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," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
C A CANNON CHAR TRUST #1 (#190)
 
Employer identification number
56-6132354
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 Governments and Organizations in the United States. Complete if the organization answered "Yes" to
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 Code 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
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Concordia Lutheran Church
5300 Poplar Tent Rd
Concord,NC28027 		56-0585245   23,000       Faith Community Nurse Program
(2) First Missionary Baptist Church
POB 1322
Concord,NC28026 		56-1572870   32,000       Faith Nurse Community Program
(3) South China Grove Church of God
163 Third Ave
China Grove,NC28023 		56-1606084   19,000       Building Repair Project
(4) Westside Church of the Nazarene
4700 Isenhour Rd
Kannapolis,NC28081 		56-6170610   10,000       Complete Building Program
(5) Church of God Children's Home
3485 Orphange Circle
Concord,NC560599234 		  75,000        
(6) Lees McRae College
375 College Dr
Banner Elk,NC28604 		56-0529953   250,000       Avery Residence Hall Renovation
(7) Rock Hill AME Zion Church
3620 Rock Hill Church Road
Concord,NC28027 		56-1958850   20,000       Debt Reduction
(8) Rowan Cabarrus Community College Foundation Inc
PO Box 1595
Salisbury,NC28145 		56-1731864   189,000       Operational Support North Campus Facilities
(9) Stanly Regional Medical Center
PO Box 1489
Albemarle,NC28002 		56-0556760   96,000       Cancer Support Resource Center/Advocacy Center Director/Case Manager
(10) Boys and Girls Club of Cabarrus County Inc
PO Box 1405
Concord,NC28026 		56-0577630   108,000       Safety procedures upgrade/Play and Fitness structure
(11) Bethel Baptist Church
2474 Dale Earnhardt Blvd
Kannapolis,NC28083 		56-1717806   20,000       Debt reduction
(12) Christ Episcopal Church
3430 Old US Hwy 70
Cleveland,NC27013 		  10,000        
(13) Freedom Christian Worship center - Church of God
607 China Grove Hwy 152 East
Rockwell,NC28138 		56-1582701   15,000       Food Pantry Buiding Project
(14) Gethsemane Missionary Baptist Church
719 South Caldwell Street
Salisbury,NC28144 		56-1287627   25,000       After school tutoring & youth mentoring program
(15) Living Water Church of God
120 S Little Texas Road
Kannapolis,NC28083 		56-1352565   35,000       Support for the Faith Community Healthcare Provider
(16) Mt Gallant Church of God
11105 Mount Gallant Rd
Rock Hill,SC29732 		57-8732619   25,000       Remodel children's church
(17) Unity UMC
8505 Unity Church Rd
Kannapolis,NC28081 		56-1247737   40,000       Mobile meals ministry
(18) Central UMC
30 Union St North
Concord,NC28025 		56-0603902   10,000       Parlor Renovation Project
(19) First Christian United Church of Christ
PO Box 1678
Burlington,NC272161678 		56-0543253   10,000       A/C replacement & Parking Lot Project
(20) First Missionary Baptist Church
PO Box 1322
Concord,NC28026 		56-1572870   20,000       Summer Youth Project
(21) Mt Vernon Presbyterian Church
435 Carson Rd
Woodleaf,NC27054 		32-0128329   15,000       Community Garden Multi Purpose Building
(22) New Birth Baptist Church
600 Annafrel St
Rock Hill,SC29730 		74-3052478   20,000       Replace Heat Pump & Minor Improvment
(23) Providence Presbytery
515 Oakland Ave
Rock Hill,SC29730 		57-0471778   50,000       New cabin construction at Bethelwoods Camp & Conference Center for York SC on behalf of 22 york county presbyterian churches
(24) St James Evangelical Lutheran Church
104 Union Street South
Concord,NC28025 		56-0591309   25,000       Window replacement project
(25) All Saint's Episcopal Church
252 Lake Concord RD NE
Concord,NC28025 		56-0787605   35,000       Debt Reduction
(26) Cabarrus County fbo Library System
PO Box 707
Concord,NC28026 		56-2581471   200,000       Supplemental funding for the Cabarrus County public library
(27) Carolinas Medical Center - Northeast
920 Church Street N
Concord,NC28025 		20-8776473   3,016,225       Required 40% distribution
(28) Catawba College
2300 West Innes Street
Salisbury,NC28144 		56-0530251   250,000       Remodel of Salisbury-Rowan Residence Hall
(29) Centergrove Road Church of Christ
2306 Centergrove Rd
Kannapolis,NC28083 		56-6017710   15,000       Mortgage Assistance, HVAC Replacement
(30) Concordia Lutheran Church
185 Concordia Church Rd
China Grove,NC28023 		56-1997338   7,000       Senior lunch program
(31) First Baptist Church
586 Vincent Street
