FREE CLINIC OF POWHATAN: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- FREE CLINIC OF POWHATAN (EIN 26-1275136)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-27
- IRS object ID
- 202221479349300217
- 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 | 2022-05-27T10:21:50-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 541953476 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIDSON DOYLE & HILTON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 800 | AddressLine1Txt |
| City | LYNCHBURG | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 245050800 | 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 | 261275136 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREE CLINIC OF POWHATAN INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 8045985637 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2320 SKAGGS ROAD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CONNIE MOSLOW | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 8045985637 | PhoneNum |
| Signature | 2022-05-26 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CONNIE | PersonFirstNm |
| Person Last | MOSLOW | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY A GALLAGHER CPA | PreparerPersonNm |
| PTIN | P00884747 | PTIN |
| Phone | 4348467611 | 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 |
| 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 | CONNIE MOSLOW | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3908 OLD BUCKINGHAM RD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $928,143 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.freeclinicofpowhatan.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | BUILDING A HEALTHIER COMMUNITY ONE PERSON AT A TIME | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 11 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,773,934 | PYContributionsGrantsAmt |
| CY Contributions Grants | $798,616 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $17,944 | PYInvestmentIncomeAmt |
| CY Investment Income | $38,267 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,248 | PYOtherRevenueAmt |
| CY Other Revenue | -$7,466 | CYOtherRevenueAmt |
| PY Total Revenue | $1,797,126 | PYTotalRevenueAmt |
| CY Total Revenue | $829,417 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $169,876 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $197,681 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $3,993 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $111,472 | PYOtherExpensesAmt |
| CY Other Expenses | $263,253 | CYOtherExpensesAmt |
| PY Total Expenses | $281,348 | PYTotalExpensesAmt |
| CY Total Expenses | $460,934 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,515,778 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $368,483 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,915,310 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,196,146 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $87,070 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,718 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,828,240 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,185,428 | NetAssetsOrFundBalancesEOYAmt |
| Mission | BUILDING A HEALTHIER COMMUNITY ONE PERSON AT A TIME | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $286,290 | ExpenseAmt |
| Desc | ORGANIZATION FACILITATES THE AVAILABILITY OF MEDICAL AND DENTAL SERVICES TO THE RESIDENTS OF POWHATAN, VIRGINIA THAT DO NOT HAVE THE RESOURCES TO THE SERVICES ELSEWHERE. | Desc |
| Total Program Service Expenses | $286,290 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 11 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONNIE MOSLOW | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8045985637 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3908 OLD BUCKINGHAM RD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| INDIA COX | ||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TIMOTHY G BENUSA CPA | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KARLA CURTIS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| STEVE HARRIS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SISTER ELENA HENDERSON | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| NED SMITHER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CONNIE MOSLOW | ||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TONYA PARRIS-WILKINS DDS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| WILL PERKINSON DDS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ROBB STALLWORTH | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| REV BRYAN STEVENS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DEMETRIUS VENABLE PHD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SHELIA GUNST | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BARBARA BROWN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $35,209 | FundraisingAmt |
| Government Grants | $62,074 | GovernmentGrantsAmt |
| All Other Contributions | $701,333 | AllOtherContributionsAmt |
| Noncash Contributions | $37,798 | NoncashContributionsAmt |
| Total Contributions | $798,616 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,999 | TotalRevenueColumnAmt |
| Exclusion | $34,999 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $94,250 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $90,982 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,268 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,268 | TotalRevenueColumnAmt |
| Exclusion | $3,268 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $35,209 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $7,744 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,744 | TotalRevenueColumnAmt |
| Exclusion | -$7,744 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $278 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $278 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $278 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $829,417 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $278 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $30,523 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,748 | TotalAmt |
| Program Services | $106,574 | ProgramServicesAmt |
| Management And General | $73,499 | ManagementAndGeneralAmt |
| Fundraising | $3,675 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,933 | TotalAmt |
| Program Services | $8,220 | ProgramServicesAmt |
| Management And General | $5,713 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,503 | TotalAmt |
| Management And General | $6,503 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,964 | TotalAmt |
| Management And General | $5,964 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,057 | TotalAmt |
| Management And General | $1,954 | ManagementAndGeneralAmt |
| Fundraising | $103 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,151 | TotalAmt |
| Program Services | $13,430 | ProgramServicesAmt |
| Management And General | $53,721 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000 | TotalAmt |
| Management And General | $1,000 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,276 | TotalAmt |
| Program Services | $2,276 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,356 | TotalAmt |
