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.
lBullet Attach to Form 990.
lBullet 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
ELDER SERVICES OF CAPE COD AND THE
ISLANDS INC
Employer identification number
04-2523904
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) S Coastal Counties Legal Srv
460 West Main Street
HYANNIS,MA02601 		04-2607691 501c3 52,000       Legal Assistance
(2) Barnstable Council On Aging
825 Falmouth Rd
Hyannis,MA02601 		04-3255644 Govt 6,000       Transportation
(3) PALLIATIVE & SUPPORTIVE CARE OF NANTUCKET
57 PROSPECT STREET
NANTUCKET,MA02554 		00-1029728 501c3 5,069       PALLIATIVE CARE
(4) ALZHEIMER'S FAMILY CAREGIVER SUPPORT CENTER
2095 MAIN STREET
BREWSTER,MA02631 		501c3 8,775       ELDER SUPPORT
(5) ORLEANS COUNCIL ON AGING
150 ROCK HARBOR ROAD
ORLEANS,MA02653 		04-6001258 GOvt         TRANSPORTATION
(6) DAVID P CHEWINTEGRATED CENTER FOR INEGRATIVE PSYCHOTHERAPY
126 MAIN STREET
NANTUCKET,MA02554 		04-8529796   7,200       BEHAVORIAL HEALTH ASSESSMENTS, COUNSELING
(7) MV COMMUNITY SERVICE COUNSEL
111 EDGARTOWN ROAD
VINEyard Haven,MA02568 		04-2301598 501c3 8,829       TRANSPORTATION
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule 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) IN HOME SERVICES 2240 14,661,002      
(2) ELDERLY HOUSING SERVICES   12,681      
(3) Emergency elder services 1782 88,738      
(4) SENIOR CARE OPTIONS   2,044,387      
(5) MONEY FOLLOWS THE PERSON   49,192      
(6) EVIDENCE BASED/OTHER   20,162      
(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: EACH SUBGRANTEE USING FEDERAL FUNDS IS MONITORED AT LEAST ONCE A YEAR. SOURCE DOCUMENTS ARE REVIEWED SUCH AS PAYROLL RECORDS, EXPENDITURE AUTHORIZATION PROCEDURES, DONATION POLICIES, PROGRAM ATTENDANCE RECORDS, FILING SYSTEMS, ETC.
Schedule I (Form 990) 2016



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