ARC HEALTHRESOURCES OF ROCKLAND INC: Form 990PF, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
ARC HEALTHRESOURCES OF ROCKLAND INC (EIN 13-4142322)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-04
IRS object ID
202223089349100632
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-04T14:41:09-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BDO USA LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1100 PARK AVENUEAddressLine1Txt
CityNEW YORKCityNm
State AbbreviationNYStateAbbreviationCd
ZIP100175001ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN134142322EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ARC HEALTH RESOURCES OF ROCKLAND INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% GANEENE O'BRIENInCareOfNm
Business Name ControlARCHBusinessNameControlTxt
Phone8452672500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1210 Route 303AddressLine1Txt
CityValley CottageCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10989ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGaneene O'BrienPersonNm
Person TitleCFOPersonTitleTxt
Phone8452672500PhoneNum
Signature2022-10-29SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstGaneenePersonFirstNm
Person LastOBrienPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonPaul HammerschmidtPreparerPersonNm
PTINP01384178PTIN
Phone2128858000PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$330,985FMVAssetsEOYAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$0ContriRcvdRevAndExpnssAmt
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Other Income Rev And Expnss$1,571,527OtherIncomeRevAndExpnssAmt
Total Rev And Expnss$1,571,527TotalRevAndExpnssAmt
Total Net Invst Incm$0TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Oth Empl Slrs Wgs Rev And Expnss$1,127,520OthEmplSlrsWgsRevAndExpnssAmt
Oth Empl Slrs Wgs Dsbrs Chrtbl$1,116,943OthEmplSlrsWgsDsbrsChrtblAmt
Pension Empl Bnft Rev And Expnss$211,305PensionEmplBnftRevAndExpnssAmt
Pension Empl Bnft Dsbrs Chrtbl$211,507PensionEmplBnftDsbrsChrtblAmt
Accounting Fees Rev And Expnss$29,750AccountingFeesRevAndExpnssAmt
Accounting Fees Chrtbl Prps$29,750AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$8,474OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$0OtherProfFeesNetInvstIncmAmt
Other Prof Fees Adj Net Incm$0OtherProfFeesAdjNetIncmAmt
Other Prof Fees Dsbrs Chrtbl$8,474OtherProfFeesDsbrsChrtblAmt
Interest Rev And Expnss$2,338InterestRevAndExpnssAmt
Interest Dsbrs Chrtbl$2,338InterestDsbrsChrtblAmt
Deprec And Dpltn Rev And Expnss$13,484DeprecAndDpltnRevAndExpnssAmt
Occupancy Rev And Expnss$8,655OccupancyRevAndExpnssAmt
Occupancy Dsbrs Chrtbl$8,655OccupancyDsbrsChrtblAmt
Trav Conf Meeting Rev And Expnss$963TravConfMeetingRevAndExpnssAmt
Trav Conf Meeting Dsbrs Chrtbl$963TravConfMeetingDsbrsChrtblAmt
Other Expenses Rev And Expnss$383,147OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$0OtherExpensesNetInvstIncmAmt
Other Expenses Adj Net Incm$0OtherExpensesAdjNetIncmAmt
Other Expenses Dsbrs Chrtbl$184,242OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$1,785,636TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$0TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Adj Net Incm$0TotOprExpensesAdjNetIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$1,562,872TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$0ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$0ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$1,785,636TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$0TotalExpensesNetInvstIncmAmt
Total Expenses Adj Net Incm$0TotalExpensesAdjNetIncmAmt
Total Expenses Dsbrs Chrtbl$1,562,872TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$214,109ExcessRevenueOverExpensesAmt
Net Investment Income$0NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash BOY$34,206CashBOYAmt
Cash EOY$65,614CashEOYAmt
Cash EOYFMV$65,614CashEOYFMVAmt
Acct Rcvbl$47,846AcctRcvblAmt
Acct Rcvbl BOY$39,387AcctRcvblBOYAmt
Acct Rcvbl EOY$47,846AcctRcvblEOYAmt
Acct Rcvbl EOYFMV$47,846AcctRcvblEOYFMVAmt
Land Bldg Equip Cost Or Other Bss$537,051LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$319,526LandBldgEquipAccumDeprecAmt
Land BOY$139,646LandBOYAmt
Land EOY$217,525LandEOYAmt
Land EOYFMV$217,525LandEOYFMVAmt
Total Assets BOY$213,239TotalAssetsBOYAmt
Total Assets EOY$330,985TotalAssetsEOYAmt
Total Assets EOYFMV$330,985TotalAssetsEOYFMVAmt
Accounts Payable BOY$115,901AccountsPayableBOYAmt
Accounts Payable EOY$91,476AccountsPayableEOYAmt
Mortgages And Notes Payable BOY$0MortgagesAndNotesPayableBOYAmt
Mortgages And Notes Payable EOY$67,260MortgagesAndNotesPayableEOYAmt
Other Liabilities BOY$2,918,865OtherLiabilitiesBOYAmt
Other Liabilities EOY$3,207,885OtherLiabilitiesEOYAmt
Total Liabilities BOY$3,034,766TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,366,621TotalLiabilitiesEOYAmt
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY-$2,821,527NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY-$3,035,636NoDonorRstrNetAssestsEOYAmt
Tot Net Ast Or Fund Balances BOY-$2,821,527TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY-$3,035,636TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$213,239TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$330,985TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY-$2,821,527TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$214,109ExcessRevenueOverExpensesAmt
Subtotal-$3,035,636SubtotalAmt
Tot Net Ast Or Fund Balances EOY-$3,035,636TotNetAstOrFundBalancesEOYAmt
FieldValueIRS element (for citing)
Cap Gains Loss Tx Invst Incm DetailCapGainsLossTxInvstIncmDetail

