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
- Form 990-PF
- Depreciation Schedule
- Mortgages And Notes Payable Sch
- Other Expenses Schedule
- Other Income Schedule2
- Other Liabilities Schedule
- Other Professional Fees Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-04T14:41:09-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 PARK AVENUE | AddressLine1Txt |
| City | NEW YORK | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 100175001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 134142322 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARC HEALTH RESOURCES OF ROCKLAND INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GANEENE O'BRIEN | InCareOfNm |
| Business Name Control | ARCH | BusinessNameControlTxt |
| Phone | 8452672500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 210 Route 303 | AddressLine1Txt |
| City | Valley Cottage | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 10989 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ganeene O'Brien | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8452672500 | PhoneNum |
| Signature | 2022-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Ganeene | PersonFirstNm |
| Person Last | OBrien | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Paul Hammerschmidt | PreparerPersonNm |
| PTIN | P01384178 | PTIN |
| Phone | 2128858000 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $330,985 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $0 | ContriRcvdRevAndExpnssAmt |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Other Income Rev And Expnss | $1,571,527 | OtherIncomeRevAndExpnssAmt |
| Total Rev And Expnss | $1,571,527 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $0 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $1,127,520 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $1,116,943 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $211,305 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $211,507 | PensionEmplBnftDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $29,750 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Chrtbl Prps | $29,750 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $8,474 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $0 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Adj Net Incm | $0 | OtherProfFeesAdjNetIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $8,474 | OtherProfFeesDsbrsChrtblAmt |
| Interest Rev And Expnss | $2,338 | InterestRevAndExpnssAmt |
| Interest Dsbrs Chrtbl | $2,338 | InterestDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $13,484 | DeprecAndDpltnRevAndExpnssAmt |
| Occupancy Rev And Expnss | $8,655 | OccupancyRevAndExpnssAmt |
| Occupancy Dsbrs Chrtbl | $8,655 | OccupancyDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $963 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $963 | TravConfMeetingDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $383,147 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $0 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Adj Net Incm | $0 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $184,242 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $1,785,636 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $1,562,872 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $0 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $0 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $1,785,636 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $1,562,872 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$214,109 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $34,206 | CashBOYAmt |
| Cash EOY | $65,614 | CashEOYAmt |
| Cash EOYFMV | $65,614 | CashEOYFMVAmt |
| Acct Rcvbl | $47,846 | AcctRcvblAmt |
| Acct Rcvbl BOY | $39,387 | AcctRcvblBOYAmt |
| Acct Rcvbl EOY | $47,846 | AcctRcvblEOYAmt |
| Acct Rcvbl EOYFMV | $47,846 | AcctRcvblEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $537,051 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $319,526 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $139,646 | LandBOYAmt |
| Land EOY | $217,525 | LandEOYAmt |
| Land EOYFMV | $217,525 | LandEOYFMVAmt |
| Total Assets BOY | $213,239 | TotalAssetsBOYAmt |
| Total Assets EOY | $330,985 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $330,985 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $115,901 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $91,476 | AccountsPayableEOYAmt |
| Mortgages And Notes Payable BOY | $0 | MortgagesAndNotesPayableBOYAmt |
| Mortgages And Notes Payable EOY | $67,260 | MortgagesAndNotesPayableEOYAmt |
| Other Liabilities BOY | $2,918,865 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $3,207,885 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $3,034,766 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,366,621 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | -$2,821,527 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | -$3,035,636 | NoDonorRstrNetAssestsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | -$2,821,527 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | -$3,035,636 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $213,239 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $330,985 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | -$2,821,527 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$214,109 | ExcessRevenueOverExpensesAmt |
| Subtotal | -$3,035,636 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | -$3,035,636 | TotNetAstOrFundBalancesEOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cap Gains Loss Tx Invst Incm Detail | CapGainsLossTxInvstIncmDetail |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $0 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $0 | SubtotalAmt |
| Tax Based On Investment Income | $0 | TaxBasedOnInvestmentIncomeAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Total Payments And Credits | $0 | TotalPaymentsAndCreditsAmt |
| Tax Due | $0 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | false | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | NY | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GANEENE O'BRIEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8452672500 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 210 ROUTE 303 | AddressLine1Txt |
| City | VALLEY COTTAGE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 10989 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | false | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| KAREN FEINSTEIN | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | PRESIDENT | 1.0 | $0 | $0 | $0 |
| LYNDA MELTZER | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | VICE PRESIDENT | 1.0 | $0 | $0 | $0 |
| EDWARD RAUSH | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | SECRETARY | 1.0 | $0 | $0 | $0 |
| DIAN CIFUNI | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | TREASURER | 1.0 | $0 | $0 | $0 |
| LAURENCE MCCUE | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | DIRECTOR as of 5/19/21 | 1.0 | $0 | $0 | $0 |
| KATHLEEN NOWAK | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | DIRECTOR as of 5/19/21 | 1.0 | $0 | $0 | $0 |
