POTOMAC HEALTHCARE FOUNDATION: Form 990PF, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- POTOMAC HEALTHCARE FOUNDATION (EIN 52-1116578)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-13
- IRS object ID
- 202431349349104288
- 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
- Form 990-PF
- Accounting Fees Schedule
- Depreciation Schedule
- Legal Fees Schedule
- Other Assets Schedule
- Other Decreases Schedule
- Other Expenses Schedule
- Other Income Schedule2
- Other Liabilities Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-05-13T15:55:43-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10200 Grand Central Ave Suite 320 | AddressLine1Txt |
| City | Owings Mills | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21117 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 521116578 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POTOMAC HEALTHCARE FOUNDATIONINC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GARY GAGNON | InCareOfNm |
| Business Name Control | POTO | BusinessNameControlTxt |
| Phone | 3017500017 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3800 FREDERICK AVENUE | AddressLine1Txt |
| City | BALTIMORE | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21229 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Leonard Sacks | PersonNm |
| Person Title | Chairman | PersonTitleTxt |
| Phone | 3017500017 | PhoneNum |
| Signature | 2024-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Leonard | PersonFirstNm |
| Person Last | Sacks | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian J Ray | PreparerPersonNm |
| PTIN | P01278507 | PTIN |
| Phone | 4103633200 | PhoneNum |
| Preparation | 2024-05-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $13,018,516 | FMVAssetsEOYAmt |
| Method Of Accounting Other | Yes (X) | MethodOfAccountingOtherInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $4,739,449 | ContriRcvdRevAndExpnssAmt |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $21,899 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $21,899 | InterestOnSavNetInvstIncmAmt |
| Interest On Savings Adj Net Incm | $21,899 | InterestOnSavingsAdjNetIncmAmt |
| Other Income Rev And Expnss | $7,164,074 | OtherIncomeRevAndExpnssAmt |
| Other Income Adj Net Incm | $7,164,074 | OtherIncomeAdjNetIncmAmt |
| Total Rev And Expnss | $11,925,422 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $21,899 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $7,185,973 | TotalAdjNetIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $2,077,753 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Adj Net Incm | $4,818 | OthEmplSlrsWgsAdjNetIncmAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $2,072,935 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $111,146 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Adj Net Incm | $258 | PensionEmplBnftAdjNetIncmAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $110,889 | PensionEmplBnftDsbrsChrtblAmt |
| Legal Fees Rev And Expnss | $1,548 | LegalFeesRevAndExpnssAmt |
| Legal Fees Net Invst Incm | $0 | LegalFeesNetInvstIncmAmt |
| Legal Fees Adj Net Incm | $4 | LegalFeesAdjNetIncmAmt |
| Legal Fees Dsbrs Chrtbl | $1,544 | LegalFeesDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $54,071 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Adj Net Incm | $125 | AccountingFeesAdjNetIncmAmt |
| Accounting Fees Chrtbl Prps | $53,946 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $1,478 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Adj Net Incm | $3 | OtherProfFeesAdjNetIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $1,475 | OtherProfFeesDsbrsChrtblAmt |
| Interest Rev And Expnss | $298,667 | InterestRevAndExpnssAmt |
| Interest Adj Net Incm | $692 | InterestAdjNetIncmAmt |
| Interest Dsbrs Chrtbl | $297,975 | InterestDsbrsChrtblAmt |
| Taxes Rev And Expnss | $163,780 | TaxesRevAndExpnssAmt |
| Taxes Adj Net Incm | $380 | TaxesAdjNetIncmAmt |
| Taxes Dsbrs Chrtbl | $163,400 | TaxesDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $341,485 | DeprecAndDpltnRevAndExpnssAmt |
| Deprec And Dpltn Adj Net Incm | $792 | DeprecAndDpltnAdjNetIncmAmt |
| Occupancy Rev And Expnss | $1,242,343 | OccupancyRevAndExpnssAmt |
| Occupancy Adj Net Incm | $2,881 | OccupancyAdjNetIncmAmt |
