RACINE COMMUNITY HEALTH CLINIC INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- RACINE COMMUNITY HEALTH CLINIC INC (EIN 83-3380912)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-05-14
- IRS object ID
- 202431359349310548
- Schema version
- 2023v5.0
- 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 | 2024-05-14T16:20:17-05:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390974031 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEGNER CPAS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2921 LANDMARK PL STE 300 | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 537134236 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 833380912 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RACINE COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RACI | BusinessNameControlTxt |
| Phone | 2628007242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 930 DR MARTIN LUTHER KING DR ENT 3 | AddressLine1Txt |
| City | RACINE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53404 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DARRICK MINZEY | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 2628007242 | PhoneNum |
| Signature | 2024-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DARRICK | PersonFirstNm |
| Person Last | MINZEY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMANDA VANNATTA CPA | PreparerPersonNm |
| PTIN | P00948755 | PTIN |
| Phone | 6082744020 | PhoneNum |
| Preparation | 2024-05-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | SHEBANIAH MUHAMMAD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 930 DR MARTIN LUTHER KING DR ENT 3 | AddressLine1Txt |
| City | RACINE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53404 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $204,602 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | RACINECHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2019 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | CONDUCT CHARITABLE AND EDUCATIONAL ACTIVITIES, PROVIDING ESSENTIAL MEDICAL AND HEALTH SERVICES TO COMMUNITY MEMBERS OF THE GREATER RACINE AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $216,466 | PYContributionsGrantsAmt |
| CY Contributions Grants | $173,781 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,790 | CYProgramServiceRevenueAmt |
| PY Investment Income | $67 | PYInvestmentIncomeAmt |
| CY Investment Income | $31 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $216,533 | PYTotalRevenueAmt |
| CY Total Revenue | $204,602 | 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 | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $16,776 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $316,553 | PYOtherExpensesAmt |
| CY Other Expenses | $659,329 | CYOtherExpensesAmt |
| PY Total Expenses | $316,553 | PYTotalExpensesAmt |
| CY Total Expenses | $659,329 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$100,020 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$454,727 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $430,128 | TotalAssetsBOYAmt |
| Total Assets EOY | $215,961 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $95,841 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $430,128 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $120,120 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ENHANCE HEALTH CARE ACCESS AND ENGAGE IN QUALITY SERVICE DELIVERY TO RESIDENTS OF RACINE COUNTY.GOALS:1. CREATE COMPREHENSIVE SERVICES/PROGRAMS THAT FILL HEALTH CARE SERVICE GAPS.2. PROVIDE HIGH-QUALITY, AFFORDABLE, COMMUNITY-CENTERED SERVICES.3. ESTABLISH SUSTAINABLE AND RESILIENT SERVICE MODEL LEVERAGING EXISTING COMMUNITY PARTNERSHIPS.4. CREATE A MORE VIBRANT COMMUNITY THROUGH RESOURCE EXPANSION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $460,524 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $30,790 | RevenueAmt |
| Desc | CONDUCT CHARITABLE AND EDUCATIONAL ACTIVITIES AND PROVIDE ESSENTIAL MEDICAL AND HEALTH SERVICES TO COMMUNITY MEMBERS OF THE GREATER RACINE AREA. | Desc |
| Total Program Service Expenses | $460,524 | 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 | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| 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 |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DARRICK MINZEY | PersonNm |
| Phone | 2628988420 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 730 WASHINGTON AVE | AddressLine1Txt |
| City | RACINE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53403 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| SHEBANIAH MUHAMMAD | ||||||
| PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SHARON JOHNSON | ||||||
| VICE PRESIDENT | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DARRICK MINZEY | ||||||
| TREASURER | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MELISSA CARBAJAL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JANICE LITZA MD | ||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |
| KIMBERLY WALKER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DANIEL B ROSS MD | ||||||
| DIRECTOR (BEGAN MARCH) | 1.00 | Yes (X) | $0 | $0 | $0 | |
| FATIMA WAKEFIELD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MELISSA KAPRELIAN | ||||||
| DIRECTOR (BEGAN MARCH) | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KENOSHA COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4006 WASHINGTON RD | AddressLine1Txt |
| City | KENOSHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53144 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | MEDICAL SERVICES | ServicesDesc |
| Compensation | $296,459 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $167,281 | GovernmentGrantsAmt |
| All Other Contributions | $6,500 | AllOtherContributionsAmt |
| Total Contributions | $173,781 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL SERVICES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $30,790 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,790 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,790 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31 | TotalRevenueColumnAmt |
| Exclusion | $31 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $204,602 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,790 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $31 | ExclusionAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $328,068 | TotalAmt |
