MIAMI RESCUE MISSION CLINIC INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
MIAMI RESCUE MISSION CLINIC INC (EIN 45-1481860)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-08-11
IRS object ID
202212239349300536
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

FieldValueIRS element (for citing)
Return2022-08-11T15:13:56-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN830696713PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GARCIA ESPINOSA MIYARES RODRIGUEZ TRUEBABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12600 S DOUGLAS ROAD SUITE 800AddressLine1Txt
CityCORAL GABLESCityNm
State AbbreviationFLStateAbbreviationCd
ZIP33134ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN451481860EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MIAMI RESCUE MISSION CLINIC INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMIAMBusinessNameControlTxt
Phone7868665705PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NW 1ST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPETER A GUTIERREZ MD MMSPersonNm
Person TitleOFFICER AND DIRECTORPersonTitleTxt
Phone3055722026PhoneNum
Signature2022-08-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstPETERPersonFirstNm
Person LastGUTIERREZ MD MMSPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJARNETTE G RODRIGUEZ CPAPreparerPersonNm
PTINP01062623PTIN
Phone3055295440PhoneNum
Preparation2022-08-11PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerPETER A GUTIERREZ MD MMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NW FIRST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,714,212GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CARINGPLACECLINIC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionMIAMI RESCUE MISSION CLINIC, INC. IS COMMITTED TO PROVIDE ACCESS TO COMPREHENSIVE PRIMARY HEALTH CARE TO THE COMMUNITY'S HOMELESS, MEDICALLY UNINSURED AND UNDERSERVED, AS WELL AS TO IMPLEMENT AND DELIVER COMMUNITY OUTREACH PROGRAMS THAT INCLUDE HEALTHCARE SCREENINGS INFORMATION AND EDUCATION, INCLUDING GUIDANCE ON AND REFERRALS TO THE FULL CONTINUUM OF PERSONAL AND COMMUNITY DEVELOPMENT. TO THIS END, MIAMI RESCUE MISSION, INC. WILL SERVE THE LOCAL COMMMUNITY WITH HIGHER STANDARDS OF MEDICAL CARE IN AN ENVIRONMENT IN WHICH EACH PATIENT IS TREATED WITH DIGNITY AND RESPECT.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee15TotalEmployeeCnt
Total Volunteers231TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$457,299PYContributionsGrantsAmt
CY Contributions Grants$453,282CYContributionsGrantsAmt
PY Program Service Revenue$764,940PYProgramServiceRevenueAmt
CY Program Service Revenue$1,257,412CYProgramServiceRevenueAmt
PY Investment Income$13PYInvestmentIncomeAmt
CY Investment Income$162CYInvestmentIncomeAmt
PY Other Revenue$214,348PYOtherRevenueAmt
CY Other Revenue$3,356CYOtherRevenueAmt
PY Total Revenue$1,436,600PYTotalRevenueAmt
CY Total Revenue$1,714,212CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$467,188PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$519,458CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$644,746PYOtherExpensesAmt
CY Other Expenses$1,087,506CYOtherExpensesAmt
PY Total Expenses$1,111,934PYTotalExpensesAmt
CY Total Expenses$1,606,964CYTotalExpensesAmt
PY Revenues Less Expenses$324,666PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$107,248CYRevenuesLessExpensesAmt
Total Assets BOY$515,839TotalAssetsBOYAmt
Total Assets EOY$762,432TotalAssetsEOYAmt
Total Liabilities BOY$50,892TotalLiabilitiesBOYAmt
Total Liabilities EOY$190,237TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$464,947NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$572,195NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITY IS TO PROVIDE PRIMARY HEALTHCARE TO THE COMMUNITY'S HOMELESS, MEDICALLY UNINSURED AND UNDERSERVED, AS WELL AS TO IMPLEMENT AND DELIVER COMMUNITY OUTREACH PROGRAMS THAT INCLUDE HEALTHCARE SCREENINGS, INFORMATION AND EDUCATION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$1,392,191ExpenseAmt
Revenue$1,260,930RevenueAmt
DescMIAMI RESCUE MISSION CLINIC, INC. HAS BEEN PROVIDING COMPREHENSIVE HEALTHCARE TO THE COMMUNITY'S HOMELESS AND MEDICALLY INSURED.Desc
Total Program Service Expenses$1,392,191TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee15EmployeeCnt
Employment Tax Returns Filed0EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind0Form8899Filedind
Form1098 C Filed0Form1098CFiledInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JESUS INGUANZOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3055722026PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NE FIRST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
NICHOLAS MASSIMINI PHD
DIRECTOR5.00Yes (X)$0$0$0
MARTA LOPEZ
DIRECTOR5.00Yes (X)$0$0$0
CARLOS ACOSTA
DIRECTOR5.00Yes (X)$0$0$0
REV RONALD BRUMITT
OFFICER AND DIRECTOR5.00Yes (X)$0$0$0
RICARDO FORBES
DIRECTOR1.00Yes (X)$0$0$0
DR ARMANDO FERRER
DIRECTOR1.00Yes (X)$0$0$0
JEFF TEW JD
DIRECTOR1.00Yes (X)$0$0$0
DR LINDA WASHINGTON
DIRECTOR1.00Yes (X)$0$0$0
JIMMY SANTANA
DIRECTOR1.00Yes (X)$0$0$0
JOAQUIN DEL CUETO
DIRECTOR5.00Yes (X)$0$0$0
ROGER M GORDON
OFFICER AND DIRECTOR5.00Yes (X)$0$0$0
ENRIQUE FERNANDEZ
DIRECTOR1.00Yes (X)$0$0$0
VICTOR MILIAN
DIRECTOR1.00Yes (X)$0$0$0
PETER A GUTIERREZ MD
OFFICER AND DIRECTOR40.00$61,539$0$0Yes (X)
JESUS INGUANZO
CHIEF OPERATING OFFICER40.00$55,000$0$0Yes (X)
GISELA BRETONES
CLINIC ADMINISTRATOR40.00$73,516$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$190,055TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Government Grants$333,567GovernmentGrantsAmt
All Other Contributions$119,715AllOtherContributionsAmt
Total Contributions$453,282TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
IN-KIND GIFTS/SERVICES621110$950,142$950,142
FEES FOR SERVICES621110$307,270$307,270
FieldValueIRS element (for citing)
Total Program Service Revenue$1,257,412TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$162TotalRevenueColumnAmt
Related Or Exempt Func Income$162RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
REFUND621110$3,242$3,242
RECORDS621110$114$114
FieldValueIRS element (for citing)
Other Revenue Total$3,356OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,714,212TotalRevenueColumnAmt
Related Or Exempt Func Income$1,260,930RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$515,536TotalAmt
Program Services$515,536ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,922TotalAmt
Program Services$3,922ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$150TotalAmt
Program Services$150ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$12,500TotalAmt
Management And General$12,500ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$22,336TotalAmt
Management And General$22,336ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$175,495TotalAmt
Program Services$146,520ProgramServicesAmt
Management And General$28,975ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$75,362TotalAmt
Management And General$75,362ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$4,386TotalAmt
Program Services$4,386ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$82TotalAmt
Management And General$82ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,549TotalAmt
Management And General$4,549ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$32,757TotalAmt
Program Services$7,501ProgramServicesAmt
Management And General$25,256ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
DONATED PROFESSIONAL FE$485,151$485,151
DONATED MATERIALS AND S$101,206$101,206
MEALS AND BEDS$57,000$57,000
MEDICAL EXPENSES$30,436$30,436

