Civic Intelligence

Forsyth Community Pcc LLC

990 • Fiscal year 2018 • EIN 81-5300614

Jan 01, 2018 to Dec 31, 2018 • Filed on Nov 11, 2019

650 N Highland Ave No 120Winston Salem, NC 27101

(336) 718-2803

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

44th percentile

0.06x

Higher debt load relative to assets than 44% of similar nonprofits.

2018 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2018

Liabilities / Revenue

99th percentile

22.98x

Higher debt load relative to revenue than 99% of similar nonprofits.

2018 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2018

Net Margin

1st percentile

-5362%

Higher net margin than 1% of similar nonprofits.

2018 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2018

Top Officer Pay

35th percentile

$0

Higher top officer pay than 35% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

2018 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2018

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2018

Revenue Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2018

Assets

$1,862,723

No earlier filing loaded for comparison.

Net Assets

$1,754,023

No earlier filing loaded for comparison.

Liabilities

$108,700

No earlier filing loaded for comparison.

Revenue

$4,731

No earlier filing loaded for comparison.

Expenses

$258,406

No earlier filing loaded for comparison.

Net Income

-$253,675

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$2.0M$1.0M$0-$1.0MAssets 2018: $1,862,723Liabilities 2018: $108,700Net Assets 2018: $1,754,0232018Assets 2019: $1,146,558Liabilities 2019: $164,579Net Assets 2019: $981,9792019Assets 2020: $1,152,697Liabilities 2020: $279,942Net Assets 2020: $872,7552020Assets 2021: $500,435Liabilities 2021: $823,760Net Assets 2021: -$323,3252021Assets 2022: $736,528Liabilities 2022: $319,663Net Assets 2022: $416,8652022Assets 2023: $1,004,734Liabilities 2023: $288,407Net Assets 2023: $716,3272023

Highlighted filing

2018

Assets$1,862,723
Liabilities$108,700
Net Assets$1,754,023

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$2.0M$1.0M$0-$1.0M-$2.0MRevenue 2018: $4,731Expenses 2018: $258,406Net Income 2018: -$253,6752018Revenue 2019: $65,317Expenses 2019: $837,361Net Income 2019: -$772,0442019Revenue 2020: $133,506Expenses 2020: $952,649Net Income 2020: -$819,1432020Revenue 2021: $243,254Expenses 2021: $1,439,334Net Income 2021: -$1,196,0802021Revenue 2022: $181,695Expenses 2022: $1,041,505Net Income 2022: -$859,8102022Revenue 2023: $349,937Expenses 2023: $1,050,475Net Income 2023: -$700,5382023

Highlighted filing

2018

Revenue$4,731
Expenses$258,406
Net Income-$253,675
Jump To
Filing Snapshot
Filing Period
Jan 1, 2018 to Dec 31, 2018
Signed
Nov 11, 2019
Return Version
2018v3.1
Gross Receipts
$4,731
Mission and Program Overview

Mission

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.

Balance Sheet Detail
LineBeginningEndChange
Assets
Cash and Non-Interest-Bearing Accounts-$1,109,128-
Land, Buildings, and Equipment, Net$0$752,244▲ $752,244
Accounts Receivable-$1,351-
Total Assets$0$1,862,723▲ $1,862,723
Liabilities
Accounts Payable and Accrued Expenses-$73,960-
Other Liabilities$0$34,740▲ $34,740
Total Liabilities$0$108,700▲ $108,700
Net Assets / Fund Balance
Unrestricted Net Assets-$1,754,023-
Total Net Assets Fund Balance$0$1,754,023▲ $1,754,023
Total Liabilities and Net Assets / Fund Balance$0$1,862,723▲ $1,862,723

Asset Categories

AssetBook ValueDepreciationBasis
Leasehold Improvements$530,034$13,591$543,625
Equipment$218,535$4,265$222,800
Other Land Buildings$3,675-$3,675
Compensation and Service Providers

Board Members and Trustees

NameTitle
Motew Stephen MdTrustee / Chair
Lord Richard MdMedical Director / Vice Chair
Burton Amanda MdTrustee
Dunham Charles MdTrustee
Holby LauraTrustee
Lambeth MartyTrustee
Prouty ChristTrustee
Scoggins StevenTrustee

Highest Paid Contractors

ContractorServicesLocationCompensation
Frank L Blum ConstructionConstruction ServicesPO BOX 4153, Winston Salem, NC 27115$473,117
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$1,686
Investment Income
$3,045
Other Revenue
$0
Change in Net Assets
$-253,675
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$258,406
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Other$74,780$11,250-$86,030
Occupancy$34,197--$34,197
Office Expenses$8,811$11,911-$20,722
Depreciation Depletion$17,857--$17,857
All Other Expenses$10,919--$10,919
Insurance-$10,075-$10,075
Other Expenses$5,554$8,000-$5,554
Information Technology$3,846--$3,846
Advertising$2,500--$2,500
Travel$140--$140
Total Functional Expenses$169,722$88,684$0$258,406
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Third Party Payable$34,740
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
Yes

Governance Explanations

Form 990, Part VI, Section A, Line 2

Form 990, part vi, section a, line 2: family and/or business relationships business relationship stephen motew charles dunham business relationship richard lord chris prouty steven scoggins

Form 990, Part VI, Section A, Line 3

Forsyth community pcc, llc ("fcpcc") has delegated management of administrative support services. The manager is responsible for certain management and administrative services including non-clinical operational oversight, utilization review and quality assurance, marketing and branding, financial management including accounting, budget preparation, billing and collections, provider contracting and credentialing, facilities and information technology management, regulatory and risk management, contracting/purchasing services, and recruitment/personnel staffing services. No current or former officers, directors, trustees, key employees or highest compensated employees were compensated by the management company for any services provided to fcpcc during the year.

Form 990, Part VI, Section A, Line 6

Form 990, part vi, section a, line 6: classes of members or stockholders the organization is a limited liability company with members.

Form 990, Part VI, Section A, Line 7A

The limited liability company's members, forsyth memorial hospital, inc. And and wake forest university baptist medical center, each appoint 1/2 of the board.

Form 990, Part VI, Section A, Line 7B

The limited liability company's members, forsyth memorial hospital, inc. And and wake forest university baptist medical center, approve certain transactions and changes to the operating agreement.

Form 990, Part VI, Section B, Line 11B

The return will be reviewed by the board prior to filing.

Form 990, Part VI, Section B, Line 12C

The organization's conflict of interest policy applies to all trustees including members of a committee with board delegated powers. With respect to particular transactions that come before the board, the conflict of interest policy would be followed. The potential conflict of interest would be disclosed by the board member before a vote on the transaction and the rest of the board would determine whether a conflict of interest exists. If the rest of the board determined that a conflict of interest existed then the board member with the conflict of interest would not participate in the deliberations and vote.

Form 990, Part VI, Section C, Line 19

Form 990, part vi, section c, line 19: governing documents disclosure no documents available to the public.

FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS

The filing entity's accounts payable function is managed by their support services provider, novant medical group, inc. (nmg) and as such, they do not issue 1099s directly. Information reported in part vii, section b represents the expenses paid on behalf of the filing entity to independent contractors over $100,000.

Filing and Contact Details

Filer

Filer Name
Forsyth Community Pcc LLC
EIN
81-5300614
Phone
3367182803
Address
650 N HIGHLAND AVE NO 120, WINSTON SALEM, NC 27101

Signing Officer

Name
Richard Lord
Title
Vice Chair
Phone
3367182803
Signed
2019-11-11

Organization Details

Principal Officer
Richard Lord Md
Formed
2016
Legal Domicile
Nc
Voting Board Members
7
Independent Board Members
7
Employees
0
Volunteers
7
Supplemental Narrative

Additional Explanations

FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES

The promotion of health for the benefit of the community is a charitable purpose. Federal health care reform and other changes relating to the provision of health care services have made it increasingly critical for hospital systems and their constituent hospitals to be able effectively to align with other health care providers and physicians as they assume a greater role in providing care for identified at-risk populations. 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 in forsyth county, nc. Access to care is regularly identified as a significant and critical need in our community health needs assessments and addressing it is critical to sustaining a healthy community. The same can be said for affordability. After extensive due diligence and in light of their complementary mission and values, fmh and wake determined that they could work together to address these issues by creating this joint community care clinic, locating it in a historically underserved community, and providing healthcare services at nominal fees. The clinic is committed to ensuring access to high-quality, affordable, comprehensive healthcare for all residents of forsyth county, regardless of their insurance status or their ability to pay.

Form 990, Part III, Line 2

Forsyth community pcc, llc opearates a physician clinic in forsyth county, nc.

Form 990, Part IX, Line 11G

Outside services: program service expenses 74,692. Management and general expenses 11,250. Fundraising expenses 0. Total expenses 85,942. Contracted services: program service expenses 88. Management and general expenses 0. Fundraising expenses 0. Total expenses 88.

FORM 990, PART XI, LINE 9:

Investment capital 2,007,698.

Financial Statement Notes

PART X, LINE 2:

The company is included in the novant health, inc. Consolidated financial statements under generally accepted accounting standards, but does not meet the control requirements to be considered a related entity for form 990 reporting. Novant health is required to evaluate uncertain tax positions. This evaluation includes a quantification of tax risk in areas such as unrelated business taxable income. This evaluation did not have a material effect on the company's consolidated statements of operations and changes in net assets for the years ended december 31, 2018 and 2017.

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IRS990ScheduleD/FootnoteTextInd0X
IRS990ScheduleD/LeaseholdImprovementsGrp/BookValueAmt0530034
IRS990ScheduleD/LeaseholdImprovementsGrp/DepreciationAmt013591
IRS990ScheduleD/LeaseholdImprovementsGrp/OtherCostOrOtherBasisAmt0543625
IRS990ScheduleD/OtherLandBuildingsGrp/BookValueAmt03675
IRS990ScheduleD/OtherLandBuildingsGrp/OtherCostOrOtherBasisAmt03675
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Amt034740
IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc0THIRD PARTY PAYABLE
IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0THE COMPANY IS INCLUDED IN THE NOVANT HEALTH, INC. CONSOLIDATED FINANCIAL STATEMENTS UNDER GENERALLY ACCEPTED ACCOUNTING STANDARDS, BUT DOES NOT MEET THE CONTROL REQUIREMENTS TO BE CONSIDERED A RELATED ENTITY FOR FORM 990 REPORTING. NOVANT HEALTH IS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS FOR THE YEARS ENDED DECEMBER 31, 2018 AND 2017.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART X, LINE 2:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt0752244
IRS990ScheduleD/TotalLiabilityAmt034740
IRS990/ScheduleJRequiredInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE PROMOTION OF HEALTH FOR THE BENEFIT OF THE COMMUNITY IS A CHARITABLE PURPOSE. FEDERAL HEALTH CARE REFORM AND OTHER CHANGES RELATING TO THE PROVISION OF HEALTH CARE SERVICES HAVE MADE IT INCREASINGLY CRITICAL FOR HOSPITAL SYSTEMS AND THEIR CONSTITUENT HOSPITALS TO BE ABLE EFFECTIVELY TO ALIGN WITH OTHER HEALTH CARE PROVIDERS AND PHYSICIANS AS THEY ASSUME A GREATER ROLE IN PROVIDING CARE FOR IDENTIFIED AT-RISK POPULATIONS. 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 IN FORSYTH COUNTY, NC. ACCESS TO CARE IS REGULARLY IDENTIFIED AS A SIGNIFICANT AND CRITICAL NEED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENTS AND ADDRESSING IT IS CRITICAL TO SUSTAINING A HEALTHY COMMUNITY. THE SAME CAN BE SAID FOR AFFORDABILITY. AFTER EXTENSIVE DUE DILIGENCE AND IN LIGHT OF THEIR COMPLEMENTARY MISSION AND VALUES, FMH AND WAKE DETERMINED THAT THEY COULD WORK TOGETHER TO ADDRESS THESE ISSUES BY CREATING THIS JOINT COMMUNITY CARE CLINIC, LOCATING IT IN A HISTORICALLY UNDERSERVED COMMUNITY, AND PROVIDING HEALTHCARE SERVICES AT NOMINAL FEES. THE CLINIC IS COMMITTED TO ENSURING ACCESS TO HIGH-QUALITY, AFFORDABLE, COMPREHENSIVE HEALTHCARE FOR ALL RESIDENTS OF FORSYTH COUNTY, REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1FORSYTH COMMUNITY PCC, LLC OPEARATES A PHYSICIAN CLINIC IN FORSYTH COUNTY, NC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2FORM 990, PART VI, SECTION A, LINE 2: FAMILY AND/OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP STEPHEN MOTEW CHARLES DUNHAM BUSINESS RELATIONSHIP RICHARD LORD CHRIS PROUTY STEVEN SCOGGINS
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3FORSYTH COMMUNITY PCC, LLC ("FCPCC") HAS DELEGATED MANAGEMENT OF ADMINISTRATIVE SUPPORT SERVICES. THE MANAGER IS RESPONSIBLE FOR CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES INCLUDING NON-CLINICAL OPERATIONAL OVERSIGHT, UTILIZATION REVIEW AND QUALITY ASSURANCE, MARKETING AND BRANDING, FINANCIAL MANAGEMENT INCLUDING ACCOUNTING, BUDGET PREPARATION, BILLING AND COLLECTIONS, PROVIDER CONTRACTING AND CREDENTIALING, FACILITIES AND INFORMATION TECHNOLOGY MANAGEMENT, REGULATORY AND RISK MANAGEMENT, CONTRACTING/PURCHASING SERVICES, AND RECRUITMENT/PERSONNEL STAFFING SERVICES. NO CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY THE MANAGEMENT COMPANY FOR ANY SERVICES PROVIDED TO FCPCC DURING THE YEAR.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE ORGANIZATION IS A LIMITED LIABILITY COMPANY WITH MEMBERS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE LIMITED LIABILITY COMPANY'S MEMBERS, FORSYTH MEMORIAL HOSPITAL, INC. AND AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, EACH APPOINT 1/2 OF THE BOARD.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6THE LIMITED LIABILITY COMPANY'S MEMBERS, FORSYTH MEMORIAL HOSPITAL, INC. AND AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, APPROVE CERTAIN TRANSACTIONS AND CHANGES TO THE OPERATING AGREEMENT.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7THE RETURN WILL BE REVIEWED BY THE BOARD PRIOR TO FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES INCLUDING MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt9FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE NO DOCUMENTS AVAILABLE TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt10THE FILING ENTITY'S ACCOUNTS PAYABLE FUNCTION IS MANAGED BY THEIR SUPPORT SERVICES PROVIDER, NOVANT MEDICAL GROUP, INC. (NMG) AND AS SUCH, THEY DO NOT ISSUE 1099S DIRECTLY. INFORMATION REPORTED IN PART VII, SECTION B REPRESENTS THE EXPENSES PAID ON BEHALF OF THE FILING ENTITY TO INDEPENDENT CONTRACTORS OVER $100,000.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt11OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 74,692. MANAGEMENT AND GENERAL EXPENSES 11,250. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 85,942. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 88. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 88.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt12INVESTMENT CAPITAL 2,007,698.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART III, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION A, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION A, LINE 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION A, LINE 6
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION A, LINE 7A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART VI, SECTION A, LINE 7B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc9FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc10FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc11FORM 990, PART IX, LINE 11G
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc12FORM 990, PART XI, LINE 9:
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IRS990/SubjectToProxyTaxInd00
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IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd00
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IRS990/TotalCompGreaterThan150KInd00
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IRS990/TotalFunctionalExpensesGrp/TotalAmt0258406
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IRS990/TotalOtherCompensationAmt00
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IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
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IRS990/USAddress/AddressLine1Txt0650 N HIGHLAND AVE NO 120
IRS990/USAddress/CityNm0WINSTON SALEM
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IRS990/VotingMembersGoverningBodyCnt07
IRS990/VotingMembersIndependentCnt07
IRS990/WebsiteAddressTxt0N/A
IRS990/WhistleblowerPolicyInd00
ReturnHeader/BuildTS02020-03-31 21:24:44Z
ReturnHeader/BusinessOfficerGrp/PersonNm0RICHARD LORD
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0VICE CHAIR
ReturnHeader/BusinessOfficerGrp/PhoneNum03367182803
ReturnHeader/BusinessOfficerGrp/SignatureDt02019-11-11
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0FORSYTH COMMUNITY PCC LLC
ReturnHeader/Filer/BusinessNameControlTxt0FORS
ReturnHeader/Filer/EIN0815300614
ReturnHeader/Filer/PhoneNum03367182803
ReturnHeader/Filer/USAddress/AddressLine1Txt0650 N HIGHLAND AVE NO 120
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ReturnHeader/FilingSecurityInformation/AtSubmissionCreationDeviceId0188B3C7D3A98A2E439561FF9EFF6E804112DA9D7
ReturnHeader/FilingSecurityInformation/AtSubmissionFilingDeviceId0A2315309B7343EB998963AA05290CF11231D17E5
ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd0P
ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt0170.98.106.254
ReturnHeader/FilingSecurityInformation/IPDt02019-11-11
ReturnHeader/FilingSecurityInformation/IPTimezoneCd0ES
ReturnHeader/FilingSecurityInformation/IPTm012:00:03
ReturnHeader/ReturnTs02019-11-15T07:36:40-06:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02018-01-01
ReturnHeader/TaxPeriodEndDt02018-12-31
ReturnHeader/TaxYr02018

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