2022-11-15T21:41:21-06:00 2021-12-31 640575804 T E LOTT & COMPANY PA PO BOX 471 COLUMBUS MS 39703 990 2021-01-01 640926626 COLUMBUS-LOWNDES FREE MEDICAL CLINIC INC COLU 6622440044 PO BOX 661 COLUMBUS MS 39703 ALAN T WILLIAMS CHAIRMAN OF THE BOARD 6623285387 2022-11-14 1 ALAN WILLIAMS 999009999 ROBERT WHITAKER CPA P01707206 6623285387 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z GOOD SAMARATIN MEDICAL CLINIC ALAN T WILLIAMS 687 GREENBRIAR COLUMBUS MS 39705 107889 0 X N/A X 2000 MS PROVIDE FREE MEDICAL PRIMARY HEALTHCARE FOR APPROXIMATELY 200 INDIGENT PATIENTS, PRIMARILY THROUGH VOLUNTEER HEALTHCARE PROFESSIONALS SERVING AT THE CLINIC'S LEASED FACILITIES. 14 14 2 0 0 0 99610 107739 0 30 283 120 0 0 99893 107889 6115 3195 0 0 74922 70299 0 0 4229 15987 15717 97024 89211 2869 18678 162665 179686 7477 5820 155188 173866 PROVIDE PRIMARY HEALTH CARE FOR APPROXIMATELY 200 INDIGENT PATIENTS, AS WELL AS PROVIDE PRESCRIPTION DRUGS OBTAINED PRIMARILY FROM THE MANUFACTURERS WITH PATIENT CARE PLANS, AND SECURED MAMMOGRAMS FOR FEMALE PATIENTS. 0 0 72138 3195 150 PROVIDE PRIMARY HEALTH CARE FOR APPROXIMATELY 200 INDIGENT PATIENTS, AS WELL AS PROVIDE PRESCRIPTION DRUGS OBTAINED PRIMARILY FROM THE MANUFACTURERS WITH PATIENT CARE PLANS, AND SECURED MAMMOGRAMS FOR FEMALE PATIENTS. 72138 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 MS X BILL WEST 6622440044 PO BOX 661 COLUMBUS MS 39703 ALAN T WILLIAMS CHAIRMAN BOARD OF DIRECT 0.00 X 0 0 0 JOHN DAVIS VICE-CHAIR BOARD OF DIRECT 0.00 X 0 0 0 RONNY ROBERTS SECRETARY BOARD OF DIRECTO 0.00 X 0 0 0 JAMES S WOODARD MEDICAL DIRECTOR, B.O.D. 0.00 X 0 0 0 BILL WEST TREASURER, BOARD OF DIRECT 0.00 X 0 0 0 DUFF JEFFERS MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 MAXINE GILMER MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 JOHNNY JUDSON MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 RICK GARNER MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 ROBERT WHITE MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 SAMMY SMITH MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 RANDY BURRIS MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 STEVE PORTER MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 MARY ELLEN SUMRALL MEMBER, BOARD OF DIRECTORS 0.00 X 0 0 0 KATHERINE M TENTONI EXECUTIVE DIRECTOR 40.00 X 59830 0 0 59830 0 0 0 0 0 0 0 107739 107739 30 30 30 120 120 107889 150 0 0 3195 3195 59080 47264 8862 2954 781 625 117 39 5640 4512 846 282 4798 3838 720 240 1034 879 155 1900 1519 285 96 1058 846 159 53 125 100 19 6 396 396 3469 2774 521 174 UTILITIES 7735 6190 1160 385 89211 72138 12844 4229 10776 10304 149082 166970 45418 43006 2807 2412 162665 179686 7477 5820 7477 5820 X 155188 173866 155188 173866 162665 179686 18678 0 X 0 0 0 X 84283 67312 94784 99609 107739 453727 84283 67312 94784 99609 107739 453727 171340 282387 497 693 707 283 120 2300 7154 30 7184 463211 0.60960 0.49200 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2017 AMOUNT: $ 7,154. 2021 AMOUNT: $ 30. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27031 25368 1663 18387 17638 749 2412 1 PRESCRIPTION DRUGS 200 1237 COST PRESCRIPTION DRUGS ARE PROVIDED DIRECTLY TO THE PATIENTS AT NO COST MAMMOGRAMS AND OTHER SERVICES 5 1958 COST MAMMOGRAMS AND OTHER SERVICES ARE PROVIDED AT NO COST TO PATIENTS PART I, LINE 2: GRANTS PAID INCLUDE $1,958 IN DIAGNOSTIC SERVICES (PRIMARILY MAMMOGRAMS) AND $1,237 IN PRESCRIPTION MEDICATIONS MADE AVAILABLE TO SPECIFIC INDIGENT PATIENTS BY ORDERS OF LICENSED MEDICAL PROFESSIONALS FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS, THE EXECUTIVE DIRECTOR AND THE TREASURER, BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 15 THE ENTIRE BOARD OF DIRECTORS MEETS AT LEAST QUARTERLY TO DETERMINE COMPENSATION FOR THE EXECUTIVE DIRECTOR INCLUDING SALARY AND FRINGE BENEFITS FORM 990, PART VI, SECTION C, LINE 18 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC DURING THE TAX YEAR BY WAY OF RECORDS FILED WITH THE MS SECRETARY OF STATE AND IRS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC DURING THE TAX YEAR BY WAY OF RECORDS FILED WITH THE MS SECRETARY OF STATE AND IRS. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC ALAN T. WILLIAMS - 687 GREENBRIAR, COLUMBUS, MS 39705. JOHN DAVIS - P.O. BOX 631, COLUMBUS, MS 39703. RONNY ROBERTS - P.O. BOX 1366, COLUMBUS, MS 39703. JAMES S. WOODARD - 112 PEYTON HALEY DRIVE, CALEDONIA, MS 39740. BILL WEST - P. O. BOX 173, COLUMBUS, MS 39703. DUFF JEFFERS - P. O. BOX 9394, COLUMBUS, MS 39705. MAXINE GILMER - 499 LACY ROAD, COLUMBUS, MS 39702. JOHNNY JUDSON - 3410 CAMELIA CIRCLE, COLUMBUS, MS 39703. RICK GARNER - 311 GREENBRIAR DRIVE, COLUMBUS, MS 39705. ROBERT WHITE - 2219 5TH STREET NORTH, COLUMBUS, MS 39705. SAMMY SMITH - 525 CO-OP RD, COLUMBUS, MS 39702. RANDY BURRIS - 128 WOODRIDGE PLACE, COLUMBUS, MS 39702. KATHERINE M. TENTONI - 82 NOTTINGHAM LANE, COLUMBUS, MS 39705. STEVE PORTER - 2900 BLUECUTT ROAD #2, COLUMBUS, MS 39705. MARY ELLEN SUMRALL - 1184 JOLLY ROAD, COLUMBUS, MS 39705.