JOHN P MURRAY COMMUNITY CARE CLINIC INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- JOHN P MURRAY COMMUNITY CARE CLINIC INC (EIN 56-2098720)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-02-01
- IRS object ID
- 202300329349301605
- Schema version
- 2021v4.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-02-01T12:50:50-08:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 273857270 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carter& Jackson Co CPAS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 73 | AddressLine1Txt |
| City | ALBEMARLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 562098720 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN P MURRAY COMMUNITY CARE CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JOHN | BusinessNameControlTxt |
| Phone | 9803234668 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 YADKIN STREET SUITE C | AddressLine1Txt |
| City | ALBEMARLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28001 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRIS VAUGHN | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 9803234668 | PhoneNum |
| Signature | 2023-01-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CHRIS | PersonFirstNm |
| Person Last | VAUGHN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KRISTI B JACKSON CPA | PreparerPersonNm |
| PTIN | P01311953 | PTIN |
| Phone | 7049833783 | PhoneNum |
| Preparation | 2023-02-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Federated Assurance Level | FAL1 | FederatedAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-03-07 01:45:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CINDY BEANE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 960 SHANKLE STREET | AddressLine1Txt |
| City | ALBEMARLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $653,663 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | communitycareclinicalbemarle.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY MEDICAL CARE, MEDICATION AND MEDICAL SUPPLIES TO LOW INCOME, UNINSURED ADULTS IN STANLY COUNTY | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $114,425 | PYContributionsGrantsAmt |
| CY Contributions Grants | $102,522 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $675 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $600 | CYProgramServiceRevenueAmt |
| PY Investment Income | $16,816 | PYInvestmentIncomeAmt |
| CY Investment Income | -$18,349 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $131,916 | PYTotalRevenueAmt |
| CY Total Revenue | $84,773 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,400 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,400 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $87,607 | PYOtherExpensesAmt |
| CY Other Expenses | $75,269 | CYOtherExpensesAmt |
| PY Total Expenses | $102,007 | PYTotalExpensesAmt |
| CY Total Expenses | $89,669 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $29,909 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,896 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $604,825 | TotalAssetsBOYAmt |
| Total Assets EOY | $597,792 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,869 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,732 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $598,956 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $594,060 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE QUALITY MEDICAL CARE, MEDICATION AND MEDICAL SUPPLIES TO LOW INCOME, UNINSURED ADULTS IN STANLY COUNTY | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $80,641 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $600 | RevenueAmt |
| Desc | Provided medical care to 420 patients during 1,664 hours of operation. Approximately 10 volunteers provided 4,190 hours of service. A total of 1,775 patient visits were recorded. | Desc |
| Total Program Service Expenses | $80,641 | 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 | Yes (true) | 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 | Yes (true) | 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 | false | 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 | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRIS VAUGHN | PersonNm |
| Phone | 9803234668 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 YADKIN STREET SUITE C | AddressLine1Txt |
| City | ALBEMARLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28001 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|
| CHRIS VAUGHN | ||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $113,156 | $0 | $34,470 | |
| LEONARD SALTZMAN MD | ||||||
| MEDICAL DIRECTOR | 1.00 | $14,400 | $0 | $0 | Yes (X) | |
| CINDY BEANE | ||||||
| CHAIRMAN | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| LINDA LEWIS | ||||||
| TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| TAMMY CRUMP | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| GARRY SCHWARTZ MD | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| SHARON EFIRD | ||||||
| SECRETARY | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| ANNE HARWOOD | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| ELLEN ISAACS | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| JENNIFER ODOM | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| JEREMY HYDE | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| BEN JOLLY | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| SARAH LEE | ||||||
| BOARD MEMBER | 0.15 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $127,556 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $34,470 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
| Federated Campaigns | $20,604 | FederatedCampaignsAmt |
| All Other Contributions | $81,918 | AllOtherContributionsAmt |
| Total Contributions | $102,522 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL RECORDS FEES | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $600 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $600 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,842 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $39,842 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $510,699 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $568,890 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$58,191 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$58,191 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$58,191 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,773 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $600 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$18,349 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,400 | TotalAmt |
| Program Services | $14,400 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,886 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $2,886 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,379 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $4,379 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,042 | TotalAmt |
