PHYSICIANS MEDICAL FORUM: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PHYSICIANS MEDICAL FORUM (EIN 30-0086728)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2022-11-14
- IRS object ID
- 202203189349319950
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T18:03:54-08:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 264122004 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grigsby Finance and Tax Services | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8050 Hansom Drive | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94605 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300086728 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Physicians Medical Forum | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PHYS | BusinessNameControlTxt |
| Phone | 5105625560 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6114 LaSalle Ave | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94611 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Warren J StrudwickJr MD | PersonNm |
| Person Title | Board Officer | PersonTitleTxt |
| Phone | 5105625560 | PhoneNum |
| Signature | 2022-11-03 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Warren | PersonFirstNm |
| Person Last | StrudwickJr MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Mittie Grigsby | PreparerPersonNm |
| PTIN | P00745728 | PTIN |
| Phone | 5106384878 | PhoneNum |
| Preparation | 2022-11-14 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
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 | Stalfana Bello Broadhead | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6114 La Salle | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94611 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $368,662 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Encourage the recruitment and retention of African American physicians, and thereby help to eliminate health disparities, improve access to care and education | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 1 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $115,350 | PYContributionsGrantsAmt |
| CY Contributions Grants | $368,656 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| CY Investment Income | $6 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $115,350 | PYTotalRevenueAmt |
| CY Total Revenue | $368,662 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $5,852 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $85,412 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $86,623 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $61,395 | PYOtherExpensesAmt |
| CY Other Expenses | $254,001 | CYOtherExpensesAmt |
| PY Total Expenses | $146,807 | PYTotalExpensesAmt |
| CY Total Expenses | $346,476 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$31,457 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $22,186 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $234,282 | TotalAssetsBOYAmt |
| Total Assets EOY | $144,909 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $234,282 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $144,909 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Encourage the recruitment and retention of African American physicians, and thereby help to eliminate health disparities, improve access to care and education | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $275,742 | ExpenseAmt |
| Grant | $5,852 | GrantAmt |
| Revenue | $368,662 | RevenueAmt |
| Desc | The Physicians Medical Forum (PMF) "Doctors On Board" Program (DOB) and Community Health Ambassadors Internship (CHA) are pipeline programs to encourage and support African American and underrepresented minority high school, college/university, community college and post baccalaureate students who want to become physicians. Students received information on applying for medical school, MCAT prep, financial aid, mock primary care & surgery clinics, workshops on writing personal statements, interviewing and skill building sessions. High School students also network and are mentored by medical students, residents, physicians, educator and community mentors. PMF also provide scholarships, stipends other access to financial resources, networks and mentoring to medical students & residents. Additionally, PMF engages in programs and initiatives with physicians and educators on health policy and community wellness. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Recruitment of African American residents and medical students that upon their completion of their enducation and training, to purse careers as physicians and remain in or come to Alameda, Contra Costa or San Francisco counties and Northern CA Bay Area to practice medicine. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | To maintain strategic operatons, outreach, education and fund development to support the organizations' vision, mission, goals and strategies of African Americans physicians, residents, medical students and pipeline programs high school students pursuing careers to become physicians in Alameda, Contra Costa and San Francisco counties and Northern CA Bay Area | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (3 entries)
| ExpenseExpenseAmt | GrantGrantAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|---|
| $0 | $0 | $0 | 1. Increased the outreach, education, scholarships and mentoring of African American/Black and underrepresented minorities interested in medicine and becoming doctors. 2. Updated database indentifying schools by county an in Northern California (public, charter, religious, private, etc. |
| 3. Partnering with medical schools, medical associations, non-profit organizations and educational institutions colleges and universities and other resources like Princeton Review and American Association of Medical Colleges,Student National Medical Association to provide students with mentoring, coaching, MCAT | |||
