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LAFOLLETTE MEDICAL FOUNDATION INC: Form 990PF, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
LAFOLLETTE MEDICAL FOUNDATION INC (EIN 20-4901729)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-08-31
IRS object ID
202312439349100126
Schema version
2022v5.0
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)
Return2023-08-31T16:19:22-05:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN621142155PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PUGH & COMPANY PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1315 N CEDAR BLUFF RD SUITE 200AddressLine1Txt
CityKNOXVILLECityNm
State AbbreviationTNStateAbbreviationCd
ZIP37923ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN204901729EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LAFOLLETTE MEDICAL FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlLAFOBusinessNameControlTxt
Phone4239126963PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 128AddressLine1Txt
CityJACKSBOROCityNm
State AbbreviationTNStateAbbreviationCd
ZIP37757ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTRACY CHAMBERSPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone4239126963PhoneNum
Signature2023-08-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTRACYPersonFirstNm
Person LastCHAMBERSPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKELLY A TUCKER CPAPreparerPersonNm
PTINP01015909PTIN
Phone8657690660PhoneNum
Preparation2023-08-15PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$9,075,672FMVAssetsEOYAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Interest On Sav Rev And Expnss$31,926InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$31,926InterestOnSavNetInvstIncmAmt
Dividends Rev And Expnss$157,857DividendsRevAndExpnssAmt
Dividends Net Invst Incm$157,857DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$84,328NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$1,599,315GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$84,328CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss$274,111TotalRevAndExpnssAmt
Total Net Invst Incm$274,111TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$0CompOfcrDirTrstDsbrsChrtblAmt
Legal Fees Rev And Expnss$4,170LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$3,128LegalFeesNetInvstIncmAmt
Legal Fees Dsbrs Chrtbl$1,042LegalFeesDsbrsChrtblAmt
Accounting Fees Rev And Expnss$15,625AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$10,434AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$5,191AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$60,765OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$60,765OtherProfFeesNetInvstIncmAmt
Other Prof Fees Dsbrs Chrtbl$0OtherProfFeesDsbrsChrtblAmt
Taxes Rev And Expnss$6,190TaxesRevAndExpnssAmt
Taxes Net Invst Incm$3,640TaxesNetInvstIncmAmt
Taxes Dsbrs Chrtbl$0TaxesDsbrsChrtblAmt
Other Expenses Rev And Expnss$25,282OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$10,000OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$15,283OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$112,032TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$87,967TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$21,516TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$554,219ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$668,298ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$666,251TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$87,967TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$689,814TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$392,140ExcessRevenueOverExpensesAmt
Net Investment Income$186,144NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$669,412SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$487,428SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$487,428SavAndTempCashInvstEOYFMVAmt
US Government Obligations BOY$1,004,129USGovernmentObligationsBOYAmt
US Government Obligations EOY$837,845USGovernmentObligationsEOYAmt
US Govt Obligations EOYFMV$837,845USGovtObligationsEOYFMVAmt
Corporate Stock BOY$9,130,934CorporateStockBOYAmt
Corporate Stock EOY$7,234,231CorporateStockEOYAmt
Corporate Stock EOYFMV$7,234,231CorporateStockEOYFMVAmt
Corporate Bonds BOY$515,295CorporateBondsBOYAmt
Corporate Bonds EOY$497,124CorporateBondsEOYAmt
Corporate Bonds EOYFMV$497,124CorporateBondsEOYFMVAmt
Other Assets BOY$7,962OtherAssetsBOYAmt
Other Assets EOY$19,044OtherAssetsEOYAmt
Other Assets EOYFMV$19,044OtherAssetsEOYFMVAmt
Total Assets BOY$11,327,732TotalAssetsBOYAmt
Total Assets EOY$9,075,672TotalAssetsEOYAmt
Total Assets EOYFMV$9,075,672TotalAssetsEOYFMVAmt
Grants Payable BOY$8,000GrantsPayableBOYAmt
Grants Payable EOY$28,000GrantsPayableEOYAmt
Other Liabilities BOY$5,320OtherLiabilitiesBOYAmt
Other Liabilities EOY$0OtherLiabilitiesEOYAmt
Total Liabilities BOY$13,320TotalLiabilitiesBOYAmt
Total Liabilities EOY$28,000TotalLiabilitiesEOYAmt
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY$11,314,412NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY$9,047,672NoDonorRstrNetAssestsEOYAmt
Tot Net Ast Or Fund Balances BOY$11,314,412TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$9,047,672TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$11,327,732TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$9,075,672TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$11,314,412TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$392,140ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$10,922,272SubtotalAmt
Other Decreases$1,874,600OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$9,047,672TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)

