WILL-GRUNDY MEDICAL CLINIC INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- WILL-GRUNDY MEDICAL CLINIC INC (EIN 36-3492306)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-15
- IRS object ID
- 202401369349305960
- Schema version
- 2022v5.0
- Note
- A later return for the same period supersedes this one.
- 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 | 2024-05-15T10:31:37-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 362416552 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WERMER ROGERS DORAN & RUZON LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 755 ESSINGTON ROAD | AddressLine1Txt |
| City | JOLIET | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 604352845 | 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 | 363492306 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILL GRUNDY MEDICAL CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WILL | BusinessNameControlTxt |
| Phone | 8157265112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 EAST CASS STREET | AddressLine1Txt |
| City | JOLIET | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60432 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LASHAWN MARCONI | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 8157265112 | PhoneNum |
| Signature | 2024-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LASHAWN | PersonFirstNm |
| Person Last | MARCONI | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | THOMAS E LANCASTER | PreparerPersonNm |
| PTIN | P01789625 | PTIN |
| Phone | 8157306250 | PhoneNum |
| Preparation | 2024-05-08 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| 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 | KATHLEEN WOLZ | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 EAST CASS STREET | AddressLine1Txt |
| City | JOLIET | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60432 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $951,467 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | PROVIDING FREE HEALTH-CARE SERVICES TO PEOPLE IN WILL AND GRUNDY COUNTIES WHO ARE UNABLE TO RECEIVE CARE FROM OTHER SOURCES. THESE SERVICES ARE PROVIDED THORUGH DEDICATED HEALTHCARE PROFESSIONALS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 33 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 33 | VotingMembersIndependentCnt |
| Total Employee | 24 | TotalEmployeeCnt |
| Total Volunteers | 390 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $982,219 | PYContributionsGrantsAmt |
| CY Contributions Grants | $982,219 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$31,823 | PYInvestmentIncomeAmt |
| CY Investment Income | -$31,823 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,071 | PYOtherRevenueAmt |
| CY Other Revenue | $1,071 | CYOtherRevenueAmt |
| PY Total Revenue | $951,467 | PYTotalRevenueAmt |
| CY Total Revenue | $951,467 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $601,139 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $601,139 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $93,553 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $475,681 | PYOtherExpensesAmt |
| CY Other Expenses | $475,681 | CYOtherExpensesAmt |
| PY Total Expenses | $1,076,820 | PYTotalExpensesAmt |
| CY Total Expenses | $1,076,820 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$125,353 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$125,353 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,186,101 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,104,820 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,182 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $72,254 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,157,919 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,032,566 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDING FREE HEALTH-CARE SERVICES TO PEOPLE IN WILL AND GRUNDY COUNTIES WHO ARE UNABLE TO RECEIVE CARE FROM OTHER SOURCES. THESE SERVICES ARE PROVIDED THORUGH DEDICATED HEALTHCARE PROFESSIONALS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $904,922 | ExpenseAmt |
| Desc | THE CLINIC PROVIDES THE FACILITIES & SERVICES NECESSARY FOR DELIVERY OF PRIMARY MEDICAL & DENTAL CARE FOR LOW INCOME INDIVIDUALS. THIS YEAR INDIVIDUALS VOLUNTEERED OVEER 16,600 HOURS TO PROVIDE THESE SERVICES. SERVICES INCLUDED 2,838 DIAGNOSTIC TESTS AND PROCEDURES. IN ADDITION, FIVE LOCAL HOSPITALS ACCEPTED OVER 47 CLINIC PATIENTS FOR SURGICAL PROCEDURES AND REALTED SERVICES WITH A TOTAL ESTIMATED COST OF APPROXIMATELY 4,919,123. THE CLINIC ASSISTED THERI PATIENTS TO OBTAIN OVER 225,684 DOLLARS OF PRESCRIPTION MEDICATIONS THROUGH THE INDIGENT PATIENT ASSISTANCE PROGRAM OFFERED BY MANY PHARMACEUTICAL COMPANIES ACROSS THE COUNTRY. | Desc |
| Total Program Service Expenses | $904,922 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 24 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 33 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 33 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LASHAWN MARCONI | PersonNm |
| Phone | 8157263677 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 EAST CASS STREET | AddressLine1Txt |
| City | JOLIET | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60432 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| LASHAWN WEST | ||||||
| DIRECTOR | 40.00 | Yes (X) | $102,082 | $0 | $0 | |
| ISIAH WILLIAMS | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARNE BAILEY | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JAMES D WRIGHT | ||||||
| EXECUTIVE DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| EDNA BRASS | ||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARY BRENCZEWSKI | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TIMOTHY BRODERICK | ||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MATT CAMPBELL | ||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KEMI ALAUSA | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DRANK CSERVENYAK | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CAROL DANIELSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KATHY DUNN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KALISH HILL | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JENNIFER FRYE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOE GEORGE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ANGELA BECK | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BRETT CARR | ||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | |
| GARY LIPINSKI | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TOM KENTNER | ||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| HAZAIQ KHAN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| AN LE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CHRISTINE LUNNINGHAM | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CHARLES MEADE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MITTCHELENA MEADE | ||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAWN MCCARTY | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $102,082 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $523,692 | GovernmentGrantsAmt |
| All Other Contributions | $458,527 | AllOtherContributionsAmt |
| Total Contributions | $982,219 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$31,823 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$31,823 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,071 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,071 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,071 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $951,467 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$30,752 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,082 | TotalAmt |
| Program Services | $81,666 | ProgramServicesAmt |
| Management And General | $10,208 | ManagementAndGeneralAmt |
| Fundraising | $10,208 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $429,857 | TotalAmt |
| Program Services | $343,885 | ProgramServicesAmt |
