PRIMARY CARE AT HOME INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PRIMARY CARE AT HOME INC (EIN 47-5519154)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-09-12
- IRS object ID
- 202232559349302013
- Schema version
- 2020v4.0
- 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 | 2022-09-12T14:07:57-07:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 680228024 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HARMON BURSTYN CPA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1012 HACIENDA DR | AddressLine1Txt |
| City | WALNUT CREEK | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94598 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 475519154 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Primary Care at Home INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PRIM | BusinessNameControlTxt |
| Phone | 5108222588 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 29th Street 306 | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94609 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Anh Nguyen | PersonNm |
| Person Title | Secretary | PersonTitleTxt |
| Signature | 2022-09-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Anh | PersonFirstNm |
| Person Last | Nguyen | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Harmon Burstyn | PreparerPersonNm |
| PTIN | P00855188 | PTIN |
| Phone | 9252863522 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
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 |
| Federated Assurance Level | FAL1 | FederatedAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Anh Nguyen | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 29th Street 306 | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94609 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $437,817 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | https://www.pcahi.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2015 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | We provide healthcare and health management services in the Oakland, California Bay Area. We seek to recognize, empathize, and correctly respond to clients individual needs both medically and psychosocially. Everyone in our care is treated with dignity and humanity. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 5 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $190,669 | PYContributionsGrantsAmt |
| CY Contributions Grants | $107,336 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $138,123 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $330,481 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $328,792 | PYTotalRevenueAmt |
| CY Total Revenue | $437,817 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,870 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $53,992 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $260,417 | PYOtherExpensesAmt |
| CY Other Expenses | $402,072 | CYOtherExpensesAmt |
| PY Total Expenses | $274,287 | PYTotalExpensesAmt |
| CY Total Expenses | $456,064 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $54,505 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$18,247 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $72,687 | TotalAssetsBOYAmt |
| Total Assets EOY | $55,008 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,264 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,098 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $60,423 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $41,910 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Primary Care at Home, INC. is a non-profit medical organization providing healthcare and health management services in the Oakland, California Bay Area. We seek to recognize, empathize, and correctly respond to clients individual needs both medically and psychosocially. Everyone in our care is treated with dignity and humanity.Central to this mission is our work towards the eradication of the HIV epidemic in Alameda County (U=U) and our support of people living with HIV/AIDS (PLWH). In addition to primary clinical care and comprehensive supportive services, our work also encompasses preventative health education and intervention (PrEP). | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $422,118 | ExpenseAmt |
| Desc | Shelter Clinic, Aids Drugs Assistance Program (ADAP), Chronic Care Management Program (CCM). Shelter Clinic is where we open a pop-up clinic to serve the homeless population living in Berkeley, which occurred once a week. ADAP is a contract given to us to help us aid people living with HIV to sign up for it and lower their medication costs. CCM is where we call patients living with chronic diseases every month, checking in with them to see if they are adhering to their medications and to assist them with their needs. | Desc |
| Total Program Service Expenses | $422,118 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 5 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Anh Nguyen | PersonNm |
| Phone | 5108222588 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 29th Street | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94609 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (5 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Tim Nguyen | |||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Manuel Mendivil | |||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Anthony E Jones | |||||||
| Chair | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Anh Nguyen | |||||||
| Secretary | 20.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Yani Hyman | |||||||
| Treasurer | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $107,336 | AllOtherContributionsAmt |
| Noncash Contributions | $94,820 | NoncashContributionsAmt |
| Total Contributions | $107,336 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| ADAP | 900099 | $11,075 | $11,075 |
| CCM | 900099 | $39,875 | $39,875 |
| Clinic | 900099 | $833 | $833 |
| RW - HCBHS | 900099 | $33,684 | $33,684 |
| Waiver | 900099 | $245,014 | $245,014 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $330,481 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $437,817 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $330,481 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,954 | TotalAmt |
| Program Services | $48,954 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,038 | TotalAmt |
| Program Services | $5,038 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,000 | TotalAmt |
| Management And General | $3,000 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,850 | TotalAmt |
| Program Services | $101,850 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,210 | TotalAmt |
| Management And General | $3,210 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,121 | TotalAmt |
