MIAMI RESCUE MISSION CLINIC INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
MIAMI RESCUE MISSION CLINIC INC (EIN 45-1481860)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-07-01
IRS object ID
202041839349301754
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 ReturnHeader

FieldValueIRS element (for citing)
Return2020-07-01T12:08:53-05:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN830696713PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GARCIA ESPINOSA MIYARES RODRIGUEZ TRUEBABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12600 DOUGLAS ROAD SUITE 800AddressLine1Txt
CityCORAL GABLESCityNm
State AbbreviationFLStateAbbreviationCd
ZIP33134ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN451481860EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MIAMI RESCUE MISSION CLINIC INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMIAMBusinessNameControlTxt
Phone7868665705PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NW 1ST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonPETER A GUTIERREZ MD MMSPersonNm
Person TitleOFFICER AND DIRECTORPersonTitleTxt
Phone3055722026PhoneNum
Signature2020-07-01SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJARNETTE G RODRIGUEZ CPAPreparerPersonNm
PTINP01062623PTIN
Phone3055295440PhoneNum
Preparation2020-07-01PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address192.110.170.154IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-07-01IPDt
IP Tm13:08:45IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id4AA628FB4116F2D5A2763B366B209C22057A6880AtSubmissionCreationDeviceId
At Submission Filing Device Id53940C140D7D5339E3F9C884854DCD9C5576AA8DAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerPETER A GUTIERREZ MD MMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NW FIRST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,077,485GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CARINGPLACECLINIC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionMIAMI RESCUE MISSION CLINIC, INC. IS COMMITTED TO PROVIDE ACCESS TO COMPREHENSIVE PRIMARY HEALTH CARE TO THE COMMUNITY'S HOMELESS, MEDICALLY UNINSURED AND UNDERSERVED, AS WELL AS TO IMPLEMENT AND DELIVER COMMUNITY OUTREACH PROGRAMS THAT INCLUDE HEALTHCARE SCREENINGS INFORMATION AND EDUCATION, INCLUDING GUIDANCE ON AND REFERRALS TO THE FULL CONTINUUM OF PERSONAL AND COMMUNITY DEVELOPMENT. TO THIS END, MIAMI RESCUE MISSION, INC. WILL SERVE THE LOCAL COMMMUNITY WITH HIGHER STANDARDS OF MEDICAL CARE IN AN ENVIRONMENT IN WHICH EACH PATIENT IS TREATED WITH DIGNITY AND RESPECT.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee17TotalEmployeeCnt
Total Volunteers135TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$362,109PYContributionsGrantsAmt
CY Contributions Grants$260,830CYContributionsGrantsAmt
PY Program Service Revenue$1,840,392PYProgramServiceRevenueAmt
CY Program Service Revenue$816,507CYProgramServiceRevenueAmt
PY Investment Income$56PYInvestmentIncomeAmt
CY Investment Income$16CYInvestmentIncomeAmt
PY Other Revenue$3,121PYOtherRevenueAmt
CY Other Revenue$132CYOtherRevenueAmt
PY Total Revenue$2,205,678PYTotalRevenueAmt
CY Total Revenue$1,077,485CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$438,946PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$467,571CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$41,637CYTotalFundraisingExpenseAmt
PY Other Expenses$1,833,343PYOtherExpensesAmt
CY Other Expenses$643,712CYOtherExpensesAmt
PY Total Expenses$2,272,289PYTotalExpensesAmt
CY Total Expenses$1,111,283CYTotalExpensesAmt
PY Revenues Less Expenses-$66,611PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$33,798CYRevenuesLessExpensesAmt
Total Assets BOY$200,217TotalAssetsBOYAmt
Total Assets EOY$195,269TotalAssetsEOYAmt
Total Liabilities BOY$26,138TotalLiabilitiesBOYAmt
Total Liabilities EOY$54,988TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$174,079NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$140,281NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITY IS TO PROVIDE PRIMARY HEALTHCARE TO THE COMMUNITY'S HOMELESS, MEDICALLY UNINSURED AND UNDERSERVED, AS WELL AS TO IMPLEMENT AND DELIVER COMMUNITY OUTREACH PROGRAMS THAT INCLUDE HEALTHCARE SCREENINGS, INFORMATION AND EDUCATION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$731,007ExpenseAmt
Revenue$816,507RevenueAmt
DescMIAMI RESCUE MISSION CLINIC, INC. HAS BEEN PROVIDING COMPREHENSIVE HEALTHCARE TO THE COMMUNITY'S HOMELESS AND MEDICALLY INSURED.Desc
Total Program Service Expenses$731,007TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee17EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JESUS INGUANZOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3055722026PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12015 NE FIRST AVENUEAddressLine1Txt
CityMIAMICityNm
State AbbreviationFLStateAbbreviationCd
ZIP33127ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
NICHOLAS MASSIMINI PHD
DIRECTOR5.00Yes (X)$0$0$0
MARTA LOPEZ MD
DIRECTOR5.00Yes (X)$0$0$0
CARLOS ACOSTA
DIRECTOR5.00Yes (X)$0$0$0
REV RONALD BRUMITT
OFFICER AND DIRECTOR5.00Yes (X)$0$0$0
RICARDO FORBES
DIRECTOR1.00Yes (X)$0$0$0
DR ARMANDO FERRER
DIRECTOR1.00Yes (X)$0$0$0
JEFF TEW JD
DIRECTOR1.00Yes (X)$0$0$0
DR LINDA WASHINGTON
DIRECTOR1.00Yes (X)$3,000$0$0
JIMMY SANTANA
DIRECTOR1.00Yes (X)$0$0$0
JOAQUIN DEL CUETO
DIRECTOR5.00Yes (X)$0$0$0
ROGER M GORDON
OFFICER AND DIRECTOR5.00Yes (X)$0$0$0
ENRIQUE FERNANDEZ
DIRECTOR1.00Yes (X)$0$0$0
VICTOR MILIAN
DIRECTOR1.00Yes (X)$0$0$0
PETER A GUTIERREZ MD
OFFICER AND DIRECTOR40.00$32,692$0$0Yes (X)
JESUS INGUANZO
CHIEF OPERATING OFFICER40.00$101,902$0$0Yes (X)
GISELA BRETONES
CLINIC ADMINISTRATOR40.00$65,068$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$202,662TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Government Grants$125,393GovernmentGrantsAmt
All Other Contributions$135,437AllOtherContributionsAmt
Total Contributions$260,830TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
IN-KIND GIFTS/SERVICES$497,314$497,314
FEES FOR SERVICES$319,193$319,193
FieldValueIRS element (for citing)
Total Program Service Revenue$816,507TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$16TotalRevenueColumnAmt
Related Or Exempt Func Income$16RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RECORDS$127$127
REFUND$5$5
FieldValueIRS element (for citing)
Other Revenue Total$132OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,077,485TotalRevenueColumnAmt
Related Or Exempt Func Income$816,655RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$447,236TotalAmt
Program Services$266,759ProgramServicesAmt
Management And General$150,548ManagementAndGeneralAmt
Fundraising$29,929FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$20,335TotalAmt
Program Services$12,129ProgramServicesAmt
Management And General$6,845ManagementAndGeneralAmt
Fundraising$1,361FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$11,500TotalAmt
Management And General$11,500ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,722TotalAmt
Management And General$3,722ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,105TotalAmt
Program Services$1,851ProgramServicesAmt
Management And General$2,254ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,820TotalAmt
Management And General$1,820ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$155,871TotalAmt
Program Services$27,660ProgramServicesAmt
Management And General$128,211ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$14,406TotalAmt
Management And General$11,037ManagementAndGeneralAmt
Fundraising$3,369FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,640TotalAmt
Management And General$4,640ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$9,644TotalAmt
Program Services$6,397ProgramServicesAmt
Management And General$3,247ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
DONATED PROFESSIONAL FE$296,536$296,536
DONATED MATERIALS & SER$62,478$62,478
HEALTH INSURANCE$19,383$11,561$6,525$1,297
MEDICAL EXPENSES$17,543$17,543