Norwood,NC28124 		56-1317291   20,000       Sanctuary repair
(32) Glenrock Baptist Church
PO Box 151
Fort Mill,SC29716 		57-1043889   12,000       Van project,debt reduction,limited parking lot paving
(33) Grace Lutheran Church
PO Box 891
Concord,NC28025 		56-1040091   34,000       Faith community health ministry
(34) Lenoir Rhyne University
LR Box 7546
Hickory,NC28601 		56-0556753   250,000       Replacement of admin building's HVAC system & relocation of tele- communication & fiber optic system
(35) Life Way Baptist Church
PO Box 98
York,SC29745 		58-2451048   10,000       Sound & Lighting systems,seating for new facility
(36) Livingstone College
701 W Monroe St
Salisbury,NC28144 		56-0603922   181,000       Capital improvementsto Varick auditorium & Tubman Theater
(37) Lutheran Theological Southern Seminary
4201 North Main Street
Columbia,SC29203 		57-0327888   50,000       Establish wireless network for campus; updating 4 clasrooms & 1 auditorium
(38) Midway UMC
108 Bethpage Rd
Kannapolis,NC28081 		56-0791340   15,000       Acoustical renovation of sanctuary
(39) New Beginnings Baptist Church
706 Old North Main Street
Clover,SC29710 		57-1031381   25,000       Support of Gold's kitchen project
(40) Price Memorial AME Zion Church
PO Box 692
Concord,NC28026 		56-1084954   32,000       Building improvements including a/c repair/ replacement & sound system upgrade request
(41) Prospect Presbyterian Church
9425 WNC 152 Highway
Mooresville,NC28115 		56-0754112   23,000       Faith community health ministry
(42) St Marks Lutheran Church
326 North Main Street
China Grove,NC28023 		56-6072354   10,000       Sanctuary floor renovation
(43) United Presbyterian Church
PO Box 28
Woodleaf,NC27054 		56-1403036   25,000       Facility expansion project
(44) Wingate University
PO Box 159
Wingate,NC28174 		56-6049935   690,000       New & renovated campus housing
(45) Woodleaf UMC
PO Box 299
Woodleaf,NC27054 		56-2113420   6,000       Faith community nurse program
(46) Appalachian Regional Healthcare System Inc
PO Box 2600
Boone,NC28607 		20-1067022   250,000       Post- Acute Care Facility
(47) Bethel AME Zion Church
2219 Dale Earnhardt Blvd
Kannapolis,NC28083 		58-1579300   15,000       Capital Campaign
(48) Bethpage UMC
109 Felowship Ave
Kannapolis,NC28081 		56-1389037   16,000       Sanctuary A/C Replacement
(49) Boger's Chapel UMC
1775 Flowes Store Rd
Concord,NC28025 		56-0186375   15,000       Sanctuary Florr Restoration
(50) Canton Baptist Church
24615 Endy Rd
Albermarle,NC28001 		56-1232494   15,000       Refurbursing projects
(51) Central Baptist Church
PO Box 689
York,SC29745 		57-0737712   10,000       Various projects
(52) Charity Baptist Church
2420 Brantley Rd
Kannapolis,NC28083 		56-1749250   15,000       Repair roof for main sanctuary, metal flashing and gutter damage
(53) East Pickens Baptist Church
2244 Gentry Memorial Hwy
Pickens,SC29671 		57-0523995   15,000       Miracle building project
(54) Eastside Baptist Church
199 Elgin Dr NE
Concord,NC28025 		20-0855278   10,000       Renovation of vestibule and parking area
(55) Ebenezer Evangelical Lutheran Church
4914 Old Beatty Ford
China Grove,NC28023 		56-1315895   15,000       HVAC replacement
(56) First Baptist of Gold Hill
16141 Old Beatty Ford Rd
Gold Hill,NC28071 		56-1535868   10,000       Paving ifront of church
(57) First Church of God
231 Corban Ave
SW Concord,NC28025 		56-6167596   10,000       Parking lot project
(58) First Presbyterian Church
POB 789
Concord,NC28026 		23-6398337   10,000       Memorial garden improvements
(59) First Presbyterian Church
508 West Davis St
Burlington,NC27216 		56-0529969   10,000       Facility Upgrade Project
(60) First Primitive Baptist Church
307 Broad Dr
SW Concord,NC28027 		56-1149291   9,000       A/C Repair
(61) Franklin Heights Baptist Church
532 Wright Ave
Kannapolis,NC28083 		56-0883984   7,300       Scouting Project, including scholarships
(62) Friendship FWB Church
532 West 22nd St
Kannaplois,NC28081 		56-1529293   8,000       Restoration of HVAC and Containment
(63) Friendship UMC
4695 Mt Pleasant Rd
South Concord,NC28025 		56-1388710   15,000       Efficient lighting for softball field
(64) Gilmore Chapel AME Zion Church
762 Central Dr
Concord,NC28027 		56-1384563   15,000       HVAC replacement and other projects
(65) Grace Baptist Church
644 Edgemont St
Albermarle,NC28001 		56-0857926   25,000       Various projects, steeple repair, sanctuary repair & exterior work
(66) Grace Evangelical Lutheran Church
3020 Grace Church Rd
