ARC HEALTHRESOURCES OF ROCKLAND INC: Form 990PF, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ARC HEALTHRESOURCES OF ROCKLAND INC (EIN 13-4142322)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-10-20
- IRS object ID
- 202012949349100006
- Schema version
- 2019v5.1
- 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
- Form 990-PF
- Accounting Fees Schedule
- 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 | 2020-10-20T12:00:04-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | 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 | 2019-01-01 | 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 | 25 HEMLOCK DRIVE | AddressLine1Txt |
| City | CONGERS | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 10920 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GANEENE O'BRIEN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8452672500 | PhoneNum |
| Signature | 2020-10-19 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Paul Hammerschmidt | PreparerPersonNm |
| PTIN | P01384178 | PTIN |
| Phone | 2128858000 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 98.116.121.209 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 26308920202945000010 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2020-10-20 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 5B647EDC1EA3D2D73D6BFB779DE102FCC5954E55 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | D70B10EF617FA1489EC280627DA9B4A800B8227E | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-04-22 16:20:28Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $338,490 | 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 | $2,263,956 | OtherIncomeRevAndExpnssAmt |
| Total Rev And Expnss | $2,263,956 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $0 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $1,573,711 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $1,566,059 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $307,897 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $300,018 | PensionEmplBnftDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $11,500 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Adj Net Incm | $0 | AccountingFeesAdjNetIncmAmt |
| Accounting Fees Chrtbl Prps | $11,500 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $16,130 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $0 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Adj Net Incm | $0 | OtherProfFeesAdjNetIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $16,130 | OtherProfFeesDsbrsChrtblAmt |
| Interest Rev And Expnss | $300 | InterestRevAndExpnssAmt |
| Interest Dsbrs Chrtbl | $300 | InterestDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $11,953 | DeprecAndDpltnRevAndExpnssAmt |
| Occupancy Rev And Expnss | $78,423 | OccupancyRevAndExpnssAmt |
| Occupancy Dsbrs Chrtbl | $78,423 | OccupancyDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $5,210 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $5,210 | TravConfMeetingDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $478,360 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $0 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Adj Net Incm | $0 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $478,360 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $2,483,484 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $2,456,000 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $0 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $0 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $2,483,484 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $2,456,000 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$219,528 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $21,590 | CashBOYAmt |
| Cash EOY | $3,899 | CashEOYAmt |
| Cash EOYFMV | $3,899 | CashEOYFMVAmt |
| Acct Rcvbl | $249,535 | AcctRcvblAmt |
| Acct Rcvbl BOY | $362,691 | AcctRcvblBOYAmt |
| Acct Rcvbl EOY | $249,535 | AcctRcvblEOYAmt |
| Acct Rcvbl EOYFMV | $249,535 | AcctRcvblEOYFMVAmt |
| Prepaid Expenses BOY | $3,082 | PrepaidExpensesBOYAmt |
| Prepaid Expenses EOY | $3,612 | PrepaidExpensesEOYAmt |
| Prepaid Expenses EOYFMV | $3,612 | PrepaidExpensesEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $381,591 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $300,147 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $45,431 | LandBOYAmt |
| Land EOY | $81,444 | LandEOYAmt |
| Land EOYFMV | $81,444 | LandEOYFMVAmt |
| Total Assets BOY | $432,794 | TotalAssetsBOYAmt |
| Total Assets EOY | $338,490 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $338,490 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $97,863 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $107,119 | AccountsPayableEOYAmt |
| Mortgages And Notes Payable BOY | $36,784 | MortgagesAndNotesPayableBOYAmt |
| Mortgages And Notes Payable EOY | $2,850 | MortgagesAndNotesPayableEOYAmt |
| Other Liabilities BOY | $2,308,037 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $2,457,939 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $2,442,684 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,567,908 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | -$2,009,890 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | -$2,229,418 | NoDonorRstrNetAssestsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | -$2,009,890 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | -$2,229,418 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $432,794 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $338,490 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | -$2,009,890 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$219,528 | ExcessRevenueOverExpensesAmt |
| Subtotal | -$2,229,418 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | -$2,229,418 | TotNetAstOrFundBalancesEOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cap Gains Loss Tx Invst Incm Detail | CapGainsLossTxInvstIncmDetail |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | false | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $2,227,990 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $31,128 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 71.575109 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $2,115,895 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $61,633 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 34.330553 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $1,750,653 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $60,960 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 28.718061 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $1,567,388 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $86,731 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 18.071831 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $1,010,340 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $77,557 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 13.027064 | DistributionYr5Rt |
| Total Distribution | 165.722618 | TotalDistributionRt |
