COMMUNITY CARE CENTER FOR FORSYTH COUNTY: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY CARE CENTER FOR FORSYTH COUNTY (EIN 58-1403699)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-08-19
IRS object ID: 202212319349300206
Schema version: 2021v4.1
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule L
Schedule M
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-08-19T06:47:54-07:00	ReturnTs
Tax Period End	2021-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	561955774	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	BROWN JENKINS AND ONEYEAR PA	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	326 South Main Street	AddressLine1Txt
City	Winston Salem	CityNm
State Abbreviation	NC	StateAbbreviationCd
ZIP	27101	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	581403699	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Community Care Center for Forsyth County	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	COMM	BusinessNameControlTxt
Phone	3367601235	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2135 New Walkertown Road	AddressLine1Txt
City	Winston Salem	CityNm
State Abbreviation	NC	StateAbbreviationCd
ZIP	27101	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Alex Turner	PersonNm
Person Title	Treasurer	PersonTitleTxt
Phone	3367601235	PhoneNum
Signature	2022-08-17	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Alex	PersonFirstNm
Person Last	Turner	PersonLastNm

Field	Value	IRS element (for citing)
SSN	XXX-XX-XXXX	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Rebecca A Oneyear CPA	PreparerPersonNm
PTIN	P00710716	PTIN
Phone	3367610366	PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	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

Field	Value	IRS element (for citing)
Principal Officer	Rob DiBella	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2135 New Walkertown Road	AddressLine1Txt
City	WinstonSalem	CityNm
State Abbreviation	NC	StateAbbreviationCd
ZIP	27101	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$14,036,304	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.CCCForsyth.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1980	FormationYr
Legal Domicile State	NC	LegalDomicileStateCd
Activity Or Mission	To provide free on-site medical and dental care to low-income families.	ActivityOrMissionDesc
Voting Members Governing Body	22	VotingMembersGoverningBodyCnt
Voting Members Independent	22	VotingMembersIndependentCnt
Total Employee	35	TotalEmployeeCnt
Total Volunteers	98	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$4,960,782	PYContributionsGrantsAmt
CY Contributions Grants	$14,028,495	CYContributionsGrantsAmt
CY Program Service Revenue	$0	CYProgramServiceRevenueAmt
PY Investment Income	$51	PYInvestmentIncomeAmt
CY Investment Income	$106	CYInvestmentIncomeAmt
PY Other Revenue	$4,951	PYOtherRevenueAmt
CY Other Revenue	$7,703	CYOtherRevenueAmt
PY Total Revenue	$4,965,784	PYTotalRevenueAmt
CY Total Revenue	$14,036,304	CYTotalRevenueAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$791,395	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$967,769	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$15,675	CYTotalFundraisingExpenseAmt
PY Other Expenses	$3,021,160	PYOtherExpensesAmt
CY Other Expenses	$12,910,702	CYOtherExpensesAmt
PY Total Expenses	$3,812,555	PYTotalExpensesAmt
CY Total Expenses	$13,878,471	CYTotalExpensesAmt
PY Revenues Less Expenses	$1,153,229	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$157,833	CYRevenuesLessExpensesAmt
Total Assets BOY	$1,889,325	TotalAssetsBOYAmt
Total Assets EOY	$2,083,831	TotalAssetsEOYAmt
Total Liabilities BOY	$23,857	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$41,802	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$1,865,468	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$2,042,029	NetAssetsOrFundBalancesEOYAmt
Mission	To provide free on-site medical and dental care to low-income families.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$13,739,583	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$0	RevenueAmt
Desc	Community Care Center of Forsyth County, Inc. is a free medical clinic for families who earn less than 200% of the federal proverty level and are not eligible for government programs and have no medical insurance. The Center provides free on-site medical and dental care to low-income families, as the sole program.	Desc
Total Program Service Expenses	$13,739,583	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	Yes (true)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	Yes (true)	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	Yes (true)	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	false	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	35	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
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	22	GoverningBodyVotingMembersCnt
Independent Voting Member	22	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	Yes (true)	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	false	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	false	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
Own Website	Yes (X)	OwnWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	Timothy J Clontz	PersonNm
Phone	3367601235	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2135 New Walkertown Rd	AddressLine1Txt
City	Winston Salem	CityNm
State Abbreviation	NC	StateAbbreviationCd
ZIP	27101	ZIPCd

