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.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
FIRELANDS REGIONAL MEDICAL CENTER
 
Employer identification number
34-4428218
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
non-cash assistance
(h) Purpose of grant
or assistance
(1) FAMILY HEALTH SERVICES OF ERIE COUNTY
1912 HAYES AVE
SANDUSKY,OH44870
26-3607741 501(C)(3) 240,004       GENERAL SUPPORT
(2) TEEN LEADERSHIP CORPS
26 E CEDAR POINT RD
SANDUSKY,OH44870
26-0324010 501(C)(3) 11,000       GENERAL SUPPORT
(3) ERIE COUNTY ECONOMIC DEVELOPMENT
247 COLUMBUS AVE
SANDUSKY,OH44870
34-1590450 501(C)(3) 12,500       GENERAL SUPPORT
(4) COMMITTEE TO REBUILD SANDUSKY
615 COLUMBUS AVE
SANDUSKY,OH44870
47-1540742 527 25,000       GENERAL SUPPORT
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014
Page 2

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. 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
(1) SCHOLARSHIPS TO BEGIN OR CONTINUE COURSE WORK 28 28,000      
(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 II LINE 1 TO EXPAND THE DELIVERY OF HEALTH CARE SERVICES AND PROMOTE A HEALTHY QUALITY OF LIFE FOR THE MEDICALLY UNDERSERVED PERSONS OF ERIE COUNTY, OHIO. FIRELANDS REGIONAL MEDICAL CENTER SUPPORTS THE MISSION OF FAMILY HEALTH SERVICES OF ERIE COUNTY TO ATTAIN THE DESIGNATION OF FEDERALLY QUALIFIED HEALTH CENTER AND DELIVER ITS INTENDED SERVICES. THE USE OF FUNDS CONTRIBUTED IS MONITORED BY THE REVIEW OF FINANCIAL AND PERFORMANCE REPORTS.
PART III LINE 1 SCHOLARSHIPS - TO BE ELIGIBLE FOR THE "EDUCATION PAYMENT PROGRAM", A CANDIDATE MUST BE A QUALIFIED FAMILY MEMBER OF A CURRENT ACTIVE EMPLOYEE AND BE SPONSORED BY THEIR FIRELANDS-EMPLOYED FAMILY MEMBER; BE A HIGH SCHOOL GRADUATE (OR EQUIVALENT) OR A HIGH SCHOOL SENIOR PLANNING TO BEGIN OR CONTINUE COURSE WORK AT AN ACCREDITED EDUCATIONAL INSTITUTION WITHIN ONE YEAR OF SUBMITTING A PROGRAM APPLICATION; AND HAVE A CUMMULATIVE ACADEMIC AVERAGE OF "C" OR BETTER.
PART III LINE 1 AWARD RECIPIENTS ARE SELECTED BASED ON APPLICATION, PAST ACADEMIC PERFORMANCE, FIELD OF STUDY, EDUCATIONAL INSTITUTION, ECONOMIC NEED AND AVAILABILITY OF FUNDS. THIS PROGRAM IS ADMINISTERED WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, AGE, ANCESTRY, NATIONAL ORIGIN OR DISABILITY. FUNDS ARE PAID DIRECTLY TO THE SCHOOL ON BEHALF OF THE RECIPIENT.
Schedule I (Form 990) 2014



Additional Data


Software ID:  
Software Version: