GOOD SAMARITAN CLINIC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN CLINIC (EIN 71-0863639)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-04-04
- IRS object ID
- 202430959349301458
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-04-04T16:49:37-04:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 843068935 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRZ CPAS & ADVISORS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 JENNY LIND RD STE B | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 710863639 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 4797830233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 NORTH B STREET | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATTI KIMBROUGH | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 4797830233 | PhoneNum |
| Signature | 2024-03-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | PATTI | PersonFirstNm |
| Person Last | KIMBROUGH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARC LUX CPA | PreparerPersonNm |
| PTIN | P00588449 | PTIN |
| Phone | 4796490888 | PhoneNum |
| Preparation | 2024-04-04 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SCOTT ZUERKER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2711 CLIFF DRIVE | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $890,188 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GOODSAMARITANFS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | TO BE A CHARITABLE HEALTHCARE MINISTRY FOR THE UNDERSERVED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 29 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 29 | VotingMembersIndependentCnt |
| Total Employee | 13 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $603,963 | PYContributionsGrantsAmt |
| CY Contributions Grants | $773,157 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $99,111 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $90,744 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,283 | PYInvestmentIncomeAmt |
| CY Investment Income | $23,633 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,809 | PYOtherRevenueAmt |
| CY Other Revenue | -$77,697 | CYOtherRevenueAmt |
| PY Total Revenue | $720,166 | PYTotalRevenueAmt |
| CY Total Revenue | $809,837 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $371,691 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $392,211 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $63,902 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $249,159 | PYOtherExpensesAmt |
| CY Other Expenses | $316,776 | CYOtherExpensesAmt |
| PY Total Expenses | $620,850 | PYTotalExpensesAmt |
| CY Total Expenses | $708,987 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $99,316 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $100,850 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,163,112 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,275,720 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,362 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,980 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,146,750 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,259,740 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UN-INSURED, ELDERLY, & HOMELESS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $568,183 | ExpenseAmt |
| Revenue | $90,744 | RevenueAmt |
| Desc | THE CLINIC PROVIDES MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UN-INSURED, ELDERLY, & HOMELESS. | Desc |
| Total Program Service Expenses | $568,183 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 13 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 29 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 29 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 4797830233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 NORTH B STREET | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| REBECCA BROWN | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MARK BUERGLER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE DAVIDSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHEN GEBHART | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DR BRANDI GUTHREY | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MELISSA HANESWORTH | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| TIM HEARN | ||||||
| PAST CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| PAT HIGHTOWER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CHRISTOPHER HOOKS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DR DAVID HUNTON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| BOBBIE LAMB | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CRYSTAL LOUGIN | ||||||
| VICE CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| HAROLD MACDOWELL | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| VICTOR MARTINEZ | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MONICA MCGRUDER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DIANNE MEADORS | ||||||
| SECRETARY | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| TINA MEEK | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| NYCOLE OLIVER | ||||||
| PAST CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE PARSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| JAY RICHARDSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DARRELL STOVALL | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| RANDY STRICKLAND | ||||||
| TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JENNIFER TERRY | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STAN VLADAMAR | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DAWN WATTS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE WHITAKER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| HOLLI WILLIS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DR LESLIE ZIEGLER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| SCOTT ZUERKER | ||||||
| CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $112,418 | FundraisingAmt |
| Government Grants | $430 | GovernmentGrantsAmt |
| All Other Contributions | $660,309 | AllOtherContributionsAmt |
| Noncash Contributions | $159,887 | NoncashContributionsAmt |
| Total Contributions | $773,157 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT PAYMENTS | Desc |
| Total Revenue Column | $90,744 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $90,744 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $90,744 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,251 | TotalRevenueColumnAmt |
| Exclusion | $26,251 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,618 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$2,618 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,618 | TotalRevenueColumnAmt |
| Exclusion | -$2,618 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $112,418 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $77,733 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$77,733 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Total Revenue Column | $36 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $36 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $809,837 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $90,780 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $23,633 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $350,676 | TotalAmt |
| Program Services | $235,676 | ProgramServicesAmt |
| Management And General | $57,500 | ManagementAndGeneralAmt |
| Fundraising | $57,500 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,643 | TotalAmt |
| Program Services | $11,193 | ProgramServicesAmt |
| Management And General | $3,450 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,892 | TotalAmt |
| Program Services | $14,208 | ProgramServicesAmt |
| Management And General | $6,342 | ManagementAndGeneralAmt |
| Fundraising | $6,342 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,368 | TotalAmt |
| Program Services | $8,368 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,917 | TotalAmt |
| Program Services | $3,917 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $865 | TotalAmt |
| Program Services | $825 | ProgramServicesAmt |
| Management And General | $24 | ManagementAndGeneralAmt |
| Fundraising | $16 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,109 | TotalAmt |
| Program Services | $80,842 | ProgramServicesAmt |
| Management And General | $2,267 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,916 | TotalAmt |
| Program Services | $1,864 | ProgramServicesAmt |
| Management And General | $52 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,788 | TotalAmt |
| Program Services | $26,057 | ProgramServicesAmt |
| Management And General | $731 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,582 | TotalAmt |
| Program Services | $18,295 | ProgramServicesAmt |
| Management And General | $287 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| IN-KIND EXPENSES | $126,887 | $126,887 | |
| MISCELLANEOUS | $17,643 | $17,162 | $481 |
| DUES & SUBSCRIPTIONS | $8,557 | $8,557 | |
| BOARD FUNCTIONS | $3,975 | $3,975 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,169 | TotalAmt |
| Program Services | $14,332 | ProgramServicesAmt |
| Management And General | $1,793 | ManagementAndGeneralAmt |
| Fundraising | $44 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $708,987 | TotalAmt |
| Program Services | $568,183 | ProgramServicesAmt |
| Management And General | $76,902 | ManagementAndGeneralAmt |
| Fundraising | $63,902 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $704,955 | BOYAmt |
| EOY | $1,085,688 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,286 | BOYAmt |
| EOY | $3,869 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $560,267 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $374,104 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $170,375 | BOYAmt |
| EOY | $186,163 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $285,496 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,163,112 | BOYAmt |
| EOY | $1,275,720 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,362 | BOYAmt |
| EOY | $15,980 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,362 | BOYAmt |
| EOY | $15,980 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $973,029 | BOYAmt |
| EOY | $1,259,740 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $173,721 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,146,750 | BOYAmt |
| EOY | $1,259,740 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,163,112 | BOYAmt |
| EOY | $1,275,720 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $100,850 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $12,140 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $497,485 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $423,664 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $665,601 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $603,963 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $773,157 | CurrentTaxYearAmt |
| Total | $2,963,870 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $497,485 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $423,664 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $665,601 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $603,963 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $773,157 | CurrentTaxYearAmt |
| Total | $2,963,870 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $512,168 | SubstantialContributorsTotAmt |
| Public Support Total170 | $2,451,702 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,271 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,181 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,825 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,826 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $26,251 | CurrentTaxYearAmt |
| Total | $51,354 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $3,015,224 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $368,758 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.81310 | PublicSupportCY170Pct |
| Public Support PY170 | 0.85260 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $250,672 | OtherCostOrOtherBasisAmt |
| Depreciation | $138,297 | DepreciationAmt |
| Book Value | $112,375 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $309,595 | OtherCostOrOtherBasisAmt |
| Depreciation | $235,807 | DepreciationAmt |
| Book Value | $73,788 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $186,163 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $899,710 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $12,140 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $77,733 | OtherRevenueAmt |
| Revenue Not Reported | $89,873 | RevenueNotReportedAmt |
| Revenue Subtotal | $809,837 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $809,837 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $786,720 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $77,733 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $77,733 | ExpensesNotReportedAmt |
| Expenses Subtotal | $708,987 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $708,987 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | FUNDRAISING EVENT EXPENSE 77,733 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | FUNDRAISING EVENT EXPENSE 77,733 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | VARIOUS EVENTS | Event1Nm |
| Gross Receipts Event1 | $112,418 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $112,418 | CharitableContriEvent1Amt |
| Other Direct Expenses Event1 | $77,733 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $112,418 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $112,418 | CharitableContributionsTotAmt |
| Oth Direct Expnss Total Events | $77,733 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $77,733 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$77,733 | NetIncomeSummaryAmt |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $33,000 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | PHYSICIAN HOURS | Desc |
| Contribution | 900 | ContributionCnt |
| Noncash Contributions Rpt F990 | $126,887 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD OF DIRECTORS REVIEWS THE FORM 990 PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | POTENTIAL BOARD MEMBERS ARE QUESTIONED OF ANY POTENTIAL CONFLICTS OF INTER EST. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE FINANCIALS AND FORM 990 ARE KEPT AT THE ORGANIZATION'S PHYSICAL LOCATION AND MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | FUNDRAISING EVENT EXPENSE 77,733 FUNDRAISING EVENT EXPENSE -77,733 |
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