OPEN ARMS FREE CLINIC INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- OPEN ARMS FREE CLINIC INC (EIN 45-4475625)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-06-02
- IRS object ID
- 202211539349301226
- Schema version
- 2021v4.0
- 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 | 2022-06-02T12:27:25-07:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 362716239 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARNES GIVENS & BARNES | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E Evergreen Ave STE 117 | AddressLine1Txt |
| City | Mount Prospect | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60056 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454475625 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OPEN ARMS FREE CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OPEN | BusinessNameControlTxt |
| Phone | 2623791401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 678 | AddressLine1Txt |
| City | ELKHORN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53121 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jeffery Scherer | PersonNm |
| Person Title | President | PersonTitleTxt |
| Signature | 2022-06-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Jeffery | PersonFirstNm |
| Person Last | Scherer | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | William J Barnes | PreparerPersonNm |
| PTIN | P00399658 | PTIN |
| Phone | 2247642442 | 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 |
| Federated Assurance Level | FAL1 | FederatedAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 678 | AddressLine1Txt |
| City | ELKHORN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 531210678 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,406,021 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | OPENARMSFREECLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | To better understand and serve with compassion the health and wellness needs of uninsured and underinsured residents of Walworth County. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 37 | TotalEmployeeCnt |
| Total Volunteers | 250 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,156,333 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,152,876 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $19,874 | PYInvestmentIncomeAmt |
| CY Investment Income | $17,250 | CYInvestmentIncomeAmt |
| PY Other Revenue | $17,827 | PYOtherRevenueAmt |
| CY Other Revenue | $36,082 | CYOtherRevenueAmt |
| PY Total Revenue | $1,194,034 | PYTotalRevenueAmt |
| CY Total Revenue | $1,206,208 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $508,727 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $546,623 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $8,831 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $273,584 | PYOtherExpensesAmt |
| CY Other Expenses | $277,400 | CYOtherExpensesAmt |
| PY Total Expenses | $782,311 | PYTotalExpensesAmt |
| CY Total Expenses | $824,023 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $411,723 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $382,185 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,199,390 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,627,799 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,585 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $46,322 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,171,805 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,581,477 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To better understand and serve with compassion the health and wellness needs of uninsured and underinsured residents of Walworth County. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $365,007 | ExpenseAmt |
| Grant | $157,300 | GrantAmt |
| Desc | Medical Services Volunteer doctors, nurses, pharmacists, lab techs, and interpreters provide direct primary and specialty medical care for qualified patients. Medical services are offered an average 3-4 days a week, 40 hours a week. Services include primary care, specialty care, lab, and medications. There were 8,101 total patient medical visits, that included 11,446 medications, 3,176 lab tests, 2,978 COVID vaccinations, 1,500 medical visits, and 243 telehealth visits. While we care for all ages, the majority (88%) are adults aged 18-64 with chronic disease (diabetes, heart disease, asthma, mental health). All services provided at no cost to the patient. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $255,876 | ExpenseAmt |
| Grant | $148,174 | GrantAmt |
| Revenue | $35,430 | RevenueAmt |
| Desc | Dental Services - Oral health care is provided by volunteer and paid dentists, assistants, and hygienists. In 2021, there were 3,770 dental procedures completed ($350,000 value). OAFC started a dental rotation in partnership with Marquette University Dental School in Fall 2021. At least 25% of the patients are children, and 6% are adults with special needs. Each patient is given an initial exam, that includes X-ray, by a dentist to determine the level of care needed, basic restorative treatment, extractions when needed, and a cleaning. All services were provided free at no cost to patients, minus those who had a minimal co-pay with their Medicaid. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $57,452 | ExpenseAmt |
| Grant | $156,500 | GrantAmt |
| Desc | Behavioral Health Services Patients can receive both medication and counseling therapeutic care within the clinic. In 2021, OAFC hired two bilingual behavioral health counselors to provide 650 counseling visits for individual, couples, and families. Medications are prescribed by the OAFC Medical providers, and a volunteer psychiatrist provided medication management and review. While no narcotics nor scheduled drugs are available, OAFC has been able to treat general anxiety, depression, and mood disorders with the available medications in the Open Arms dispensary. All services provided at no cost to the patient. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $678,335 | 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 | 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 | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 37 | 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 |
| Form8282 Filed | 0 | Form8282FiledCnt |
| 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | false | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | 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 | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SARA NICHOLS | PersonNm |
| Phone | 2623791401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 678 | AddressLine1Txt |
| City | ELKHORN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 531210678 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Lakisha Arif-Holmes DDS | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Linda Franz | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Thomas Hartz | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Steve Jensen | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Karen Littig | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| James Lovell | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Gerard Scoop Makovec | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Donna Neshek RN | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Rev Daniel Sanders | |||||||
| Dir-ex officio | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Robert Youngquist DDS | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Catherine Rapp RN | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Wenda Shereos | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Marianela Smale | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Jeffrey Bahr MD | |||||||
| Vice President | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Jeffery Scherer MD | |||||||
| President | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Karla Tildahl RN | |||||||
| Secretary | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Nick Vorpagel | |||||||
| Treasurer | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $198,824 | FundraisingAmt |
| Government Grants | $561,974 | GovernmentGrantsAmt |
| All Other Contributions | $392,078 | AllOtherContributionsAmt |
| Noncash Contributions | $700 | NoncashContributionsAmt |
| Total Contributions | $1,152,876 | TotalContributionsAmt |
