COMMUNITY HEALTH FOUNDATION OF FAIRFIELD: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH FOUNDATION OF FAIRFIELD (EIN 57-0930442)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202301359349306545
- Schema version
- 2021v4.2
- Note
- A later return for the same period supersedes this one.
- 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 | 2023-05-15T11:25:52-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 620713250 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRAFTCPAS PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6136 SHALLOWFORD ROAD 101 | AddressLine1Txt |
| City | CHATTANOOGA | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 374217214 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 570930442 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH FOUNDATION OF FAIRFIELD | BusinessNameLine1Txt |
| Business Name Line2 | JOHN A MARTIN PRIMARY HEALTH CARE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 8036356099 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 56 US HWY 321 BYPASS NORTH | AddressLine1Txt |
| City | WINNSBORO | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29180 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK SHAFFER | PersonNm |
| Person Title | MEDICAL DIRECTOR | PersonTitleTxt |
| Phone | 8036356099 | PhoneNum |
| Signature | 2023-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MARK | PersonFirstNm |
| Person Last | SHAFFER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | FRANCES E LEAHY | PreparerPersonNm |
| PTIN | P00713593 | PTIN |
| Phone | 4238947400 | PhoneNum |
| Preparation | 2023-05-15 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN A MARTIN PRIMARY HEALTH CARE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARK SHAFFER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 56 US HWY 321 BYPASS NORTH | AddressLine1Txt |
| City | WINNSBORO | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29180 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $657,452 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | SC | LegalDomicileStateCd |
| Activity Or Mission | OPERATION OF A MEDICAL CLINIC IN A RURAL AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 6 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $190,700 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $727,906 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $657,450 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6 | PYInvestmentIncomeAmt |
| CY Investment Income | $2 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $918,612 | PYTotalRevenueAmt |
| CY Total Revenue | $657,452 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $593,052 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $409,640 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $402,445 | PYOtherExpensesAmt |
| CY Other Expenses | $245,599 | CYOtherExpensesAmt |
| PY Total Expenses | $995,497 | PYTotalExpensesAmt |
| CY Total Expenses | $655,239 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$76,885 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,213 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $390,383 | TotalAssetsBOYAmt |
| Total Assets EOY | $388,154 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $434,072 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $412,592 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$43,689 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$24,438 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OPERATION OF A MEDICAL CLINIC IN A RURAL AREA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $595,535 | ExpenseAmt |
| Revenue | $657,450 | RevenueAmt |
| Desc | THE ORGANIZATION OPERATES AN ACADEMIC CLINICAL CENTER IN A RURAL AREA TO DELIVER HEALTH CARE TO A DEFINED POPULATION. OPERATIONS CEASED IN JANUARY 2022 WHEN PRISMA HEALTH ASSUMED OPERATIONS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $787 | ExpenseAmt |
| Desc | THE ORGANIZATION ALSO DELIVERS HEALTH RELATED EDUCATIONAL SERVICES TO STUDENTS IN MEDICAL SCHOOL, PUBLIC HEALTH AND SOCIAL WORK. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $596,322 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 8 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 6 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | SC | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK SHAFFER MD | PersonNm |
| Phone | 8036356099 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 56 US HWY 321 BYPASS NORTH | AddressLine1Txt |
| City | WINNSBORO | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29180 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| KIMBERLY SEIBLES | ||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| LESS HALL MD | ||||||
| USC DEAN REPRESENTATIVE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DORIS LEITNER | ||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| THOMAS CHANDLER PHD | ||||||
| USC DEAN REPRESENTATIVE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DEE MATTOX | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BERTHA GOINS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SUSAN GROSSLIGHT | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SHERYL MITCHELL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARK SHAFFER | ||||||
| MEDICAL DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HEALTH CARE SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $657,450 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $657,450 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $657,450 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2 | TotalRevenueColumnAmt |
| Exclusion | $2 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $657,452 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $657,450 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $320,022 | TotalAmt |
| Program Services | $304,021 | ProgramServicesAmt |
| Management And General | $16,001 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,016 | TotalAmt |
| Program Services | $65,565 | ProgramServicesAmt |
| Management And General | $3,451 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,602 | TotalAmt |