| Program Services | $17,042 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $281 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,158 | TotalAmt |
| Program Services | $3,742 | ProgramServicesAmt |
| Management And General | $416 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $804 | TotalAmt |
| Program Services | $804 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,451 | TotalAmt |
| Program Services | $2,791 | ProgramServicesAmt |
| Management And General | $660 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| DUES AND SUBSCRIPTIONS | $1,763 | $1,613 | $150 | $0 |
| CLIENT TRAVEL | $492 | $492 | $0 | $0 |
| GIFTS/VOLUNTEER EXPENSE | $508 | $508 | $0 | $0 |
| MEDICATION | $27,902 | $27,902 | $0 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,603 | TotalAmt |
| Program Services | $11,347 | ProgramServicesAmt |
| Management And General | $256 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,669 | TotalAmt |
| Program Services | $80,641 | ProgramServicesAmt |
| Management And General | $9,028 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,555 | BOYAmt |
| EOY | $68,966 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,118 | BOYAmt |
| EOY | $9,701 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,645 | BOYAmt |
| EOY | $7,929 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,168 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,168 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,507 | BOYAmt |
| EOY | $511,196 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $604,825 | BOYAmt |
| EOY | $597,792 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,869 | BOYAmt |
| EOY | $3,732 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,869 | BOYAmt |
| EOY | $3,732 | 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 | $598,956 | BOYAmt |
| EOY | $594,060 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $598,956 | BOYAmt |
| EOY | $594,060 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $604,825 | BOYAmt |
| EOY | $597,792 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$4,896 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| 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 |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support CY170 | 0 | PublicSupportCY170Pct |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $98,740 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $94,894 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $125,958 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $114,425 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $102,522 | CurrentTaxYearAmt |
| Total | $536,539 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | 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 |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $98,740 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $94,894 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $125,958 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $114,425 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $102,522 | CurrentTaxYearAmt |
| Total | $536,539 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,968 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $850 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $650 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,000 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $435 | CurrentTaxYearAmt |
| Total | $4,903 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,968 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $850 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $650 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,000 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $435 | CurrentTaxYearAmt |
| Total | $4,903 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $531,636 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,967 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,740 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,883 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,203 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $39,842 | CurrentTaxYearAmt |
| Total | $98,635 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,967 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,740 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,883 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,203 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $39,842 | CurrentTaxYearAmt |
| Total | $98,635 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $635,174 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.83700 | PublicSupportCY509Pct |
| Public Support PY509 | 0.87260 | PublicSupportPY509Pct |
| Investment Income CY | 0.15530 | InvestmentIncomeCYPct |
| Investment Income PY | 0.11870 | InvestmentIncomePYPct |
| 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 D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $3,168 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,168 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRIS VAUGHN | PersonNm |
| Base Compensation Filing Org | $113,156 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $8,934 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $25,536 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $147,626 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Other | FormAndLineReferenceDesc |
| Explanation | PART II LINE 1 THE EXECUTIVE DIRECTOR IS A PAID EMPLOYEE OF ATRIUM HEALTH STANLY | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED AT ITS OFFICES ON 303 YADKIN STREET IN ALBEMARLE, NC AND ARE AVAILABLE FOR PUBLIC INSPECTION ON REQUEST |
| Pt VI, Line 15a | THE CEO'S SALARY IS PAID BY THE LOCAL HOSPITAL - ATRIUM HEALTH STANLY AND AS SUCH IS A VOLUNTEER POSITION WITHIN THE ORGANIZATION. SALARIES AT THE HOSPITAL ARE DETERMINED BY REVIEW WITHIN THE SYSTEM AND WITH THE USE OF COMPARABILITY DATA AVAILABLE WITHIN THE HEALTHCARE SYSTEM. |
| Pt VI, Line 15b | MEDICAL OFFICER AND NURSES FEES ARE BASED UPON PERFORMANCE APPRAISALS AS WELL AS REVIEWS OF AMOUNTS PAID BY LIKE ORGANIZATIONS FOR SIMILAR SERVICES |
| Other | ATRIUM HEALTH STANLY PROVIDED SUPPORT FOR THE ORGANIZATION AS FOLLOWS: SALARIES AND PAYROLL TAXES $226,737, OFFICE AND CLERICAL SPACE $30,871, CLINICAL SUPPORT AND MAINTENANCE $6 |
| Pt VI, Line 11b | COPIES OF THE 990 WERE DELIVERED TO BOARD MEMBERS PRIOR TO THEIR SCHEDULED BOARD MEETING. MEMBERS WERE GIVEN THE OPPORTUNITY TO REVIEW THE 990 AND ASK QUESTIONS BOTH BEFORE AND DURING THE BOARD MEETING. AFTER REVIEW AND APPROVAL THE COMPLETED 990 WAS FILED |
| Pt VI, Line 12c | BOARD MEMBERS SIGN A DISCLOSURE FORM AT THE FIRST BOARD MEETING OF THE CALENDAR YEAR STATING ANY POTENTIAL CONFLICTS |
| Form 990, Part IX, Line 11g | PROFESSIONAL FEES-NURSES 17042. 17042. 0. 0. |
| Form 990, Part IX, Line 24e | MEDICAL SUPPLIES 11141. 11141. 0. 0. |
| Form 990, Part IX, Line 24e | LICENSES 50. 50. 0. 0. |
| Form 990, Part IX, Line 24e | CLIENT CARE SUPPLIES 156. 156. 0. 0. |
| Form 990, Part IX, Line 24e | BOD MEETING EXPENSE 256. 0. 256. 0. |
Comments