GOOD SAMARITAN CLINIC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN CLINIC (EIN 71-0863639)
- Tax period
- 2023-07-01 to 2024-06-30
- Filed
- 2025-05-08
- IRS object ID
- 202541289349302489
- Schema version
- 2023v6.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-05-08T12:48:47-04:00 | ReturnTs |
| Tax Period End | 2024-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 843068935 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRZ CPAS & ADVISORS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 JENNY LIND RD STE B | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 710863639 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 4797830233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 S ZERO STREET | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATTI KIMBROUGH | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 4797830233 | PhoneNum |
| Signature | 2025-05-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARC LUX CPA | PreparerPersonNm |
| PTIN | P00588449 | PTIN |
| Phone | 4796490888 | PhoneNum |
| Preparation | 2025-05-08 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | CRYSTAL LOUGIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3201 S 97TH STREET | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72903 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,756,343 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GOODSAMARITANFS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | TO BE A CHARITABLE HEALTHCARE MINISTRY FOR THE UNDERSERVED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 29 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 29 | VotingMembersIndependentCnt |
| Total Employee | 12 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $773,157 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,631,791 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $90,744 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $88,054 | CYProgramServiceRevenueAmt |
| PY Investment Income | $23,633 | PYInvestmentIncomeAmt |
| CY Investment Income | -$81,410 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$77,697 | PYOtherRevenueAmt |
| CY Other Revenue | -$55,184 | CYOtherRevenueAmt |
| PY Total Revenue | $809,837 | PYTotalRevenueAmt |
| CY Total Revenue | $1,583,251 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $392,211 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $461,285 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $78,077 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $316,776 | PYOtherExpensesAmt |
| CY Other Expenses | $1,283,174 | CYOtherExpensesAmt |
| PY Total Expenses | $708,987 | PYTotalExpensesAmt |
| CY Total Expenses | $1,744,459 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $100,850 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$161,208 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,275,720 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,143,481 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,980 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,172 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,259,740 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,110,309 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UN-INSURED, ELDERLY, & HOMELESS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,536,313 | ExpenseAmt |
| Revenue | $88,054 | RevenueAmt |
| Desc | THE CLINIC PROVIDES MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UN-INSURED, ELDERLY, & HOMELESS. | Desc |
| Total Program Service Expenses | $1,536,313 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 12 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 29 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 29 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 4797830233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 S ZERO STREET | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| REBECCA BROWN | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MARK BUERGLER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE DAVIDSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MARCELA ESCOBAR | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHEN GEBHART | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DR BRANDI GUTHREY | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MELISSA HANESWORTH | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| PAT HIGHTOWER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CHRISTOPHER HOOKS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DR DAVID HUNTON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CRYSTAL LOUGIN | ||||||
| CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| HAROLD MACDOWELL | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| VICTOR MARTINEZ | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MONICA MCGRUDER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DIANNE MEADORS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| TINA MEEK | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| LEXI MORRIS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| NYCOLE OLIVER | ||||||
| SECRETARY | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| STEPHANIE PARSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| JAY RICHARDSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DARRELL STOVALL | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| RANDY STRICKLAND | ||||||
| TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JENNIFER TERRY | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STAN VLADAMAR | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DAWN WATTS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE WHITAKER | ||||||
| VICE CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| HOLLI WILLIS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DR LESLIE ZIEGLER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| SCOTT ZUERKER | ||||||
| PAST CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $82,807 | FundraisingAmt |
| All Other Contributions | $1,548,984 | AllOtherContributionsAmt |
| Noncash Contributions | $1,112,240 | NoncashContributionsAmt |
| Total Contributions | $1,631,791 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT PAYMENTS | Desc |
| Total Revenue Column | $88,054 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $88,054 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $88,054 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,380 | TotalRevenueColumnAmt |
| Exclusion | $36,380 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $117,790 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$117,790 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$117,790 | TotalRevenueColumnAmt |
| Exclusion | -$117,790 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $82,807 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $55,302 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$55,302 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Total Revenue Column | $118 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $118 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $118 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,583,251 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $88,172 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | -$81,410 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $406,661 | TotalAmt |
| Program Services | $277,123 | ProgramServicesAmt |
| Management And General | $64,769 | ManagementAndGeneralAmt |
| Fundraising | $64,769 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,419 | TotalAmt |
| Program Services | $13,454 | ProgramServicesAmt |
| Management And General | $6,820 | ManagementAndGeneralAmt |
| Fundraising | $3,145 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,205 | TotalAmt |
| Program Services | $21,295 | ProgramServicesAmt |
| Management And General | $4,955 | ManagementAndGeneralAmt |
| Fundraising | $4,955 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,548 | TotalAmt |