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$0InvestmentIncomeExciseTaxAmt
Subtotal$0SubtotalAmt
Tax Based On Investment Income$0TaxBasedOnInvestmentIncomeAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Total Payments And Credits$0TotalPaymentsAndCreditsAmt
Tax Due$0TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political ActyfalseLegislativePoliticalActyInd
More Than100 SpentfalseMoreThan100SpentInd
Form1120 POL FiledfalseForm1120POLFiledInd
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Changes To Articles Or BylawsfalseChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Section508e Rqr SatisfiedfalseSection508eRqrSatisfiedInd
At Least5000 In AssetsYes (true)AtLeast5000InAssetsInd
Org Report Or Register StateNYOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (true)Form990PFFiledWithAttyGenInd
Private Operating FoundationfalsePrivateOperatingFoundationInd
New Substantial ContributorsfalseNewSubstantialContributorsInd
Own Controlled EntityfalseOwnControlledEntityInd
Donor Advised FundfalseDonorAdvisedFundInd
Comply With Public Insp RqrYes (true)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1GANEENE O'BRIENBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8452672500PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1210 ROUTE 303AddressLine1Txt
CityVALLEY COTTAGECityNm
State AbbreviationNYStateAbbreviationCd
ZIP10989ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts QuestionfalseForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified PrsnfalseSaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified PrsnfalseBrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnfalseFurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnfalsePayCompDisqualifiedPrsnInd
Transfer Ast Disqualified PrsnfalseTransferAstDisqualifiedPrsnInd
Payment To Government OfficialfalsePaymentToGovernmentOfficialInd
Uncorrected Prior ActsfalseUncorrectedPriorActsInd
Undistributed Income PYfalseUndistributedIncomePYInd
Business HoldingsfalseBusinessHoldingsInd
Jeopardy InvestmentsfalseJeopardyInvestmentsInd
Uncorrected PY Jeopardy InvstfalseUncorrectedPYJeopardyInvstInd
Influence LegislationfalseInfluenceLegislationInd
Influence ElectionfalseInfluenceElectionInd
Grants To IndividualsfalseGrantsToIndividualsInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Noncharitable PurposefalseNoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
KAREN FEINSTEIN
210 Route 303Valley CottageNY10989PRESIDENT1.0$0$0$0
LYNDA MELTZER
210 Route 303Valley CottageNY10989VICE PRESIDENT1.0$0$0$0
EDWARD RAUSH
210 Route 303Valley CottageNY10989SECRETARY1.0$0$0$0
DIAN CIFUNI
210 Route 303Valley CottageNY10989TREASURER1.0$0$0$0
LAURENCE MCCUE
210 Route 303Valley CottageNY10989DIRECTOR as of 5/19/211.0$0$0$0
KATHLEEN NOWAK
210 Route 303Valley CottageNY10989DIRECTOR as of 5/19/211.0$0$0$0
MICHAEL REINER
210 Route 303Valley CottageNY10989DIRECTOR as of 5/19/211.0$0$0$0
JESSICA SIROTA
210 Route 303Valley CottageNY10989DIRECTOR as of 5/19/211.0$0$0$0
SUSAN CONKLIN
210 Route 303Valley CottageNY10989SECRETARY thru 5/19/211.0$0$0$0