| Occupancy Dsbrs Chrtbl | $1,239,462 | OccupancyDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $7,407,798 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Adj Net Incm | $6,056,563 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $1,111,804 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $11,700,069 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $6,066,516 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $5,053,430 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $0 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $0 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $11,700,069 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $6,066,516 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $5,053,430 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $225,353 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $21,899 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $1,119,457 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $5,818,913 | CashBOYAmt |
| Cash EOY | $2,857,002 | CashEOYAmt |
| Cash EOYFMV | $2,857,002 | CashEOYFMVAmt |
| Sav And Temp Cash Invst EOY | $1,214,491 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $1,214,491 | SavAndTempCashInvstEOYFMVAmt |
| Acct Rcvbl | $317,298 | AcctRcvblAmt |
| Acct Rcvbl BOY | $641,279 | AcctRcvblBOYAmt |
| Acct Rcvbl EOY | $317,298 | AcctRcvblEOYAmt |
| Acct Rcvbl EOYFMV | $317,298 | AcctRcvblEOYFMVAmt |
| Grants Receivable BOY | $69,509 | GrantsReceivableBOYAmt |
| Grants Receivable EOY | $132,931 | GrantsReceivableEOYAmt |
| Grants Receivable EOYFMV | $132,931 | GrantsReceivableEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $9,151,457 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,401,678 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $8,091,005 | LandBOYAmt |
| Land EOY | $7,749,779 | LandEOYAmt |
| Land EOYFMV | $7,749,779 | LandEOYFMVAmt |
| Other Assets BOY | $162,683 | OtherAssetsBOYAmt |
| Other Assets EOY | $747,015 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $747,015 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $14,783,389 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,018,516 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $13,018,516 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $353,460 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $227,888 | AccountsPayableEOYAmt |
| Deferred Revenue BOY | $1,439,539 | DeferredRevenueBOYAmt |
| Deferred Revenue EOY | $0 | DeferredRevenueEOYAmt |
| Mortgages And Notes Payable BOY | $5,231,254 | MortgagesAndNotesPayableBOYAmt |
| Mortgages And Notes Payable EOY | $5,122,905 | MortgagesAndNotesPayableEOYAmt |
| Other Liabilities BOY | $2,487,420 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $2,427,862 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $9,511,673 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,778,655 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $4,298,380 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $4,319,861 | NoDonorRstrNetAssestsEOYAmt |
| Donor Rstr Net Assets BOY | $973,334 | DonorRstrNetAssetsBOYAmt |
| Donor Rstr Net Assets EOY | $920,000 | DonorRstrNetAssetsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $5,271,714 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $5,239,861 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $14,783,387 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $13,018,516 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $5,271,714 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $225,353 | ExcessRevenueOverExpensesAmt |
| Subtotal | $5,497,067 | SubtotalAmt |
| Other Decreases | $257,206 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $5,239,861 | TotNetAstOrFundBalancesEOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cap Gains Loss Tx Invst Incm Detail | CapGainsLossTxInvstIncmDetail |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $304 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $304 | SubtotalAmt |
| Tax Based On Investment Income | $304 | TaxBasedOnInvestmentIncomeAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Total Payments And Credits | $0 | TotalPaymentsAndCreditsAmt |
| Tax Due | $304 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | DC | OrgReportOrRegisterStateCd |
| Org Report Or Register State | MD | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | Yes (true) | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GARY GAGNON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3017500017 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 136 | AddressLine1Txt |
