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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
PROVIDENCE HEALTH SYSTEM - SO
CALIFORNIA
Employer identification number
51-0216589
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) ALL INCLUSIVE COMMUNITY HEALTH CENTER
1311 N SAN FERNANDO BLVD
BURBANK,CA91504
27-4198722 501(C)(3) 225,000 0     SPONSORSHIP
(2) ASCENCIA
1851 TYBURN ST
GLENDALE,CA912042900
20-4233822 501(C)(3) 300,500 0     SPONSORSHIP
(3) BEHAVIORAL HEALTH SERVICE INC
15591 CRENSHAW BLVD
GARDENA,CA902494525
95-2838006 501(C)(3) 100,000 0     SPONSORSHIP
(4) BURBANK COMMUNITY YMCA
321 E MAGNOLIA BLVD
BURBANK,CA915021132
95-1664139 501(C)(3) 170,344 0     SPONSORSHIP
(5) BURBANK TEMPORARY AID CENTER
1304 W BURBANK BLVD
BURBANK,CA91506
95-3309130 501(C)(3) 150,000 0     SPONSORSHIP
(6) CENTER FOR FAMILY HEALTH AND EDUCATION INC
8727 VAN NUYS BLVD STE 101-102
PANORAMA CITY,CA914022451
27-0224623 501(C)(3) 125,000 0     SPONSORSHIP
(7) CHILD DEVELOPMENT INSTITUTE
18050 VANOWEN ST
REDESA,CA913355638
95-4545540 501(C)(3) 100,000 0     SPONSORSHIP
(8) CITY OF BURBANK
275 E OLIVE AVENUE
BURBANK,CA915021232
GOVERNMENT 250,000 0     SPONSORSHIP
(9) COMPREHENSIVE COMMUNITY HEALTH CENTERS
801S CHEVY CHASE DR STE 210
GLENDALE,CA916061576
42-1553807 501(C)(3) 125,000 0     SPONSORSHIP
(10) CONVALESCENT AIDE SOCIETY
3255 E FOOTHILL BLVD
PASADENA,CA911073110
95-1782304 501(C)(3) 130,000 0     OPERATIONAL SUPPORT
(11) DIDI HIRSCH MENTAL HEALTH SERVICES
4760 S SEPULVEDA BLVD
CULVER CITY,CA902304820
95-1816023 501(C)(3) 450,000 0     SPONSORSHIP
(12) EL CENTRO DE AMISTAD
7038 OWENSMOUTH AVE
CANOGA PARK,CA91303
95-3498639 501(C)(3) 150,000 0     OPERATIONAL SUPPORT
(13) EL PROYECTO DEL BARRIO INC
8902 WOODMAN AVE
ARLETA,CA913116401
95-2662606 501(C)(3) 250,000 0     SPONSORSHIP
(14) FAMILY PROMISE OF VERDUGO
PO BOX 7151
BURBANK,CA915107151
26-2458342 501(C)(3) 150,500 0     SPONSORSHIP
(15) FAMILY SERVICES AGENCY
ECPCA-2721 W BURBANK BLVD
BURBANK,CA915052306
95-6118623 501(C)(3) 100,000 0     SPONSORSHIP
(16) GREATER IRVINE CHAMBER OF COMMERCE
36 EXECUTIVE PARK SUITE 100
IRVINE,CA92614
95-3433541 501(C)(6) 5,500 0     SPONSORSHIP
(17) HARBOR COMMUNICTY CLINIC INC
593 W 6TH ST
SAN PEDRO,CA907312521
23-7103245 501(C)(3) 175,000 0     SPONSORSHIP
(18) HARBOR INTERFAITH SERVICES INC
670 W 9TH ST
SAN PEDRO,CA907313180
33-0031099 501(C)(3) 250,000 0     SPONSORSHIP
(19) JFS FAMILY VIOLENCE PROJECT
330 N FAIR FAX AVE
LOS ANGELES,CA900362109
95-1691013 501(C)(3) 500,000 0     SPONSORSHIP
(20) KIDS COMMUNITY DENTAL CLINIC
400 W ELMWOOD AVE
BURBANK,CA915063304
95-4791296 501(C)(3) 420,017 0     SPONSORSHIP
(21) LA JEWISH HOME FOR THE AGED
7150 TAMPA AVE
RESEDA,CA91335
95-3510024 501(C)(3) 259,898 0     SPONSORSHIP
(22) NATIONAL HEALTH FOUNDATION
515 S FIGUEROA ST STE 1300
LOS ANGELES,CA900713322
23-7314808 501(C)(3) 836,838 0     SPONSORSHIP
(23) NORTH VALLEY CARING SERVICES
15453 RAYEN ST
NORTH HILLS,CA913435119
