POTOMAC HEALTH FOUNDATION: Form 990PF, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- POTOMAC HEALTH FOUNDATION (EIN 52-1340920)
- Tax period
- 2022-11-01 to 2022-12-31
- Filed
- 2023-11-01
- IRS object ID
- 202323059349100027
- 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
- Form 990-PF
- Investments Corp Bonds Schedule
- Investments Corp Stock Schedule
- Investments Govt Obligations Sch
- Investments Other Schedule2
- Land Etc Schedule2
- Other Decreases 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 | 2023-11-01T10:55:23-05:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 NORTH GLEBE ROAD SUITE 200 | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22203 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2022-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 521340920 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POTOMAC HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POTO | BusinessNameControlTxt |
| Phone | 7035230620 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2296 OPITZ BLVD 200 | AddressLine1Txt |
| City | WOODBRIDGE | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22191 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | R MICHAEL SORENSEN | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 7035230620 | PhoneNum |
| Signature | 2023-10-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | R | PersonFirstNm |
| Person Last | MICHAEL SORENSEN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ROBERT WILLIAMS | PreparerPersonNm |
| PTIN | P01345960 | PTIN |
| Phone | 5712279500 | PhoneNum |
| Preparation | 2023-10-30 | 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 | 2022 | 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 | $105,638,628 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $14 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $14 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $781,733 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $1,098,851 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $2,704,342 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $7,331,089 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $3,772,426 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $0 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $162,330 | OtherIncomeNetInvstIncmAmt |
| Total Rev And Expnss | $3,486,089 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $5,033,621 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $30,195 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $4,529 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $19,317 | CompOfcrDirTrstDsbrsChrtblAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $30,417 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Net Invst Incm | $0 | OthEmplSlrsWgsNetInvstIncmAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $15,810 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $13,941 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Net Invst Incm | $1,041 | PensionEmplBnftNetInvstIncmAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $8,081 | PensionEmplBnftDsbrsChrtblAmt |
| Other Prof Fees Rev And Expnss | $126,848 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $103,448 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $13,400 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $46,941 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $1,196 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $567 | DeprecAndDpltnRevAndExpnssAmt |
| Deprec And Dpltn Net Invst Incm | $0 | DeprecAndDpltnNetInvstIncmAmt |
| Occupancy Rev And Expnss | $6,284 | OccupancyRevAndExpnssAmt |
| Occupancy Net Invst Incm | $0 | OccupancyNetInvstIncmAmt |
| Occupancy Dsbrs Chrtbl | $0 | OccupancyDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $2,929 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Net Invst Incm | $0 | TravConfMeetingNetInvstIncmAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $2,929 | TravConfMeetingDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $10,438 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $230,005 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $18,816 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $268,560 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $340,219 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $78,353 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $1,195,000 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $866,400 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $1,463,560 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $340,219 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $944,753 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $2,022,529 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $4,693,402 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $70,630 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $286,722 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $286,722 | SavAndTempCashInvstEOYFMVAmt |
| Acct Rcvbl | $89,717 | AcctRcvblAmt |
| Acct Rcvbl BOY | $80,873 | AcctRcvblBOYAmt |
| Acct Rcvbl EOY | $89,717 | AcctRcvblEOYAmt |
| Acct Rcvbl EOYFMV | $89,717 | AcctRcvblEOYFMVAmt |
| Pledges Rcvbl | $233,411 | PledgesRcvblAmt |
