SACRED HEART COMMUNITY CLINIC INC: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
SACRED HEART COMMUNITY CLINIC INC (EIN 27-2901548)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-10-01
IRS object ID
202432759349300493
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 ReturnHeader

FieldValueIRS element (for citing)
Return2024-10-01T14:07:42-05:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN272901548EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sacred Heart Community ClinicBusinessNameLine1Txt
Business Name Line2Sacred Heart Community ClinicBusinessNameLine2Txt
FieldValueIRS element (for citing)
In Care Of% Jody M PoslusznyInCareOfNm
Business Name ControlSACRBusinessNameControlTxt
Phone5127163929PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1620 Round Rock West Dr Ste BLD 8AddressLine1Txt
CityRound RockCityNm
State AbbreviationTXStateAbbreviationCd
ZIP78681ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJODY M POSLUSZNYPersonNm
Person TitleTreasurerPersonTitleTxt
Phone5127163929PhoneNum
Signature2024-10-01SignatureDt
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrfalseIRSResponsiblePrtyInfoCurrInd
Tax2023TaxYr
Build TS2024-10-15 13:58:12ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Sacred Heart Community ClinicBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerDEBORAH HOPPSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1620 Round Rock West Dr Ste Bld 8AddressLine1Txt
CityRound RockCityNm
State AbbreviationTXStateAbbreviationCd
ZIP78681ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$981,138GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.sacredheartclinic.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2010FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionTo provide free outpatient health and dental services to the uninsured and underinsured of Williamson County TXActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee17TotalEmployeeCnt
Total Volunteers100TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$588,435PYContributionsGrantsAmt
CY Contributions Grants$733,982CYContributionsGrantsAmt
PY Program Service Revenue$163PYProgramServiceRevenueAmt
CY Program Service Revenue$90CYProgramServiceRevenueAmt
PY Investment Income$10,567PYInvestmentIncomeAmt
CY Investment Income$21,572CYInvestmentIncomeAmt
PY Other Revenue$114,765PYOtherRevenueAmt
CY Other Revenue$158,757CYOtherRevenueAmt
PY Total Revenue$713,930PYTotalRevenueAmt
CY Total Revenue$914,401CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$393,521PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$427,879CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$86,483CYTotalFundraisingExpenseAmt
PY Other Expenses$381,407PYOtherExpensesAmt
CY Other Expenses$341,480CYOtherExpensesAmt
PY Total Expenses$774,928PYTotalExpensesAmt
CY Total Expenses$769,359CYTotalExpensesAmt
PY Revenues Less Expenses-$60,998PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$145,042CYRevenuesLessExpensesAmt
Total Assets BOY$1,272,597TotalAssetsBOYAmt
Total Assets EOY$1,448,574TotalAssetsEOYAmt
Total Liabilities BOY$78,078TotalLiabilitiesBOYAmt
Total Liabilities EOY$98,007TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,194,519NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,350,567NetAssetsOrFundBalancesEOYAmt
MissionTo provide no-cost outpatient basic health and dental services, and nutrition and diabetic education to low-income, uninsured and under- insured adult residents of Williamson County, TexasMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$474,933ExpenseAmt
DescProvision of basic outpatient health and dental services, diabetic and nutrional education to qualifying low-income adult residents of Williamson County, TexasDesc
Total Program Service Expenses$474,933TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document10IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld CompliancefalseBackupWthldComplianceInd
Employee17EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Form990 T FiledfalseForm990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Excs Tax Sect4951 Or4952 Or4953falseExcsTaxSect4951Or4952Or4953Ind
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJODY POSLUSZNYPersonNm
Phone5127163929PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1620 Round Rock West Dr Ste Bld 8AddressLine1Txt
CityRound RockCityNm
State AbbreviationTXStateAbbreviationCd
ZIP78681ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
DEBORAH HOPPS
PresidentYes (X)Yes (X)$0$0$0
JODY POSLUSZNY
TreasurerYes (X)Yes (X)$0$0$0
CAROLINE HILBERT
DirectorYes (X)$0$0$0
REV FRANCISCO RODRIGUEZ
DirectorYes (X)$0$0$0
CAROLYN KOEHN
SecretaryYes (X)$0$0$0
VINCE PADUA
directorYes (X)$0$0$0
NANCY NAPOLITANO
directorYes (X)$0$0$0
JODEE O'BRIEN
directorYes (X)$0$0$0
SUMAN CASEY
directorYes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Federated Campaigns$22,500FederatedCampaignsAmt
Fundraising$14,858FundraisingAmt
Government Grants$450,199GovernmentGrantsAmt
All Other Contributions$246,425AllOtherContributionsAmt
Noncash Contributions$29,526NoncashContributionsAmt
Total Contributions$733,982TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescRecord RequestsDesc
Business621110BusinessCd
Total Revenue Column$90TotalRevenueColumnAmt
Related Or Exempt Func Income$90RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$90TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$21,572TotalRevenueColumnAmt
Related Or Exempt Func Income$21,572RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$221,915FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$14,858ContriRptFundraisingEventAmt
Fundraising Direct Expenses$66,737FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$155,178TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescRedemption creditDesc
Business621110BusinessCd
Total Revenue Column$3,579TotalRevenueColumnAmt
Related Or Exempt Func Income$3,579RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$3,579OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$914,401TotalRevenueColumnAmt
Related Or Exempt Func Income$25,241RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$397,472TotalAmt
Program Services$190,787ProgramServicesAmt
Management And General$131,166ManagementAndGeneralAmt
Fundraising$75,519FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$30,407TotalAmt
Program Services$14,595ProgramServicesAmt
Management And General$10,034ManagementAndGeneralAmt
Fundraising$5,778FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$9,519TotalAmt
Management And General$9,519ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$2,183TotalAmt
Management And General$2,183ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$142,938TotalAmt
Program Services$142,938ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$853TotalAmt
Management And General$853ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$11,667TotalAmt
Program Services$755ProgramServicesAmt
Management And General$10,912ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$12,184TotalAmt
Management And General$12,184ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$15,689TotalAmt
Management And General$15,689ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,666TotalAmt
Management And General$3,666ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$27,082TotalAmt
Program Services$25,186ProgramServicesAmt
Management And General$1,896ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$4,923TotalAmt
Management And General$4,923ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Pharmaceuticals$39,650$39,650
Medica, Dental Supplies$40,784$40,784
Ancillary MedicalServices$19,984$19,984
Fees & Dues$10,104$4,918$5,186

