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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.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
KERSHAWHEALTH
 
Employer identification number
57-6005963
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) COMMUNITY MEDICAL CLINIC
110C E DEKALB STREET STE 1B
CAMDEN,SC29020 		57-1074191 501C3 100,000       SUPPORT FOR THE CONT
(2) FOOD FOR THE SOUL
PO BOX 1591
CAMDEN,SC29021 		26-4244051 501C3 100,000       TO PROVIDE FOR A PAR
(3) UNITED WAY OF KERSHAW COUNTY
110 E DEKALB STREET
CAMDEN,SC29020 		57-0717334 501C3 100,000       COMMUNITY TRANSPORT
(4) ACCESSKERSHAW
1165 US 1 SOUTH SUITE 300
LUGOFF,SC29078 		57-1074191 501C3 32,423       PROVIDED TO FUND BI-
(5) IRON SHARPENS INRON CONSULTING GROU
140 AMICKS FERRY RD
SUITE A 319
CHAPIN,SC29036 		81-4472026   18,849       COMMUNITY HEALTH NEE
(6) KERSHAW COUNTY SCHOOL DISTRICT
NORTH CENTRAL HIGH SCHOOL
3000 LOCKHART RD
KERSHAW,SC29067 		57-6000369 GOV 16,000       PROVIDE MH WORKERS
(7) UNITED WAY OF KERSHAW COUNTY
110 E DEKALB STREET
CAMDEN,SC29020 		57-0717334 501C3 25,000       COMMUNITY TRANSPORT
(8) BOYS & GIRLS CLUB OF KERSHAW COUNTY
JACKSON TEEN CENTER
PO BOX 4
CAMDEN,SC29021 		82-4818594 501C3 8,800       SUPPORT YOUTH
(9) IRON SHARPENS IRON CONSULTING GROUP
140 AMICKS FERRY RD
SUITE A 319
CHAPIN,SC29036 		81-4472026   18,848       COMMUNITY HEALTH NEE
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

Schedule I (Form 990) 2021
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
SCHEDULE I, PAGE 1, PART I, LINE 2 THE ORGANIZATION WORKS CLOSELY WITH THE ORGANIZATIONS RECEIVING THE FUNDS AND ENSURES THAT THE FUNDS ARE USED IN ACCORDANCE WITH THE OPERATIONS INTENDED. IN ADDITION, THE ORGANIZATION INCURS EXPENSES ON BEHALF OF THE HOSPITAL FOUNDATION TO ADVANCE HEALTH CARE IN KERSHAW COUNTY TO PROVIDE FOR FUNDRAISING EFFORTS ON BEHALF OF THE ORGANIZATION.
Schedule I (Form 990) 2021



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