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,660 | TotalRevenueColumnAmt |
| Exclusion | $14,660 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $143,955 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $141,365 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,590 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,590 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,590 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $58,448 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $198,824 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $58,448 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Total Revenue Column | $36,082 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,082 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $36,082 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,206,208 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,672 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $14,660 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $497,466 | TotalAmt |
| Program Services | $385,159 | ProgramServicesAmt |
| Management And General | $112,307 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,157 | TotalAmt |
| Program Services | $38,135 | ProgramServicesAmt |
| Management And General | $11,022 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,050 | TotalAmt |
| Management And General | $8,050 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,782 | TotalAmt |
| Management And General | $1,782 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,455 | TotalAmt |
| Program Services | $4,026 | ProgramServicesAmt |
| Fundraising | $1,429 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,350 | TotalAmt |
| Program Services | $3,604 | ProgramServicesAmt |
| Management And General | $56 | ManagementAndGeneralAmt |
| Fundraising | $690 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,837 | TotalAmt |
| Program Services | $36,285 | ProgramServicesAmt |
| Management And General | $1,187 | ManagementAndGeneralAmt |
| Fundraising | $365 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,619 | TotalAmt |
| Program Services | $10,420 | ProgramServicesAmt |
| Management And General | $524 | ManagementAndGeneralAmt |
| Fundraising | -$6,325 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| Patient care expenses | $136,420 | $136,420 | |
| Utilities | $24,717 | $24,717 | |
| Repairs and maintenance | $23,162 | $23,162 | |
| Equipment and software | $18,040 | $10,972 | $7,068 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,968 | TotalAmt |
| Program Services | $5,435 | ProgramServicesAmt |
| Management And General | $1,929 | ManagementAndGeneralAmt |
| Fundraising | $5,604 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $824,023 | TotalAmt |
| Program Services | $678,335 | ProgramServicesAmt |
| Management And General | $136,857 | ManagementAndGeneralAmt |
| Fundraising | $8,831 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $717,884 | BOYAmt |
| EOY | $702,685 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,021 | BOYAmt |
| EOY | $132,173 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,819 | BOYAmt |
| EOY | $18,990 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,013,924 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $238,668 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $736,665 | BOYAmt |
| EOY | $775,256 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $606,001 | BOYAmt |
| EOY | $998,695 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,199,390 | BOYAmt |
| EOY | $2,627,799 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,585 | BOYAmt |
| EOY | $46,322 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,585 | BOYAmt |
| EOY | $46,322 | 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 | $1,897,212 | BOYAmt |
| EOY | $2,386,180 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $274,593 | BOYAmt |
| EOY | $195,297 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,171,805 | BOYAmt |
| EOY | $2,581,477 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,199,390 | BOYAmt |
| EOY | $2,627,799 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $382,185 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $27,487 | 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 | false | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $124,828 | OtherCostOrOtherBasisAmt |
| Book Value | $124,828 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $524,221 | OtherCostOrOtherBasisAmt |
| Depreciation | $34,239 | DepreciationAmt |
| Book Value | $489,982 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $364,875 | OtherCostOrOtherBasisAmt |
| Depreciation | $204,429 | DepreciationAmt |
| Book Value | $160,446 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $775,256 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,155,791 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $27,487 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $923,878 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $951,365 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,204,426 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $1,782 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $1,782 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,206,208 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,746,119 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $923,878 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $923,878 | ExpensesNotReportedAmt |
| Expenses Subtotal | $822,241 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $1,782 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $1,782 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $824,023 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X : FIN48 Footnote | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HAS ADOPTED ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ASC 740-10 EFFECTIVE JANUARY 1, 2009. THE COMMITTEE'S POLICY IS TO EVALUATE, AT LEAST ANNUALY, THE POTENTIAL FOR INCOME TAX EXPOSURE. ANY EXPOSURE FROM SUCH POSITIONS IS RECORDED BASED ON THE LARGEST COST THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING INCURRED UPON ULTIMATE SETTLEMENT. THE ADOPTION OF ASC 740-10 DID NOT HAVE A MATERIAL EFFECT ON ITS FINANCIAL POSITION, RESULTS OF OPERATIONS OR CASH FLOWS. | ExplanationTxt |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agrmt Prof Fundraising Acty | false | AgrmtProfFundraisingActyInd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | BIRTHDAY EVENT | Event1Nm |
| Gross Receipts Event1 | $135,289 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $102,043 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $33,246 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $27,809 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $5,437 | OtherDirectExpensesEvent1Amt |
| Event2 | OTHER EVENTS | Event2Nm |
| Gross Receipts Event2 | $61,030 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $57,695 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $3,335 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $3,335 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $60,953 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $39,086 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $21,867 | GrossRevenueOtherEventsAmt |
| Cash Prizes Other Events | $1,658 | CashPrizesOtherEventsAmt |
| Food And Beverage Other Events | $14,020 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $6,189 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $257,272 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $198,824 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $58,448 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,658 | CashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $41,829 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $14,961 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $58,448 | DirectExpenseSummaryEventsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | FORM 990 IS REVIEWED, SIGNED, AND FILED BY THE PRESIDENT WHO THEN PRESENTS A COPY TO EACH MEMEBER OF THE BOARD OF DIRECTORS. SHOULD ANY MATERIAL REASON BE FOUND, AMENDMENTS TO THE RETURN WOULD BE MADE UNDER BOARD DIRECTION AND APPROVAL. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST |
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