FREE MEDICAL CLINIC OF NEWBERRY COUNTY INC: Form 990, tax year 2021
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- Organization
- FREE MEDICAL CLINIC OF NEWBERRY COUNTY INC (EIN 20-0390941)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202243199349311374
- 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 | 2022-11-15T12:38:42-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 570292726 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGREGOR AND COMPANY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | POST OFFICE BOX 135 | AddressLine1Txt |
| City | COLUMBIA | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29202 | 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 | 200390941 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREE MEDICAL CLINIC OF NEWBERRY | BusinessNameLine1Txt |
| Business Name Line2 | COUNTY INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 8032766665 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | POST OFFICE BOX 783 | AddressLine1Txt |
| City | NEWBERRY | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29108 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAROLYN TOBE | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 8032766665 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CAROLYN | PersonFirstNm |
| Person Last | TOBE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DEAN L RICHARDSON CPA | PreparerPersonNm |
| PTIN | P00579157 | PTIN |
| Phone | 8037870003 | PhoneNum |
| Preparation | 2022-11-15 | PreparationDt |
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
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAME AS PRIMARY NAME ON RECORD | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CAROLYN TOBE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2568 KINARD STREET | AddressLine1Txt |
| City | NEWBERRY | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $172,354 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://WWW.NEWBERRYCLINIC.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | SC | LegalDomicileStateCd |
| Activity Or Mission | THE CLINIC PROVIDES A MEDICAL HOME AND HEALTHCARE SERVICES TO UNINSURED NEWBERRY COUNTY RESIDENTS WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 3 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $104,261 | PYContributionsGrantsAmt |
| CY Contributions Grants | $123,177 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $184 | PYInvestmentIncomeAmt |
| CY Investment Income | $2 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,354 | PYOtherRevenueAmt |
| CY Other Revenue | $49,175 | CYOtherRevenueAmt |
| PY Total Revenue | $108,799 | PYTotalRevenueAmt |
| CY Total Revenue | $172,354 | 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 | $113,029 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $118,354 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $23,671 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $57,143 | PYOtherExpensesAmt |
| CY Other Expenses | $59,208 | CYOtherExpensesAmt |
| PY Total Expenses | $170,172 | PYTotalExpensesAmt |
| CY Total Expenses | $177,562 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$61,373 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,208 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $212,644 | TotalAssetsBOYAmt |
| Total Assets EOY | $195,303 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,512 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,379 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $184,132 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $178,924 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE CLINIC PROVIDES A MEDICAL HOME AND HEALTHCARE SERVICES TO UNINSURED NEWBERRY COUNTY RESIDENTS WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $106,611 | ExpenseAmt |
| Desc | THE CLINIC PROVIDES A MEDICAL HOME AND HEALTHCARE SERVICES TO UNINSURED NEWBERRY COUNTY RESIDENTS WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. | Desc |
| Total Program Service Expenses | $106,611 | 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 | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 | 0 | 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 | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | 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 | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | 0 | 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 | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | 0 | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | SC | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREE MEDICAL CLINIC OF NEWBERRY COUNTY INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8032766665 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2568 KINARD STREET | AddressLine1Txt |
| City | NEWBERRY | CityNm |
| State Abbreviation | SC | StateAbbreviationCd |
| ZIP | 29108 | 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 | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| CARLA ARMFIELD | ||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JESSE BAKER | ||||||
| CO-CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DR COREY HUNT | ||||||
| MEDICAL DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |
| TERI MURDOCK | ||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN GLASGOW | ||||||
| CO-CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| LYNN BEASLEY | ||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |
| HAROLD BETTY | ||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |
| CAROLYN TOBE | ||||||
| TREASURER | 2.00 | Yes (X) | 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 |
| Federated Campaigns | $30,019 | FederatedCampaignsAmt |
| Government Grants | $13,158 | GovernmentGrantsAmt |
| All Other Contributions | $80,000 | AllOtherContributionsAmt |
| Total Contributions | $123,177 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PPP LOAN FORGIVENESS B | 621110 | $44,364 | $44,364 |
| MEDICAL RECORDS AND SE | 621110 | $4,811 | $4,811 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $49,175 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $172,354 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $49,177 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,274 | TotalAmt |