| City | EMMITSBURG | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21727 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (true) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | false | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| Leonard Sacks | ||||||||
| 3800 FREDERICK AVENUE | BALTIMORE | MD | 21229 | Chairman/Treasurer/Trustee | 1.0 | $0 | $0 | $0 |
| BARBARA GROVES | ||||||||
| 3800 FREDERICK AVENUE | BALTIMORE | MD | 21229 | President/SECRETARY/TRUSTE | 1.0 | $0 | $0 | $0 |
| Helen Stefan Moreau | ||||||||
| 3800 FREDERICK AVENUE | BALTIMORE | MD | 21229 | Trustee | 1.0 | $0 | $0 | $0 |
| Harold Joyce | ||||||||
| 3800 FREDERICK AVENUE | BALTIMORE | MD | 21229 | Trustee | 1.0 | $0 | $0 | $0 |
| Jonathan Novak | ||||||||
| 3800 FREDERICK AVENUE | BALTIMORE | MD | 21229 | Trustee | 1.0 | $0 | $0 | $0 |
Compensation Highest Paid Empl CompensationHighestPaidEmplGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt |
|---|---|---|---|---|---|---|
| ROBY WILLIAM | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | CFO | 40.0 | $213,923 |
| DIOMI CHIMENE | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | RGISTERED NURSE | 40.0 | $171,346 |
| MARTIN AMY | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | CRNP | 30.0 | $136,691 |
| STAHLEY PHYLLIS | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | DIRECTOR OF ADMISSIO | 40.0 | $125,135 |
| GAGNON GARY | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | CONTROLLER | 40.0 | $92,366 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Employee Paid Over50k | 13 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NETSMART | |||||
| PO BOX 713519 | PHILADELPHIA | PA | 19171 | ELECTRONIC RECORDS | $159,646 |
| BDO | |||||
| PO BOX 642743 | PITTSBURGH | PA | 15264 | AUDIT FIRM | $70,571 |
| DEMPSEY | |||||
| 1200 MID VALLEY DRIVE | JESSUP | PA | 18434 | CLEANING SERVICES | $52,003 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 3 | ContractorPaidOver50kCnt |
Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | THE FOUNDATION PROVIDES RESIDENTIAL TREATMENT AND SERVICES FOR ALCOHOL AND/OR DRUG DEPENDENT PREGNANT AND POSTPARTUM WOMEN ALONG WITH THEIR CHILDREN. | Description1Txt |
| Expenses1 | $5,038,456 | Expenses1Amt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | . | Description1Txt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $0 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $3,829,571 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $3,829,571 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $3,829,571 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $57,444 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $3,772,127 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $188,606 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sect4942j3j5 Fndtn And Frgn Org | Yes (X) | Sect4942j3j5FndtnAndFrgnOrgInd |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $5,053,430 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $5,053,430 | QualifyingDistributionsAmt |
Private Operating Foundations PrivateOperatingFoundationsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Private Operating Fndtn Ruling | 2022-07-26 | PrivateOperatingFndtnRulingDt |
| Section4942j3 | Yes (X) | Section4942j3Ind |
Lessor Adj Net Incm Min Invst Ret LessorAdjNetIncmMinInvstRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $188,606 | CurrentYearAmt |
| Year1 | $389,323 | Year1Amt |
| Year2 | $261 | Year2Amt |
| Year3 | $1,332 | Year3Amt |
| Total | $579,522 | TotalAmt |
Pct85 Lessor Adj Incm Or Min Ret Pct85LessorAdjIncmOrMinRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $160,315 | CurrentYearAmt |
| Year1 | $330,925 | Year1Amt |
| Year2 | $222 | Year2Amt |
| Year3 | $1,132 | Year3Amt |
| Total | $492,594 | TotalAmt |
Qualifying Distributions QualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $5,053,430 | CurrentYearAmt |
| Year1 | $4,890,562 | Year1Amt |
| Year2 | $5,342,759 | Year2Amt |
| Year3 | $5,540,617 | Year3Amt |
| Total | $20,827,368 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Qualifying Distri Not Used Drt | QualifyingDistriNotUsedDrtGrp |
Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $5,053,430 | CurrentYearAmt |
| Year1 | $4,890,562 | Year1Amt |
| Year2 | $5,342,759 | Year2Amt |
| Year3 | $5,540,617 | Year3Amt |
| Total | $20,827,368 | TotalAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $0 | CurrentYearAmt |
| Year1 | $0 | Year1Amt |
| Total | $0 | TotalAmt |
