MIAMI RESCUE MISSION CLINIC INC: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
MIAMI RESCUE MISSION CLINIC INC (EIN 45-1481860)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-06-14
IRS object ID
202411669349300316
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

FieldValueIRS element (for citing)
Return2024-06-14T08:48:37-05:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN830696713PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GARCIA ESPINOSA MIYARES RODRIGUEZ TRUEBABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12600 S DOUGLAS ROAD SUITE 800AddressLine1Txt
CityCORAL GABLESCityNm
State AbbreviationFLStateAbbreviationCd
ZIP33134ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN451481860EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MIAMI RESCUE MISSION CLINIC INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMIAMBusinessNameControlTxt
Phone7868665705PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NW 1ST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPETER A GUTIERREZ MD MMSPersonNm
Person TitleOFFICER AND DIRECTORPersonTitleTxt
Phone3055722026PhoneNum
Signature2024-06-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstPETERPersonFirstNm
Person LastGUTIERREZ MD MMSPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJARNETTE G RODRIGUEZ CPAPreparerPersonNm
PTINP01062623PTIN
Phone3055295440PhoneNum
Preparation2024-05-28PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerPETER A GUTIERREZ MD MMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NW FIRST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,980,109GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CARINGPLACECLINIC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionMIAMI RESCUE MISSION CLINIC, INC. IS COMMITTED TO PROVIDE ACCESS TO COMPREHENSIVE PRIMARY HEALTH CARE TO THE COMMUNITY'S HOMELESS, MEDICALLY UNINSURED AND UNDERSERVED, AS WELL AS TO IMPLEMENT AND DELIVER COMMUNITY OUTREACH PROGRAMS THAT INCLUDE HEALTHCARE SCREENINGS INFORMATION AND EDUCATION, INCLUDING GUIDANCE ON AND REFERRALS TO THE FULL CONTINUUM OF PERSONAL AND COMMUNITY DEVELOPMENT. TO THIS END, MIAMI RESCUE MISSION, INC. WILL SERVE THE LOCAL COMMMUNITY WITH HIGHER STANDARDS OF MEDICAL CARE IN AN ENVIRONMENT IN WHICH EACH PATIENT IS TREATED WITH DIGNITY AND RESPECT.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee14TotalEmployeeCnt
Total Volunteers247TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$436,005PYContributionsGrantsAmt
CY Contributions Grants$376,895CYContributionsGrantsAmt
PY Program Service Revenue$1,636,796PYProgramServiceRevenueAmt
CY Program Service Revenue$1,600,040CYProgramServiceRevenueAmt
PY Investment Income$324PYInvestmentIncomeAmt
CY Investment Income$349CYInvestmentIncomeAmt
PY Other Revenue$4,114PYOtherRevenueAmt
CY Other Revenue$2,825CYOtherRevenueAmt
PY Total Revenue$2,077,239PYTotalRevenueAmt
CY Total Revenue$1,980,109CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$611,810PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$590,227CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$42,554CYTotalFundraisingExpenseAmt
PY Other Expenses$1,334,045PYOtherExpensesAmt
CY Other Expenses$1,136,868CYOtherExpensesAmt
PY Total Expenses$1,945,855PYTotalExpensesAmt
CY Total Expenses$1,727,095CYTotalExpensesAmt
PY Revenues Less Expenses$131,384PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$253,014CYRevenuesLessExpensesAmt
Total Assets BOY$726,265TotalAssetsBOYAmt
Total Assets EOY$1,037,055TotalAssetsEOYAmt
Total Liabilities BOY$22,686TotalLiabilitiesBOYAmt
Total Liabilities EOY$80,462TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$703,579NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$956,593NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITY IS TO PROVIDE PRIMARY HEALTHCARE TO THE COMMUNITY'S HOMELESS, MEDICALLY UNINSURED AND UNDERSERVED, AS WELL AS TO IMPLEMENT AND DELIVER COMMUNITY OUTREACH PROGRAMS THAT INCLUDE HEALTHCARE SCREENINGS, INFORMATION AND EDUCATION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$1,321,571ExpenseAmt
Revenue$1,603,214RevenueAmt
DescMIAMI RESCUE MISSION CLINIC, INC. HAS BEEN PROVIDING COMPREHENSIVE HEALTHCARE TO THE COMMUNITY'S HOMELESS AND MEDICALLY INSURED.Desc
Total Program Service Expenses$1,321,571TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee14EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind0Form8899Filedind
Form1098 C Filed0Form1098CFiledInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GUSTAVO AGUIARBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3055722026PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NE FIRST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
NICOLAS MASSIMINI
DIRECTOR5.00Yes (X)$0$0$0
MARTH LOPEZ
DIRECTOR5.00Yes (X)$0$0$0
CARLOS ACOSTA
DIRECTOR5.00Yes (X)$0$0$0
RICARDO FORBES
DIRECTOR1.00Yes (X)$0$0$0
DR ARMANDO FERRER
DIRECTOR1.00Yes (X)$0$0$0
JEFF TEW JD
DIRECTOR1.00Yes (X)$0$0$0
DR LINDA WASHINGTON
DIRECTOR1.00Yes (X)$0$0$0
JIMMY SANTANA
DIRECTOR1.00Yes (X)$0$0$0
JOAQUIN DEL CUETO
DIRECTOR5.00Yes (X)$0$0$0
ROGER M GORDON
OFFICER AND DIRECTOR5.00Yes (X)$0$0$0
ENRIQUE FERNANDEZ
DIRECTOR1.00Yes (X)$0$0$0
VICTOR MILIAN
DIRECTOR1.00Yes (X)$0$0$0
RONALD BRUMMIT
PRESIDENT1.00Yes (X)$0$0$0
STANLEY MARKS
DIRECTOR1.00Yes (X)$0$0$0
PAUL DAVIES
DIRECTOR1.00Yes (X)$0$0$0
PETER A GUTIERREZ MD
OFFICER AND DIRECTOR40.00$100,000$0$0Yes (X)
JESUS INGUANZO
CHIEF OPERATING OFFICER40.00$5,712$0$0Yes (X)
GISELA BRETONES
CLINIC ADMINISTRATOR40.00$87,125$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$192,837TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Government Grants$265,692GovernmentGrantsAmt
All Other Contributions$111,203AllOtherContributionsAmt
Total Contributions$376,895TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
IN-KIND GIFTS/SERVICES621110$1,288,856$1,288,856
FEES FOR SERVICES621110$311,184$311,184
FieldValueIRS element (for citing)
Total Program Service Revenue$1,600,040TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$349TotalRevenueColumnAmt
Related Or Exempt Func Income$349RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescREFUNDDesc
Business621110BusinessCd
Total Revenue Column$2,825TotalRevenueColumnAmt
Related Or Exempt Func Income$2,825RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$2,825OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,980,109TotalRevenueColumnAmt
Related Or Exempt Func Income$1,603,214RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$544,610TotalAmt
Program Services$386,526ProgramServicesAmt
Management And General$141,631ManagementAndGeneralAmt
Fundraising$16,453FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$45,617TotalAmt
Program Services$31,634ProgramServicesAmt
Management And General$12,530ManagementAndGeneralAmt
Fundraising$1,453FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$19,000TotalAmt
Management And General$19,000ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$16,830TotalAmt
Program Services$1,561ProgramServicesAmt
Management And General$15,269ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$11,443TotalAmt
Management And General$2,585ManagementAndGeneralAmt
Fundraising$8,858FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$16,074TotalAmt
Program Services$16,074ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$505TotalAmt
Management And General$505ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$49,166TotalAmt
Program Services$40,188ProgramServicesAmt
Management And General$8,045ManagementAndGeneralAmt
Fundraising$933FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
DONATED PROFESSIONAL FE$555,487$555,487
DONATED RENT$146,520$29,304$117,216
MEDICAL DOCTOR$142,750$142,750
DONATED MATERIALS AND S$39,999$39,999

