PHOENIXVILLE FREE CLINIC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- PHOENIXVILLE FREE CLINIC (EIN 23-3072363)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2023-12-06
- IRS object ID
- 202313409349300706
- 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
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-12-06T08:49:47-06:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 232194268 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WOOLARD KRAJNIK MASCIANGELO LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 W WELSH POOL ROAD | AddressLine1Txt |
| City | EXTON | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19341 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 233072363 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHOENIXVILLE FREE CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PHOE | BusinessNameControlTxt |
| Phone | 6109351134 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 143 CHURCH STREET | AddressLine1Txt |
| City | PHOENIXVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19460 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTI SEIDEL | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 6109351134 | PhoneNum |
| Signature | 2023-12-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CHRISTI | PersonFirstNm |
| Person Last | SEIDEL | 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 | FRANK LOUGHRY | PreparerPersonNm |
| PTIN | P01444525 | PTIN |
| Phone | 6103635200 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | 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 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Change | Yes (X) | NameChangeInd |
| Principal Officer | CHRISTI SEIDEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 143 CHURCH STREET | AddressLine1Txt |
| City | PHOENIXVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19460 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,539,437 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PHOENIXVILLEFREECLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTHCARE TO THE UNINSURED AND UNDERSERVED WITH DIGNITY AND RESPECT. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 11 | TotalEmployeeCnt |
| Total Volunteers | 140 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,589,268 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,396,306 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,113 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,690 | CYProgramServiceRevenueAmt |
| PY Investment Income | $20,937 | PYInvestmentIncomeAmt |
| CY Investment Income | $15,848 | CYInvestmentIncomeAmt |
| PY Other Revenue | $22,120 | PYOtherRevenueAmt |
| CY Other Revenue | $47,787 | CYOtherRevenueAmt |
| PY Total Revenue | $1,633,438 | PYTotalRevenueAmt |
| CY Total Revenue | $1,471,631 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $305,492 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $213,761 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $953,930 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $896,637 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $96,014 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $289,752 | PYOtherExpensesAmt |
| CY Other Expenses | $327,751 | CYOtherExpensesAmt |
| PY Total Expenses | $1,549,174 | PYTotalExpensesAmt |
| CY Total Expenses | $1,438,149 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $84,264 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $33,482 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,194,873 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,343,079 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $145,372 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $229,357 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,049,501 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,113,722 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE QUALITY HEALTHCARE TO THE UNINSURED AND UNDERSERVED WITH DIGNITY AND RESPECT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,164,900 | ExpenseAmt |
| Grant | $213,761 | GrantAmt |
| Revenue | $11,690 | RevenueAmt |
| Desc | THE PHOENIXVILLE FREE CLINIC (PFC) IS A NONPROFIT FREE CLINIC IN PHOENIXVILLE THAT PROVIDES MEDICAL CARE TO UNINSURED RESIDENTS OF THE GREATER PHOENIXVILLE AREA, PRIMARILY IN CHESTER AND MONTGOMERY COUNTIES. IN OUR OVER 21 YEAR HISTORY, WE HAVE PROVIDED 175,000 PATIENT VISITS TO OUR MOST VULNERABLE NEIGHBORS. WITHOUT PFC'S SERVICES, UNINSURED RESIDENTS OF OUR COMMUNITY WOULD RELY HEAVILY ON EMERGENCY SERVICES AT LOCAL HOSPITALS AND GO WITHOUT PREVENTATIVE CARE, COMPOUNDING MEDICAL ISSUES AND LEADING TO CHRONIC DISEASE.DURING OUR 2022-23 FISCAL YEAR, WE PROVIDED 1,789 UNIQUE PATIENTS WITH 6,241 PATIENT VISITS. THIS INCLUDES BOTH PRIMARY CARE VISITS AND SPECIALTY CARE WITH OUR VOLUNTEER PHYSICIANS IN THE FIELDS OF PEDIATRICS, CARDIOLOGY, ALLERGY, NEUROLOGY, PODIATRY, GASTROENTEROLOGY, GYNECOLOGY, MENTAL HEALTH COUNSELING, ORTHOPEDICS, PULMONOLOGY, DERMATOLGY, AND MORE. AS THE COVID RESTRICTIONS EASED, THE NUMBER OF PATIENTS WE SERVE CONTINUES TO INCREASE.CLINICAL LABORATORY TESTS ARE CRUCIAL TO COMPREHENSIVE CARE IN BOTH DIAGNOSIS AND TREATMENT. PFC OPERATES AN IN-HOUSE LAB AND ALSO UTILIZES LABCORP FOR TESTS WE CANNOT PROCESS IN-HOUSE. DURING OUR 2022-23 FISCAL YEAR, WE PROVIDED 1,632 OF OUR PATIENTS WITH 5,622 LAB TESTS, WHICH OUR PROVIDERS USE TO CHECK ORGAN FUNCTION, MONITOR THE PROGRESSION OF CHRONIC DISEASE, DIAGNOSE HEALTH ISSUES, AND DEVELOP TREATMENT PLANS.PFC AND PAOLI HOSPITAL CONTINUE OUR PARTNERSHIP TO PROVIDE DIAGNOSTIC TESTS SUCH AS X-RAYS, ULTRASOUNDS, MRIS, CT SCANS, MAMMOGRAMS, AND OTHER STUDIES/CONSULTATIONS UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE CARE PROGRAM. DURING OUR 2022-23 FISCAL YEAR, WE PROVIDED 713 CLINIC PATIENTS WITH SERVICES