Totals
- Total revenue
- $181,695
- Total expenses
- $1,041,505
- Contributions and grants received
- $0
- Grants paid
- $0
- Program service revenue
- $179,338
- Investment income
- $2,342
- Other revenue
- $15
- Total assets, end of year
- $736,528
- Total liabilities, end of year
- $319,663
- Net assets or fund balances, end of year
- $416,865
- Program services expenses (Part IX)
- $956,655
- Management and general expenses
- $84,850
- Fundraising expenses
- $0
- Program service expenses (Part III)
- $956,655
Program services were 91.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.
Line items
Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.
Revenue
Part VIII, the statement of revenue.
-
2a · Program service revenue: NET PATIENT REVENUE
total $175,541 · related or exempt $175,541
-
2b · Program service revenue: RENTAL INCOME
total $3,297 · related or exempt $3,297
-
2c · Program service revenue: VALUE BASED INCENTIVE
total $500 · related or exempt $500
-
3 · Investment income
total $2,342 · excluded $2,342
-
11a · Other revenue: MISCELLANEOUS REVENUE
total $15 · related or exempt $15
-
11e · Other revenue, total
$15
Functional expenses
Part IX, the statement of functional expenses.
-
11a · Fees: management
total $11,404 · management and general $11,404
-
11g · Fees: other
total $708,157 · program services $706,949 · management and general $1,208
-
12 · Advertising and promotion
total $265 · program services $265
-
13 · Office expenses
total $42,786 · program services $8,400 · management and general $34,386
-
14 · Information technology
total $8,450 · program services $8,450
-
16 · Occupancy
total $89,742 · program services $89,742
-
17 · Travel
total $1,304 · program services $1,304
-
22 · Depreciation, depletion and amortization
total $108,022 · program services $107,765 · management and general $257
-
23 · Insurance
total $23,777 · program services $228 · management and general $23,549
-
24a · Other expenses: MEDICAL SUPPLIES
total $14,093 · program services $14,093
-
24b · Other expenses: BILLING FEES
total $12,110 · management and general $12,110
-
24c · Other expenses: PHARMACEUTICALS
total $11,453 · program services $11,453
-
24d · Other expenses: OTHER SUPPLIES
total $2,476 · program services $2,350 · management and general $126
-
24e · All other expenses
total $7,466 · program services $5,656 · management and general $1,810
Balance sheet
Part X, book values.
-
1 · Cash, non-interest-bearing
beginning of year $14,619 · end of year $350,435
-
4 · Accounts receivable
beginning of year $55,186 · end of year $63,485
-
10a · Land, buildings and equipment: cost or other basis
$772,549
-
10b · Land, buildings and equipment: accumulated depreciation
$449,941
-
10c · Land, buildings and equipment, net
beginning of year $430,630 · end of year $322,608
-
17 · Accounts payable and accrued expenses
beginning of year $251,639 · end of year $101,045
-
25 · Other liabilities
beginning of year $572,121 · end of year $218,618
-
27 · Net assets without donor restrictions
beginning of year -$323,325 · end of year $416,865
Mission and programs · 2022
Mission
SEE SCHEDULE O
Activities or mission (Part I)
FORSYTH COMMUNITY PCC, LLC IS A JOINT VENTURE FORMED IN 2018 BETWEEN FORSYTH MEMORIAL HOSPITAL, INC. AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER TO PROVIDE HEALTHCARE SERVICES TO FORSYTH COUNTY, NC.
-
FORSYTH COMMUNITY PCC, LLC ("FCPCC") IS A JOINT VENTURE FORMED IN 2018 BETWEEN FORSYTH MEMORIAL HOSPITAL, INC. AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER TO PROVIDE HEALTHCARE SERVICES IN FORSYTH COUNTY, NC. FCPCC OPERATES A COMMUNITY CARE CLINIC, LOCATED IN A HISTORICALLY UNDERSERVED COMMUNITY, AND PROVIDES HEALTHCARE SERVICES AT NOMINAL FEES.
Expenses $956,655 · Revenue $179,353
As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.
Listed in Part VII
-
Amanda BurtonAMANDA BURTON
TREASURER
- Total calculated
- $0
- Hours/week
- 0.2
-
Lia Erickson MDLIA ERICKSON MD
TRUSTEE
- Total calculated
- $0
- Hours/week
- 0.2
-
Joyce MounceJOYCE MOUNCE
SECRETARY
- Total calculated
- $0
- Hours/week
- 0.2
-
Paula BirdPAULA BIRD
TRUSTEE
- Total calculated
- $0
- Hours/week
- 0.2
-
Richard Lord MDRICHARD LORD MD
MEDICAL DIRECTOR/CHAIR
- Total calculated
- $0
- Hours/week
- 0.2
-
John Mann MDJOHN MANN MD
VICE CHAIR
- Total calculated
- $0
- Hours/week
- 0.2
-
Christopher ProutyCHRISTOPHER PROUTY
TRUSTEE
- Total calculated
- $0
- Hours/week
- 0.2
-
Steven ScogginSTEVEN SCOGGIN
TRUSTEE
- Total calculated
- $0
- Hours/week
- 0.2
Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those.
Grants on this return
No itemized grants to organizations on this return.
Provenance
- Return type
- form_990
- Tax year
- 2022
- Filed
- 14 November 2023
- IRS schema version
- 2022v5.0
- Source object
- 202313189349307431
Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.
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