| Pledges Rcvbl BOY | $252,258 | PledgesRcvblBOYAmt |
| Pledges Rcvbl EOY | $233,411 | PledgesRcvblEOYAmt |
| Pledges Rcvbl EOYFMV | $233,411 | PledgesRcvblEOYFMVAmt |
| Prepaid Expenses BOY | $42,907 | PrepaidExpensesBOYAmt |
| Prepaid Expenses EOY | $17,550 | PrepaidExpensesEOYAmt |
| Prepaid Expenses EOYFMV | $17,550 | PrepaidExpensesEOYFMVAmt |
| US Government Obligations BOY | $65 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $334,683 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $334,683 | USGovtObligationsEOYFMVAmt |
| Corporate Stock BOY | $46,174,205 | CorporateStockBOYAmt |
| Corporate Stock EOY | $46,681,801 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $46,681,801 | CorporateStockEOYFMVAmt |
| Corporate Bonds BOY | $29,585,290 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $29,781,276 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $29,781,276 | CorporateBondsEOYFMVAmt |
| Other Investments BOY | $28,136,645 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $28,203,230 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $28,203,230 | OtherInvestmentsEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $61,243 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $51,005 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $10,805 | LandBOYAmt |
| Land EOY | $10,238 | LandEOYAmt |
| Land EOYFMV | $10,238 | LandEOYFMVAmt |
| Total Assets BOY | $104,353,678 | TotalAssetsBOYAmt |
| Total Assets EOY | $105,638,628 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $105,638,628 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $463,290 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $445,176 | AccountsPayableEOYAmt |
| Grants Payable BOY | $4,077,656 | GrantsPayableBOYAmt |
| Grants Payable EOY | $4,406,256 | GrantsPayableEOYAmt |
| Other Liabilities BOY | $127,587 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $126,250 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $4,668,533 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,977,682 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $99,685,145 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $100,660,946 | NoDonorRstrNetAssestsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $99,685,145 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $100,660,946 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $104,353,678 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $105,638,628 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $99,685,145 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $2,022,529 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $101,707,674 | SubtotalAmt |
| Other Decreases | $1,046,728 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $100,660,946 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (5 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|
| PUBLICLY TRADED SECURITIES | P | $4,613,123 | $4,626,747 | -$13,624 | -$13,624 |
| SEI GLOBAL PRIVATE ASSETS V, LP | P | $14,268 | $14,268 | ||
| SEI GLOBAL PRIVATE ASSETS IV, LP | P | $100,248 | $100,248 | ||
| SEI CORE PROPERTY FUND LP | P | $953,568 | $953,568 | ||
| CAPITAL GAINS DIVIDENDS | P | $2,717,966 | $2,717,966 | $2,717,966 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $3,772,426 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $65,238 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $65,238 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $65,238 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $31,312 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $75,000 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $106,312 | TotalPaymentsAndCreditsAmt |
| Es Penalty | $0 | EsPenaltyAmt |
| Overpayment | $41,074 | OverpaymentAmt |
| Applied To ES Tax | $41,074 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | VA | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | WWW.POTOMACHEALTHFOUNDATION.ORG | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERIN MATTHEWS THOMAS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7035230620 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2296 OPITZ BOULEVARD SUITE 200 | AddressLine1Txt |
| City | WOODBRIDGE | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22191 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (1) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | 0 | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | Yes (1) | UndistributedIncomePYInd |
| Undistributed Income PY1 | 2021 | UndistributedIncomePY1Yr |
| Undistr Incm Sect4942a2 Not App | Yes (1) | UndistrIncmSect4942a2NotAppInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (13 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 |
|---|---|---|---|---|---|---|---|---|
| STEVEN LIGA | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | EXECUTIVE DIRECTOR | 40.00 | $30,195 | $6,945 | $100 |
| MARION M WALL | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | CHAIR | 4.00 | $0 | $0 | $0 |
| CAROL S SHAPIRO MD MBA | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | VICE-CHAIR | 4.00 | $0 | $0 | $0 |
| R MICHAEL SORENSEN | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | TREASURER | 3.00 | $0 | $0 | $0 |
| WAYNE MALLARD | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | SECRETARY | 2.00 | $0 | $0 | $0 |