WORTH OVER $3M.THIS YEAR, PFC SUCCESSFULLY EXPANDED OUR BEHAVIORAL HEALTH PROGRAM WHICH PROVIDES COMPREHENSIVE INDIVIDUAL BEHAVIORAL HEALTH SERVICES. THE CENTRAL GOAL IS TO PROVIDE ONGOING MENTAL AND BEHAVIORAL SERVICES TO THE UNINSURED TO PROMOTE OVERALL WELLNESS AND PREVENT MENTAL HEALTH CRISIS SITUATIONS.DESCRIPTION OF THE COMMUNITY SERVED: THE UNITED WAY OF PENNSYLVANIA ANNUAL ALICE REPORT HIGHLIGHTS HOUSEHOLDS THAT EARN MORE THAN THE FEDERAL POVERTY LEVEL BUT LESS THAN THE BASIC COST OF LIVING FOR THE AREA (THE ALICE THRESHOLD). CREATED BY THE UNITED WAY, ALICE, WHICH STANDS FOR ASSET LIMITED, INCOME CONSTRAINED BUT EMPLOYED REPRESENTS THE GROWING NUMBER OF FAMILIES WHO ARE UNABLE TO AFFORD THE BASICS OF HOUSING, CHILD CARE, FOOD, TRANSPORTATION, HEALTHCARE, AND TECHNOLOGY. THESE WORKERS OFTEN STRUGGLE TO KEEP THEIR OWN HOUSEHOLDS FROM FINANCIAL RUIN, WHILE KEEPING OUR LOCAL COMMUNITIES RUNNING. IN CHESTER COUNTY, WHICH IS THE WEALTHIEST COUNTY IN THE STATE, 6% OF HOUSEHOLDS ARE LIVING IN POVERTY, AND 24% OF HOUSEHOLDS ARE CLASSIFIED AS ALICE. THE MAJORITY OF THE CLINIC'S PATIENTS FALL UNDER ONE OF THESE TWO DESIGNATIONS.SINCE MANY PATIENTS DELAY MEDICAL CARE BECAUSE OF THEIR INABILITY TO PAY, PATIENTS SEEN BY OUR PROVIDERS OFTEN HAVE MULTIPLE MEDICAL ISSUES AND REQUIRE CARE FROM MULTIPLE SPECIALISTS, IN ADDITION TO PRIMARY CARE. THIS CAN PRESENT CHALLENGES WITH REGARD TO THE DELIVERY OF COMPREHENSIVE CARE, AND OUR ABILITY TO PROVIDE OUR PATIENTS WITH SPECIALTY CARE AND ANCILLARY SERVICES LIKE LAB TESTING AND MEDICATIONS IS CRITICAL. OUR PATIENTS, IN TURN, FACE A MULTITUDE OF CHALLENGES AND THOSE HARDSHIPS WERE HEIGHTENED DURING COVID, WHEN MANY LOST THEIR JOBS AND EXPERIENCED INCREASED FINANCIAL STRAIN AND FOOD AND HOUSING INSECURITY. OTHER BARRIERS INCLUDE MENTAL HEALTH AND ADDICTION ISSUES, LACK OF SOCIAL AND FAMILY SUPPORT, AND LIMITED TRANSPORTATION. PFC SERVES A DIVERSE POPULATION. 58.5% OF OUR PATIENTS ARE HISPANIC/LATINO AND 55.8% ARE WOMEN. | Desc |
| Total Program Service Expenses | $1,164,900 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | 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 | Yes (1) | 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 | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 11 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | 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 | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN ASHMAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6109351134 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 143 CHURCH STREET | AddressLine1Txt |
| City | PHOENIXVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19460 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|
| MARK DELOWERY DO | |||||||
| BOARD PRESIDENT | 8.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHRISTOPHER KELLY | |||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GREG CARE CPA | |||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JEANNE FRANKLIN | |||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KATHLEEN DEMUTIS DNP ANP-BC | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| TODD JACKSON | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JESSE KONTRA | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT MCMURTRIE JR DO MBA FAOCA | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM PARADIS | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| GILLIAN MCCARTHY CFP | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JOE SEIBERLICH | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTI SEIDEL | |||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $134,716 | $0 | $0 | ||
| SISSY JOHN MD | |||||||
| MEDICAL DIRECTOR | 40.00 | $165,616 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $300,332 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $1,396,306 | AllOtherContributionsAmt |
| Noncash Contributions | $213,761 | NoncashContributionsAmt |
| Total Contributions | $1,396,306 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL RECORDS | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $11,690 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,690 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,690 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,377 | TotalRevenueColumnAmt |
| Exclusion | $20,377 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,529 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$4,529 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,529 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$4,529 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $111,064 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $63,277 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,787 | TotalRevenueColumnAmt |
| Exclusion | $47,787 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,471,631 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,161 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $68,164 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $213,761 | TotalAmt |
| Program Services | $213,761 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $751,427 | TotalAmt |
| Program Services | $621,139 | ProgramServicesAmt |
| Management And General | $59,269 | ManagementAndGeneralAmt |
| Fundraising | $71,019 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,003 | TotalAmt |
| Program Services | $1,604 | ProgramServicesAmt |
| Management And General | $222 | ManagementAndGeneralAmt |
| Fundraising | $177 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,805 | TotalAmt |
| Program Services | $67,990 | ProgramServicesAmt |
| Management And General | $9,844 | ManagementAndGeneralAmt |
| Fundraising | $5,971 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,402 | TotalAmt |
| Program Services | $49,583 | ProgramServicesAmt |