PropertyPropertyDescHow AcquiredHowAcquiredCdGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
PUBLICLY TRADED SECURITIES HELD IN BROKERAGE ACCOUNTP$1,593,795$1,514,987$78,808$78,808
CAPITAL GAINS DIVIDENDSP$5,520$5,520$5,520
FieldValueIRS element (for citing)
Capital Gain Net Income$84,328CapitalGainNetIncomeAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$2,587InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$2,587SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$2,587TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$11,720EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$11,720TotalPaymentsAndCreditsAmt
Es Penalty$0EsPenaltyAmt
Overpayment$9,133OverpaymentAmt
Applied To ES Tax$9,133AppliedToESTaxAmt
Refund$0RefundAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateTNOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial Contributors0NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressWWW.LAFOLLETTEMEDICALFOUNDATION.ORGWebsiteAddressTxt
Individual With BooksJUNE WILBURNIndividualWithBooksNm
Phone4239126963PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1905 RIVERVIEW DRIVEAddressLine1Txt
CityLAFOLLETTECityNm
State AbbreviationTNStateAbbreviationCd
ZIP37766ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
STACEY WOOD-HEATHERLY
PO BOX 128JACKSBOROTN37757SECRETARY1.00$0$0$0
MICHEAL E WALDEN
PO BOX 128JACKSBOROTN37757TREASURER1.00$0$0$0
TRACI CHAMBERS
PO BOX 128JACKSBOROTN37757PRESIDENT1.00$0$0$0
DR RICHARD BURDEAUX
PO BOX 128JACKSBOROTN37757DIRECTOR1.00$0$0$0
WAYNE KITTS
PO BOX 128JACKSBOROTN37757DIRECTOR1.00$0$0$0
JIM FARRIS JR
PO BOX 128JACKSBOROTN37757DIRECTOR1.00$0$0$0
DEBRA NELSON
PO BOX 128JACKSBOROTN37757DIRECTOR1.00$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$9,142,632AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$629,202AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$9,771,834TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$9,771,834AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$146,578CashDeemedCharitableAmt
Net Vl Noncharitable Assets$9,625,256NetVlNoncharitableAssetsAmt
Minimum Investment Return$481,263MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$481,263MinimumInvestmentReturnAmt
Tax Based On Investment Income$2,587TaxBasedOnInvestmentIncomeAmt
Total Tax$2,587TotalTaxAmt
Distributable Before Adj$478,676DistributableBeforeAdjAmt
Recoveries Qualfied Distri$114,079RecoveriesQualfiedDistriAmt
Distributable Before Ded$592,755DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$592,755DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

