POTOMAC HEALTHCARE FOUNDATION: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- POTOMAC HEALTHCARE FOUNDATION (EIN 52-1116578)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202321359349104337
- Schema version
- 2021v4.2
- 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
- Depreciation Schedule
- Legal Fees Schedule
- Other Assets Schedule
- Other Expenses Schedule
- Other Income Schedule2
- Other Liabilities Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-15T14:02:05-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10200 Grand Central Ave Suite 320 | AddressLine1Txt |
| City | Owings Mills | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21117 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 521116578 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POTOMAC HEALTHCARE FOUNDATIONINC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GARY GAGNON | InCareOfNm |
| Business Name Control | POTO | BusinessNameControlTxt |
| Phone | 3017500017 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3800 FREDERICK AVENUE | AddressLine1Txt |
| City | BALTIMORE | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21229 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Barbara Groves | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 3017500017 | PhoneNum |
| Signature | 2023-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Barbara | PersonFirstNm |
| Person Last | Groves | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian J Ray | PreparerPersonNm |
| PTIN | P01278507 | PTIN |
| Phone | 4103633200 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | TrustedCustomerGrp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $14,783,389 | FMVAssetsEOYAmt |
| Method Of Accounting Other | Yes (X) | MethodOfAccountingOtherInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $3,992,692 | ContriRcvdRevAndExpnssAmt |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $2,303 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $2,303 | InterestOnSavNetInvstIncmAmt |
| Interest On Savings Adj Net Incm | $2,303 | InterestOnSavingsAdjNetIncmAmt |
| Other Income Rev And Expnss | $6,141,808 | OtherIncomeRevAndExpnssAmt |
| Other Income Adj Net Incm | $6,141,808 | OtherIncomeAdjNetIncmAmt |
| Total Rev And Expnss | $10,136,803 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $2,303 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $6,144,111 | TotalAdjNetIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $1,885,752 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Adj Net Incm | $9,934 | OthEmplSlrsWgsAdjNetIncmAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $1,875,818 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $117,026 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Adj Net Incm | $616 | PensionEmplBnftAdjNetIncmAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $116,410 | PensionEmplBnftDsbrsChrtblAmt |
| Legal Fees Rev And Expnss | $8,483 | LegalFeesRevAndExpnssAmt |
| Legal Fees Net Invst Incm | $0 | LegalFeesNetInvstIncmAmt |
| Legal Fees Adj Net Incm | $45 | LegalFeesAdjNetIncmAmt |
| Legal Fees Dsbrs Chrtbl | $8,438 | LegalFeesDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $30,850 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Adj Net Incm | $163 | AccountingFeesAdjNetIncmAmt |
| Accounting Fees Chrtbl Prps | $30,687 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $19,117 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Adj Net Incm | $101 | OtherProfFeesAdjNetIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $19,016 | OtherProfFeesDsbrsChrtblAmt |
| Interest Rev And Expnss | $294,854 | InterestRevAndExpnssAmt |
| Interest Adj Net Incm | $1,553 | InterestAdjNetIncmAmt |
| Interest Dsbrs Chrtbl | $293,301 | InterestDsbrsChrtblAmt |
| Taxes Rev And Expnss | $149,939 | TaxesRevAndExpnssAmt |
| Taxes Adj Net Incm | $790 | TaxesAdjNetIncmAmt |
| Taxes Dsbrs Chrtbl | $149,118 | TaxesDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $332,082 | DeprecAndDpltnRevAndExpnssAmt |
| Deprec And Dpltn Adj Net Incm | $1,749 | DeprecAndDpltnAdjNetIncmAmt |
| Occupancy Rev And Expnss | $1,245,898 | OccupancyRevAndExpnssAmt |
| Occupancy Adj Net Incm | $6,563 | OccupancyAdjNetIncmAmt |
| Occupancy Dsbrs Chrtbl | $1,239,335 | OccupancyDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $6,642,362 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Adj Net Incm | $5,464,044 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $1,158,439 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $10,726,363 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $5,485,558 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $4,890,562 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $0 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $0 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $10,726,363 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $5,485,558 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $4,890,562 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$589,560 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $2,303 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $658,553 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $10,276,206 | CashBOYAmt |
| Cash EOY | $5,818,913 | CashEOYAmt |
| Cash EOYFMV | $5,818,913 | CashEOYFMVAmt |
| Acct Rcvbl | $641,279 | AcctRcvblAmt |
| Acct Rcvbl EOY | $641,279 | AcctRcvblEOYAmt |
| Acct Rcvbl EOYFMV | $641,279 | AcctRcvblEOYFMVAmt |
| Grants Receivable BOY | $78,730 | GrantsReceivableBOYAmt |
| Grants Receivable EOY | $69,509 | GrantsReceivableEOYAmt |
