LAFOLLETTE MEDICAL FOUNDATION INC: Form 990PF, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- LAFOLLETTE MEDICAL FOUNDATION INC (EIN 20-4901729)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-09-24
- IRS object ID
- 202422689349100217
- Schema version
- 2023v5.1
- 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
- General Explanation Attachment
- Investments Corp Bonds Schedule
- Investments Corp Stock Schedule
- Investments Govt Obligations Sch
- Legal Fees Schedule
- Other Assets Schedule
- Other Expenses Schedule
- Other Increases Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-09-24T15:39:48-05:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621142155 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUGH & COMPANY PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 315 N CEDAR BLUFF RD SUITE 200 | AddressLine1Txt |
| City | KNOXVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204901729 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAFOLLETTE MEDICAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAFO | BusinessNameControlTxt |
| Phone | 4239126963 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1Txt |
| City | JACKSBORO | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37757 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TRACY CHAMBERS | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 4239126963 | PhoneNum |
| Signature | 2024-08-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KELLY A TUCKER CPA | PreparerPersonNm |
| PTIN | P01015909 | PTIN |
| Phone | 8657690660 | PhoneNum |
| Preparation | 2024-08-22 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-08-08 14:25:15Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $9,611,102 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $40,011 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $40,011 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $183,424 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $183,424 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $288,782 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $1,681,605 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $288,782 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $512,217 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $512,217 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $0 | CompOfcrDirTrstDsbrsChrtblAmt |
| Legal Fees Rev And Expnss | $2,700 | LegalFeesRevAndExpnssAmt |
| Legal Fees Net Invst Incm | $2,025 | LegalFeesNetInvstIncmAmt |
| Legal Fees Dsbrs Chrtbl | $675 | LegalFeesDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $16,550 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $11,052 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $5,498 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $60,221 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $60,221 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $9,241 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $3,355 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $29,752 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $12,000 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $17,753 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $118,464 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $88,653 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $23,926 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $543,241 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $581,575 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $661,705 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $88,653 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $605,501 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$149,488 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $423,564 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $487,428 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $312,286 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $312,286 | SavAndTempCashInvstEOYFMVAmt |
| US Government Obligations BOY | $837,845 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $976,145 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $976,145 | USGovtObligationsEOYFMVAmt |
| Corporate Stock BOY | $7,234,231 | CorporateStockBOYAmt |
| Corporate Stock EOY | $7,727,980 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $7,727,980 | CorporateStockEOYFMVAmt |
| Corporate Bonds BOY | $497,124 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $579,983 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $579,983 | CorporateBondsEOYFMVAmt |
| Other Assets BOY | $19,044 | OtherAssetsBOYAmt |
| Other Assets EOY | $14,708 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $14,708 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $9,075,672 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,611,102 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $9,611,102 | TotalAssetsEOYFMVAmt |
| Grants Payable BOY | $28,000 | GrantsPayableBOYAmt |
| Total Liabilities BOY | $28,000 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $9,047,672 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $9,611,102 | NoDonorRstrNetAssestsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $9,047,672 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $9,611,102 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $9,075,672 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $9,611,102 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $9,047,672 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$149,488 | ExcessRevenueOverExpensesAmt |