| Management And General | $42,986 | ManagementAndGeneralAmt |
| Fundraising | $42,986 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,027 | TotalAmt |
| Program Services | $12,821 | ProgramServicesAmt |
| Management And General | $1,603 | ManagementAndGeneralAmt |
| Fundraising | $1,603 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,173 | TotalAmt |
| Program Services | $42,539 | ProgramServicesAmt |
| Management And General | $5,317 | ManagementAndGeneralAmt |
| Fundraising | $5,317 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,531 | TotalAmt |
| Program Services | $4,425 | ProgramServicesAmt |
| Management And General | $553 | ManagementAndGeneralAmt |
| Fundraising | $553 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,319 | TotalAmt |
| Program Services | $1,055 | ProgramServicesAmt |
| Management And General | $132 | ManagementAndGeneralAmt |
| Fundraising | $132 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,571 | TotalAmt |
| Program Services | $7,657 | ProgramServicesAmt |
| Management And General | $957 | ManagementAndGeneralAmt |
| Fundraising | $957 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,538 | TotalAmt |
| Program Services | $14,830 | ProgramServicesAmt |
| Management And General | $1,854 | ManagementAndGeneralAmt |
| Fundraising | $1,854 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,838 | TotalAmt |
| Program Services | $27,870 | ProgramServicesAmt |
| Management And General | $3,484 | ManagementAndGeneralAmt |
| Fundraising | $3,484 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $872 | TotalAmt |
| Program Services | $698 | ProgramServicesAmt |
| Management And General | $87 | ManagementAndGeneralAmt |
| Fundraising | $87 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,978 | TotalAmt |
| Program Services | $23,982 | ProgramServicesAmt |
| Management And General | $2,998 | ManagementAndGeneralAmt |
| Fundraising | $2,998 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,511 | TotalAmt |
| Program Services | $22,009 | ProgramServicesAmt |
| Management And General | $2,751 | ManagementAndGeneralAmt |
| Fundraising | $2,751 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| HOUSING AND TRANSPORTAT | $202,536 | $202,536 | ||
| PRESCRIPTIONS | $68,197 | $68,197 | ||
| ALL OTHER EXPENSES | $41,784 | $34,914 | $3,435 | $3,435 |
| ADMINISTRATIVE | $19,798 | $15,838 | $1,980 | $1,980 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,208 | TotalAmt |
| Fundraising | $15,208 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,076,820 | TotalAmt |
| Program Services | $904,922 | ProgramServicesAmt |
| Management And General | $78,345 | ManagementAndGeneralAmt |
| Fundraising | $93,553 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,865 | BOYAmt |
| EOY | $88,335 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,059 | BOYAmt |
| EOY | $30,101 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,210 | BOYAmt |
| EOY | $44,712 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,397,792 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $789,440 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $622,113 | BOYAmt |
| EOY | $608,352 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $369,854 | BOYAmt |
| EOY | $333,320 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,186,101 | BOYAmt |
| EOY | $1,104,820 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,182 | BOYAmt |
| EOY | $22,250 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $50,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $4 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,182 | BOYAmt |
| EOY | $72,254 | 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 | $869,728 | BOYAmt |
| EOY | $990,153 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $288,191 | BOYAmt |
| EOY | $42,413 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,157,919 | BOYAmt |
| EOY | $1,032,566 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,186,101 | BOYAmt |
| EOY | $1,104,820 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$125,353 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $317,529 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $329,027 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $495,336 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $499,653 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $924,211 | CurrentTaxYearAmt |
| Total | $2,565,756 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $317,529 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $329,027 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $495,336 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $499,653 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $924,211 | CurrentTaxYearAmt |
| Total | $2,565,756 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $2,565,756 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,984 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,660 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $37,256 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $48,747 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | -$31,823 | CurrentTaxYearAmt |
| Total | $87,824 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $59,079 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $76,920 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $58,356 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $71,819 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $103,796 | CurrentTaxYearAmt |
| Total | $369,970 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $3,023,550 | TotalSupportAmt |
| Public Support CY170 | 0.84860 | PublicSupportCY170Pct |
| Public Support PY170 | 0.79030 | 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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,101 | BeginningYearBalanceAmt |
| End Year Balance | $30,101 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,000 | BeginningYearBalanceAmt |
| End Year Balance | $30,000 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,000 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $169 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $30,000 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $30,000 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $168 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $30,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $90,000 | OtherCostOrOtherBasisAmt |
| Book Value | $90,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,149,558 | OtherCostOrOtherBasisAmt |
| Depreciation | $634,212 | DepreciationAmt |
| Book Value | $515,346 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $98,171 | OtherCostOrOtherBasisAmt |
| Depreciation | $95,165 | DepreciationAmt |
| Book Value | $3,006 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $60,063 | OtherCostOrOtherBasisAmt |
| Depreciation | $60,063 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $608,352 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ROUNDING | Desc |
| Amt | $4 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $951,467 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $951,467 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $951,467 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,076,820 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,076,820 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,076,820 | TotalExpensesPerForm990Amt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A MEETING WAS HELD BY THE BOARD OF DIRECTORS TO REVIEW THE FORM 990 PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 15 | IT IS THE POLICY OF THE CLINCIC TO PAY NO MORE THAN REASONABLE COMPENSATION FOR PERSONNEL SERVICES RENDERED TO THE CLINIC. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVENRING DOCUMENTS, POLICIES NAD FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY PROVIDING COPIES UPON REQUEST. |
Comments