| Average Distribution | 33.144524 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $34,869 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $1,155,716 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $0 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $1,155,716 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $2,456,000 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | Yes (X) | DomesticOrgMeetingSect4940eInd |
| Investment Income Excise Tax | $0 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $0 | SubtotalAmt |
| Tax Based On Investment Income | $0 | TaxBasedOnInvestmentIncomeAmt |
| 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 | 25 HEMLOCK DRIVE | AddressLine1Txt |
| City | CONGERS | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 10920 | 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 (5 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 | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | PRESIDENT | 1.0 | $0 | $0 | $0 |
| JOHN M SMITH | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | VICE PRESIDENT | 1.0 | $0 | $0 | $0 |
| EDWARD RAUSH | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | TREASURER | 1.0 | $0 | $0 | $0 |
| SUSAN CONKLIN | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | SECRETARY | 1.0 | $0 | $0 | $0 |
| LYNDA MELTZER | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | DIRECTOR | 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 |
|---|---|---|---|---|---|---|---|---|
| ANDREA RITCHEN | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | MEDICAL DIRECTOR | 40.0 | $117,822 | $183 | $0 |
| THERESA MCGEEVER | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | PHYSICAL THERAPIST | 35.0 | $99,833 | $9,030 | $0 |
| NEHA AMIN | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | PHYSICAL THERAPIST | 35.0 | $97,795 | $8,060 | $0 |
| MARS MEDINA | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | PHYSICAL THERAPIST | 40.0 | $89,970 | $7,975 | $0 |
| ANDREA CIOFFI | ||||||||
| 25 HEMLOCK DRIVE | CONGERS | NY | 10920 | A16 TREATMENT SUPVR | 35.0 | $83,579 | $7,299 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Employee Paid Over50k | 12 | 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 | $189,545 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
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 | $2,253,120 | 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 | $35,400 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $35,400 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $35,400 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $531 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $34,869 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $1,743 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $1,743 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $0 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $0 | TotalTaxAmt |
| Distributable Before Adj | $1,743 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $1,743 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $1,743 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $2,456,000 | 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 | $2,456,000 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $0 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $2,456,000 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $1,743 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Prior Year1 | 2017 | PriorYear1Yr |
| Prior Year2 | 2016 | PriorYear2Yr |
| Prior Year3 | 2015 | PriorYear3Yr |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $1,006,462 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $1,563,051 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $1,747,605 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $2,112,813 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $2,226,434 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $8,656,365 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $2,456,000 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Current Year | $1,743 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $2,454,257 | RemainingDistriFromCorpusAmt |
| Total Corpus | $11,110,622 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov From Yr5 | $1,006,462 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $10,104,160 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $1,563,051 | ExcessFromYear4Amt |
| Excess From Year3 | $1,747,605 | ExcessFromYear3Amt |
| Excess From Year2 | $2,112,813 | ExcessFromYear2Amt |
| Excess From Year1 | $2,226,434 | ExcessFromYear1Amt |
| Excess From Current Year | $2,454,257 | 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 Rev Part VII ProgramServiceRevPartVIIGrp (2 entries)
| DescDesc | BusinessBusinessCd | Related Or Exempt Function IncmRelatedOrExemptFunctionIncmAmt |
|---|---|---|
| PATIENT SERVICE REVENUE | 623000 | $2,220,950 |
| MEDICAID | 623000 | $31,893 |
| 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 | |
| Div And Int From Sec Part VII | DivAndIntFromSecPartVIIGrp | |
| 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 Incm Part VII | OtherInvestmentIncmPartVIIGrp | |
| 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 | $11,113 | RelatedOrExemptFunctionIncmAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | $2,263,956 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $2,263,956 | 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 |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $11,500 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $11,500 | DisbursementsCharitablePrpsAmt |
Depreciation Schedule DepreciationSchedule
Mortgages And Notes Payable Sch MortgagesAndNotesPayableSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mortgage | $2,850 | MortgageAmt |
Note Payable NotePayableGrp
Lender Name LenderNameGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NYSARC INC - TELP | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Loan Original | $164,277 | LoanOriginalAmt |
| Balance Due | $2,850 | BalanceDueAmt |
| Note | 2015-01 | NoteDt |
| Loan Maturity | 2020-12 | LoanMaturityDt |
| Interest | 1.63 | InterestRt |
| Loan Purpose | TO PURCHASE MEDICAL CLINIC SOFTWARE | LoanPurposeTxt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (7 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|---|
| OFFICE EXPENSES | $220,029 | $0 | $0 | $220,029 |
| MANAGEMENT FEES | $230,364 | $230,364 | ||
| BAD DEBT EXPENSE | $1,152 | $1,152 | ||
| MEDICAL SUPPLIES | $11,547 | $11,547 | ||
| INSURANCE | $10,757 | $10,757 | ||
| EQUIPMENT RENTAL | $2,615 | $2,615 | ||
| MISCELLANEOUS EXPENSES | $1,896 | $1,896 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (3 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt |
|---|---|
| PATIENT SERVICE REVENUE | $2,220,950 |
| MEDICAID | $31,893 |
| OTHER REVENUE | $11,113 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATE | Desc |
| BOY Book Value | $2,308,037 | BOYBookValueAmt |
| EOY Book Value | $2,457,939 | 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 | $6,317 | $0 | $0 | $6,317 |
| OTHER CONSULTING FEES | $9,813 | $9,813 |
Comments