| MICHAEL REINER | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | DIRECTOR as of 5/19/21 | 1.0 | $0 | $0 | $0 |
| JESSICA SIROTA | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | DIRECTOR as of 5/19/21 | 1.0 | $0 | $0 | $0 |
| SUSAN CONKLIN | ||||||||
| 210 Route 303 | Valley Cottage | NY | 10989 | SECRETARY thru 5/19/21 | 1.0 | $0 | $0 | $0 |
Compensation Highest Paid Empl CompensationHighestPaidEmplGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee BenefitsEmployeeBenefitsAmt | Expense AccountExpenseAccountAmt |
|---|---|---|---|---|---|---|---|---|
| RUSSELL H TOBE | ||||||||
| 210 ROUTE 303 | VALLEY COTTAGE | NY | 10989 | PSYCHIATRIST | 13.0 | $263,900 | $14,057 | $0 |
| ANDREA KO RITCHIN | ||||||||
| 210 ROUTE 303 | VALLEY COTTAGE | NY | 10989 | MED. DIR./PHYSICIAN | 21.0 | $195,850 | $19,192 | $0 |
| BETHANY RAE RICHMOND | ||||||||
| 210 ROUTE 303 | VALLEY COTTAGE | NY | 10989 | CHIEF CLINICAL OFF. | 40.0 | $140,067 | $585 | $0 |
| WILLIAM MICHAEL MILLER | ||||||||
| 210 ROUTE 303 | VALLEY COTTAGE | NY | 10989 | PODIATRIST | 40.0 | $136,500 | $1,797 | $0 |
| DINORAH RAQUEL D'AURIA | ||||||||
| 210 ROUTE 303 | VALLEY COTTAGE | NY | 10989 | CHIEF CLINICAL OFF. | 40.0 | $127,005 | $2,047 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Employee Paid Over50k | 5 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUREMD | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 BROADWAY 35TH FLOOR | AddressLine1Txt |
| City | NEW YORK | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 10271 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Service Type | SOFTWARE BILLING | ServiceTypeTxt |
| Compensation | $113,857 | CompensationAmt |
Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | TO PROVIDE PRIMARY MEDICAL CARE AND RELATED SERVICES TO PEOPLE WITH DISABILITIES. | Description1Txt |
| Expenses1 | $1,586,731 | Expenses1Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sum Of Program Related Invst | SumOfProgramRelatedInvstGrp |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $0 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $70,990 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $70,990 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $70,990 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $1,065 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $69,925 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $3,496 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $3,496 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $0 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $0 | TotalTaxAmt |
| Distributable Before Adj | $3,496 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $3,496 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $3,496 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $1,562,872 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $1,562,872 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $3,496 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Prior Year1 | 2019 | PriorYear1Yr |
| Prior Year2 | 2018 | PriorYear2Yr |
| Prior Year3 | 2017 | PriorYear3Yr |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $1,747,605 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $2,112,813 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $2,226,434 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $2,454,257 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $2,026,550 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $10,567,659 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $1,562,872 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Current Year | $3,496 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $1,559,376 | RemainingDistriFromCorpusAmt |
| Total Corpus | $12,127,035 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov From Yr5 | $1,747,605 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $10,379,430 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $2,112,813 | ExcessFromYear4Amt |
| Excess From Year3 | $2,226,434 | ExcessFromYear3Amt |
| Excess From Year2 | $2,454,257 | ExcessFromYear2Amt |
| Excess From Year1 | $2,026,550 | ExcessFromYear1Amt |
| Excess From Current Year | $1,559,376 | ExcessFromCurrentYearAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Private Operating Foundations | PrivateOperatingFoundationsGrp |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Program Service Revenue Dtl ProgramServiceRevenueDtl (2 entries)
| DescDesc | BusinessBusinessCd | Related Or Exempt Function IncmRelatedOrExemptFunctionIncmAmt |
|---|---|---|
| PATIENT SERVICE REVENUE | 623000 | $1,440,409 |
| MEDICAID | 623000 | $109,274 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp | |
| Int On Sav And Temp Cash Invst | IntOnSavAndTempCashInvstGrp | |
| Dividends And Interest From Sec Dtl | DividendsAndInterestFromSecDtl | |
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp | |
| Net Rntl Incm Re Not Debt Fincd Prop | NetRntlIncmReNotDebtFincdProp | |
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Income | OtherInvestmentIncomeGrp | |
| Gain Sales Ast Oth Than Invntry | GainSalesAstOthThanInvntryGrp | |
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Other Revenue Described OtherRevenueDescribedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Exclusion | 01 | ExclusionCd |
| Related Or Exempt Function Incm | $21,844 | RelatedOrExemptFunctionIncmAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | $1,571,527 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $1,571,527 | TotalIncomeProducingActyAmt |
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (2 entries)
| Line NumberLineNumberTxt | Relationship StatementRelationshipStatementTxt |
|---|---|
| 1A&B | REVENUE FOR PATIENT SERVICE VISITS TO THE COMPANY'S CLINIC DUE FROM VARIOUS PAYERS, INCLUDING MEDICAID AND MEDICARE. |
| 11A | MISCELLANEOUS INCOME USED IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PURPOSE. |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Depreciation Schedule DepreciationSchedule
Mortgages And Notes Payable Sch MortgagesAndNotesPayableSch
Note Payable NotePayableGrp
Lender Name LenderNameGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SMALL BUSINESS ADMINISTRATION | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Loan Original | $67,260 | LoanOriginalAmt |
| Balance Due | $67,260 | BalanceDueAmt |
| Note | 2021-04 | NoteDt |
| Repayment Terms | LOANS ARE FORGIVABLE IN CERTAIN SITUATIONS | RepaymentTermsTxt |
| Interest | 1. | InterestRt |
| Loan Purpose | TO PROMOTE CONTINUED EMPLOYMENT | LoanPurposeTxt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (8 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements 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)
| DescDesc | Revenue 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATE | Desc |
| BOY Book Value | $2,918,865 | BOYBookValueAmt |
| EOY Book Value | $3,207,885 | EOYBookValueAmt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|---|
| PAYROLL PROCESSING FEES | $2,290 | $0 | $0 | $2,290 |
| OTHER CONSULTING FEES | $6,184 | $0 | $0 | $6,184 |
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