FREE CLINIC OF THE GREATER MENOMONIE AREA INC: Form 990EZ, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- FREE CLINIC OF THE GREATER MENOMONIE AREA INC (EIN 20-1285809)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-07-19
- IRS object ID
- 202212039349200011
- Schema version
- 2021v4.2
- 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 | 2022-07-19T01:40:16-00:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 391952253 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Michael Fekete CPA LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 735 24th St N | AddressLine1Txt |
| City | Menomonie | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54751 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201285809 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Free Clinic of the Greater Menomonie Area Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 7152337655 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 624 | AddressLine1Txt |
| City | Menomonie | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54751 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Nels Paulson | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 7152337655 | PhoneNum |
| Signature | 2022-07-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Nels | PersonFirstNm |
| Person Last | Paulson | PersonLastNm |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Michael Fekete | PreparerPersonNm |
| PTIN | P01235420 | PTIN |
| Phone | 7152352755 | PhoneNum |
| Preparation | 2022-07-19 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Website Address | menomoniefreeclinic.org | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $99,718 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $99,681 | ContributionsGiftsGrantsEtcAmt |
| Investment Income | $37 | InvestmentIncomeAmt |
| Total Revenue | $99,718 | TotalRevenueAmt |
| Fees And Other Pymt To Ind Cntrct | $29,981 | FeesAndOtherPymtToIndCntrctAmt |
| Other Expenses Total | $53,986 | OtherExpensesTotalAmt |
| Total Expenses | $83,967 | TotalExpensesAmt |
| Excess Or Deficit For Year | $15,751 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $221,926 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $237,677 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,524 | BOYAmt |
| EOY | $247,316 | EOYAmt |
Other Assets Total Detail OtherAssetsTotalDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,008 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,524 | BOYAmt |
| EOY | $248,324 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,598 | BOYAmt |
| EOY | $10,647 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $221,926 | BOYAmt |
| EOY | $237,677 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | Provide access to healthcare and healthcare education | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | Provided access to healthcare for low income residents of Western Wisconsin to help fill healthcare coverage gaps such as high deductibles for ACA, non-participants in ACA and/or lack of dental coverage | DescriptionProgramSrvcAccomTxt |
| Program Service Expenses | $70,967 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $70,967 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (15 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt |
|---|---|---|
| Steve Rosas MD | ||
| Medical director | 001.00 | $0 |
| Christina Mayer | ||
| Director | 001.00 | $0 |
| Jennie Kasfeldt | ||
| Director | 000.50 | $0 |
| Nels Paulson | ||
| President | 001.00 | $0 |
| Andrea Nodolf | ||
| Secretary | 001.00 | $0 |
| Mark Winterfeldt | ||
| Director | 000.50 | $0 |
| Jessica Rudiger | ||
| Director | 000.50 | $0 |
| Wendy Sterry | ||
| Director | 000.50 | $0 |
| Dr Emma Czechowicz | ||
| Director | 000.50 | $0 |
| Lynn Fekete | ||
| Director | 000.50 | $0 |
| Stacey Evans | ||
| Treasurer | 001.00 | $0 |
| Kelli Sue Dwyer | ||
| Director | 000.50 | $0 |
| MaryBeth Fitzgerald | ||
| Director | 000.50 | $0 |
| Kasey Pogorelski | ||
| Director | 000.50 | $0 |
| Kelly Wojtalewicz | ||
| Director | 000.50 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | false | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | false | OrganizationHadUBIInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Form1120 Pol Filed | false | Form1120PolFiledInd |
| Made Loans To From Officers | false | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael Fekete | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 735 24th St N | AddressLine1Txt |
| City | Menomonie | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54751 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7152352755 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Foreign Office | false | ForeignOfficeInd |
| Donor Advised Fnds | false | DonorAdvisedFndsInd |
| Operate Hospital | false | OperateHospitalInd |
| Tanning Services Provided | false | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| School Operating | false | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (true) | FiledScheduleAInd |
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 | $65,813 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $44,849 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $69,253 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $79,601 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $99,681 | CurrentTaxYearAmt |
| Total | $359,197 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $65,813 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $44,849 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $69,253 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $79,601 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $99,681 | CurrentTaxYearAmt |
| Total | $359,197 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $359,197 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,386 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,742 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,941 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,889 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $37 | CurrentTaxYearAmt |
| Total | $6,995 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,379 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,379 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $31,206 | CurrentTaxYearMinus2YearsAmt |
| Total | $67,964 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $434,156 | TotalSupportAmt |
| Public Support CY170 | 0.82730 | PublicSupportCY170Pct |
| Public Support PY170 | 0.78340 | 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 G IRS990ScheduleG
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990-EZ, Part I, Line 16, Other Expenses | Fundraising 864 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Pharmacy costs 9,145 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Dental services 2,092 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Labs and Xrays 35,997 |
| Form 990-EZ, Part I, Line 16, Other Expenses | License renewals 64 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Medical services and supplies 157 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Insurance 2,813 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Volunteer expense 1,319 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Office expense 1,296 |
| Form 990-EZ, Part I, Line 16, Other Expenses | Webpage 239 |
| Form 990-EZ, Part II, Line 24, Other Assets | Prepaid expenses Beginning of year 0, End of year 1,008 |
| Form 990-EZ, Part II, Line 26, Liabilities | Accounts payable Beginning of year 11,598, End of year 10,647 |
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