GOOD SAMARITAN CLINIC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN CLINIC (EIN 71-0863639)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2020-11-12
- IRS object ID
- 202033179349306103
- Schema version
- 2019v5.0
- 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 | 2020-11-12T13:47:08-06:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 202759879 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRZYBYSZ & ASSOCIATES CPAS PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 JENNY LIND RD STE B | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 710863639 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 4797830233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 NORTH B STREET | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATTI KIMBROUGH | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 4797830233 | PhoneNum |
| Signature | 2020-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARC LUX CPA | PreparerPersonNm |
| PTIN | P00588449 | PTIN |
| Phone | 4796490888 | PhoneNum |
| Preparation | 2020-11-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 72.205.197.34 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-11-12 | IPDt |
| IP Tm | 13:47:08 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 1F957A76B39E61F73B5CC5EAB16A937EB5ABE984 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | AD1A46D4064038E122F72A36A5C31CF427A9015A | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIM HEARN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3417 DUKE AVE | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72908 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $490,967 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GOODSAMARITANFS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | TO BE A CHARITABLE HEALTHCARE MINISTRY FOR THE UNDERSERVED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 29 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 29 | VotingMembersIndependentCnt |
| Total Employee | 15 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $497,485 | PYContributionsGrantsAmt |
| CY Contributions Grants | $423,664 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $47,122 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $54,905 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,271 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,406 | CYInvestmentIncomeAmt |
| PY Other Revenue | $622 | PYOtherRevenueAmt |
| CY Other Revenue | $442 | CYOtherRevenueAmt |
| PY Total Revenue | $551,500 | PYTotalRevenueAmt |
| CY Total Revenue | $483,417 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $317,788 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $300,647 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $45,561 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $182,735 | PYOtherExpensesAmt |
| CY Other Expenses | $153,523 | CYOtherExpensesAmt |
| PY Total Expenses | $500,523 | PYTotalExpensesAmt |
| CY Total Expenses | $454,170 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $50,977 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $29,247 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $794,641 | TotalAssetsBOYAmt |
| Total Assets EOY | $936,293 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $22,878 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $138,628 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $771,763 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $797,665 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UN-INSURED, ELDERLY, & HOMELESS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $359,626 | ExpenseAmt |
| Revenue | $54,905 | RevenueAmt |
| Desc | THE CLINIC PROVIDES MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UN-INSURED, ELDERLY, & HOMELESS. | Desc |
| Total Program Service Expenses | $359,626 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 15 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 29 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 29 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 4797830233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 NORTH B STREET | AddressLine1Txt |
| City | FORT SMITH | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 72901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)
| TitleTitleTxt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|
| KEITH BROWN | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| REBECCA BROWN | |||||
| SECRETARY | Yes (X) | $0 | $0 | $0 | Yes (X) |
| MARK BUERGLER | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| SARAH GARLOW | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| STEVE GEBHART | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| DR BRANDI GUTHREY | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| SONYA HALL | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| LISA HEAM | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| TIM HEARN | |||||
| BOARD CHAIR | Yes (X) | $0 | $0 | $0 | Yes (X) |
| PAT HIGHTOWER | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| LAURA HOOD | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| MICHEAL LAGER | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| BOBBIE LAMB | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| CRYSTAL LOUGIN | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| HAROLD MACDOWELL | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| VICTOR MARTINEZ | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| TINA MEEK | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| DR STEVE NELSON | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| NYCOLE OLIVER | |||||
| BOARD VICE C | Yes (X) | $0 | $0 | $0 | Yes (X) |
| RENEE PARKER | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE PARSON | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| JAY RICHARDSON | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| DARRELL STOVALL | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| RANDY STRICKLAND | |||||
| TREASURER | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JENNIFER THOMAS | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| STAN VLADAMAR | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| BETH WATSON | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| DR LESLIE ZIEGLER | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| SCOTT ZUERKER | |||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $880 | FundraisingAmt |
| Government Grants | $1,500 | GovernmentGrantsAmt |
| All Other Contributions | $421,284 | AllOtherContributionsAmt |
| Total Contributions | $423,664 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT PAYMENTS | Desc |
| Total Revenue Column | $54,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $54,905 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $54,905 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,181 | TotalRevenueColumnAmt |
| Exclusion | $8,181 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,775 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,550 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$3,775 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,775 | TotalRevenueColumnAmt |
| Exclusion | -$3,775 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $880 | ContriRptFundraisingEventAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Total Revenue Column | $442 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $442 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $442 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $483,417 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $55,347 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $4,406 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $267,721 | TotalAmt |