Field	Value	IRS element (for citing)
No Listed Persons Compensated	Yes (X)	NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd
Dr William M Satterwhite Jr
Emeritus	0.00	Yes (X)	$0	$0	$0
Timothy Clontz
Executive Director	40.00	Yes (X)	$133,330	$0	$0
James T Robinson
Director	0.00	Yes (X)	$0	$0	$0
J Baldwin Smith MD
Director	0.00	Yes (X)	$0	$0	$0
Robert F Coil
Director	0.00	Yes (X)	$0	$0	$0
Alex Turner
Finance Committee Chair/Treasurer	0.00	Yes (X)	$0	$0	$0	Yes (X)
Ben Hough
Director	0.00	Yes (X)	$0	$0	$0
Yen Nguyen DDS
Director	0.00	Yes (X)	$0	$0	$0
Robert P DiBella
Board Chair	0.00	Yes (X)	$0	$0	$0	Yes (X)
Dr Robert V Ford
Director	0.00	Yes (X)	$0	$0	$0
Anthony H Brett
Director	0.00	Yes (X)	$0	$0	$0
Millie Schultz
Director	0.00	Yes (X)	$0	$0	$0
Rudy Allen
Director	0.00	Yes (X)	$0	$0	$0
Kimberly W Gregg
Director	0.00	Yes (X)	$0	$0	$0
Gilmour Lake
Director	0.00	Yes (X)	$0	$0	$0
Marlon Hunter
Director	0.00	Yes (X)	$0	$0	$0
Sharon Storm
Director	0.00	Yes (X)	$0	$0	$0
Lucinda Jones
Immediate Past Chair	0.00	Yes (X)	$0	$0	$0	Yes (X)
Gregory G Holthusen MD
Director	0.00	Yes (X)	$0	$0	$0
Loraine Frank Lightfoot
Director	0.00	Yes (X)	$0	$0	$0
Carl Westscott
Director	0.00	Yes (X)	$0	$0	$0
Dr Nancy Smith
Director	0.00	Yes (X)	$0	$0	$0
Sarah Sabiston
Secretary	0.00	Yes (X)	$0	$0	$0	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$133,330	TotalReportableCompFromOrgAmt
Indiv Rcvd Greater Than100 K	1	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	false	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd
Federated Campaigns	$85,561	FederatedCampaignsAmt
Fundraising	$88,499	FundraisingAmt
Government Grants	$199,209	GovernmentGrantsAmt
All Other Contributions	$13,655,226	AllOtherContributionsAmt
Noncash Contributions	$12,575,303	NoncashContributionsAmt
Total Contributions	$14,028,495	TotalContributionsAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$106	TotalRevenueColumnAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$106	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Contri Rpt Fundraising Event	$88,499	ContriRptFundraisingEventAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	Misc. Revenue - Related	Desc
Business	900099	BusinessCd
Total Revenue Column	$7,703	TotalRevenueColumnAmt
Related Or Exempt Func Income	$7,703	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$7,703	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$14,036,304	TotalRevenueColumnAmt
Related Or Exempt Func Income	$7,703	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$106	ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$834,138	TotalAmt
Program Services	$754,140	ProgramServicesAmt
Management And General	$79,998	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$70,362	TotalAmt
Program Services	$68,234	ProgramServicesAmt
Management And General	$2,128	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$63,269	TotalAmt
Program Services	$57,149	ProgramServicesAmt
Management And General	$6,120	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$10,000	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$10,000	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$17,475	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$17,475	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$7,492	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$7,492	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$3,535	TotalAmt
Program Services	$3,535	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$51,933	TotalAmt
Program Services	$51,933	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$17,547	TotalAmt
Program Services	$17,547	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$1,176	TotalAmt
Program Services	$1,176	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$5,824	TotalAmt
Program Services	$5,824	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$11,875	TotalAmt
Program Services	$11,875	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medicines & Medical Supplies	$12,641,978	$12,641,978	$0	$0
Miscellaneous	$22,526	$22,526	$0	$0
Outside Services	$17,075	$17,075	$0	$0
Repairs	$73,517	$73,517	$0	$0