| Management And General | $7,548 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,505 | TotalAmt |
| Program Services | $3,923 | ProgramServicesAmt |
| Management And General | $1,089 | ManagementAndGeneralAmt |
| Fundraising | $493 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $911 | TotalAmt |
| Program Services | $869 | ProgramServicesAmt |
| Management And General | $25 | ManagementAndGeneralAmt |
| Fundraising | $17 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,650 | TotalAmt |
| Program Services | $1,650 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,515 | TotalAmt |
| Program Services | $101,511 | ProgramServicesAmt |
| Management And General | $13,004 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,933 | TotalAmt |
| Program Services | $1,933 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,736 | TotalAmt |
| Program Services | $24,241 | ProgramServicesAmt |
| Management And General | $5,495 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,061 | TotalAmt |
| Program Services | $16,185 | ProgramServicesAmt |
| Management And General | $2,730 | ManagementAndGeneralAmt |
| Fundraising | $146 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| IN-KIND EXPENSES | $1,049,190 | $1,048,435 | $453 | $302 |
| MISCELLANEOUS | $9,891 | $9,891 | ||
| BOARD FUNCTIONS | $8,726 | $8,726 | ||
| DUES & SUBSCRIPTIONS | $8,105 | $2,725 | $1,251 | $4,129 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,403 | TotalAmt |
| Program Services | $22,969 | ProgramServicesAmt |
| Management And General | $3,313 | ManagementAndGeneralAmt |
| Fundraising | $121 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,744,459 | TotalAmt |
| Program Services | $1,536,313 | ProgramServicesAmt |
| Management And General | $130,069 | ManagementAndGeneralAmt |
| Fundraising | $78,077 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,085,688 | BOYAmt |
| EOY | $484,268 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $309,522 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,869 | BOYAmt |
| EOY | $4,747 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $136,909 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $54,111 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $186,163 | BOYAmt |
| EOY | $82,798 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $262,146 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,275,720 | BOYAmt |
| EOY | $1,143,481 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,980 | BOYAmt |
| EOY | $33,172 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,980 | BOYAmt |
| EOY | $33,172 | 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 | $1,259,740 | BOYAmt |
| EOY | $1,070,309 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $40,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,259,740 | BOYAmt |
| EOY | $1,110,309 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,275,720 | BOYAmt |
| EOY | $1,143,481 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$161,208 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $11,777 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $423,664 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $665,601 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $603,963 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $773,157 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,631,791 | CurrentTaxYearAmt |
| Total | $4,098,176 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $423,664 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $665,601 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $603,963 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $773,157 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,631,791 | CurrentTaxYearAmt |
| Total | $4,098,176 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $334,984 | SubstantialContributorsTotAmt |
| Public Support Total170 | $3,763,192 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,181 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,825 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,826 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $26,251 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $36,380 | CurrentTaxYearAmt |
| Total | $81,463 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,179,639 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $409,186 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.90040 | PublicSupportCY170Pct |
| Public Support PY170 | 0.81310 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,812 | OtherCostOrOtherBasisAmt |
| Depreciation | $618 | DepreciationAmt |
| Book Value | $41,194 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $95,097 | OtherCostOrOtherBasisAmt |
| Depreciation | $53,493 | DepreciationAmt |
| Book Value | $41,604 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $82,798 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $1,650,330 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $11,777 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $55,302 | OtherRevenueAmt |
| Revenue Not Reported | $67,079 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,583,251 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,583,251 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,799,761 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $55,302 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $55,302 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,744,459 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,744,459 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | THE CLINIC FOLLOWS THE GUIDANCE OF THE ACCOUNTING STANDARDS CODIFICATION (ASC) 740, ACCOUNTING FOR INCOME TAXES, RELATED TO UNCERTAINTIES IN INCOME TAXES, WHICH PRESCRIBES A THRESHOLD OF MORE LIKELY THAN NOT FOR RECOGNITION AND DERECOGNITION OF POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. FOR THE YEAR ENDED JUNE 30, 2024, MANAGEMENT OF THE CLINIC IS NOT AWARE OF ANY MATERIAL UNCERTAIN TAX POSITIONS. ALL TAX EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE AND OTHER APPLICABLE AGENCIES. SUCH AGENCIES MAY REVIEW THE TAXABILITY OF UNRELATED BUSINESS INCOME, OR THE QUALIFICATION OF THE TAX-EXEMPT ENTITY UNDER THE INTERNAL REVENUE CODE AND APPLICABLE STATE STATUES. FOR FEDERAL TAX PURPOSES, THE TAX RETURNS REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. |
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | FUNDRAISING EVENT EXPENSE 55,302 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | FUNDRAISING EVENT EXPENSE 55,302 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | VARIOUS EVENTS | Event1Nm |
| Gross Receipts Event1 | $82,807 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $82,807 | CharitableContriEvent1Amt |
| Other Direct Expenses Event1 | $55,302 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $82,807 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $82,807 | CharitableContributionsTotAmt |
| Oth Direct Expnss Total Events | $55,302 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $55,302 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$55,302 | NetIncomeSummaryAmt |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $63,050 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $923,571 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | PHYSICIAN HOURS | 876 | $109,000 | AVERAGE HOURLY SALARY |
| Yes (X) | EQUIPMENT LEASE | 1 | $16,619 | COST |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD OF DIRECTORS REVIEWS THE FORM 990 PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | POTENTIAL BOARD MEMBERS ARE QUESTIONED OF ANY POTENTIAL CONFLICTS OF INTER EST. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE FINANCIALS AND FORM 990 ARE KEPT AT THE ORGANIZATION'S PHYSICAL LOCATION AND MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | FUNDRAISING EVENT EXPENSE 55,302 FUNDRAISING EVENT EXPENSE -55,302 |
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