a designated
foreign organization, foreign government,
or foreign individual. Instead, report them on
Schedule F (Form 990), Statement of
Activities Outside the United States.
Who Must File
An organization that answered “Yes” on
Form 990, Part IV, Checklist of Required
Schedules, line 21 or 22, must complete Part I
and either Part II or Part III of this schedule
and attach it to Form 990.
If an organization isn’t required to file Form
990 but chooses to do so, it must file a
complete return and provide all of the
information requested, including the required
schedules.
Specific Instructions
Part I. General Information on
Grants and Assistance
Complete this part if the organization
answered “Yes” on Form 990, Part IV, line 21
or 22.
Lines 1 and 2. On line 1, indicate “Yes” or
“No” regarding whether the organization
maintains records to substantiate amounts,
eligibility, and selection criteria used for
grants. In general terms, describe how the
organization monitors its grants to ensure that
such grants are used for proper purposes and
aren’t otherwise diverted from the intended
use. For example, the organization can
describe the periodic reports required or field
investigations conducted. Use Part IV for the
organization’s narrative response to line 2.
Part II. Grants and Other
Assistance to Domestic
Organizations and Domestic
Governments
Line 1. Complete line 1 if the organization
answered “Yes” on Form 990, Part IV, line 21.
A “Yes” response means that the organization
reported more than $5,000 on Form 990, Part
IX, line 1,column (A). Enter information only
for eachrecipient domestic organization or
domestic government that received more
than $5,000aggregate of grants or assistance
from theorganization during the tax year.
Enter the details of each organization or
entity on a separate line of Part II. If there are
more organizations or entities to report in Part
II than space available, report the additional
organizations or entities on duplicate copies
of Part II. Use as many duplicate copies as
needed, and number each page. Use Part IV if
additional space is needed for descriptions of
particular column entries.
Column (a). Enter the full legal name and
mailing address of each recipient organization
or government entity.
Column (b). Enter the employer
identification number (EIN) of the grant
recipient.
Column (c). Enter the section of the
Internal Revenue Code under which the
organization receiving the assistance is
tax-exempt, if applicable (for example, a
school described in section 501(c)(3) or a
social club described in section 501(c)(7)). If a
recipient is a government entity, enter the
name of the government entity. If a recipient
is neither a tax-exempt nor a government
entity, leave column (c) blank.
Column (d). Enter the total dollar amount of
cash grants to each recipient organization or
entity for the tax year. Cash grants include
grants and allocations paid by cash, check,
money order, electronic fund or wire transfer,
and other charges against funds on deposit at
a financial institution.
Columns (e) and (f). Enter the fair market
valueof noncash property. Describe the
method of valuation. Report property with a
readily determinable market value (for
example, market quotations forsecurities) at
its fair market value. For marketable securities
registered and listed on a recognized
securities exchange, measure market value
on the date the property is distributed to the
grantee by the average of the highest and
lowest quoted selling prices or the average
between the bona fide bid and asked prices.
When fair market value cannot be readily
determined, use an appraised or estimated
value.
Column (g). For noncash property or
assistance, enter a description of the property
or assistance. List all that apply. Examples of
noncash assistance include medical supplies
or equipment, pharmaceuticals, blankets, and
books or other educational supplies.
Column (h). Describe the purpose or
ultimate use of the grant funds or other
assistance. Don’t usegeneral terms such as
charitable, educational,religious, or scientific.
Use more specificdescriptions such as
general support,payments for nursing
services, or laboratory construction. Enter the
type of assistance,such as medical, dental, or
free care forindigent hospital patients. In the
case ofdisaster assistance, include a
description of the disaster and the assistance
provided (for example, “Food, shelter, and
clothing for Organization A’s assistance to
victims of Colorado wildfires”). Use Part IV if
additional space is needed for descriptions.
TIP
If the organization checks
“Accrual” on Form 990, Part XII,
line 1; follows SFAS 116 (ASC
958) (see instructions for Form
990, Part IX); and makes a grant during the
tax year to be paid in future years to a
domestic organization or domestic
government, it should report the grant’s
present value in Part II, line 1, column (d) or
(e), and report any accruals of present value
increments in future years.