| Management And General | $4,524 | ManagementAndGeneralAmt |
| Fundraising | $5,295 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,250 | TotalAmt |
| Management And General | $9,250 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,558 | TotalAmt |
| Management And General | $29,558 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,534 | TotalAmt |
| Fundraising | $1,534 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,712 | TotalAmt |
| Program Services | $19,356 | ProgramServicesAmt |
| Management And General | $15,485 | ManagementAndGeneralAmt |
| Fundraising | $3,871 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,161 | TotalAmt |
| Program Services | $22,621 | ProgramServicesAmt |
| Management And General | $6,032 | ManagementAndGeneralAmt |
| Fundraising | $1,508 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,140 | TotalAmt |
| Program Services | $16,605 | ProgramServicesAmt |
| Management And General | $4,428 | ManagementAndGeneralAmt |
| Fundraising | $1,107 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,140 | TotalAmt |
| Program Services | $2,198 | ProgramServicesAmt |
| Management And General | $785 | ManagementAndGeneralAmt |
| Fundraising | $157 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $990 | TotalAmt |
| Program Services | $742 | ProgramServicesAmt |
| Management And General | $198 | ManagementAndGeneralAmt |
| Fundraising | $50 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,892 | TotalAmt |
| Management And General | $1,892 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,067 | TotalAmt |
| Management And General | $21,067 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,449 | TotalAmt |
| Program Services | $15,704 | ProgramServicesAmt |
| Management And General | $1,396 | ManagementAndGeneralAmt |
| Fundraising | $349 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| PHARMACUTICALS | $78,835 | $78,835 | ||
| REPAIRS AND MAINTENANCE | $21,811 | $16,358 | $4,362 | $1,091 |
| TELEPHONE | $12,090 | $9,068 | $2,417 | $605 |
| JANITORIAL SERVICES | $12,000 | $9,000 | $2,400 | $600 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,122 | TotalAmt |
| Program Services | $20,336 | ProgramServicesAmt |
| Management And General | $4,106 | ManagementAndGeneralAmt |
| Fundraising | $2,680 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,438,149 | TotalAmt |
| Program Services | $1,164,900 | ProgramServicesAmt |
| Management And General | $177,235 | ManagementAndGeneralAmt |
| Fundraising | $96,014 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $307,410 | BOYAmt |
| EOY | $272,234 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $90,523 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $152,054 | BOYAmt |
| EOY | $152,147 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250 | BOYAmt |
| EOY | $2,989 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,173 | BOYAmt |
| EOY | $3,256 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $758,727 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $474,474 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $292,419 | BOYAmt |
| EOY | $284,253 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $423,567 | BOYAmt |
| EOY | $461,177 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $76,500 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,194,873 | BOYAmt |
| EOY | $1,343,079 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,840 | BOYAmt |
| EOY | $44,953 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $90,523 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,532 | BOYAmt |
| EOY | $93,881 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $145,372 | BOYAmt |
| EOY | $229,357 | 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 | $716,281 | BOYAmt |
| EOY | $744,168 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $333,220 | BOYAmt |
| EOY | $369,554 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,049,501 | BOYAmt |
| EOY | $1,113,722 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,194,873 | BOYAmt |
| EOY | $1,343,079 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $33,482 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $30,739 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| 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 Minus4 Years | $2,132,296 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $687,127 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,537,537 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,570,584 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,396,306 | CurrentTaxYearAmt |
| Total | $7,323,850 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,201 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $400 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $940 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,113 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,690 | CurrentTaxYearAmt |
| Total | $15,344 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,133,497 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $687,527 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,538,477 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,571,697 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,407,996 | CurrentTaxYearAmt |
| Total | $7,339,194 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $205,200 | CurrentTaxYearMinus4YearsAmt |
| Total | $205,200 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $205,200 | CurrentTaxYearMinus4YearsAmt |
| Total | $205,200 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $7,133,994 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,091 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,344 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,136 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,942 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,377 | CurrentTaxYearAmt |