| Program Services | $187,015 | ProgramServicesAmt |
| Management And General | $40,353 | ManagementAndGeneralAmt |
| Fundraising | $40,353 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,583 | TotalAmt |
| Program Services | $10,361 | ProgramServicesAmt |
| Management And General | $1,222 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,343 | TotalAmt |
| Program Services | $15,375 | ProgramServicesAmt |
| Management And General | $2,984 | ManagementAndGeneralAmt |
| Fundraising | $2,984 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,512 | TotalAmt |
| Program Services | $8,512 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,478 | TotalAmt |
| Program Services | $2,380 | ProgramServicesAmt |
| Fundraising | $2,098 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,091 | TotalAmt |
| Program Services | $2,951 | ProgramServicesAmt |
| Management And General | $84 | ManagementAndGeneralAmt |
| Fundraising | $56 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,074 | TotalAmt |
| Program Services | $19,526 | ProgramServicesAmt |
| Management And General | $548 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40 | TotalAmt |
| Program Services | $39 | ProgramServicesAmt |
| Management And General | $1 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,731 | TotalAmt |
| Program Services | $15,302 | ProgramServicesAmt |
| Management And General | $429 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,325 | TotalAmt |
| Program Services | $20,046 | ProgramServicesAmt |
| Management And General | $279 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| REPAYMENT OF GRANT MONIES | $30,000 | $30,000 |
| LABORATORY TEST SUPPLIES | $21,021 | $21,021 |
| MEDICAL SUPPLIES | $6,706 | $6,706 |
| PHARMACEUTICAL SUPPLIES | $6,227 | $6,227 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,318 | TotalAmt |
| Program Services | $14,165 | ProgramServicesAmt |
| Management And General | $3,083 | ManagementAndGeneralAmt |
| Fundraising | $70 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $454,170 | TotalAmt |
| Program Services | $359,626 | ProgramServicesAmt |
| Management And General | $48,983 | ManagementAndGeneralAmt |
| Fundraising | $45,561 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $370,422 | BOYAmt |
| EOY | $532,454 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $934 | BOYAmt |
| EOY | $13,188 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $423,948 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $312,734 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $126,945 | BOYAmt |
| EOY | $111,214 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $296,340 | BOYAmt |
| EOY | $279,437 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $794,641 | BOYAmt |
| EOY | $936,293 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,878 | BOYAmt |
| EOY | $13,722 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $68,206 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $56,700 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,878 | BOYAmt |
| EOY | $138,628 | 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 | $568,042 | BOYAmt |
| EOY | $598,944 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $203,721 | BOYAmt |
| EOY | $198,721 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $771,763 | BOYAmt |
| EOY | $797,665 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $794,641 | BOYAmt |
| EOY | $936,293 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $29,247 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$3,345 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $476,052 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $613,188 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $432,246 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $497,485 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $423,664 | CurrentTaxYearAmt |
| Total | $2,442,635 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $476,052 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $613,188 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $432,246 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $497,485 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $423,664 | CurrentTaxYearAmt |
| Total | $2,442,635 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $102,440 | SubstantialContributorsTotAmt |
| Public Support Total170 | $2,340,195 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,774 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,935 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,484 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,271 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,181 | CurrentTaxYearAmt |
| Total | $34,645 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $2,477,280 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $214,039 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.94470 | PublicSupportCY170Pct |
| Public Support PY170 | 0.98620 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $186,812 | OtherCostOrOtherBasisAmt |
| Depreciation | $110,730 | DepreciationAmt |
| Book Value | $76,082 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $237,136 | OtherCostOrOtherBasisAmt |
| Depreciation | $202,004 | DepreciationAmt |
| Book Value | $35,132 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $111,214 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ARKANSAS COMMUNITY FOUNDATION | Desc |
| Book Value | $279,437 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $279,437 | TotalBookValueSecuritiesAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $480,072 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$3,345 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$3,345 | RevenueNotReportedAmt |
| Revenue Subtotal | $483,417 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $483,417 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $454,170 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $454,170 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $454,170 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE TAX EFFECTS FROM AN UNCERTAIN TAX POSITION TO BE RECOGNIZED IN THE FINANCIAL STATEMENTS ONLY IF THE POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED IF THE POSITION WERE TO BE CHALLENGED BY A TAXING AUTHORITY. THE ASSESSMENT OF THE TAX POSITION IS BASED SOLELY ON THE TECHNICAL MERITS OF THE POSITION, WITHOUT REGARD TO THE LIKELIHOOD THAT THE TAX POSITION MAY BE CHALLENGED. IF AN UNCERTAIN TAX POSITION MEETS THE MORE-LIKELY-THAN-NOT THRESHOLD, THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY TO BE RECOGNIZED UPON ULTIMATE SETTLEMENT WITH THE TAXING AUTHORITY IS RECORDED. THE CLINIC'S PRIMARY TAX POSITIONS RELATE TO ITS STATUS AS A NOT-FOR-PROFIT ENTITY EXEMPT FROM INCOME TAXES AND CLASSIFICATION OF ACTIVITIES RELATED TO ITS EXEMPT PURPOSE. THE CLINIC HAS ANALYZED ITS TAX POSITIONS TAKEN FOR FILINGS WITH THE INTERNAL REVENUE SERVICE. IT BELIEVES THAT ITS FILING POSITIONS WILL BE SUSTAINED UPON EXAMINATION AND DOES NOT ANTICIPATE ANY ADJUSTMENTS THAT WOULD RESULT IN A MATERIAL ADVERSE EFFECT ON ITS FINANCIAL CONDITION, RESULTS OF OPERATIONS, OR CASH FLOWS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD OF DIRECTORS REVIEWS THE FORM 990 PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | POTENTIAL BOARD MEMBERS ARE QUESTIONED OF ANY POTENTIAL CONFLICTS OF INTER EST. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE FINANCIALS AND FORM 990 ARE KEPT AT THE ORGANIZATION'S PHYSICAL LOCATION AND MADE AVAILABLE UPON REQUEST. |
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