FieldValueIRS element (for citing)
Expenses And Contributions$689,814ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$689,814QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$592,755DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Excess Distribution Cyov Yr5$3,250ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4$7,218ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3$35,051ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$103,417ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$159,203ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$308,139TotalExcessDistributionCyovAmt
Qualifying Distributions$689,814QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$592,755AppliedToCurrentYearAmt
Remaining Distri From Corpus$97,059RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$405,198TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$3,250ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$401,948ExcessDistriCyovToNextYrAmt
Excess From Year4$7,218ExcessFromYear4Amt
Excess From Year3$35,051ExcessFromYear3Amt
Excess From Year2$103,417ExcessFromYear2Amt
Excess From Year1$159,203ExcessFromYear1Amt
Excess From Current Year$97,059ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonLAFOLLETTE MEDICAL FOUNDATIONRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 128AddressLine1Txt
CityJACKSBOROCityNm
State AbbreviationTNStateAbbreviationCd
ZIP37757ZIPCd
FieldValueIRS element (for citing)
Recipient Phone4239126963RecipientPhoneNum
Recipient Email AddressGRANTS@LAFOLLETTEMEDICALFOUNDATION.ORGRecipientEmailAddressTxt
Form And Info And MaterialsPLEASE VISIT THE ORGANIZATION'S WEBSITE AT WWW.LAFOLLETTEMEDICALFOUNDATION.ORG TO OBTAIN THE GRANT APPLICATIONFormAndInfoAndMaterialsTxt
Submission DeadlinesNONESubmissionDeadlinesTxt
Restrictions On AwardsIN ORDER TO BE ELIGIBLE FOR A GRANT FROM THE FOUNDATION, AN ORGANIZATION MUST QUALIFY FOR EXEMPTION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND MUST NOT BE A PRIVATE FOUNDATION AS DEFINED BY SECTION 509(A) OF THE CODE, OR IT MUST BE A PUBLIC INSTRUMENTALITY. GRANTS MAY NOT BE MADE TO INDIVIDUALS. THE FOUNDATION MAY MAKE GRANTS TO ORGANIZATIONS PROVIDING SERVICES TO CAMPBELL COUNTY, TN RESIDENTS FOR THE FOLLOWING PURPOSES: HEALTH SERVICES, PREVENTATIVE ILLNESS, CHILDREN HEALTH AND WELL-BEING, SENIOR SAFETY AND WELLNESS AND ANY HEALTH PROGRAM THAT HAS MERIT AND IS RELATED TO THE FOUNDATION'S MISSION AND OBJECTIVES.RestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (15 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
CAMPBELL COUNTY BOARD OF EDUCATION
172 VALLEY STREETJACKSBOROTN37757NONEGOVERNMENT AGENCYINFLUENZA VACCINATION PROGRAM, JELLICO HIGH SCHOOL ATHLETIC PERSONAL TRAINER$60,000
CAMPBELL COUNTY CHILDREN'S CENTER
203 INDEPENDENCE LANELAFOLLETTETN37766NONE501(C)(3)HEALTH EDUCATION/PREVENTION PROGRAM$40,331
CAMPBELL COUNTY RURAL FIRE SERVICE
4422 VICTORY ROADLAFOLLETTETN37766NONE501(C)(3)FIRE PROTECTION FOR CAMPBELL COUNTY$14,196
CAMPBELL COUNTY SENIOR CITIZENS
102 8TH STREETLAFOLLETTETN37766NONE501(C)(3)HOME DELIVERED MEALS FOR ELIGIBLE SENIORS$37,800
CAMPBELL COUNTY HEALTH COUNCIL
162 SHARP AND PERKINS ROADJACKSBOROTN37757NONE501(C)(3)COMMUNITY HEALTH$10,000
CASA OF CAMPBELL COUNTY
PO BOX 1054JACKSBOROTN37757NONE501(C)(3)VOLUNTEER OUTREACH SERVICES$20,000
CATHOLIC CHARITIES OF EAST TENNESSEE
3009 LAKE BROOK BLVDKNOXVILLETN37909NONE501(C)(3)PREGNANCY HELP CENTER$24,000
CITY OF LAFOLLETTE FIRE DEPARTMENT
105 E BEECH STREETLAFOLLETTETN37766NONEGOVERNMENT AGENCYFIRE PROTECTION FOR THE CITY OF LAFOLLETTE$136,849
COMMUNITY HEALTH OF EAST TENNESSEE
PO BOX 209 507 MAIN STREETJACKSBOROTN37757NONE501(C)(3)DRUG COURT PROGRAM, PATIENT CARE$43,000
EAST TENNESSEE HUMAN RESOURCES AGENCY
9111 CROSS PARK DR STE D10KNOXVILLETN37766NONE501(C)(3)SENIOR SAFETY AND WELLNESS SUPPORT$30,000
LAFOLLETTE RESCUE SQUAD
222 FIRE RESCUE LNLAFOLLETTETN37766NONEGOVERNMENT AGENCYCOMMUNICATIONS$16,272
PINNACLE RESOURCE CENTER
507 MAIN STJACKSBOROTN37757NONE501(C)(3)HELP PROVIDE INDIVIDUALS FACING HOMELESSNESS WITH THE TOOLS AND RESOURCE TO GET BACK ON THEIR FEET$20,000
SPRINGS OF LIFE RECOVERY CENTER
PO BOX 893JELLICOTN37762NONE501(C)(3)RECOVERY CENTER FOR MEN$160,000
TOWN OF JACKSBORO FIRE DEPARTMENT
585 MAIN STREETJACKSBOROTN37757NONEGOVERNMENT AGENCYRESCUE EQUIPMENT$35,851
BRIDGES TO RECOVERY
PO BOX 417JACKSBOROTN37757NONE501(C)(3)MENTAL HEALTH PROGRAMMENTAL HEALTH PROGRAM$20,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$668,299TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$31,926ExclusionAmt

Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$157,857ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$84,328ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$274,111ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$274,111TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$15,625Amt
Net Investment Income$10,434NetInvestmentIncomeAmt
Disbursements Charitable Prps$5,191DisbursementsCharitablePrpsAmt

General Explanation Attachment GeneralExplanationAttachment

General Explanation GeneralExplanationGrp

FieldValueIRS element (for citing)
IdentifierDETAIL INFO REQUESTIdentifierTxt
Form And Line ReferenceFORM 990 PF, PART II, LINE 10B AND LINE 10CFormAndLineReferenceDesc
Medium ExplanationTHE INSTRUCTIONS FOR FORM 990-PF REQUIRE A SCHEDULE THAT LISTS EACH SECURITY HELD AT THE END OF THE YEAR, AND TO SHOW WHETHER THAT SECURITY IS REPORTED AT COST BASIS OR FMV. ALL SECURITIES ARE HELD IN A BROKERAGE ACCOUNT THROUGHOUT THE YEAR AND ARE REPORTED AT FMV. THIS SCHEDULE CAN BE PROVIDED TO THE IRS AT THEIR REQUEST.MediumExplanationTxt

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corporate Bonds InvestmentsCorporateBondsGrp

FieldValueIRS element (for citing)
BondUBS #KAXX118 (HELD IN BROKERAGE A/C DETAIL AVAILABLE UPON REQUEST)BondNm
EOY Book Value$497,124EOYBookValueAmt
EOYFMV$497,124EOYFMVAmt

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp

FieldValueIRS element (for citing)
StockUBS #KAXX118 (HELD IN BROKERAGE ACCOUNT - DETAIL AVAILABLE UPON REQUEST)StockNm
EOY Book Value$7,234,231EOYBookValueAmt
EOYFMV$7,234,231EOYFMVAmt

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

FieldValueIRS element (for citing)
US Govt Obligations Book Vl EOY$837,845USGovtObligationsBookVlEOYAmt
US Govt Obligations EOYFMV$837,845USGovtObligationsEOYFMVAmt
State Local Sec Book Vl EOY$0StateLocalSecBookVlEOYAmt
State Local Sec EOYFMV$0StateLocalSecEOYFMVAmt

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryLEGAL FEESCategoryTxt
Legal Fees$4,170LegalFeesAmt
Net Investment Income$3,128NetInvestmentIncomeAmt
Disbursements Charitable Prps$1,042DisbursementsCharitablePrpsAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp (2 entries)

DescDescBOY Book ValueBOYBookValueAmtEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
ACCRUED INTEREST RECEIVABLE$7,962$9,970$9,970
PREPAID TAXES$0$9,074$9,074

Other Decreases Schedule OtherDecreasesSchedule

Other Decreases Detail OtherDecreasesDetail

FieldValueIRS element (for citing)
DescUNREALIZED GAINDesc
Amt$1,874,600Amt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
INSURANCE$2,632$0$2,632
OFFICE EXPENSES$2,650$0$2,651
CONTRACT LABOR$20,000$10,000$10,000

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail

FieldValueIRS element (for citing)
DescTAXES PAYABLEDesc
BOY Book Value$5,320BOYBookValueAmt
EOY Book Value$0EOYBookValueAmt

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryUBS FEESCategoryTxt
Amt$60,765Amt
Net Investment Income$60,765NetInvestmentIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail (2 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
FEDERAL EXCISE TAX$2,550$0$0
FOREIGN TAX WITHHOLDING$3,640$3,640$0

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