| PAUL GADEN | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| SAM HILL EDD | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| KATHIE JOHNSON | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| PHYLLIS MORGAN PHD | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| ALA S MORTAZAVI MD | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| WILLIAM M MOSS | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| SARAH PITKIN PHD | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| CLARICE TORAN MED | ||||||||
| 2296 OPITZ BOULEVARD SUITE 200 | WOODBRIDGE | VA | 22191 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEI GLOBAL INSTITUTIONAL GROUP | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 FREEDOM VALLEY DRIVE | AddressLine1Txt |
| City | OAKS | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19456 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Service Type | INVESTMENT MANAGEMENT | ServiceTypeTxt |
| Compensation | $103,448 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $106,352,767 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $109,235 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $106,462,002 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $106,462,002 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $1,596,930 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $104,865,072 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $876,253 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $876,253 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $65,238 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $65,238 | TotalTaxAmt |
| Distributable Before Adj | $811,015 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $811,015 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $811,015 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $944,753 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $944,753 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $811,015 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $1,743,732 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $944,753 | QualifyingDistributionsAmt |
| Applied To Year1 | $944,753 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $0 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $0 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $798,979 | Taxable2Amt |
| Undistributed Income CY | $811,015 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (8 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt | Address Line2RecipientUSAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|
| CATHOLIC CHARITIES ARLINGTON DIOCESE MOTHER OF MERCY FREE MEDICAL CLINIC | |||||||
| 9380 FORESTWOOD LANE UNIT B | MANASSAS | VA | 20110 | PC | OPERATING SUPPORT | $120,000 | |
| GEORGE MASON UNIVERSITY OFFICE OF SPONSORED PROGRAMS | |||||||
| 4400 UNIVERSITY DRIVE MSN 4C6 | FAIRFAX | VA | 220304422 | PC | OPERATING SUPPORT | $100,000 | |
| GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER | |||||||
| 4379 RIDGEWOOD CENTER DRIVE SUITE | WOODBRIDGE | VA | 22192 | PC | OPERATING SUPPORT | $120,000 | 102 |
| LLOYD F MOSS FREE CLINIC | |||||||
| 1301 SAM PERRY BOULEVARD | FREDERICKSBURG | VA | 22401 | PC | OPERATING SUPPORT | $124,000 | |
| NORTHERN VIRGINIA FAMILY SERVICE | |||||||
| 10455 WHITE GRANITE DRIVE SUITE 100 | OAKTON | VA | 22124 | PC | KIDS CONNECT | $38,400 | |
| NOVA SCRIPTSCENTRAL INC | |||||||
| 6400 ARLINGTON BOULEVARD SUITE 120 | FALLS CHURCH | VA | 22042 | PC | OPERATING SUPPORT | $184,000 | |
| RX PARTNERSHIP | |||||||
| 2924 EMERYWOOD PARKWAY SUITE 300 | RICHMOND | VA | 23294 | PC | OPERATING SUPPORT | $40,000 | |
| SENTARA NORTHERN VIRGINIA MEDICAL CENTER | |||||||
| 2300 OPITZ BOULEVARD | WOODBRIDGE | VA | 22191 | PC | OPERATING SUPPORT | $140,000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $866,400 | TotalGrantOrContriPdDurYrAmt |
Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp (9 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt | Address Line2RecipientUSAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|
| CATHOLIC CHARITIES ARLINGTON DIOCESE MOTHER OF MERCY FREE MEDICAL CLINIC | |||||||
| 9380 FORESTWOOD LANE UNIT B | MANASSAS | VA | 20110 | PC | OPERATING SUPPORT | $30,000 | |
| GEORGE MASON UNIVERSITY OFFICE OF SPONSORED PROGRAMS | |||||||
| 4400 UNIVERSITY DRIVE MSN 4C6 | FAIRFAX | VA | 220304422 | PC | OPERATING SUPPORT | $25,000 | |
| GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER | |||||||
| 4379 RIDGEWOOD CENTER DRIVE SUITE | WOODBRIDGE | VA | 22192 | PC | OPERATING SUPPORT | $30,000 | 102 |
| INSTITUTE OF PUBLIC HEALTH INNOVATION | |||||||
| 1301 CONNECTICUT AVENUE NW SUITE | WASHINGTON | DC | 20036 | PC | CAPACITY BUILDING | $112,000 | 200 |
| LLOYD F MOSS FREE CLINIC | |||||||
| 1301 SAM PERRY BOULEVARD | FREDERICKSBURG | VA | 22401 | PC | OPERATING SUPPORT | $31,000 | |
| NORTHERN VIRGINIA FAMILY SERVICE | |||||||
| 10455 WHITE GRANITE DRIVE SUITE 100 | OAKTON | VA | 22124 | PC | KIDS CONNECT | $9,600 | |
| NOVA SCRIPTSCENTRAL INC | |||||||
| 6400 ARLINGTON BOULEVARD SUITE 120 | FALLS CHURCH | VA | 22042 | PC | OPERATING SUPPORT | $46,000 | |
| RX PARTNERSHIP | |||||||