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$254TotalAmt
Program Services$254ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$769,359TotalAmt
Program Services$474,933ProgramServicesAmt
Management And General$207,943ManagementAndGeneralAmt
Fundraising$86,483FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$183,827BOYAmt
EOY$242,493EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$327,792BOYAmt
EOY$329,612EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$18,750BOYAmt
EOY$146,350EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$8,124BOYAmt
EOY$13,583EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$710,745LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$217,195LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$508,483BOYAmt
EOY$493,550EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$225,621BOYAmt
EOY$222,986EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,272,597BOYAmt
EOY$1,448,574EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$24,244BOYAmt
EOY$14,567EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$53,834BOYAmt
EOY$83,440EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$78,078BOYAmt
EOY$98,007EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,177,644BOYAmt
EOY$1,339,317EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$16,875BOYAmt
EOY$11,250EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,194,519BOYAmt
EOY$1,350,567EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,272,597BOYAmt
EOY$1,448,574EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$145,042ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$11,006NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$670,269CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$928,193CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$829,092CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$701,000CurrentTaxYearMinus1YearAmt
Current Tax Year$889,160CurrentTaxYearAmt
Total$4,017,714TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$670,269CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$928,193CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$829,092CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$701,000CurrentTaxYearMinus1YearAmt
Current Tax Year$889,160CurrentTaxYearAmt
Total$4,017,714TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$4,017,714PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,477CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,447CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$6,314CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$8,346CurrentTaxYearMinus1YearAmt
Current Tax Year$19,448CurrentTaxYearAmt
Total$44,032TotalAmt
FieldValueIRS element (for citing)
Total Support$4,061,746TotalSupportAmt
Public Support CY1700.98916PublicSupportCY170Pct
Public Support PY1700.99275PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

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

FieldValueIRS element (for citing)
Disclosed Org Leg CtrlfalseDisclosedOrgLegCtrlInd
Disclosed For Charitable PrpsfalseDisclosedForCharitablePrpsInd
Written Policy MonitoringfalseWrittenPolicyMonitoringInd
Section170h Rqr StsfdfalseSection170hRqrStsfdInd
Solicited Assets SalefalseSolicitedAssetsSaleInd
Agent Trustee EtcfalseAgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabfalseInclEscrowCustodialAcctLiabInd

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$557,893InvestmentCostOrOtherBasisAmt
Depreciation$105,052DepreciationAmt
Book Value$452,841BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$152,852InvestmentCostOrOtherBasisAmt
Depreciation$112,143DepreciationAmt
Book Value$40,709BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$493,550TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$1,219,159TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$11,006NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts$227,015DonatedServicesAndUseFcltsAmt
Other Revenue$66,737OtherRevenueAmt
Revenue Not Reported$304,758RevenueNotReportedAmt
Revenue Subtotal$914,401RevenueSubtotalAmt
Total Revenue Per Form990$914,401TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$1,063,111TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$227,015DonatedServicesUseFcltsAmt
Other Expenses Included$66,737OtherExpensesIncludedAmt
Expenses Not Reported$293,752ExpensesNotReportedAmt
Expenses Subtotal$769,359ExpensesSubtotalAmt
Total Expenses Per Form990$769,359TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
P12, Ln 2dFund raising expenses netted in revenue
P11, Ln 2dFund raising expenses netted in revenue

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GalaEvent1Nm
Gross Receipts Event1$162,391GrossReceiptsEvent1Amt
Gross Revenue Event1$162,391GrossRevenueEvent1Amt
Non Cash Prizes Event1$20,099NonCashPrizesEvent1Amt
Rent Facility Costs Event1$5,703RentFacilityCostsEvent1Amt
Food And Beverage Event1$31,309FoodAndBeverageEvent1Amt
Entertainment Event1$7,099EntertainmentEvent1Amt
Other Direct Expenses Event1$9,094OtherDirectExpensesEvent1Amt
Gross Receipts Total$162,391GrossReceiptsTotalAmt
Gross Revenue Total Events$162,391GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$20,099NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$5,703RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$31,309FoodAndBeverageTotalEventsAmt
Entertainment Total Events$7,099EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$9,094OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$73,304DirectExpenseSummaryEventsAmt
Net Income Summary$89,087NetIncomeSummaryAmt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Noncash Contributions Rpt F990$29,526NoncashContributionsRptF990Amt
Method Of Determining RevenuesFMVMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGiftsInd
Third Parties UsedfalseThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part VI Line 11bIf the board does not meet at the time the 990 is completed, it is
Part VI Line 11breviewed by the executive director, board president and secretary.
Part VI Line 12cBoard reviews significant transactions as discovered.
Part VI Line 19Upon request
Part IX Line 11gMedical Professionals Total expenses - $142938.00 Program service expenses - $142938.00 Mgmt and general expenses - $0.00 Fundraising expenses - $0.00

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