| Other Increases | $712,918 | OtherIncreasesAmt |
| Subtotal | $9,611,102 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $9,611,102 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|
| PUBLICLY TRADED SECURITIES | P | $1,677,708 | $1,392,823 | $284,885 | $284,885 |
| CAPITAL GAINS DIVIDENDS | P | $3,897 | $3,897 | $3,897 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $288,782 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $5,888 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $5,888 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $5,888 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $9,133 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $0 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $9,133 | TotalPaymentsAndCreditsAmt |
| Es Penalty | $0 | EsPenaltyAmt |
| Overpayment | $3,245 | OverpaymentAmt |
| Applied To ES Tax | $3,245 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | TN | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | WWW.LAFOLLETTEMEDICALFOUNDATION.ORG | WebsiteAddressTxt |
| Individual With Books | JUNE WILBURN | IndividualWithBooksNm |
| Phone | 4239126963 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 RIVERVIEW DRIVE | AddressLine1Txt |
| City | LAFOLLETTE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | 0 | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|
| STACEY WOOD-HEATHERLY | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | PRESIDENT | 1.00 | $0 | $0 | $0 |
| MICHEAL E WALDEN | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | TREASURER | 1.00 | $0 | $0 | $0 |
| TRACI CHAMBERS | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | SECRETARY | 1.00 | $0 | $0 | $0 |
| DR RICHARD BURDEAUX | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| WAYNE KITTS | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| JIM FARRIS JR | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| DEBRA NELSON | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $8,895,709 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $471,346 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $9,367,055 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $9,367,055 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $140,506 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $9,226,549 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $461,327 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $461,327 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $5,888 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $5,888 | TotalTaxAmt |
| Distributable Before Adj | $455,439 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $38,333 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $493,772 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $493,772 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $605,501 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $605,501 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $493,772 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $7,218 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $35,051 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $103,417 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $159,203 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $97,059 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $401,948 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $605,501 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $493,772 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $111,729 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $513,677 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $7,218 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $506,459 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $35,051 | ExcessFromYear4Amt |
| Excess From Year3 | $103,417 | ExcessFromYear3Amt |
| Excess From Year2 | $159,203 | ExcessFromYear2Amt |
| Excess From Year1 | $97,059 | ExcessFromYear1Amt |
| Excess From Current Year | $111,729 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | LAFOLLETTE MEDICAL FOUNDATION | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1Txt |
| City | JACKSBORO | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37757 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 4239126963 | RecipientPhoneNum |
| Recipient Email Address | GRANTS@LAFOLLETTEMEDICALFOUNDATION.ORG | RecipientEmailAddressTxt |
| Form And Info And Materials | PLEASE VISIT THE ORGANIZATION'S WEBSITE AT WWW.LAFOLLETTEMEDICALFOUNDATION.ORG TO OBTAIN THE GRANT APPLICATION | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | NONE | SubmissionDeadlinesTxt |
| Restrictions On Awards | IN ORDER TO BE ELIGIBLE FOR A GRANT FROM THE FOUNDATION, AN ORGANIZATION MUST QUALIFY FOR EXEMPTION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND MUST NOT BE A PRIVATE FOUNDATION AS DEFINED BY SECTION 509(A) OF THE CODE, OR IT MUST BE A PUBLIC INSTRUMENTALITY. GRANTS MAY NOT BE MADE TO INDIVIDUALS. THE FOUNDATION MAY MAKE GRANTS TO ORGANIZATIONS PROVIDING SERVICES TO CAMPBELL COUNTY, TN RESIDENTS FOR THE FOLLOWING PURPOSES: HEALTH SERVICES, PREVENTATIVE ILLNESS, CHILDREN HEALTH AND WELL-BEING, SENIOR SAFETY AND WELLNESS AND ANY HEALTH PROGRAM THAT HAS MERIT AND IS RELATED TO THE FOUNDATION'S MISSION AND OBJECTIVES. | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (15 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| CAMPBELL COUNTY BOARD OF EDUCATION | |||||||
