JUPITER ISLAND MEDICAL CLINIC INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- JUPITER ISLAND MEDICAL CLINIC INC (EIN 20-4659155)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-02-08
- IRS object ID
- 202200399349300540
- Schema version
- 2020v4.0
- 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 | 2022-02-08T13:38:58-06:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 651063964 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NARDA E BUTNER CPA PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 NORTHLAKE BLVD STE 105 | AddressLine1Txt |
| City | PALM BEACH GARDENS | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 334031703 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204659155 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JUPITER ISLAND MEDICAL CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JUPI | BusinessNameControlTxt |
| Phone | 7725463751 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 ESTRADA SQUARE | AddressLine1Txt |
| City | HOBE SOUND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33455 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TYLER R CAIN | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 7725463751 | PhoneNum |
| Signature | 2022-02-15 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TYLER R | PersonFirstNm |
| Person Last | CAIN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NARDA E BUTNER | PreparerPersonNm |
| PTIN | P00844716 | PTIN |
| Phone | 5616533330 | PhoneNum |
| Preparation | 2022-02-02 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TYLER R CAIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 316 SOUTH BEACH ROAD | AddressLine1Txt |
| City | HOBE SOUND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33455 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,192,909 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | NONE | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE MEDICAL SERVICES TO ALL MEMBERS OF THE COMMUNITY WHO NEED THEM REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 5 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $737,877 | PYContributionsGrantsAmt |
| CY Contributions Grants | $796,939 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $106,358 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $95,709 | CYProgramServiceRevenueAmt |
| PY Investment Income | $91,877 | PYInvestmentIncomeAmt |
| CY Investment Income | $176,829 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $936,112 | PYTotalRevenueAmt |
| CY Total Revenue | $1,069,477 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $211,554 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $210,678 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,859 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $435,686 | PYOtherExpensesAmt |
| CY Other Expenses | $967,653 | CYOtherExpensesAmt |
| PY Total Expenses | $647,240 | PYTotalExpensesAmt |
| CY Total Expenses | $1,178,331 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $288,872 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$108,854 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,390,217 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,220,519 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,099 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $186 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,388,118 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,220,333 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDE MEDICAL SERVICES TO ALL MEMBERS OF THE COMMUNITY WHO NEED THEM REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,006,329 | ExpenseAmt |
| Revenue | $95,709 | RevenueAmt |
| Desc | TO PROVIDE MEDICAL SERVICES TO ALL MEMBERS OF THE COMMUNITY WHO NEED THEM REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $1,006,329 | 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 | false | 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 | false | 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 | false | 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 | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 5 | 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 | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | 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 | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | FL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARY KRISKE | PersonNm |
| Phone | 7725463751 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 ESTRADA ROAD | AddressLine1Txt |
| Address Line2 | 100 ESTRADA ROAD | AddressLine2Txt |
| City | HOBE SOUND | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33455 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| DR KENNETH BOTSFORD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TYLER R CAIN | ||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| ELIZABETH F LONG | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| W SCOTT MCGRAW | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CHARLES V MOORE | ||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| SUZANNE W PARSONS | ||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| 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 |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHERYL J ROBERT MD | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4300 US HIGHWAY 1 203-113 | AddressLine1Txt |
| City | JUPITER | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33477 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | MEDICAL DOCTOR | ServicesDesc |
| Compensation | $271,980 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $796,939 | AllOtherContributionsAmt |
| Total Contributions | $796,939 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| MEDICAL SERVICES REVENUE | $97,624 | $97,624 |
| PATIENT REFUNDS | -$1,915 | -$1,915 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $95,709 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,064 | TotalRevenueColumnAmt |
| Exclusion | $92,064 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $208,197 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $123,432 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $84,765 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,765 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $84,765 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,069,477 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $180,474 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $92,064 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,674 | TotalAmt |
| Program Services | $139,801 | ProgramServicesAmt |
| Management And General | $55,873 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,004 | TotalAmt |
| Management And General | $15,004 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,869 | TotalAmt |
| Management And General | $7,869 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,076 | TotalAmt |
| Program Services | $299,076 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,671 | TotalAmt |
| Management And General | $36,671 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,476 | TotalAmt |
| Management And General | $8,476 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,961 | TotalAmt |
| Management And General | $9,961 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| COVID-10 TESTING EXPENSES | $540,180 | $540,180 | |
| MEDICAL SUPPLIES AND SERV | $26,876 | $26,876 | |
| COMPUTER SUPPORT | $20,606 | $20,606 | |
| OFFICE SUPPLIES AND EXPEN | $8,412 | $8,412 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,526 | TotalAmt |
| Program Services | $396 | ProgramServicesAmt |
| Management And General | $7,271 | ManagementAndGeneralAmt |
| Fundraising | $1,859 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,178,331 | TotalAmt |
| Program Services | $1,006,329 | ProgramServicesAmt |
| Management And General | $170,143 | ManagementAndGeneralAmt |
| Fundraising | $1,859 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,476 | BOYAmt |
| EOY | $55,725 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $552,176 | BOYAmt |
| EOY | $381,370 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,559 | BOYAmt |
| EOY | $7,482 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $608 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $15,849 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,371 | BOYAmt |
| EOY | $2,385 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $117,764 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $99,118 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,395 | BOYAmt |
| EOY | $18,646 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,799,180 | BOYAmt |
| EOY | $4,738,394 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60 | BOYAmt |
| EOY | $60 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,390,217 | BOYAmt |
| EOY | $5,220,519 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,099 | BOYAmt |
| EOY | $186 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,099 | BOYAmt |
| EOY | $186 | 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 | $588,938 | BOYAmt |
| EOY | $481,939 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,799,180 | BOYAmt |
| EOY | $4,738,394 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,388,118 | BOYAmt |
| EOY | $5,220,333 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,390,217 | BOYAmt |
| EOY | $5,220,519 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$108,854 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $934,647 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $6,422 | PriorPeriodAdjustmentsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Rev Etc Audited Fincl Stmt | $2,004,124 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $934,647 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $934,647 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,069,477 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,069,477 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,178,331 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $1,178,331 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,178,331 | TotalExpensesPerForm990Amt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | THE VOLUNTEER ARE THE BOARD OF DIRECTORS AND MEMBERS OF THE BOARD |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD OF DIRECTORS REVIEW AND APPROVES THE ANNUAL AUDITED FINANCIAL STATEMENTS. THE BOARD OF DIRECTORS ALSO REVIEWS AND APPROVES THE ANNUAL FORM 990 RETURN OF THE ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THERE ARE NO RELATED PARTIES EMPLOYED BY THE CLINIC. THE EMPLOYEES AND DOCTORS ARE HIRED BASED ON THEIR SKILLS AND ABILITY TO DO THE JOB. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS APPROVES ALL SALARIES AND DOCTORS COMPENSATIONS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE BOARD OF DIRECTORS GIVE ANNUAL BONUSES AND RAISES BASED ON THE INDIVIDUALS ABILITY AND SKILLS DEMONSTRATED ON THE JOB. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | DR. CHERYL J. ROBERTS 299,076 0 0 |
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