COMMUNITY CARE CENTER FOR FORSYTH COUNTY: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY CARE CENTER FOR FORSYTH COUNTY (EIN 58-1403699)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-11
IRS object ID
202143159349301614
Schema version
2020v4.1
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

FieldValueIRS element (for citing)
Return2021-11-11T05:46:53-08:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BROWN JENKINS AND ONEYEAR PABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1326 South Main StreetAddressLine1Txt
CityWinston SalemCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27101ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN581403699EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Community Care Center for Forsyth CountyBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone3367601235PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12135 New Walkertown RoadAddressLine1Txt
CityWinston SalemCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27101ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAlex TurnerPersonNm
Person TitleTreasurerPersonTitleTxt
Phone3367601235PhoneNum
Signature2021-11-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstAlexPersonFirstNm
Person LastTurnerPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRebecca A Oneyear CPAPreparerPersonNm
PTINP00710716PTIN
Phone3367610366PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
Federated Assurance LevelFAL1FederatedAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLucinda JonesPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12135 New Walkertown RoadAddressLine1Txt
CityWinstonSalemCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27101ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,965,784GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CCCForsyth.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1980FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTo provide free on-site medical and dental care to low-income families.ActivityOrMissionDesc
Voting Members Governing Body24VotingMembersGoverningBodyCnt
Voting Members Independent24VotingMembersIndependentCnt
Total Employee33TotalEmployeeCnt
Total Volunteers364TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,814,616PYContributionsGrantsAmt
CY Contributions Grants$4,960,782CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$118PYInvestmentIncomeAmt
CY Investment Income$51CYInvestmentIncomeAmt
PY Other Revenue$4,793PYOtherRevenueAmt
CY Other Revenue$4,951CYOtherRevenueAmt
PY Total Revenue$2,819,527PYTotalRevenueAmt
CY Total Revenue$4,965,784CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$756,884PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$791,395CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$3,461CYTotalFundraisingExpenseAmt
PY Other Expenses$2,115,089PYOtherExpensesAmt
CY Other Expenses$3,021,160CYOtherExpensesAmt
PY Total Expenses$2,871,973PYTotalExpensesAmt
CY Total Expenses$3,812,555CYTotalExpensesAmt
PY Revenues Less Expenses-$52,446PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,153,229CYRevenuesLessExpensesAmt
Total Assets BOY$747,757TotalAssetsBOYAmt
Total Assets EOY$1,889,325TotalAssetsEOYAmt
Total Liabilities BOY$47,387TotalLiabilitiesBOYAmt
Total Liabilities EOY$23,857TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$700,370NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,865,468NetAssetsOrFundBalancesEOYAmt
MissionTo provide free on-site medical and dental care to low-income families.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$3,640,142ExpenseAmt
Grant$0GrantAmt
Revenue$0RevenueAmt
DescCommunity Care Center of Forsyth County, Inc. is a free medical clinic for families who earn less than 200% of the federal proverty level and are not eligible for government programs and have no medical insurance. The Center provides free on-site medical and dental care to low-income families, as the sole program.Desc
Total Program Service Expenses$3,640,142TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (true)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee33EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members24GoverningBodyVotingMembersCnt
Independent Voting Member24IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcfalseRegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Own WebsiteYes (X)OwnWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonTimothy J ClontzPersonNm
Phone3367601235PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12135 New Walkertown RdAddressLine1Txt
CityWinston SalemCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27101ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
Dr William M Satterwhite Jr
Emeritus0.00Yes (X)$0$0$0
James T Robinson
Executive Director0.00Yes (X)$0$0$0
J Baldwin Smith MD
Director0.00Yes (X)$0$0$0
Robert F Coil
Director0.00Yes (X)$0$0$0
Dr Ernesto De la Torre
Emeritus0.00Yes (X)$0$0$0
Ben Hough
Director0.00Yes (X)$0$0$0
Paula A Henao DDS
Director0.00Yes (X)$0$0$0
Robert P DiBella
Vice Chair0.00Yes (X)$0$0$0Yes (X)