| Program Services | $19,572 | ProgramServicesAmt |
| Management And General | $1,030 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,757 | TotalAmt |
| Program Services | $3,569 | ProgramServicesAmt |
| Management And General | $188 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,233 | TotalAmt |
| Management And General | $9,233 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,001 | TotalAmt |
| Program Services | $8,982 | ProgramServicesAmt |
| Management And General | $2,019 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,828 | TotalAmt |
| Program Services | $38,559 | ProgramServicesAmt |
| Management And General | $2,269 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208 | TotalAmt |
| Program Services | $208 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,374 | TotalAmt |
| Management And General | $9,374 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,546 | TotalAmt |
| Program Services | $14,769 | ProgramServicesAmt |
| Management And General | $777 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRACT LABOR | $67,679 | $57,527 | $10,152 |
| SUPPLIES | $51,617 | $49,036 | $2,581 |
| COMPUTER EXPENSE | $27,237 | $25,875 | $1,362 |
| INJECTIONS AND VACCINES | $4,364 | $4,364 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,755 | TotalAmt |
| Program Services | $4,275 | ProgramServicesAmt |
| Management And General | $480 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $655,239 | TotalAmt |
| Program Services | $596,322 | ProgramServicesAmt |
| Management And General | $58,917 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,448 | BOYAmt |
| EOY | $160,437 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,617 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,168 | BOYAmt |
| EOY | $128,168 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $365,997 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $266,448 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,150 | BOYAmt |
| EOY | $99,549 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $390,383 | BOYAmt |
| EOY | $388,154 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $413,569 | BOYAmt |
| EOY | $392,089 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,065 | BOYAmt |
| EOY | $20,065 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $438 | BOYAmt |
| EOY | $438 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $434,072 | BOYAmt |
| EOY | $412,592 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$43,689 | BOYAmt |
| EOY | -$24,438 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$43,689 | BOYAmt |
| EOY | -$24,438 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $390,383 | BOYAmt |
| EOY | $388,154 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,213 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $17,038 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | 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 Minus3 Years | $24,743 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $190,700 | CurrentTaxYearMinus1YearAmt |
| Total | $215,443 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,016,589 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,042,371 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $893,402 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $727,906 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $657,540 | CurrentTaxYearAmt |
| Total | $4,337,808 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,016,589 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,067,114 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $893,402 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $918,606 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $657,540 | CurrentTaxYearAmt |
| Total | $4,553,251 | 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 |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $4,553,251 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $103 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $148 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $81 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2 | CurrentTaxYearAmt |
| Total | $340 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $103 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $148 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $81 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2 | CurrentTaxYearAmt |
| Total | $340 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,016,692 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,067,262 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $893,483 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $918,612 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $657,542 | CurrentTaxYearAmt |
| Total | $4,553,591 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99990 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99990 | PublicSupportPY509Pct |
| Investment Income CY | 0.00010 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $365,997 | OtherCostOrOtherBasisAmt |
| Depreciation | $266,448 | DepreciationAmt |
| Book Value | $99,549 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $99,549 | TotalBookValueLandBuildingsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | DAY TO DAY OPERATIONS OF THE ACADEMIC CLINIC CENTER IN A RURAL AREA CEASED IN JANUARY 2022 WHEN PRISMA HEALTH TOOK OVER THOSE OPERATIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE GOVERNING BODY IS GIVEN AN OPPORTUNITY TO REVIEW THE FORM 990 BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR TOP MANAGEMENT IS DETERMINED AND PAID BY RELATED ORGANIZATIONS. THESE ORGANIZATIONS ARE THE UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE AND THE UNIVERSITY OF SOUTH CAROLINA. NO OTHER OFFICER OR EMPLOYEE OF THE ORGANIZATION IS PAID MORE THAN $100,000. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AND OTHER PUBLIC DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII | THE BOARD OF DIRECTORS AUTHORIZED DR. MARK SHAFFER TO SIGN THE FORM 990. HE IS NOT AN OFFICIAL OFFICER FOR THE ORGANIZATION, BUT AN AUTHORIZED REPRESENTATIVE. |
Comments