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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
CUMBERLAND COUNTY HOSPITAL SYSTEM INC
 
Employer identification number
56-0845796
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) Cape Fear Valley Health Foundation
PO Box 87526
Fayetteville,NC28304 		56-1947017 501(c)(3) 467,833       GENERAL SUPPORT
(2) Cape Fear Regional Theatre
1209 Hay St
Fayetteville,NC28305 		56-0856992 501(c)(3) 48,000       General Support
(3) Community Concerts of Fayetteville Incorporated
PO BOX 53932
FAYETTEVILLE,NC28305 		56-1449568 501(c)(3) 30,000       GENERAL SUPPORT
(4) Cape Fear Botanical Garden
536 N Eastern Blvd
Fayetteville,NC28301 		56-1673281 501(c)(3) 20,000       GENERAL SUPPORT
(5) PARTNERSHIP FOR CHILDREN OF CUMBERLAND COUNTY
351 Wagoner Drive
Fayetteville,NC28303 		56-1845926 501(c)(3) 20,000       GENERAL SUPPORT
(6) FAYETTEVILLE TECHNICAL COMMUNITY COLLEGE
2201 HULL ROAD
FAYETTEVILLE,NC28303 		58-1640133 GOVT 15,000       GENERAL SUPPORT
(7) FAYETTEVILLE SYMPHONY ORCHESTRA INC
PO BOX 302
FAYETTEVILLE,NC28302 		58-1393271 501(c)(3) 10,000       GENERAL SUPPORT
(8) GREATER FAYETTEVILLE CHAMBER
225 RAY AVE SUITE 165
FAYETTEVILLE,NC28301 		80-0058724 501(c)(6) 10,000       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
7
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) 2019
Page 2

Schedule I (Form 990) 2019
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)
(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 I, Line 2 Cumberland County Hospital System awards grants to the Cape Fear Valley MedicaY Foundation for the purpose of assisting patients in paying various bills and other expenses which patients cannot pay due to their excessive medical expenses required for treating illness. Patients apply and applications are reviewed by hospital social workers. Any funds granted are paid directly to the organization for which patient owes the bill and/or expense.
Schedule I (Form 990) 2019



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