| $0 | $0 | $0 | Prep, SAT/ACT Prep, personal interview skill building preparing and writing personal statements for application packets, scholarships and financial aid information, communication/virtual skills, networks of tutors and on-line courses, and connecting to physicians and health professionals in various specialities and fields of medicine and healthcare. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $0 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $275,742 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | 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 | Yes (true) | 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 |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | 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 |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Stalfano Bello Broadhead | PersonNm |
| Phone | 5105625560 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6114 LaSalle Ave 601 | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94611 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| Stalfana Bello Broadhead MPA | |||||||
| Executive Director | 37.50 | Yes (X) | $0 | $0 | $0 | ||
| Albert L Brooks MD | |||||||
| President | 10.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Kathryn Malone MD | |||||||
| Vice-President | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Warren Strudwick MD | |||||||
| Chief Financial Officer | 6.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Carol Miller MD | |||||||
| Secretary | 5.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| Thurman Hunt MD | |||||||
| Director | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Renee Navarro MD | |||||||
| Director | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Alden McDonald MD | |||||||
| Director | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $93,333 | GovernmentGrantsAmt |
| All Other Contributions | $275,323 | AllOtherContributionsAmt |
| Noncash Contributions | $200,000 | NoncashContributionsAmt |
| Total Contributions | $368,656 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| 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) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $368,662 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,852 | TotalAmt |
| Program Services | $5,852 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,222 | TotalAmt |
| Program Services | $56,900 | ProgramServicesAmt |
| Management And General | $6,322 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,401 | TotalAmt |
| Program Services | $21,061 | ProgramServicesAmt |
| Management And General | $2,340 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,809 | TotalAmt |
| Program Services | $1,059 | ProgramServicesAmt |
| Management And General | $4,750 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,200 | TotalAmt |
| Program Services | $14,200 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,012 | TotalAmt |
| Program Services | $13,012 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,488 | TotalAmt |
| Program Services | $9,766 | ProgramServicesAmt |
| Management And General | $722 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $1,000 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,441 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $2,441 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Bank charges | -$51 | $0 | -$51 | $0 |
| Other | $3,210 | $0 | $3,210 | $0 |
| Equip and program supplies | $3,395 | $3,395 | $0 | $0 |
| In Kind | $200,000 | $150,000 | $50,000 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $497 | TotalAmt |
| Program Services | $497 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $346,476 | TotalAmt |
| Program Services | $275,742 | ProgramServicesAmt |
| Management And General | $70,734 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,979 | BOYAmt |
| EOY | $32,037 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $224,303 | BOYAmt |
| EOY | $112,872 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $234,282 | BOYAmt |
| EOY | $144,909 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | 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 | $234,282 | BOYAmt |
| EOY | $144,909 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $234,282 | BOYAmt |
| EOY | $144,909 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $234,282 | BOYAmt |
| EOY | $144,909 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $22,186 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support CY170 | 0 | PublicSupportCY170Pct |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $114,551 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $310,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $115,350 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $168,333 | CurrentTaxYearAmt |
| Total | $708,234 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $114,551 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $310,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $115,350 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $168,333 | CurrentTaxYearAmt |
| Total | $708,234 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $708,234 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $708,234 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1.00000 | PublicSupportCY509Pct |
| Public Support PY509 | 1.00000 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Scholarships | GrantTypeTxt |
| Recipient | 3 | RecipientCnt |
| Cash Grant | $5,852 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Valuation Method Used | fmv | ValuationMethodUsedDesc |
| Non Cash Assistance | cash scholarship | NonCashAssistanceDesc |
Schedule M IRS990ScheduleM
| 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 (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 7a | Acct prepares return; reviewed by E, Pres & CFO |
| Pt VI, Line 12c | Annual reviews are completed with legal review |
| Pt VI, Line 15a | business attorney recommendation based on non-profit model |
| Pt VI, Line 19 | Interest parties contact org; appt is set for review |
| Pt XI | Net change in investment income |
| Pt VI, Line 15b | Review performed by board members |
| Pt V, Line 3b | Organization does not have this type of income |
| Pt V, Line 14b | organization does not have this type of service |
| Pt VI, Line 11b | Organization did not have this type of income |
| Form 990, Part III, Line 4d | 1. Increased the outreach, education, scholarships 0. 0. 0. |
| Form 990, Part III, Line 4d | Prep, SAT/ACT Prep, personal interview skill building 0. 0. 0. |
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