| Program Services | $311,452 | ProgramServicesAmt |
| Management And General | $13,847 | ManagementAndGeneralAmt |
| Fundraising | $2,769 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,195 | TotalAmt |
| Management And General | $5,195 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,443 | TotalAmt |
| Management And General | $17,443 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,780 | TotalAmt |
| Program Services | $25,046 | ProgramServicesAmt |
| Management And General | $7,156 | ManagementAndGeneralAmt |
| Fundraising | $3,578 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,734 | TotalAmt |
| Program Services | $25,041 | ProgramServicesAmt |
| Management And General | $12,520 | ManagementAndGeneralAmt |
| Fundraising | $4,173 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,992 | TotalAmt |
| Program Services | $22,110 | ProgramServicesAmt |
| Management And General | $9,332 | ManagementAndGeneralAmt |
| Fundraising | $1,550 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,333 | TotalAmt |
| Program Services | $66,180 | ProgramServicesAmt |
| Management And General | $29,447 | ManagementAndGeneralAmt |
| Fundraising | $4,706 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,936 | TotalAmt |
| Program Services | $4,934 | ProgramServicesAmt |
| Management And General | $20,002 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,106 | TotalAmt |
| Management And General | $3,106 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,216 | TotalAmt |
| Management And General | $44,216 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,474 | TotalAmt |
| Program Services | $916 | ProgramServicesAmt |
| Management And General | $19,558 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL SUPPLIES | Desc |
| Total | $4,845 | TotalAmt |
| Program Services | $4,845 | ProgramServicesAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207 | TotalAmt |
| Management And General | $207 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $659,329 | TotalAmt |
| Program Services | $460,524 | ProgramServicesAmt |
| Management And General | $182,029 | ManagementAndGeneralAmt |
| Fundraising | $16,776 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $430,128 | BOYAmt |
| EOY | $41,089 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $134,869 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $36,432 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $98,437 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $76,435 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $430,128 | BOYAmt |
| EOY | $215,961 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $60,395 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $35,446 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $95,841 | 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 | $430,128 | BOYAmt |
| EOY | $120,120 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $430,128 | BOYAmt |
| EOY | $120,120 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $430,128 | BOYAmt |
| EOY | $215,961 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$454,727 | ReconcilationRevenueExpnssAmt |
| Donated Services And Use Fclts | -$6,000 | DonatedServicesAndUseFcltsAmt |
| Prior Period Adjustments | $13,532 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $137,187 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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 Minus3 Years | $15,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $536,524 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $216,466 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $173,781 | CurrentTaxYearAmt |
| Total | $941,771 | TotalAmt |
Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $18,000 | CurrentTaxYearAmt |
| Total | $18,000 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $15,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $536,524 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $216,466 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $191,781 | CurrentTaxYearAmt |
| Total | $959,771 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $959,771 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $19 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $67 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $31 | CurrentTaxYearAmt |
| Total | $117 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $959,888 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $30,790 | GrossReceiptsRltdActivitiesAmt |
| First5 Years170 | Yes (X) | First5Years170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, SHORT YEAR EXPLANATION: | FormAndLineReferenceDesc |
| Explanation | THE 2019 COLUMN ON SCHEDULE A, PART II REPRESENTS THE SHORT TAX YEAR BEGINNING JANUARY 10, 2019 AND ENDING DECEMBER 31, 2019. THERE WAS NO ACTIVITY DURING THIS INITIAL SHORT YEAR. | ExplanationTxt |
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
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $134,869 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,432 | DepreciationAmt |
| Book Value | $98,437 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $98,437 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE RIGHT-OF-USE ASSETS | Desc |
| Book Value | $76,435 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $76,435 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE LIABILITIES | Desc |
| Amt | $35,446 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $35,446 | TotalLiabilityAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE PREPARED FORM 990 IS REVIEWED BY THE ORGANIZATION'S GOVERNING BODY AND MANAGEMENT BEFORE THE RETURN IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS AND DIRECTORS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY STATEMENT ON AN ANNUAL BASIS. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE REPORTED CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BODY DELEGATED POWERS. AFTER DISCLOSURE OF THE INTEREST AND ALL MATERIAL FACTS, THE INTERESTED PERSON SHALL LEAVE THE GOVERNING BODY OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON BY THE REMAINING DIRECTORS OR COMMITTEE MEMBERS. THE GOVERNING BODY OR DESIGNATED COMMITTEE CONDUCTS PERIODIC REVIEWS TO ENSURE THAT THE ORGANIZATION DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CASH TO ACCRUAL ADJUSTMENT 137,187. |