Salisbury,NC28147 		56-1119038   10,000       Family Life Center- Sound System Project
(67) Hillside Presbyterian Church
3743 Maple Ave
Burlington,NC27215 		12-3216547   10,000       HVAC Replacement
(68) Jackson Park United Methodist Church
715 Mabel Ave
Kannapois,NC28081 		56-1131506   7,200       Boiler replacement
(69) Main Street Baptist
POB 62
China Grove,NC28023 		56-1821137   13,000       Paving project
(70) McGill Avenue Baptist Church
5300 Poplar Tent Rd
Concord,NC28027 		56-0585245   35,000       Debt reduction
(71) Milford Hills UMC
1630 Stateville Blvd
Salisbury,NC28144 		56-0791341   10,000       Debt reduction
(72) Mission 217 Baptist Church
465 S Cannon Blvd
Kannapolis,NC28083 		45-4331716   10,000       Sanctuary equipment
(73) Mission Baptist Church
12444 Mission Church Rd
Locust,NC28097 		56-1187930   40,000       Building re-use project, expansion of children's space
(74) Mt Olive Evangelical Lutheran Church
9400 Gold Hill
Mt Pleasant,NC28124 		56-1764587   10,000       Renovation of fellowship building
(75) Mt Zion Missionary Baptist Church
401 Wall Street
Albermarle,NC28001 		20-4659252   10,000       Facility upgrade projects
(76) New Kirk Baptist Church
175 Museum Rd
Rock Hill,SC29732 		57-0988996   10,000       New family life center gym completion
(77) North Kannapolis UMC
1307 North Main St
Kannapolis,NC28081 		56-6001441   20,000       Debt reduction
(78) North Main Baptist Church
1501 N Main St
Salisbury,NC28144 		58-1313646   20,000       Repair and remodeling of sanctuary & other needed repairs
(79) Oakland Baptist Church
1067 Oakland Ave
Rock Hill,SC29732 		57-0792932   10,000       Debt reduction
(80) Parkers Chapel AME Zion Church
578 Old Charlotte Road
Concord,NC28027 		56-1294294   15,000       HVAC Replacement
(81) Pfeiffer University
PO Box960
Misenheimer,NC28109 		56-0529990   200,000       Harris Hall renovation & marketing/branding support
(82) Pickens- 12 Mile Baptist Association
POB 902
Pickens,SC29671 		57-0527739   20,000       Mary's House operations
(83) Pleasant Grove Baptist Church
17236 Frog Pond Rd
Oakboro,NC28129 		56-2188365   35,000       Sanctuary renovation & remodeling
(84) Price Memorial AME Zion Church
POB 692
Concord,NC28026 		56-1084954   15,000       Renovation project - additional grant
(85) Rocky Ridge UMC
1428 Old Charlotte Rd
Concord,NC28027 		56-6170457   10,000       Family Life Center construction
(86) Roddey Baptist Church
PO Box 36
Catawba,SC29704 		57-0699159   10,000       FFinish land project for Family Life Center
(87) Norwood Church of the Nazarene
POB1099
Norwood,NC28128 		58-1371049   10,000       Parking Lot Improvement
(88) Saint Andrew's Episcopal Church
PO Box 849 Rt 70
Haw River,NC27258 		58-1488820   15,000       Window protection & community garden water project
(89) South China Grove Church of God
163 Third Ave
China Grove,NC28023 		56-1606084   53,000       Faith Community Nurse & Renovation of FCN facility
(90) St John's Lutheran Church
100 St Johns Church Rd
Concord,NC28025 		56-0599230   15,000       Installation of heat pump system
(91) St Lukes Lutheran Church
11020 NC Hwy 801
Mt Ulla,NC28125 		56-0599230   10,000       Fellowship building capital campaign support
(92) St Matthews Episcopal Church San Matoe Ministry
4401 Stateville Blvd
Statesville,NC28147 		56-6064806   20,000       Parish house renovation project
(93) Stanly Community College Stanly Community College Foundation
141 College Dr
Albermarle,NC28001 		56-0994111   250,000       Allied health campus concentration project
(94) Trinity United Presbyterian Church of Salisbury
PO Box 1046
Salisbury,NC28145 		56-1357571   20,000       Heating and Air Condition systems renovation
(95) United Love Baptist Church
11487 Flowes Store Rd
Midland,NC28107 		56-1258395   10,000       Foundation work
(96) West Oakboro
16803 Silver Rd
Oakboro,NC28129 		56-1391494   35,000       Debt reduction
(97) York Baptist Assocaition
434 Museum Rd
Rock Hill,SC29732 		57-0426922   15,000       York County Christian Women's Job Corps
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) 2012
Page 2

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to 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
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
910 EXPLANATION FOR FORM 990, SCHEDULE I, PART 1, LINE 2 ORGANIZATIONS ARE REQUIRED TO SUBMIT A DETAILED LIST OF ACTIVITIES FOR WHICH THE GRANT FUNDS WERE USED, AT THE END OF THE YEAR.
Schedule I (Form 990) 2012


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