| Total | $62,890 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,091 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,344 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,136 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,942 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,377 | CurrentTaxYearAmt |
| Total | $62,890 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,147,588 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $691,871 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,548,613 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,585,639 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,428,373 | CurrentTaxYearAmt |
| Total | $7,402,084 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.96380 | PublicSupportCY509Pct |
| Public Support PY509 | 0.93750 | PublicSupportPY509Pct |
| Investment Income CY | 0.00850 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00750 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $347,381 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $22,173 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $369,554 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $388,794 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$41,413 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $347,381 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,391 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $75,403 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $388,794 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $326,833 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$13,442 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $313,391 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $264,736 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $62,097 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $326,833 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $512,275 | OtherCostOrOtherBasisAmt |
| Depreciation | $237,317 | DepreciationAmt |
| Book Value | $274,958 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $142,564 | OtherCostOrOtherBasisAmt |
| Depreciation | $134,149 | DepreciationAmt |
| Book Value | $8,415 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $103,888 | OtherCostOrOtherBasisAmt |
| Depreciation | $103,008 | DepreciationAmt |
| Book Value | $880 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $284,253 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RIGHT OF USE LEASE | Desc |
| Book Value | $76,500 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $76,500 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| WAGES & TAXES PAYABLE | $17,381 |
| RIGHT OF USE LEASE | $76,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $93,881 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $2,577,371 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $1,075,001 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $30,739 | OtherRevenueAmt |
| Revenue Not Reported | $1,105,740 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,471,631 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,471,631 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,513,150 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $1,075,001 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $1,075,001 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,438,149 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,438,149 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | TO PROVIDE FUTURE INCOME TO SUPPORT THE PROGRAMS OF THE CLINIC |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | UNREALIZED GAINS 30,739. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | AUCTION | Event1Nm |
| Gross Receipts Event1 | $4,775 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $4,775 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $296 | OtherDirectExpensesEvent1Amt |
| Event2 | 20TH ANNIVERSARY GALA | Event2Nm |
| Gross Receipts Event2 | $106,289 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $106,289 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $62,981 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $111,064 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $111,064 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $63,277 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $63,277 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $47,787 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | HEALTHCARE ASSISTANCE | GrantTypeTxt |
| Non Cash Assistance | $38,027 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | PHARMACEUTICALS AND SUPPLIES | NonCashAssistanceDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SISSY JOHN MD | PersonNm |
| Title | MEDICAL DIRECTOR | TitleTxt |
| Base Compensation Filing Org | $150,000 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $15,616 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $165,616 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Noncash Contributions Rpt F990 | $5,643 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Noncash Contributions Rpt F990 | $38,027 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND PROVIDED TO THE FULL BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EVERY MEMBER OF THE BOARD REVIEWS AND EXECUTES A CONFLICT OF INTEREST STATEMENT ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS A GOVERNANCE COMMITTEE. THE COMMITTEE DETERMINES SALARIES BY USING THE COMPENSATION AND BENEFITS SURVEY BY THE NONPROFIT TIMES. |
| FORM 990, PART VI, SECTION C, LINE 19 | SEE SCHEDULE O |
| FORM 990, PART XII, LINE 2C: | FINANCE COMMITTEE RESPONSIBLE FOR OVERSIGHT OF AUDIT. NO CHANGES FROM PRIOR YEAR. |
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