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$139,094TotalAmt
Program Services$78,048ProgramServicesAmt
Management And General$46,189ManagementAndGeneralAmt
Fundraising$14,857FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,727,095TotalAmt
Program Services$1,321,571ProgramServicesAmt
Management And General$362,970ManagementAndGeneralAmt
Fundraising$42,554FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$340,400BOYAmt
EOY$557,232EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$378,889BOYAmt
EOY$477,239EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$3,887BOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$30,129LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$30,129LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$505BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$2,584BOYAmt
EOY$2,584EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$726,265BOYAmt
EOY$1,037,055EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$11,674BOYAmt
EOY$21,066EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$11,012BOYAmt
EOY$59,396EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$22,686BOYAmt
EOY$80,462EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$703,579BOYAmt
EOY$956,593EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$703,579BOYAmt
EOY$956,593EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$726,265BOYAmt
EOY$1,037,055EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$253,014ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit Committee0AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$30,129InvestmentCostOrOtherBasisAmt
Depreciation$30,129DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$1,980,109TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$1,980,109RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$1,980,109TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$1,727,095TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$1,727,095ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$1,727,095TotalExpensesPerForm990Amt

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonPETER GUITERREZPersonNm
Relationship With OrgDIRECTORRelationshipWithOrgTxt
Loan PurposeTO OPEN A BANK ACCOUNT FOR PAYING FUTURE INVOICES FROM ATHENA HEALTH.LoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$3,887OriginalPrincipalAmt
Balance Due$0BalanceDueAmt
Default0DefaultInd
Board Or Committee ApprovalYes (1)BoardOrCommitteeApprovalInd
Written Agreement0WrittenAgreementInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L - PART IIFormAndLineReferenceDesc
ExplanationATHENA HEALTH IS THE COMPANY IN CHARGE OF KEEPING CLINIC'S MEDICAL RECORDS AND THE BILLING OF POSSIBLE PAYMENTS TO BE RECEIVED FROM MEDICARE AND MEDICAID.ExplanationTxt

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)PROFESSIONAL SERVICES0$555,487ORGANIZATION'S LIST
Yes (X)RENT0$146,520MARKET VALUE OF RENT
Yes (X)MEDICINES0$39,999CONTRIBUTORS PROVIDE
IN-KIND GIFTS0$0CONTRIBUTORS PROVIDE
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BFORM 990 IS REVIEWED AND APPROVED BY THE ORGANIZATION TREASURER PRIOR TO FILING.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION WILL PROVIDE INFORMATION TO THE PUBLIC UPON REQUEST

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