| Program Services | $31,364 | ProgramServicesAmt |
| Management And General | $10,455 | ManagementAndGeneralAmt |
| Fundraising | $10,455 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,252 | TotalAmt |
| Program Services | $24,752 | ProgramServicesAmt |
| Management And General | $8,250 | ManagementAndGeneralAmt |
| Fundraising | $8,250 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,644 | TotalAmt |
| Program Services | $10,586 | ProgramServicesAmt |
| Management And General | $3,529 | ManagementAndGeneralAmt |
| Fundraising | $3,529 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,184 | TotalAmt |
| Program Services | $4,310 | ProgramServicesAmt |
| Management And General | $1,437 | ManagementAndGeneralAmt |
| Fundraising | $1,437 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,232 | TotalAmt |
| Management And General | $12,232 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,138 | TotalAmt |
| Program Services | $1,773 | ProgramServicesAmt |
| Management And General | $365 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,891 | TotalAmt |
| Program Services | $5,302 | ProgramServicesAmt |
| Management And General | $589 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,272 | TotalAmt |
| Management And General | $8,272 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,889 | TotalAmt |
| Program Services | $4,400 | ProgramServicesAmt |
| Management And General | $489 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHYSICIAN FEES - SPECIA | $6,975 | $6,975 | |
| TELEPHONE | $6,703 | $6,033 | $670 |
| LOCAL TRAVEL AND MEETIN | $4,050 | $3,645 | $405 |
| MEDICAL SUPPLIES | $2,183 | $2,183 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,875 | TotalAmt |
| Program Services | $5,288 | ProgramServicesAmt |
| Management And General | $587 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,562 | TotalAmt |
| Program Services | $106,611 | ProgramServicesAmt |
| Management And General | $47,280 | ManagementAndGeneralAmt |
| Fundraising | $23,671 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,185 | BOYAmt |
| EOY | $7,116 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,869 | BOYAmt |
| EOY | $18,869 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $301,558 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $132,240 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,590 | BOYAmt |
| EOY | $169,318 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $212,644 | BOYAmt |
| EOY | $195,303 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,284 | BOYAmt |
| EOY | $12,863 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,228 | BOYAmt |
| EOY | $3,516 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,512 | BOYAmt |
| EOY | $16,379 | 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 | $184,132 | BOYAmt |
| EOY | $178,924 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,132 | BOYAmt |
| EOY | $178,924 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $212,644 | BOYAmt |
| EOY | $195,303 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$5,208 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $145,323 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $189,980 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $148,321 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $108,615 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $172,354 | CurrentTaxYearAmt |
| Total | $764,593 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $145,323 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $189,980 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $148,321 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $108,615 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $172,354 | CurrentTaxYearAmt |
| Total | $764,593 | 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 | $764,593 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $326 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $279 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $277 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $184 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2 | CurrentTaxYearAmt |
| Total | $1,068 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $326 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $279 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $277 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $184 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2 | CurrentTaxYearAmt |
| Total | $1,068 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $145,649 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $190,259 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $148,598 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $108,799 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $172,356 | CurrentTaxYearAmt |
| Total | $765,661 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99860 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99820 | PublicSupportPY509Pct |
| Investment Income CY | 0.00140 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00180 | 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,000 | OtherCostOrOtherBasisAmt |
| Book Value | $25,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $236,581 | OtherCostOrOtherBasisAmt |
| Depreciation | $99,209 | DepreciationAmt |
| Book Value | $137,372 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,977 | OtherCostOrOtherBasisAmt |
| Depreciation | $33,031 | DepreciationAmt |
| Book Value | $6,946 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $169,318 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED PAYROLL, TAXES AND WITHHOLDINGS | Desc |
| Amt | $3,516 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,516 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | NONE REPORTED - N/A | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE CLINIC PROVIDES A COMPLETE COPY OF FORM 990 TO ALL MEMBERS OF THE GOVERNING BODY BY EMAIL DISTRIBUTION FOR THEIR REVIEW AND APPROVAL OF THE INFORMATION RETURN BEFORE IT IS ELECTRONICALLY FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CLINIC MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE AT BOARD MEETINGS AND BY OPEN REQUEST OF THE GENERAL PUBLIC. |
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