Compensation Highest Paid Empl CompensationHighestPaidEmplGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee BenefitsEmployeeBenefitsAmtExpense AccountExpenseAccountAmt
RUSSELL H TOBE
210 ROUTE 303VALLEY COTTAGENY10989PSYCHIATRIST13.0$263,900$14,057$0
ANDREA KO RITCHIN
210 ROUTE 303VALLEY COTTAGENY10989MED. DIR./PHYSICIAN21.0$195,850$19,192$0
BETHANY RAE RICHMOND
210 ROUTE 303VALLEY COTTAGENY10989CHIEF CLINICAL OFF.40.0$140,067$585$0
WILLIAM MICHAEL MILLER
210 ROUTE 303VALLEY COTTAGENY10989PODIATRIST40.0$136,500$1,797$0
DINORAH RAQUEL D'AURIA
210 ROUTE 303VALLEY COTTAGENY10989CHIEF CLINICAL OFF.40.0$127,005$2,047$0
FieldValueIRS element (for citing)
Other Employee Paid Over50k5OtherEmployeePaidOver50kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CUREMDBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1120 BROADWAY 35TH FLOORAddressLine1Txt
CityNEW YORKCityNm
State AbbreviationNYStateAbbreviationCd
ZIP10271ZIPCd
FieldValueIRS element (for citing)
Service TypeSOFTWARE BILLINGServiceTypeTxt
Compensation$113,857CompensationAmt

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

FieldValueIRS element (for citing)
Description1TO PROVIDE PRIMARY MEDICAL CARE AND RELATED SERVICES TO PEOPLE WITH DISABILITIES.Description1Txt
Expenses1$1,586,731Expenses1Amt
FieldValueIRS element (for citing)
Sum Of Program Related InvstSumOfProgramRelatedInvstGrp

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$0AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$70,990AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$70,990TotalFMVOfUnusedAssetsAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$70,990AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$1,065CashDeemedCharitableAmt
Net Vl Noncharitable Assets$69,925NetVlNoncharitableAssetsAmt
Minimum Investment Return$3,496MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$3,496MinimumInvestmentReturnAmt
Tax Based On Investment Income$0TaxBasedOnInvestmentIncomeAmt
Total Tax$0TotalTaxAmt
Distributable Before Adj$3,496DistributableBeforeAdjAmt
Distributable Before Ded$3,496DistributableBeforeDedAmt
Distributable As Adjusted$3,496DistributableAsAdjustedAmt

PF Qualifying Distributions PFQualifyingDistributionsGrp

FieldValueIRS element (for citing)
Expenses And Contributions$1,562,872ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Charitable Assets Acquis Paid$0CharitableAssetsAcquisPaidAmt
Set Aside Suitability Test$0SetAsideSuitabilityTestAmt
Set Aside Cash Distri Test$0SetAsideCashDistriTestAmt
Qualifying Distributions$1,562,872QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$3,496DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Prior Year12019PriorYear1Yr
Prior Year22018PriorYear2Yr
Prior Year32017PriorYear3Yr
Total For Prior Years$0TotalForPriorYearsAmt
Excess Distribution Cyov Yr5$1,747,605ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4$2,112,813ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3$2,226,434ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$2,454,257ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$2,026,550ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$10,567,659TotalExcessDistributionCyovAmt
Qualifying Distributions$1,562,872QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Current Year$3,496AppliedToCurrentYearAmt
Remaining Distri From Corpus$1,559,376RemainingDistriFromCorpusAmt
Total Corpus$12,127,035TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Excess Distri Cyov From Yr5$1,747,605ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$10,379,430ExcessDistriCyovToNextYrAmt
Excess From Year4$2,112,813ExcessFromYear4Amt
Excess From Year3$2,226,434ExcessFromYear3Amt
Excess From Year2$2,454,257ExcessFromYear2Amt
Excess From Year1$2,026,550ExcessFromYear1Amt
Excess From Current Year$1,559,376ExcessFromCurrentYearAmt
FieldValueIRS element (for citing)
Private Operating FoundationsPrivateOperatingFoundationsGrp