Schedule I (Form 990) (2016)
Page 4
Line 2. Add the number of recipient
organizations listed on Schedule I(Form 990),
Part II, line 1, that (a) have been recognized by
the Internal Revenue Service as exempt from
federal income tax as described in section
501(c)(3); (b) are churches, including
synagogues, temples, and mosques; (c) are
integrated auxiliaries of churches and
conventions or association of churches; or(d)
are domestic governments. Enter the total.
Line 3. Add the number of recipient
organizations listed on Schedule I(Form 990),
Part II, line 1, that aren’t described on line 2.
This number should include both
organizations that aren’t tax-exempt and
organizations that are tax-exempt under
section 501(c) but not section 501(c)(3).
Part III. Grants and Other
Assistance to Domestic
Individuals
Complete Part III if the organization answered
“Yes” on Form 990, Part IV, line 22. A “Yes”
response means that the organization
reported more than $5,000 on Form 990, Part
IX, line 2, column (A).
Enter information for grants and other
assistance made to or for the benefit of
individual recipients. Don’t complete Part III
for grants or assistance provided to
individuals through another organization or
entity, unless the grant or assistance is
earmarked by the filing organization for the
benefit of one or more specific domestic
individuals. Instead, complete Part II, earlier.
For example, report a payment to a hospital
designated to cover the medical expenses of
particular domestic individuals in Part III and
report a contribution to a hospital designated
to provide some service to the general public
or to unspecified domestic charity patients in
Part II.
Enter the details of each type of assistance
to individuals on a separate line of Part III. If
there are more types of assistance than space
available, report the types of assistance on
duplicate copies of Part III. Use as many
duplicate copies as needed, and number each
page. Use Part IV if additional space is
needed for descriptions of particular column
entries.
Column (a). Specify type(s) of assistance
provided, or describe the purpose or use of
grant funds. Don’t use general terms such as
charitable, educational, religious, or scientific.
Use more specific descriptions, such as
scholarships for students attending a
particular school; provision of books or other
educational supplies; food, clothing, and
shelter for indigents, or direct cash assistance
to indigents; etc. In the case of specific
disaster assistance, include a description of
the type of assistance provided and identify
the disaster (for example, “Food, shelter, and
clothing for immediate relief for victims of
Colorado wildfires”).
Column (b). Enter the number of recipients
foreach type of assistance. If the organization
is unable to determine the actual number,
provide an estimate of the number. Explain in
Part IV how the organization arrived at the
estimate.
Column (c). Enter the aggregate dollar
amount of cash grants for each type of grant
or assistance. Cash grants include grants and
allocations paid by cash, check, money order,
electronic fund or wire transfer, and other
charges against funds on deposit at a
financial institution.
Columns (d) and (e). Enter the fair market
value of noncash property. Describe the
method of valuation. Report property with a
readily determinable market value (for
example, market quotations for securities) at
its fair market value. For marketable securities
registered and listed on a recognized
securities exchange, measure market value by
the average of the highest and lowest quoted
selling prices or the average between the
bona fide bid and asked prices, on the date
the property is distributed to the grantee.
When fair market value cannot be readily
determined, use an appraised or estimated
value.
Column (f). For noncash grants or assistance,
enter descriptions of property. List all that
apply. Examples of noncash assistance
include medical supplies or equipment,
pharmaceuticals, blankets, and books or
other educational supplies.
TIP
If the organization checks
“Accrual” on Form 990, Part XII,
line 1; follows SFAS 116 (ASC
958) (see instructions for Form
990, Part IX); and makes a grant during the
tax year to be paid in future years to a
domestic individual, it should report the
grant’s present value in Part III, column (c) or
(d), and report any accruals of present value
increments in future years.
Part IV. Supplemental Information
Use Part IV to provide narrative information
required in Part I, line 2, regarding monitoring
of funds, and in Part III, column (b), regarding
how the organization estimated the number of
recipients for each type of grant or
assistance. Also use Part IV to provide other
narrative explanations and descriptions, as
needed. Identify the specific part and line(s)
that the response supports. Part IV can be
duplicated if more space is needed.
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