95-4444561 501(C)(3) 125,000 0     SPONSORSHIP
(24) NORTHEAST VALLEY HEALTH CORPORATION
1172 N MACAY AVENUE
SAN FERNANDO,CA91340
23-7120632 501(C)(3) 400,000 0     SPONSORSHIP
(25) ONE GENERATION
18255 VICTORY BLVD
RESEDA,CA913356420
47-3049639 501(C)(3) 40,000 0     SPONSORSHIP
(26) ORANGE COUNTRY BUSINESS COUNCIL
2 PARK PLAZA SUITE 100
IRVINE,CA926145904
23-7084107 501(C)(6) 17,500 0     SPONSORSHIP
(27) PARTNER IN CARE FOUNDATION
732 MOTT ST STE 150
SAN FERNANDO,CA913404241
95-3954057 501(C)(3) 520,000 0     SPONSORSHIP
(28) PROVIDENCE MEDICAL INSTITUTE
21311 MADRONA STE 101
TORRANCE,CA905035970
33-0283773 501(C)(3) 1,208,718 0     OPERATIONAL SUPPORT
(29) RITCHSTONE FAMILY CENTER
13634 CORDARY AVE
HAWTHRONE,CA902507490
23-7373745 501(C)(3) 350,000 0     SPONSORSHIP
(30) SAN FERNANDO COMMUNITY HEALTH CENTER
732 MOTT ST STE 100-110
SAN FERNANDO,CA913404237
51-0142144 501(C)(3) 650,000 0     SPONSORSHIP
(31) SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER INC
16360 ROSECO BLVD 2ND FLR
VAN NUYS,CA914061219
95-6194487 501(C)(3) 300,000 0     OPERATIONAL SUPPORT
(32) SOUTH BAY FAMILY HEALTHCARE CENTER
BLDG 3 STE 210 23430 HAWTHORNE BLVD
TORREANCE,CA90505
23-7049937 501(C)(3) 100,000 0     SPONSORSHIP
(33) TARZANA TREATMENT CENTER
CCHCA-18646 OXNARD ST
TARZANA,CA913561411
94-2219349 501(C)(3) 1,184,254 0     SPONSORSHIP
(34) THE VILLAGE FAMILY SERVICES
6736 LAUREL CANYON BLVD STE 200
NORTH HOLLYWOOD,CA916061576
95-4625826 501(C)(3) 200,000 0     SPONSORSHIP
(35) UNIHEALTH FOUNDATION
800 WILSHIRE BLVD 1300
LOS ANGELES,CA900172665
95-5004033 501(C)(3) 1,200,617 0     SPONSORSHIP
(36) VALLEY INDUSTRY COMMERCE ASSOCIATION
16600 SHERMAN WAY SUITE 170
VAN NUYS,CA914063861
23-7182039 501(C)(4) 11,000 0     SPONSORSHIP
(37) VENICE FAMILY CLINIC
604 ROSE AVE
VENICE,CA902912767
95-2769432 501(C)(3) 550,000 0     SPONSORSHIP
(38) WILMINGTON COMMUNITY CLINIC
ECPCA-1009 N AVALON BLVD
WILMINGTON,CA900744505
95-3137803 501(C)(3) 175,000 0     SPONSORSHIP
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
35
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

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
PART I, LINE 2: DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS IN THE APPLICATION FOR SUPPORT, A DETAILED EXPLANATION OF THE KIND OF SERVICES PROVIDED TO THE COMMUNITY ALONG WITH SPECIFIC FINANCIAL DATA IS REQUESTED. IF THE APPLICATION FOR SUPPORT IS APPROVED, A LETTER IS SENT INDICATING THE AMOUNT OF THE SUPPORT ALONG WITH A REQUEST FOR DOCUMENTATION OF HOW THE FUNDS WERE USED, ALONG WITH A REPORT OF THE NUMBER OF CHILDREN/FAMILIES SERVED OVER THE YEAR. GRANTS MADE TO AFFILIATED FOUNDATIONS ARE MONITORED ON A MONTHLY BASIS AS THE FINANCIAL STATEMENTS OF THESE ORGANIZATIONS ARE READILY AVAILABLE. OTHER GRANTS ARE MADE THAT COMPLY WITH THE MISSION AND FURTHER THE TAX-EXEMPT PURPOSE OF THE ORGANIZATION.
Schedule I (Form 990) 2021



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