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Program Service Revenue Dtl ProgramServiceRevenueDtl (2 entries)

DescDescBusinessBusinessCdRelated Or Exempt Function IncmRelatedOrExemptFunctionIncmAmt
PATIENT SERVICE REVENUE623000$1,440,409
MEDICAID623000$109,274
FieldValueIRS element (for citing)
Fees Contracts From Govt AgFeesContractsFromGovtAgGrp
Membership Dues And AssmntMembershipDuesAndAssmntGrp
Int On Sav And Temp Cash InvstIntOnSavAndTempCashInvstGrp
Dividends And Interest From Sec DtlDividendsAndInterestFromSecDtl
Net Rntl Incm Re Debt Fincd PropNetRntlIncmReDebtFincdPropGrp
Net Rntl Incm Re Not Debt Fincd PropNetRntlIncmReNotDebtFincdProp
Net Rental Income Personal PropNetRentalIncomePersonalPropGrp
Other Investment IncomeOtherInvestmentIncomeGrp
Gain Sales Ast Oth Than InvntryGainSalesAstOthThanInvntryGrp
Net Income Loss From Special EvtNetIncomeLossFromSpecialEvtGrp
Gross Profit Loss Sls Of InvntryGrossProfitLossSlsOfInvntryGrp

Other Revenue Described OtherRevenueDescribedGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business900099BusinessCd
Exclusion01ExclusionCd
Related Or Exempt Function Incm$21,844RelatedOrExemptFunctionIncmAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Related Or Exempt Function Incm$1,571,527RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$1,571,527TotalIncomeProducingActyAmt

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (2 entries)

Line NumberLineNumberTxtRelationship StatementRelationshipStatementTxt
1A&BREVENUE FOR PATIENT SERVICE VISITS TO THE COMPANY'S CLINIC DUE FROM VARIOUS PAYERS, INCLUDING MEDICAID AND MEDICARE.
11AMISCELLANEOUS INCOME USED IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PURPOSE.

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EOfalseTrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EOfalseTrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of AssetsfalseSalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EOfalsePurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth AssetsfalseRentalOfFacilitiesOthAssetsInd
Reimbursement ArrangementsfalseReimbursementArrangementsInd
Loans Or Loan GuaranteesfalseLoansOrLoanGuaranteesInd
Performance Of Services EtcfalsePerformanceOfServicesEtcInd
Sharing Of Facilities EtcfalseSharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOfalseRelationshipsNonchrtblEOInd

Depreciation Schedule DepreciationSchedule

Mortgages And Notes Payable Sch MortgagesAndNotesPayableSch

Note Payable NotePayableGrp

Lender Name LenderNameGrp

FieldValueIRS element (for citing)
PersonSMALL BUSINESS ADMINISTRATIONPersonNm
FieldValueIRS element (for citing)
Loan Original$67,260LoanOriginalAmt
Balance Due$67,260BalanceDueAmt
Note2021-04NoteDt
Repayment TermsLOANS ARE FORGIVABLE IN CERTAIN SITUATIONSRepaymentTermsTxt
Interest1.InterestRt
Loan PurposeTO PROMOTE CONTINUED EMPLOYMENTLoanPurposeTxt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (8 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
MANAGEMENT FEES$198,905$0$0$0
OFFICE EXPENSES$136,637$0$0$136,637
INSURANCE$15,652$0$0$15,652
BAD DEBT EXPENSE$12,000$0$0$12,000
MEDICAL SUPPLIES$9,073$0$0$9,073
EQUIPMENT RENTAL$2,882$0$0$2,882
BUILDING REPAIRS & MAINTENANCE$2,163$0$0$2,163
MISCELLANEOUS EXPENSES$5,835$0$0$5,835

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail (3 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt
PATIENT SERVICE REVENUE$1,440,409
MEDICAID$109,274
OTHER REVENUE$21,844

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail

FieldValueIRS element (for citing)
DescDUE TO AFFILIATEDesc
BOY Book Value$2,918,865BOYBookValueAmt
EOY Book Value$3,207,885EOYBookValueAmt

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
PAYROLL PROCESSING FEES$2,290$0$0$2,290
OTHER CONSULTING FEES$6,184$0$0$6,184

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