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$28,749	TotalAmt
Program Services	$13,074	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$15,675	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$13,878,471	TotalAmt
Program Services	$13,739,583	ProgramServicesAmt
Management And General	$123,213	ManagementAndGeneralAmt
Fundraising	$15,675	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$559,060	BOYAmt
EOY	$693,386	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$930,325	BOYAmt
EOY	$930,418	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$185,828	BOYAmt
EOY	$134,493	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$19,766	BOYAmt
EOY	$19,766	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$12,919	BOYAmt
EOY	$10,264	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$758,058	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$618,051	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$45,216	BOYAmt
EOY	$140,007	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
EOY	$2,888	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$136,211	BOYAmt
EOY	$152,609	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,889,325	BOYAmt
EOY	$2,083,831	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$23,857	BOYAmt
EOY	$41,802	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$23,857	BOYAmt
EOY	$41,802	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	$1,703,825	BOYAmt
EOY	$1,884,754	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$161,643	BOYAmt
EOY	$157,275	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,865,468	BOYAmt
EOY	$2,042,029	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,889,325	BOYAmt
EOY	$2,083,831	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$157,833	ReconcilationRevenueExpnssAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Public Organization170	Yes (X)	PublicOrganization170Ind
Other Support Sum	$0	OtherSupportSumAmt

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$2,107,889	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$3,023,378	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$2,818,266	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$4,960,782	CurrentTaxYearMinus1YearAmt
Current Tax Year	$14,028,495	CurrentTaxYearAmt
Total	$26,938,810	TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$2,107,889	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$3,023,378	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$2,818,266	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$4,960,782	CurrentTaxYearMinus1YearAmt
Current Tax Year	$14,028,495	CurrentTaxYearAmt
Total	$26,938,810	TotalAmt

Field	Value	IRS element (for citing)
Substantial Contributors Tot	$0	SubstantialContributorsTotAmt
Public Support Total170	$26,938,810	PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$13,389	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	-$657	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$16,093	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$8,155	CurrentTaxYearMinus1YearAmt
Current Tax Year	$22,548	CurrentTaxYearAmt
Total	$59,528	TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Income170 OtherIncome170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$38,989	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$31,592	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$4,793	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$4,951	CurrentTaxYearMinus1YearAmt
Current Tax Year	$7,703	CurrentTaxYearAmt
Total	$88,028	TotalAmt

Field	Value	IRS element (for citing)
Total Support	$27,086,366	TotalSupportAmt
Public Support CY170	0.99460	PublicSupportCY170Pct
Public Support PY170	0.98980	PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170	Yes (X)	ThirtyThrPctSuprtTestsCY170Ind
Public Support Total509	$0	PublicSupportTotal509Amt
Public Support CY509	0	PublicSupportCY509Pct
Investment Income CY	0	InvestmentIncomeCYPct

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

Field	Value	IRS element (for citing)
Form And Line Reference	Pt II Ln 10	FormAndLineReferenceDesc
Explanation	Other Income Part II, Line 10 Description: Other Income 2017: 38989. 2018: 31592. 2019: 4793. 2020: 4951. 2021: 7703.	ExplanationTxt