Total Assets Sect4942j3 Bi TotalAssetsSect4942j3BiGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $125,737 | CurrentYearAmt |
| Year1 | $259,549 | Year1Amt |
| Year2 | $262,841 | Year2Amt |
| Year3 | $177,303 | Year3Amt |
| Total | $825,430 | TotalAmt |
Total Support TotalSupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Public Support Type PublicSupportType
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Largest Support From EO LargestSupportFromEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Gross Investment Income GrossInvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Program Service Revenue Dtl ProgramServiceRevenueDtl (3 entries)
| DescDesc | BusinessBusinessCd | Related Or Exempt Function IncmRelatedOrExemptFunctionIncmAmt |
|---|---|---|
| PATIENT REVENUE | 623990 | $6,970,981 |
| OUTPATIENT RENT | 623990 | $168,093 |
| OTHER INCOME | 623990 | $25,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp |
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $21,899 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Dividends And Interest From Sec Dtl | DividendsAndInterestFromSecDtl | |
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp | |
| Net Rntl Incm Re Not Debt Fincd Prop | NetRntlIncmReNotDebtFincdProp | |
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Income | OtherInvestmentIncomeGrp | |
| Gain Sales Ast Oth Than Invntry | GainSalesAstOthThanInvntryGrp | |
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $21,899 | ExclusionAmt |
| Related Or Exempt Function Incm | $7,164,074 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $7,185,973 | TotalIncomeProducingActyAmt |
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (3 entries)
| Line NumberLineNumberTxt | Relationship StatementRelationshipStatementTxt |
|---|---|
| 1a | PATIENT INCOME |
| 1b | OUTPATIENT INCOME |
| 1c | OTHER INCOME |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $54,071 | Amt |
| Adjusted Net Income | $125 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $53,946 | DisbursementsCharitablePrpsAmt |
Depreciation Schedule DepreciationSchedule
Legal Fees Schedule LegalFeesSchedule
Legal Fees LegalFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | LEGAL | CategoryTxt |
| Legal Fees | $1,548 | LegalFeesAmt |
| Adjusted Net Income | $4 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $1,544 | DisbursementsCharitablePrpsAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (3 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| RIGHT OF USE LEASE ASSETS | $0 | $590,764 | $590,764 |
| DEFFERED FINANCING COSTS | $159,169 | $152,737 | $152,737 |
| SECURITY DEPOSITS | $3,514 | $3,514 | $3,514 |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases Detail OtherDecreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PRIOR PERIOD ADJUSTMENT | Desc |
| Amt | $257,206 | Amt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (12 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| BANK CHARGES | $678 | $2 | $676 |
| CONSULTING FEES | $41,808 | $97 | $41,711 |
| DRUGS AND MEDICINE | $1,216 | $3 | $1,213 |
| INSURANCE | $31,380 | $73 | $31,307 |
| MANAGEMENT FEES | $592,041 | $1,371 | $590,668 |
| MINOR EQUIPMENT | $6,497 | $15 | $6,482 |
| PURCHASED SERVICES | $6,053,424 | $6,053,424 | |
| PURCHASED SERVICES - OTHER | $70,285 | $163 | $70,122 |
| SUPPLIES | $346,561 | $804 | $345,757 |
| TRANSPORTATION | $22,536 | $52 | $22,484 |
| ADVERTIZING | $1,386 | $3 | $1,384 |
| AMORTIZATION | $239,986 | $556 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (3 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Adjusted Net IncomeAdjustedNetIncomeAmt |
|---|---|---|
| Patient Revenue | $6,970,981 | $6,970,981 |
| Out patient rent | $168,093 | $168,093 |
| OTHER INCOME | $25,000 | $25,000 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail (2 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt |
|---|---|---|
| DUE TO RELATED PARTIES | $2,487,420 | $1,837,098 |
| RIGHT OF USE LEASE LIABILITY | $0 | $590,764 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | PROFESSIONAL FEES | CategoryTxt |
| Amt | $1,478 | Amt |
| Adjusted Net Income | $3 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $1,475 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | PAYROLL TAXES | CategoryTxt |
| Amt | $163,780 | Amt |
| Adjusted Net Income | $380 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $163,400 | DisbursementsCharitablePrpsAmt |