Dr Robert V Ford
Director0.00Yes (X)$0$0$0
Anthony H Brett
Director0.00Yes (X)$0$0$0
Millie Schultz
Director0.00Yes (X)$0$0$0
Julia H Floyd
Director0.00Yes (X)$0$0$0
Kimberly W Gregg
Director0.00Yes (X)$0$0$0
Gilmour Lake
Director0.00Yes (X)$0$0$0
Marlon Hunter
Director0.00Yes (X)$0$0$0
Sharon Storm
Director0.00Yes (X)$0$0$0
Lucinda Jones
Board Chair0.00Yes (X)$0$0$0Yes (X)
Gregory G Holthusen MD
Director0.00Yes (X)$0$0$0
Terry Steelman
Director0.00Yes (X)$0$0$0
Carl Westscott
Director0.00Yes (X)$0$0$0
Brad Clark
Director0.00Yes (X)$0$0$0
Dr Nancy Smith
Director0.00Yes (X)$0$0$0
Sarah Sabiston
Director0.00Yes (X)$0$0$0
Lars Nycum
Director0.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Robinson Association Mgmt Svcs IncBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line12135 New Walkertown RoadAddressLine1Txt
CityWinstonSalemCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27101ZIPCd
FieldValueIRS element (for citing)
ServicesManagement CompanyServicesDesc
Compensation$120,000CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Federated Campaigns$65,874FederatedCampaignsAmt
Fundraising$1,500FundraisingAmt
Government Grants$340,611GovernmentGrantsAmt
All Other Contributions$4,552,797AllOtherContributionsAmt
Noncash Contributions$2,609,754NoncashContributionsAmt
Total Contributions$4,960,782TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$51TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$51ExclusionAmt
FieldValueIRS element (for citing)
Contri Rpt Fundraising Event$1,500ContriRptFundraisingEventAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMisc. Revenue - RelatedDesc
Business900099BusinessCd
Total Revenue Column$4,951TotalRevenueColumnAmt
Related Or Exempt Func Income$4,951RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,951OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,965,784TotalRevenueColumnAmt
Related Or Exempt Func Income$4,951RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$51ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$665,889TotalAmt
Program Services$665,889ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$75,197TotalAmt
Program Services$75,197ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$50,309TotalAmt
Program Services$50,309ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$120,000TotalAmt
Program Services$0ProgramServicesAmt
Management And General$120,000ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$17,369TotalAmt
Program Services$0ProgramServicesAmt
Management And General$17,369ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$31,583TotalAmt
Program Services$0ProgramServicesAmt
Management And General$31,583ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$4,865TotalAmt
Program Services$4,865ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$44,507TotalAmt
Program Services$44,507ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$16,609TotalAmt
Program Services$16,609ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,682TotalAmt
Program Services$4,682ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$13,339TotalAmt
Program Services$13,339ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Medicines & Medical Supplies$2,654,550$2,654,550$0$0
Miscellaneous$21,313$21,313$0$0
Outside Services$23,340$23,340$0$0
Repairs$55,636$55,636$0$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$13,367TotalAmt
Program Services$9,906ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$3,461FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,812,555TotalAmt
Program Services$3,640,142ProgramServicesAmt
Management And General$168,952ManagementAndGeneralAmt
Fundraising$3,461FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$422,655BOYAmt
EOY$559,060EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,596BOYAmt
EOY$930,325EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$102,221BOYAmt
EOY$185,828EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$19,766BOYAmt
EOY$19,766EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$13,660BOYAmt
EOY$12,919EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$659,683LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$614,467LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$49,899BOYAmt
EOY$45,216EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$133,960BOYAmt
EOY$136,211EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$747,757BOYAmt
EOY$1,889,325EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$47,387BOYAmt
EOY$23,857EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$47,387BOYAmt
EOY$23,857EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$494,233BOYAmt
EOY$1,703,825EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$206,137BOYAmt
EOY$161,643EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$700,370BOYAmt
EOY$1,865,468EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$747,757BOYAmt
EOY$1,889,325EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,153,229ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind
Other Support Sum$0OtherSupportSumAmt

