OCRACOKE HEALTH CENTER INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
OCRACOKE HEALTH CENTER INC (EIN 56-1273237)
Tax period
2016-02-01 to 2017-01-31
Filed
2017-12-08
IRS object ID
201743429349300409
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-12-08T10:23:41-05:00ReturnTs
Tax Period End2017-01-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN472785532PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SHERRI ROSE CPA PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line18732 UNION GROVE CHURCH RDAddressLine1Txt
CityCHAPEL HILLCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27516ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-02-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN561273237EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1OCRACOKE HEALTH CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlOCRABusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 543AddressLine1Txt
CityOCRACOKECityNm
State AbbreviationNCStateAbbreviationCd
ZIP27960ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSUSAN PENTZPersonNm
Person TitleCHAIRPersonTitleTxt
Phone2529288104PhoneNum
Signature2017-10-31SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSHERRI ROSEPreparerPersonNm
PTINP00695775PTIN
Phone9199498483PhoneNum
Preparation2017-11-09PreparationDt

Filing Security Information FilingSecurityInformation

FieldValueIRS element (for citing)
At Submission Creation Device Id11A20D36BFFC1B773FEFEEFD8202FD2EB733C4B3AtSubmissionCreationDeviceId
At Submission Filing Device Id11A20D36BFFC1B773FEFEEFD8202FD2EB733C4B3AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSUSAN PENTZPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1305 BACK ROADAddressLine1Txt
CityOCRACOKECityNm
State AbbreviationNCStateAbbreviationCd
ZIP27960ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$673,333GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1980FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionPROVIDE MEDICAL CARE AND OUTREACH TO UNDERUTILIZED COMMUNITYActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee20TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$808,644PYContributionsGrantsAmt
CY Contributions Grants$326,901CYContributionsGrantsAmt
PY Program Service Revenue$411,540PYProgramServiceRevenueAmt
CY Program Service Revenue$346,432CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$1,220,184PYTotalRevenueAmt
CY Total Revenue$673,333CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$622,600PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$526,481CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$379,991PYOtherExpensesAmt
CY Other Expenses$332,357CYOtherExpensesAmt
PY Total Expenses$1,002,591PYTotalExpensesAmt
CY Total Expenses$858,838CYTotalExpensesAmt
PY Revenues Less Expenses$217,593PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$185,505CYRevenuesLessExpensesAmt
Total Assets BOY$911,353TotalAssetsBOYAmt
Total Assets EOY$737,499TotalAssetsEOYAmt
Total Liabilities BOY$16,589TotalLiabilitiesBOYAmt
Total Liabilities EOY$28,240TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$894,764NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$709,259NetAssetsOrFundBalancesEOYAmt
MissionPROVIDE MEDICAL CARE AND OUTREACH TO UNDERUTILIZED COMMUNITYMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$658,312ExpenseAmt
Revenue$364,176RevenueAmt
DescPROVIDE MEDICAL CARE AND OUTREACHDesc
Total Program Service Expenses$658,312TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document2IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee20EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnfalseAnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcfalseRegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Other WebsiteYes (X)OtherWebsiteInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1OCRACOKE MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2529281511PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 543AddressLine1Txt
CityOCRACOKECityNm
State AbbreviationNCStateAbbreviationCd
ZIP27960ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
SUSAN PENTZ
CHAIRYes (X)Yes (X)$0$0$0
MICHAEL ADAMS
MEMBERYes (X)$0$0$0
AMY HILTON
SECRETARYYes (X)$0$0$0
ALICE KEENEY
MEMBERYes (X)$0$0$0
R S SPENCER JR
VICE CHAIRYes (X)$0$0$0
ART KEENEY
MEMBERYes (X)$0$0$0
JASON WELLS
MEMBERYes (X)$0$0$0
HOWARD BENNINK
MEMBERYes (X)$0$0$0
ALICE MCCABE
MEMBERYes (X)$0$0$0
EARL PUGH JR
MEMBERYes (X)$0$0$0
JULIO MORALES
TREASURERYes (X)$0$0$0
JUSTIN LEBLANC
MEMBERYes (X)$0$0$0
MORTY GASKILL
MEMBERYes (X)$0$0$0
MEL PEREZ
MEMBERYes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Federated Campaigns$119FederatedCampaignsAmt
Government Grants$309,038GovernmentGrantsAmt
All Other Contributions$17,744AllOtherContributionsAmt
Total Contributions$326,901TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPROGRAM SERVICE REVENUEDesc
Total Revenue Column$346,432TotalRevenueColumnAmt
Related Or Exempt Func Income$346,432RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$346,432TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$673,333TotalRevenueColumnAmt
Related Or Exempt Func Income$346,432RelatedOrExemptFuncIncomeAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$432,113TotalAmt
Program Services$325,581ProgramServicesAmt
Management And General$106,532ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$55,033TotalAmt
Program Services$34,801ProgramServicesAmt
Management And General$20,232ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$39,335TotalAmt
Program Services$27,912ProgramServicesAmt
Management And General$11,423ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$19,665TotalAmt
Management And General$19,665ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$16,058TotalAmt
Program Services$12,827ProgramServicesAmt
Management And General$3,231ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$126TotalAmt
Program Services$126ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$16,353TotalAmt
Program Services$10,889ProgramServicesAmt
Management And General$5,464ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$13,545TotalAmt
Program Services$12,466ProgramServicesAmt
Management And General$1,079ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$9,370TotalAmt
Program Services$8,965ProgramServicesAmt
Management And General$405ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$8,709TotalAmt
Program Services$3,375ProgramServicesAmt
Management And General$5,334ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$195TotalAmt
Management And General$195ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$81,826TotalAmt
Program Services$81,826ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$27,078TotalAmt
Program Services$16,896ProgramServicesAmt
Management And General$10,182ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
VACCINES$38,862$38,862
BAD DEBT$24,854$24,854
MAINTENANCE - BLDG$15,189$11,871$3,318
DISPENSARY$11,017$11,017