| Program Services | $71,356 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,989 | TotalAmt |
| Management And General | $3,989 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| DENTAL SERVICES | $36,735 | $36,735 |
| PRESCRIPTIONS | $16,055 | $16,055 |
| DENTAL SUPPLIES | $15,420 | $15,420 |
| MEDICAL SUPPLIES | $12,722 | $12,722 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,025 | TotalAmt |
| Program Services | $3,502 | ProgramServicesAmt |
| Management And General | $18,308 | ManagementAndGeneralAmt |
| Fundraising | $215 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $460,934 | TotalAmt |
| Program Services | $286,290 | ProgramServicesAmt |
| Management And General | $170,651 | ManagementAndGeneralAmt |
| Fundraising | $3,993 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,210,188 | BOYAmt |
| EOY | $866,863 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $310,927 | BOYAmt |
| EOY | $311,915 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,297 | BOYAmt |
| EOY | $189,723 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,124 | BOYAmt |
| EOY | $1,279 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $859,922 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $91,139 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $764,449 | BOYAmt |
| EOY | $768,783 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $338,325 | BOYAmt |
| EOY | $1,057,583 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,915,310 | BOYAmt |
| EOY | $3,196,146 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,070 | BOYAmt |
| EOY | $10,718 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,070 | BOYAmt |
| EOY | $10,718 | 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 | $2,616,128 | BOYAmt |
| EOY | $3,081,946 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $212,112 | BOYAmt |
| EOY | $103,482 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,828,240 | BOYAmt |
| EOY | $3,185,428 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,915,310 | BOYAmt |
| EOY | $3,196,146 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $368,483 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$11,295 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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 | $425,335 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $325,309 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $409,697 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,343,120 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $798,616 | CurrentTaxYearAmt |
| Total | $3,302,077 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $425,335 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $325,309 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $409,697 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,343,120 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $798,616 | CurrentTaxYearAmt |
| Total | $3,302,077 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,189,736 | SubstantialContributorsTotAmt |
| Public Support Total170 | $2,112,341 | PublicSupportTotal170Amt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $325 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $74 | CurrentTaxYearMinus2YearsAmt |
| Total | $399 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $3,302,476 | TotalSupportAmt |
| Public Support CY170 | 0.63960 | PublicSupportCY170Pct |
| Public Support PY170 | 0.57000 | 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 D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $652,146 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,251 | DepreciationAmt |
| Book Value | $607,895 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $154,094 | OtherCostOrOtherBasisAmt |
| Depreciation | $39,377 | DepreciationAmt |
| Book Value | $114,717 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $53,682 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,511 | DepreciationAmt |
| Book Value | $46,171 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $768,783 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $848,801 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$11,295 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $36,643 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$5,964 | OtherRevenueAmt |
| Revenue Not Reported | $19,384 | RevenueNotReportedAmt |
| Revenue Subtotal | $829,417 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $829,417 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $491,613 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $36,643 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | -$5,964 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $30,679 | ExpensesNotReportedAmt |
| Expenses Subtotal | $460,934 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $460,934 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | Accounting principles generally accepted in the United States of America require corporation management to evaluate tax positions taken by the corporation and recognize a tax liability (or asset) if the corporation has taken an uncertain tax position that more likely than not would be sustained upon examination by the Internal Revenue Service. Free Clinic of Powhatan's management has analyzed the tax positions taken by the clinic, and has concluded that as of December 31, 2021, no uncertain positions are taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The clinic is subject to routine audits by taxing jurisdictions; however, there are currently no audits of any tax periods in progress. The clinic believes it is no longer subject to income tax examinations for years prior to 2017. |
| Part XI, Line 2d - Other Adjustments: | INVESTMENT EXPENSE -5,964. |
| Part XII, Line 2d - Other Adjustments: | INVESTMENT EXPENSE -5,964. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | DINNER | Event1Nm |
| Gross Receipts Event1 | $35,209 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $35,209 | CharitableContriEvent1Amt |
| Other Direct Expenses Event1 | $7,744 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $35,209 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $35,209 | CharitableContributionsTotAmt |
| Oth Direct Expnss Total Events | $7,744 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $7,744 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$7,744 | NetIncomeSummaryAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LISA BENUSA | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | WIFE OF BOARD TREASURER | RelationshipDescriptionTxt |
| Transaction | $14,640 | TransactionAmt |
| Transaction | USED BUSINESS LOCATION FOR EVENT AND WAS COMPENSATED FOR ITS USE. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $37,798 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 7a | THE EXECUTIVE BOARD NOMINATES DIRECTORS EVERY THREE YEARS. |
| Form 990, Part VI, Section B, line 11b | OFFICERS REVIEW ON AN ANNUAL BASIS |
| Form 990, Part VI, Section B, line 12c | THE OFFICER'S REVIEW FOR POTENTIAL CONFLICTS CONTINUOUSLY |
| Form 990, Part VI, Section B, line 15 | OFFICERS REVIEW ON ANNUAL BASIS |
| Form 990, Part VI, Section C, line 19 | AVAILABLE UPON REQUEST |
Comments