| 172 VALLEY STREET | JACKSBORO | TN | 37757 | NONE | GOVERNMENT AGENCY | INFLUENZA VACCINATION PROGRAM, JELLICO HIGH SCHOOL ATHLETIC PERSONAL TRAINER | $50,000 |
| CAMPBELL COUNTY CHILDREN'S CENTER | |||||||
| 203 INDEPENDENCE LANE | LAFOLLETTE | TN | 37766 | NONE | 501(C)(3) | HEALTH EDUCATION/PREVENTION PROGRAM | $40,280 |
| CAMPBELL COUNTY HEALTH COUNCIL | |||||||
| 162 SHARP AND PERKINS ROAD | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | COMMUNITY HEALTH | $10,000 |
| CAMPBELL COUNTY RURAL FIRE SERVICE | |||||||
| 4422 VICTORY ROAD | LAFOLLETTE | TN | 37766 | NONE | 501(C)(3) | FIRE PROTECTION FOR CAMPBELL COUNTY | $25,000 |
| CAMPBELL COUNTY SENIOR CITIZENS | |||||||
| 102 8TH STREET | LAFOLLETTE | TN | 37766 | NONE | 501(C)(3) | HOME DELIVERED MEALS FOR ELIGIBLE SENIORS | $73,500 |
| CATHOLIC CHARITIES OF EAST TENNESSEE | |||||||
| 3009 LAKE BROOK BLVD | KNOXVILLE | TN | 37909 | NONE | 501(C)(3) | PREGNANCY HELP CENTER | $24,000 |
| CITY OF LAFOLLETTE FIRE DEPARTMENT | |||||||
| 105 E BEECH STREET | LAFOLLETTE | TN | 37766 | NONE | GOVERNMENT AGENCY | FIRE PROTECTION FOR THE CITY OF LAFOLLETTE | $94,964 |
| COMMUNITY HEALTH OF EAST TENNESSEE | |||||||
| PO BOX 209 507 MAIN STREET | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | DRUG COURT PROGRAM, PATIENT CARE | $29,000 |
| EAST TENNESSEE HUMAN RESOURCES AGENCY | |||||||
| 9111 CROSS PARK DR STE D10 | KNOXVILLE | TN | 37766 | NONE | 501(C)(3) | SENIOR SAFETY AND WELLNESS SUPPORT | $30,000 |
| PINNACLE RESOURCE CENTER | |||||||
| 507 MAIN ST | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | HELP PROVIDE INDIVIDUALS FACING HOMELESSNESS WITH THE TOOLS AND RESOURCE TO GET BACK ON THEIR FEET | $32,000 |
| SPRINGS OF LIFE RECOVERY CENTER | |||||||
| PO BOX 893 | JELLICO | TN | 37762 | NONE | 501(C)(3) | RECOVERY CENTER FOR MEN | $60,000 |
| TOWN OF JACKSBORO FIRE DEPARTMENT | |||||||
| 585 MAIN STREET | JACKSBORO | TN | 37757 | NONE | GOVERNMENT AGENCY | RESCUE EQUIPMENT | $17,331 |
| FOOD LIFE SERVICES OF CAMBELL CO | |||||||
| 800 E CHESTNUT ST | LAFOLLETTE | TN | 37766 | NONE | GOVERNMENT AGENCY | EXPANDED NUTRITIONAL DISTRIBUTION | $5,000 |
| HOL HEALTH COUNSELING | |||||||
| 507 MAIN ST | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | MENTAL/BEHAVIORAL HEALTH TREATMENT | $38,500 |
| OPEN ARMS MINISTRY FOOD PANTRY | |||||||
| 1112 MCGHEE LN | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | FOOD PURCHASES | $52,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $581,575 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $40,011 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $183,424 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $288,782 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $512,217 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $512,217 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $16,550 | Amt |
| Net Investment Income | $11,052 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $5,498 | DisbursementsCharitablePrpsAmt |
General Explanation Attachment GeneralExplanationAttachment
General Explanation GeneralExplanationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DETAIL INFO REQUEST | IdentifierTxt |
| Form And Line Reference | FORM 990 PF, PART II, LINE 10B AND LINE 10C | FormAndLineReferenceDesc |
| Medium Explanation | THE INSTRUCTIONS FOR FORM 990-PF REQUIRE A SCHEDULE THAT LISTS EACH SECURITY HELD AT THE END OF THE YEAR, AND TO SHOW WHETHER THAT SECURITY IS REPORTED AT COST BASIS OR FMV. ALL SECURITIES ARE HELD IN A BROKERAGE ACCOUNT THROUGHOUT THE YEAR AND ARE REPORTED AT FMV. THIS SCHEDULE CAN BE PROVIDED TO THE IRS AT THEIR REQUEST. | MediumExplanationTxt |
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond | UBS #KAXX118 (HELD IN BROKERAGE A/C DETAIL AVAILABLE UPON REQUEST) | BondNm |
| EOY Book Value | $579,983 | EOYBookValueAmt |
| EOYFMV | $579,983 | EOYFMVAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Stock | UBS #KAXX118 (HELD IN BROKERAGE ACCOUNT - DETAIL AVAILABLE UPON REQUEST) | StockNm |
| EOY Book Value | $7,727,980 | EOYBookValueAmt |
| EOYFMV | $7,727,980 | EOYFMVAmt |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $976,145 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $976,145 | USGovtObligationsEOYFMVAmt |
| State Local Sec Book Vl EOY | $0 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $0 | StateLocalSecEOYFMVAmt |
Legal Fees Schedule LegalFeesSchedule
Legal Fees LegalFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | LEGAL FEES | CategoryTxt |
| Legal Fees | $2,700 | LegalFeesAmt |
| Net Investment Income | $2,025 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $675 | DisbursementsCharitablePrpsAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (2 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| ACCRUED INTEREST RECEIVABLE | $9,970 | $11,519 | $11,519 |
| PREPAID TAXES | $9,074 | $3,189 | $3,189 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| INSURANCE | $2,532 | $0 | $2,532 |
| OFFICE EXPENSES | $3,220 | $0 | $3,221 |
| CONTRACT LABOR | $24,000 | $12,000 | $12,000 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | UNREALIZED GAIN | Desc |
| Amt | $712,918 | Amt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | UBS FEES | CategoryTxt |
| Amt | $60,221 | Amt |
| Net Investment Income | $60,221 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| FEDERAL EXCISE TAX | $5,886 | $0 | $0 |
| FOREIGN TAX WITHHOLDING | $3,355 | $3,355 | $0 |
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