| Grants Receivable EOYFMV | $69,509 | GrantsReceivableEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $9,154,097 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,063,092 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $7,956,715 | LandBOYAmt |
| Land EOY | $8,091,005 | LandEOYAmt |
| Land EOYFMV | $8,091,005 | LandEOYFMVAmt |
| Other Assets BOY | $168,572 | OtherAssetsBOYAmt |
| Other Assets EOY | $162,683 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $162,683 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $18,480,223 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,783,389 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $14,783,389 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $1,068,427 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $353,460 | AccountsPayableEOYAmt |
| Deferred Revenue BOY | $1,728,303 | DeferredRevenueBOYAmt |
| Deferred Revenue EOY | $1,439,539 | DeferredRevenueEOYAmt |
| Mortgages And Notes Payable BOY | $5,333,739 | MortgagesAndNotesPayableBOYAmt |
| Mortgages And Notes Payable EOY | $5,231,254 | MortgagesAndNotesPayableEOYAmt |
| Other Liabilities BOY | $4,488,480 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $2,487,420 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $12,618,949 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,511,673 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $4,834,607 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $4,298,380 | NoDonorRstrNetAssestsEOYAmt |
| Donor Rstr Net Assets BOY | $1,026,667 | DonorRstrNetAssetsBOYAmt |
| Donor Rstr Net Assets EOY | $973,334 | DonorRstrNetAssetsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $5,861,274 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $5,271,714 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $18,480,223 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $14,783,387 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $5,861,274 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$589,560 | ExcessRevenueOverExpensesAmt |
| Subtotal | $5,271,714 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $5,271,714 | TotNetAstOrFundBalancesEOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cap Gains Loss Tx Invst Incm Detail | CapGainsLossTxInvstIncmDetail |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $32 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $32 | SubtotalAmt |
| Tax Based On Investment Income | $32 | TaxBasedOnInvestmentIncomeAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Total Payments And Credits | $0 | TotalPaymentsAndCreditsAmt |
| Tax Due | $32 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | DC | OrgReportOrRegisterStateCd |
| Org Report Or Register State | MD | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | Yes (true) | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GARY GAGNON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3017500017 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 136 | AddressLine1Txt |
| City | EMMITSBURG | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21727 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (true) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | false | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|
| Leonard Sacks | ||||||||
| 3800 FREDERICK AVE | bALTIMORE | MD | 21229 | Chairman/Treasurer/Trustee | 1.0 | $0 | $0 | $0 |
| BARBARA GROVES | ||||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | President/SECRETARY/TRUSTE | 1.0 | $0 | $0 | $0 |
| Helen Stefan Moreau | ||||||||
| 3800 FREDERICK AVE | bALTIMORE | MD | 21229 | Trustee | 1.0 | $0 | $0 | $0 |
| Harold Joyce | ||||||||
| 3800 FREDERICK AVE | bALTIMORE | MD | 21229 | Trustee | 1.0 | $0 | $0 | $0 |
| Jonathan Novak | ||||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | Trustee | 1.0 | $0 | $0 | $0 |
Compensation Highest Paid Empl CompensationHighestPaidEmplGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt |
|---|---|---|---|---|---|---|
| ROBY WILLIAM | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | CFO | 40.0 | $206,000 |
| DIOMI CHIMENE | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | RGISTERED NURSE | 40.0 | $161,538 |
| MARTIN AMY | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | CRNP | 58.0 | $1,114,544 |
| STAHLEY PHYLLIS | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | DIRECTOR OF ADMISSIO | 40.0 | $112,000 |
| GAGNON GARY | ||||||
| 3800 FREDERICK AVE | BALTIMORE | MD | 21229 | CONTROLLER | 40.0 | $80,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Employee Paid Over50k | 11 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Costello | |||||
| 10211 Wincopin Cir Ste 100 | COLUMBIA | MD | 21044 | Construction | $654,143 |
| Netsmart | |||||
| PO Box 713519 | PHILADELPHIA | MD | 19171 | Health Info Technolo | $223,766 |
| S & W Construction | |||||
| 1 Yellowbird Trail | FAIRFIELD | PA | 17320 | Construction | $110,813 |
| Fireline | |||||
| 4506 Hollins Ferry Rd | BALTIMORE | MD | 21227 | Construction | $77,719 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 4 | ContractorPaidOver50kCnt |
Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | THE FOUNDATION PROVIDES RESIDENTIAL TREATMENT AND SERVICES FOR ALCOHOL AND/OR DRUG DEPENDENT PREGNANT AND POSTPARTUM WOMEN ALONG WITH THEIR CHILDREN. | Description1Txt |
| Expenses1 | $4,916,494 | Expenses1Amt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | . | Description1Txt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $0 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $7,905,041 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $7,905,041 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $7,905,041 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $118,576 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $7,786,465 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $389,323 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sect4942j3j5 Fndtn And Frgn Org | Yes (X) | Sect4942j3j5FndtnAndFrgnOrgInd |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $4,890,562 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $4,890,562 | QualifyingDistributionsAmt |