| 2924 EMERYWOOD PARKWAY SUITE 300 | RICHMOND | VA | 23294 | PC | OPERATING SUPPORT | $10,000 | |
| SENTARA NORTHERN VIRGINIA MEDICAL CENTER | |||||||
| 2300 OPITZ BOULEVARD | WOODBRIDGE | VA | 22191 | PC | OPERATING SUPPORT (MOBILE VAN) | $35,000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Apprv Fut | $328,600 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $14 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $781,733 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $2,704,342 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $3,486,089 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $3,486,089 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | Yes (1) | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
Transfer Schedule Detail TransferScheduleDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Line Number | 1a(1) | LineNumberTxt |
| Involved | $375 | InvolvedAmt |
Noncharitable Exempt Org Name NoncharitableExemptOrgName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRINCE WILLIAM CHAMBER OF COMMERCE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transfers Trans And Shr Arrngm | MEMBERSHIP DUES | TransfersTransAndShrArrngmDesc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp (3 entries)
| BondBondNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| SEI CORE FIXED INCOME FUND #285 | $23,331,281 | $23,331,281 |
| SEI SIIT REAL RETURN A | $1,865,722 | $1,865,722 |
| SIIT ULTRA SHORT DURATION BOND FUND | $4,584,273 | $4,584,273 |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (6 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| SEI ISHARES MSCI USA MIN VOL FACTOR ETF | $8,685,527 | $8,685,527 |
| SEI LARGE CAP FUND | $18,280,314 | $18,280,314 |
| SEI EXTENDED MKT INDEX-A | $2,720,767 | $2,720,767 |
| SEI WORLD EQUITY EX-US FUND | $7,583,571 | $7,583,571 |
| SEI STATE ST EMG MKT EQTY INDX-K | $2,761,570 | $2,761,570 |
| SEI STATE STREET GLB ALL CAP EQ X US IN | $6,650,052 | $6,650,052 |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $334,683 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $334,683 | USGovtObligationsEOYFMVAmt |
| State Local Sec Book Vl EOY | $0 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $0 | StateLocalSecEOYFMVAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (4 entries)
| Category Or ItemCategoryOrItemTxt | Listed At Cost Or FMVListedAtCostOrFMVCd | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| SEI GLOBAL PRIVATE ASSETS V LP | FMV | $1,259,599 | $1,259,599 |
| SEI GLOBAL PRIVATE ASSETS IV LP | FMV | $4,203,949 | $4,203,949 |
| SEI SPECIAL SITUATIONS FUND LTD | FMV | $5,788,778 | $5,788,778 |
| SEI CORE PROPERTY FUND LP | FMV | $16,950,904 | $16,950,904 |
Land Etc Schedule2 LandEtcSchedule2
Land Etc LandEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category Or Item | FURNITURE, EQUIPMENT AND TECHNOLOGY | CategoryOrItemTxt |
| Cost Or Other Basis | $61,243 | CostOrOtherBasisAmt |
| Accumulated Depreciation | $51,005 | AccumulatedDepreciationAmt |
| Book Value | $10,238 | BookValueAmt |
| EOYFMV | $10,238 | EOYFMVAmt |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases Detail OtherDecreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | UNREALIZED LOSS ON INVESTMENTS | Desc |
| Amt | $1,046,728 | Amt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (9 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| PROFESSIONAL DEVELOPMENT | $5,854 | $0 | $1,270 |
| TECH EXPENSE | $4,097 | $0 | $14,681 |
| OTHER EXPENSE | $487 | $0 | $2,865 |
| SEI GLOBAL PRIVATE ASSETS IV, LP DEDUCTIONS - ROYALTY INCOME | $0 | $613 | $0 |
| SEI GLOBAL PRIVATE ASSETS V, LP OTHER DEDUCTIONS | $0 | $42,191 | $0 |
| SEI GLOBAL PRIVATE ASSETS IV, LP OTHER DEDUCTIONS | $0 | $119,211 | $0 |
| SEI CORE PROPERTY FUND LP OTHER DEDUCTIONS | $0 | $51,187 | $0 |
| SEI GLOBAL PRIVATE ASSETS V, LP INVESTMENT INTEREST EXPENSE | $0 | $4,473 | $0 |
| SEI GLOBAL PRIVATE ASSETS IV, LP INVESTMENT INTEREST EXPENSE | $0 | $12,330 | $0 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (9 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt |
|---|---|---|---|
| SEI GLOBAL PRIVATE ASSETS V, LP ORDINARY LOSS | $0 | -$6,899 | $0 |
| SEI GLOBAL PRIVATE ASSETS IV, LP ORDINARY INCOME | $0 | $51,089 | $0 |
| SEI GLOBAL PRIVATE ASSETS V, LP RENTAL LOSS | $0 | -$888 | $0 |
| SEI GLOBAL PRIVATE ASSETS IV, LP RENTAL LOSS | $0 | -$789 | $0 |
| SEI GLOBAL PRIVATE ASSETS V, LP ROYALTY INCOME | $0 | $8 | $0 |
| SEI GLOBAL PRIVATE ASSETS IV, LP ROYALTY INCOME | $0 | $4,834 | $0 |
| SEI GLOBAL PRIVATE ASSETS V, LP OTHER INCOME | $0 | $193 | $0 |
| SEI GLOBAL PRIVATE ASSETS IV, LP OTHER INCOME | $0 | $30,958 | $0 |
| SEI CORE PROPERTY FUND LP OTHER INCOME | $0 | $83,824 | $0 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail (2 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt |
|---|---|---|
| DUE TO RELATED PARTY | $24,626 | $37,839 |
| DEFERRED TAX LIABILITY | $102,961 | $88,411 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| CONSULTANT FEES | $23,400 | $0 | $13,400 |
| INVESTMENT MANAGEMENT FEES | $103,448 | $103,448 | $0 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| EXCISE TAX | $46,941 | $0 | $0 |
| SEI GLOBAL PRIVATE ASSETS V, LP | $0 | $93 | $0 |
| SEI GLOBAL PRIVATE ASSETS IV, LP | $0 | $1,103 | $0 |
Comments