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$86,096TotalAmt
Program Services$40,383ProgramServicesAmt
Management And General$45,713ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,606,964TotalAmt
Program Services$1,392,191ProgramServicesAmt
Management And General$214,773ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$507,728BOYAmt
EOY$751,431EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,887EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$30,129LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$25,599LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,527BOYAmt
EOY$4,530EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$2,584BOYAmt
EOY$2,584EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$515,839BOYAmt
EOY$762,432EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$8,672BOYAmt
EOY$7,667EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$42,220BOYAmt
EOY$182,570EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$50,892BOYAmt
EOY$190,237EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$464,947BOYAmt
EOY$572,195EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$464,947BOYAmt
EOY$572,195EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$515,839BOYAmt
EOY$762,432EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$107,248ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$30,129InvestmentCostOrOtherBasisAmt
Depreciation$25,599DepreciationAmt
Book Value$4,530BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,530TotalBookValueLandBuildingsAmt

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonPETER GUITERREZPersonNm
Relationship With OrgDIRECTORRelationshipWithOrgTxt
Loan PurposeTO OPEN A BANK ACCOUNT FOR PAYING FUTURE INVOICES FROM ATHLENA HEALTH.LoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$3,887OriginalPrincipalAmt
Balance Due$3,887BalanceDueAmt
Default0DefaultInd
Board Or Committee ApprovalYes (1)BoardOrCommitteeApprovalInd
Written Agreement0WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$3,887TotalBalanceDueAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L - PART IIFormAndLineReferenceDesc
ExplanationATHENA HEALTH IS THE COMPANY IN CHARGE OF KEEPING CLINIC'S MEDICAL RECORDS AND THE BILLING OF POSSIBLE PAYMENTS TO BE RECEIVED FROM MEDICARE AND MEDICAID.ExplanationTxt

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)PROFESSIONAL SERVICES0$485,151ORGANIZATION'S LIST
Yes (X)RENT0$146,520MARKET VALUE OF RENT
Yes (X)MEDICINES0$83,866CONTRIBUTORS PROVIDE
Yes (X)IN-KIND GIFTS0$17,340CONTRIBUTORS PROVIDE
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BFORM 990 IS REVIEWED AND APPROVED BY THE ORGANIZATION TREASURER PRIOR TO FILING.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION WILL PROVIDE INFORMATION TO THE PUBLIC UPON REQUEST

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