Private Operating Foundations PrivateOperatingFoundationsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Private Operating Fndtn Ruling | 2022-07-26 | PrivateOperatingFndtnRulingDt |
| Section4942j3 | Yes (X) | Section4942j3Ind |
Lessor Adj Net Incm Min Invst Ret LessorAdjNetIncmMinInvstRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $389,323 | CurrentYearAmt |
| Year1 | $261 | Year1Amt |
| Year2 | $1,332 | Year2Amt |
| Year3 | $162,774 | Year3Amt |
| Total | $553,690 | TotalAmt |
Pct85 Lessor Adj Incm Or Min Ret Pct85LessorAdjIncmOrMinRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $330,925 | CurrentYearAmt |
| Year1 | $222 | Year1Amt |
| Year2 | $1,132 | Year2Amt |
| Year3 | $138,358 | Year3Amt |
| Total | $470,637 | TotalAmt |
Qualifying Distributions QualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $4,890,562 | CurrentYearAmt |
| Year1 | $5,342,759 | Year1Amt |
| Year2 | $5,540,617 | Year2Amt |
| Year3 | $5,784,091 | Year3Amt |
| Total | $21,558,029 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Qualifying Distri Not Used Drt | QualifyingDistriNotUsedDrtGrp |
Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $4,890,562 | CurrentYearAmt |
| Year1 | $5,342,759 | Year1Amt |
| Year2 | $5,540,617 | Year2Amt |
| Year3 | $5,784,091 | Year3Amt |
| Total | $21,558,029 | TotalAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $0 | CurrentYearAmt |
| Total | $0 | TotalAmt |
Total Assets Sect4942j3 Bi TotalAssetsSect4942j3BiGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year | $259,549 | CurrentYearAmt |
| Year1 | $262,841 | Year1Amt |
| Year2 | $177,303 | Year2Amt |
| Year3 | $108,516 | Year3Amt |
| Total | $808,209 | TotalAmt |
Total Support TotalSupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Public Support Type PublicSupportType
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Largest Support From EO LargestSupportFromEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Gross Investment Income GrossInvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Program Service Revenue Dtl ProgramServiceRevenueDtl (2 entries)
| DescDesc | BusinessBusinessCd | Related Or Exempt Function IncmRelatedOrExemptFunctionIncmAmt |
|---|---|---|
| PATIENT REVENUE | 623990 | $5,907,062 |
| OUTPATIENT RENT | 623990 | $234,746 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp |
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $2,303 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Dividends And Interest From Sec Dtl | DividendsAndInterestFromSecDtl | |
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp | |
| Net Rntl Incm Re Not Debt Fincd Prop | NetRntlIncmReNotDebtFincdProp | |
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Income | OtherInvestmentIncomeGrp | |
| Gain Sales Ast Oth Than Invntry | GainSalesAstOthThanInvntryGrp | |
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $2,303 | ExclusionAmt |
| Related Or Exempt Function Incm | $6,141,808 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $6,144,111 | TotalIncomeProducingActyAmt |
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (2 entries)
| Line NumberLineNumberTxt | Relationship StatementRelationshipStatementTxt |
|---|---|
| 1a | Patient income |
| 1b | Outpatient income |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | Accounting Fees | CategoryTxt |
| Amt | $30,850 | Amt |
| Adjusted Net Income | $163 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $30,687 | DisbursementsCharitablePrpsAmt |
Depreciation Schedule DepreciationSchedule
Legal Fees Schedule LegalFeesSchedule
Legal Fees LegalFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | legal | CategoryTxt |
| Legal Fees | $8,483 | LegalFeesAmt |
| Adjusted Net Income | $45 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $8,438 | DisbursementsCharitablePrpsAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (2 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| deffered financing costs | $165,600 | $159,169 | $159,169 |
| Security Deposits | $2,972 | $3,514 | $3,514 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (11 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| Bank Charges | $751 | $4 | $747 |
| CONSULTING FEES | $41,923 | $221 | $41,702 |
| Drugs and Medicine | $6,425 | $34 | $6,391 |
| INSURANCE | $22,903 | $121 | $22,782 |
| Management Fees | $506,688 | $2,669 | $504,019 |
| MINOR EQUIPMENT | $24,410 | $129 | $24,281 |
| Purchased Services | $5,664,549 | $5,458,892 | $205,657 |
| Supplies | $333,650 | $1,758 | $331,892 |
| Transportation | $19,703 | $104 | $19,599 |
| ADVERTIZING | $1,376 | $7 | $1,369 |
| AMORTIZATION | $19,984 | $105 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Adjusted Net IncomeAdjustedNetIncomeAmt |
|---|---|---|
| Patient Revenue | $5,907,062 | $5,907,062 |
| Out patient rent | $234,746 | $234,746 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Related Parties | Desc |
| BOY Book Value | $4,488,480 | BOYBookValueAmt |
| EOY Book Value | $2,487,420 | EOYBookValueAmt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | Professional Fees | CategoryTxt |
| Amt | $19,117 | Amt |
| Adjusted Net Income | $101 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $19,016 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| payroll taxes | $149,908 | $790 | $149,118 |
| Excise Tax | $31 |
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