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

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$136,517	BeginningYearBalanceAmt
Investment Earnings Or Losses	$22,381	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$5,184	GrantsOrScholarshipsAmt
Administrative Expenses	$1,439	AdministrativeExpensesAmt
End Year Balance	$152,275	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$134,815	BeginningYearBalanceAmt
Investment Earnings Or Losses	$8,169	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$5,200	GrantsOrScholarshipsAmt
Administrative Expenses	$1,267	AdministrativeExpensesAmt
End Year Balance	$136,517	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$125,013	BeginningYearBalanceAmt
Investment Earnings Or Losses	$16,209	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$5,108	GrantsOrScholarshipsAmt
Administrative Expenses	$1,299	AdministrativeExpensesAmt
End Year Balance	$134,815	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$132,032	BeginningYearBalanceAmt
Investment Earnings Or Losses	-$639	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$5,056	GrantsOrScholarshipsAmt
Administrative Expenses	$1,324	AdministrativeExpensesAmt
End Year Balance	$125,013	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$124,911	BeginningYearBalanceAmt
Investment Earnings Or Losses	$13,405	InvestmentEarningsOrLossesAmt
Grants Or Scholarships	$5,008	GrantsOrScholarshipsAmt
Administrative Expenses	$1,276	AdministrativeExpensesAmt
End Year Balance	$132,032	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Endowments Held Unrelated Org	Yes (true)	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	false	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$0	InvestmentCostOrOtherBasisAmt
Book Value	$0	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$162,871	OtherCostOrOtherBasisAmt
Depreciation	$26,851	DepreciationAmt
Book Value	$136,020	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$588,892	OtherCostOrOtherBasisAmt
Depreciation	$585,005	DepreciationAmt
Book Value	$3,887	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,295	OtherCostOrOtherBasisAmt
Depreciation	$6,195	DepreciationAmt
Book Value	$100	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$140,007	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDesc	Book ValueBookValueAmt
Other Assets	$334
Funds Held in Trust - Endowment	$152,275

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$152,609	TotalBookValueOtherAssetsAmt
Total Rev Etc Audited Fincl Stmt	$22,649,863	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$22,442	NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts	$8,591,117	DonatedServicesAndUseFcltsAmt
Revenue Not Reported	$8,613,559	RevenueNotReportedAmt
Revenue Subtotal	$14,036,304	RevenueSubtotalAmt
Total Revenue Per Form990	$14,036,304	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$22,469,588	TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts	$8,591,117	DonatedServicesUseFcltsAmt
Expenses Not Reported	$8,591,117	ExpensesNotReportedAmt
Expenses Subtotal	$13,878,471	ExpensesSubtotalAmt
Total Expenses Per Form990	$13,878,471	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Pt V, Line 4	The purpose of the endowment fund is to provide a permanent fund which may be used by the organization to support the provision of healthcare services to the medically uninsured and underserved who meet the eligibility requirement guidelines of the organization.
Pt XII, Line 2d	Rounding

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Robinson Association Mgmt	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Relationship Description	Owned by Executive Director	RelationshipDescriptionTxt
Transaction	$10,000	TransactionAmt
Transaction	Management	TransactionDesc
Sharing Of Revenues	false	SharingOfRevenuesInd

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Contribution	4	ContributionCnt
Noncash Contributions Rpt F990	$12,572,923	NoncashContributionsRptF990Amt
Method Of Determining Revenues	Donor Provided	MethodOfDeterminingRevenuesTxt

Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)

Non Cash CheckboxNonCashCheckboxInd	DescDesc	ContributionContributionCnt	Noncash Contributions Rpt F990NoncashContributionsRptF990Amt	Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)	Food for Volunteers	0	$1,288	Cost
Yes (X)	Laptop	1	$1,092	Cost

Field	Value	IRS element (for citing)
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	false	ReviewProcessUnusualNCGiftsInd
Third Parties Used	false	ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Pt VI, Line 3	The organization received management services under a board approved contract from Robinson Association Management Services, Inc. until February 1, 2021. An entity owned by James T. Robinson, Executive Director.
Pt VI, Line 11b	A copy of the 990 is provided to the Executive Director and Treasurer for their review prior to the return being filed. The 990 is subsequently reviewed by the finance committee.
Pt VI, Line 15a	Salaries and management contracts are reviewed and recommendations made by the personnel committee which is made up of independent persons. Those recommendations then go to the finance committee for review and finally to the board for approval.
Pt VI, Line 15b	Salaries and management contracts are reviewed and recommendations made by the personnel committee which is made up of independent persons. Those recommendations then go to the finance committee for review and finally to the board for approval.
Pt VI, Line 19	The organization makes its governing documents, conflict of interest policy, and financial statements available to anyone that request a copy of the information.