| Program Services | $37,121 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,080 | TotalAmt |
| Management And General | $2,080 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,032 | TotalAmt |
| Management And General | $6,032 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Patient Supplies | $94,820 | $94,820 |
| Waiver - Food Vouchers/Supple. | $46,050 | $46,050 |
| Waiver Expenses | $26,500 | $26,500 |
| CCM Stipends | $21,624 | $21,624 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,785 | TotalAmt |
| Program Services | $40,161 | ProgramServicesAmt |
| Management And General | $19,624 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $456,064 | TotalAmt |
| Program Services | $422,118 | ProgramServicesAmt |
| Management And General | $33,946 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,321 | BOYAmt |
| EOY | $55,008 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,366 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,687 | BOYAmt |
| EOY | $55,008 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,264 | BOYAmt |
| EOY | $13,098 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,264 | BOYAmt |
| EOY | $13,098 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,423 | BOYAmt |
| EOY | $41,910 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,423 | BOYAmt |
| EOY | $41,910 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,687 | BOYAmt |
| EOY | $55,008 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$18,247 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$266 | PriorPeriodAdjustmentsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,581 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $91,461 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $190,669 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $107,336 | CurrentTaxYearAmt |
| Total | $404,047 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $138,122 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $330,481 | CurrentTaxYearAmt |
| Total | $468,603 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,581 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $91,461 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $328,791 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $437,817 | CurrentTaxYearAmt |
| Total | $872,650 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $872,650 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,581 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $91,461 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $328,791 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $437,817 | CurrentTaxYearAmt |
| Total | $872,650 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1.00000 | PublicSupportCY509Pct |
| Public Support PY509 | 1.00000 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $94,820 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (25 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | A draft is provided and any needed changes are made prior to filing. |
| Form 990, Part VI, Line 18: Explanation of Other Means Forms Available For Public Inspection | The Form 990 is available at irs.gov and guidestar.org. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Upon request. |
| Form 990, Part IX, Line 24e: Other Expenses | Bank Charge: Column (A) - Total = $482; Column (B) - Program Services = $0; Column (C) - Management & General = $482; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Books, Subscriptions, Ref: Column (A) - Total = $57; Column (B) - Program Services = $57; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Business Licensure: Column (A) - Total = $2221; Column (B) - Program Services = $0; Column (C) - Management & General = $2221; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Business Registration Fees: Column (A) - Total = $65; Column (B) - Program Services = $0; Column (C) - Management & General = $65; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | EHR: Column (A) - Total = $5853; Column (B) - Program Services = $0; Column (C) - Management & General = $5853; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Hardware: Column (A) - Total = $4617; Column (B) - Program Services = $0; Column (C) - Management & General = $4617; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Job Postings: Column (A) - Total = $2587; Column (B) - Program Services = $0; Column (C) - Management & General = $2587; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Payroll Fees: Column (A) - Total = $714; Column (B) - Program Services = $0; Column (C) - Management & General = $714; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Printing and Publications: Column (A) - Total = $300; Column (B) - Program Services = $0; Column (C) - Management & General = $300; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Ryan White Expenses - Other: Column (A) - Total = $112; Column (B) - Program Services = $112; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Shelter Stipends: Column (A) - Total = $9331; Column (B) - Program Services = $9331; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Software: Column (A) - Total = $2785; Column (B) - Program Services = $0; Column (C) - Management & General = $2785; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Staff Incentives: Column (A) - Total = $162; Column (B) - Program Services = $162; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Stipends - Other: Column (A) - Total = $2200; Column (B) - Program Services = $2200; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Stipends - RDN: Column (A) - Total = $9970; Column (B) - Program Services = $9970; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Supplies: Column (A) - Total = $2936; Column (B) - Program Services = $2936; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Telephone/Communications: Column (A) - Total = $1663; Column (B) - Program Services = $1663; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Waiver - DME for Ps: Column (A) - Total = $393; Column (B) - Program Services = $393; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Waiver - Mileage: Column (A) - Total = $189; Column (B) - Program Services = $189; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Waiver - Phones: Column (A) - Total = $2035; Column (B) - Program Services = $2035; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Waiver - Transportation: Column (A) - Total = $10621; Column (B) - Program Services = $10621; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Waiver Expenses - Other: Column (A) - Total = $492; Column (B) - Program Services = $492; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
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