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$42,064TotalAmt
Program Services$28,093ProgramServicesAmt
Management And General$8,290ManagementAndGeneralAmt
Fundraising$5,681FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,111,283TotalAmt
Program Services$731,007ProgramServicesAmt
Management And General$338,639ManagementAndGeneralAmt
Fundraising$41,637FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$186,272BOYAmt
EOY$183,376EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$25,510LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$16,201LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$13,945BOYAmt
EOY$9,309EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$2,584EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$200,217BOYAmt
EOY$195,269EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$9,177BOYAmt
EOY$6,426EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$16,961BOYAmt
EOY$30,225EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$18,337EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,138BOYAmt
EOY$54,988EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$174,079BOYAmt
EOY$140,281EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$174,079BOYAmt
EOY$140,281EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$200,217BOYAmt
EOY$195,269EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$33,798ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

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

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$25,510OtherCostOrOtherBasisAmt
Depreciation$16,201DepreciationAmt
Book Value$9,309BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$9,309TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescACCRUED WAGESDesc
Amt$18,337Amt
FieldValueIRS element (for citing)
Total Liability$18,337TotalLiabilityAmt

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)PROFESSIONAL SERVICES0$296,536ORGANIZATION'S LIST
Yes (X)RENT0$138,300MARKET VALUE OF RENT
Yes (X)IN-KIND GIFTS0$36,680CONTRIBUTORS PROVIDE
Yes (X)MEDICINES0$25,798CONTRIBUTORS PROVIDE
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BFORM 990 IS REVIEWED AND APPROVED BY THE ORGANIZATION TREASURER PRIOR TO FILING.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION WILL PROVIDE INFORMATION TO THE PUBLIC UPON REQUEST

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