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$49,510TotalAmt
Program Services$36,044ProgramServicesAmt
Management And General$13,466ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$858,838TotalAmt
Program Services$658,312ProgramServicesAmt
Management And General$200,526ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$290,774BOYAmt
EOY$175,385EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$55,087BOYAmt
EOY$42,751EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$12,112BOYAmt
EOY$16,654EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,103,853LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$601,144LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$553,380BOYAmt
EOY$502,709EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$911,353BOYAmt
EOY$737,499EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$9,055BOYAmt
EOY$23,980EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,534BOYAmt
EOY$4,260EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,589BOYAmt
EOY$28,240EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$894,764BOYAmt
EOY$709,259EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$894,764BOYAmt
EOY$709,259EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$911,353BOYAmt
EOY$737,499EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$185,505ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$507,373CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$808,644CurrentTaxYearMinus1YearAmt
Current Tax Year$326,901CurrentTaxYearAmt
Total$1,642,918TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$507,373CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$808,644CurrentTaxYearMinus1YearAmt
Current Tax Year$326,901CurrentTaxYearAmt
Total$1,642,918TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$1,642,918PublicSupportTotal170Amt
Total Support$1,642,918TotalSupportAmt
Gross Receipts Rltd Activities$346,432GrossReceiptsRltdActivitiesAmt
Public Support CY1701.00000PublicSupportCY170Pct
Public Support PY1701.00000PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$47,135OtherCostOrOtherBasisAmt
Book Value$47,135BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$617,790OtherCostOrOtherBasisAmt
Depreciation$285,031DepreciationAmt
Book Value$332,759BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$396,441OtherCostOrOtherBasisAmt
Depreciation$291,332DepreciationAmt
Book Value$105,109BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$42,487OtherCostOrOtherBasisAmt
Depreciation$24,781DepreciationAmt
Book Value$17,706BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$502,709TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescOTHER LIABILITIESDesc
Amt$4,260Amt
FieldValueIRS element (for citing)
Total Liability$4,260TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$673,333TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$673,333RevenueSubtotalAmt
Total Revenue Per Form990$673,333TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$858,838TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$858,838ExpensesSubtotalAmt
Total Expenses Per Form990$858,838TotalExpensesPerForm990Amt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 11BTHE COMPLETED 990 IS REVIEWED BY THE CFO AND DIRECTOR BEFORE IT IS FILED. THE RETURN IS PRESENTED TO THE BOARD OF DIRECTORS AS THE NEXT SCHEDULED MEETING.
FORM 990, PAGE 6, PART VI, LINE 15AAPPROVED BY THE BOARD
FORM 990, PAGE 6, PART VI, LINE 15BREVIEWED AND APPROVED BY THE BOARD
FORM 990, PAGE 6, PART VI, LINE 19AVAILABLE UPON REQUEST

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1ENGELHARD MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 277AddressLine1Txt
CityENGELHARDCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27824ZIPCd
FieldValueIRS element (for citing)
EIN202271983EIN
Primary ActivitiesFQHCPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd
Exempt Code Section501C3ExemptCodeSectionTxt
Public Charity Status7PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE RFormAndLineReferenceDesc
ExplanationCOMMON BOARD OF DIRECTORS AND MANAGEMENTExplanationTxt

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