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,598,777CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,107,889CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,023,378CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,818,266CurrentTaxYearMinus1YearAmt
Current Tax Year$4,960,782CurrentTaxYearAmt
Total$14,509,092TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,598,777CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,107,889CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,023,378CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,818,266CurrentTaxYearMinus1YearAmt
Current Tax Year$4,960,782CurrentTaxYearAmt
Total$14,509,092TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$0SubstantialContributorsTotAmt
Public Support Total170$14,509,092PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,915CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,389CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years-$657CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$16,093CurrentTaxYearMinus1YearAmt
Current Tax Year$8,155CurrentTaxYearAmt
Total$42,895TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$26,270CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$38,989CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$31,592CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,793CurrentTaxYearMinus1YearAmt
Current Tax Year$4,951CurrentTaxYearAmt
Total$106,595TotalAmt
FieldValueIRS element (for citing)
Total Support$14,658,582TotalSupportAmt
Public Support CY1700.98980PublicSupportCY170Pct
Public Support PY1700.98440PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind
Public Support Total509$0PublicSupportTotal509Amt
Public Support CY5090PublicSupportCY509Pct
Investment Income CY0InvestmentIncomeCYPct

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferencePt II Ln 10FormAndLineReferenceDesc
ExplanationOther Income Part II, Line 10 Description: Other Income 2016: 26270. 2017: 38989. 2018: 31592. 2019: 4793. 2020: 4951.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$134,815BeginningYearBalanceAmt
Investment Earnings Or Losses$8,169InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,200GrantsOrScholarshipsAmt
Administrative Expenses$1,267AdministrativeExpensesAmt
End Year Balance$136,517EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$125,013BeginningYearBalanceAmt
Investment Earnings Or Losses$16,209InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,108GrantsOrScholarshipsAmt
Administrative Expenses$1,299AdministrativeExpensesAmt
End Year Balance$134,815EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$132,032BeginningYearBalanceAmt
Investment Earnings Or Losses-$639InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,056GrantsOrScholarshipsAmt
Administrative Expenses$1,324AdministrativeExpensesAmt
End Year Balance$125,013EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$124,911BeginningYearBalanceAmt
Investment Earnings Or Losses$13,405InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,008GrantsOrScholarshipsAmt
Administrative Expenses$1,276AdministrativeExpensesAmt
End Year Balance$132,032EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$125,234BeginningYearBalanceAmt
Investment Earnings Or Losses$5,921InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,012GrantsOrScholarshipsAmt
Administrative Expenses$1,232AdministrativeExpensesAmt
End Year Balance$124,911EndYearBalanceAmt
FieldValueIRS element (for citing)
Endowments Held Unrelated OrgYes (true)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Book Value$0BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$62,254OtherCostOrOtherBasisAmt
Depreciation$23,089DepreciationAmt
Book Value$39,165BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$591,134OtherCostOrOtherBasisAmt
Depreciation$585,183DepreciationAmt
Book Value$5,951BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,295OtherCostOrOtherBasisAmt
Depreciation$6,195DepreciationAmt
Book Value$100BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$45,216TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
Other Assets-$306
Funds Held in Trust - Endowment$136,517
FieldValueIRS element (for citing)
Total Book Value Other Assets$136,211TotalBookValueOtherAssetsAmt
Total Rev Etc Audited Fincl Stmt$11,121,253TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$8,155NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts$6,147,314DonatedServicesAndUseFcltsAmt
Revenue Not Reported$6,155,469RevenueNotReportedAmt
Revenue Subtotal$4,965,784RevenueSubtotalAmt
Total Revenue Per Form990$4,965,784TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$9,959,869TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$6,147,314DonatedServicesUseFcltsAmt
Expenses Not Reported$6,147,314ExpensesNotReportedAmt
Expenses Subtotal$3,812,555ExpensesSubtotalAmt
Total Expenses Per Form990$3,812,555TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt V, Line 4The purpose of the endowment fund is to provide a permanent fund which may be used by the organization to support the provision of healthcare services to the medically uninsured and underserved who meet the eligibility requirement guidelines of the organization.
Pt XII, Line 2dRounding

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Robinson Association MgmtBusinessNameLine1Txt
FieldValueIRS element (for citing)
Relationship DescriptionOwned by Executive DirectorRelationshipDescriptionTxt
Transaction$120,000TransactionAmt
TransactionManagementTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution1ContributionCnt
Noncash Contributions Rpt F990$2,606,046NoncashContributionsRptF990Amt
Method Of Determining RevenuesDonor ProvidedMethodOfDeterminingRevenuesTxt

Other Non Cash Contri Table OtherNonCashContriTableGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
DescFood for VolunteersDesc
Contribution0ContributionCnt
Noncash Contributions Rpt F990$3,858NoncashContributionsRptF990Amt
Method Of Determining RevenuesCostMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGiftsInd
Third Parties UsedfalseThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt VI, Line 3The organization receives management services under a board approved contract from Robinson Association Management Services, Inc. An entity owned by James T. Robinson, Executive Director.
Pt VI, Line 11bA copy of the 990 is provided to the Executive Director and Treasurer for their review prior to the return being filed. The 990 is subsequently reviewed by the finance committee.
Pt VI, Line 15aSalaries and management contracts are reviewed and recommendations made by the personnel committee which is made up of independent persons. Those recommendations then go to the finance committee for review and finally to the board for approval.
Pt VI, Line 15bSalaries and management contracts are reviewed and recommendations made by the personnel committee which is made up of independent persons. Those recommendations then go to the finance committee for review and finally to the board for approval.
Pt VI, Line 19The organization makes its governing documents, conflict of interest policy, and financial statements available to anyone that request a copy of the information.

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