COLUMBIA COUNTY VOLUNTEERS INMEDICINE INC: Form 990, tax year 2019
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- Organization
- COLUMBIA COUNTY VOLUNTEERS INMEDICINE INC (EIN 20-5695518)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-16
- IRS object ID
- 202043219349310734
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-16T11:06:10-08:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HMS LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1426 Wyoming Ave | AddressLine1Txt |
| City | Kingston | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18704 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205695518 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLUMBIA COUNTY VOLUNTEERS IN MEDICINE CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COLU | BusinessNameControlTxt |
| Phone | 5707521780 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 310 E THIRD ST PO BOX 416 | AddressLine1Txt |
| City | MIFFLINVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18631 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CINDY RUPP | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5707521780 | PhoneNum |
| Signature | 2020-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARILYN A DEROLF | PreparerPersonNm |
| PTIN | P01484474 | PTIN |
| Phone | 5707145272 | PhoneNum |
| Preparation | 2020-11-16 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 173.163.145.149 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-11-16 | IPDt |
| IP Tm | 11:06:01 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | A4BE2797301789388011EABFF2B877132FC4D933 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A4BE2797301789388011EABFF2B877132FC4D933 | 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 | CINDY RUPP | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 310 E THIRD ST | AddressLine1Txt |
| City | MIFFLINVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18631 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $296,265 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW/CCVIM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE MEDICAL CARE TO THE WORKING UNINSURED OF THE ORGANIZATION'S SERVICE AREA BY OPERATING A VOLUNTEER CLINIC. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 7 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $470,959 | PYContributionsGrantsAmt |
| CY Contributions Grants | $281,053 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,814 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $437 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,287 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,775 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $485,060 | PYTotalRevenueAmt |
| CY Total Revenue | $296,265 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $115,946 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $124,573 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $503 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $32,161 | PYOtherExpensesAmt |
| CY Other Expenses | $33,239 | CYOtherExpensesAmt |
| PY Total Expenses | $148,107 | PYTotalExpensesAmt |
| CY Total Expenses | $157,812 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $336,953 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $138,453 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $515,621 | TotalAssetsBOYAmt |
| Total Assets EOY | $676,279 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,402 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,454 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $511,219 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $672,825 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE MEDICAL CARE TO THE WORKING UNINSURED OF THE ORGANIZATION'S SERVICE AREA BY OPERATING A VOLUNTEER CLINIC. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $125,597 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $324,071 | RevenueAmt |
| Desc | BY OPERATING A FREE MEDICAL CLINIC, THE CLINIC WAS ABLE TO PROVIDE THE AREA'S UNINSURED RESIDENTS WITH MEDICAL CARE FOR THE YEAR. THERE WERE OVER 1,500 PATIENT VISITS AND MANY WERE PROVIDED ADDITIONAL SERVICES SUCH AS SUPPORT FOR ONGOING DIRECTION TO OBTAIN MEDICINE, FOOD AND ASSISTANCE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | 1 | ActivityCd |
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | BY OPERATING A FREE MEDICAL CLINIC THE CLINIC PROVIDES UNINSURED RESIDENTS OF THE AREA WITH MEDICAL CARE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $0 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $125,597 | 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 | Yes (true) | 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 | false | 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 7 | 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 |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | false | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR BIPIN CHOPRA | PersonNm |
| Phone | 5707521780 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 310 E THIRD | AddressLine1Txt |
| City | MIFFLINVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18631 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| BIPIN CHOPRA | |||||||
| DIRECTOR | 40.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CINDY RUPP | |||||||
| PRESIDENT | 5.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KATHY NIHOFF | |||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |||
| CINDY LOMBARD | |||||||
| TREASURER | 3.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BECKY AARDWEG | |||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DR JAMES GALLAGHER | |||||||
| MEDICAL DIRECTOR | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DAVID KINGSBOROUGH | |||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |||
| CAITLYN EROH | |||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |||
| MARK GOLOMB | |||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $16,799 | FundraisingAmt |
| All Other Contributions | $264,254 | AllOtherContributionsAmt |
| Total Contributions | $281,053 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| MEDICAL RECORD | 621111 | $85 | $0 | $0 |
| OTHER MEDICAL REVENUE | 621111 | $352 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $437 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,916 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,859 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $6,859 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,859 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,859 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $16,799 | ContriRptFundraisingEventAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $296,265 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,212 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,469 | TotalAmt |
| Program Services | $24,174 | ProgramServicesAmt |
| Management And General | $13,295 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,499 | TotalAmt |
| Program Services | $74,399 | ProgramServicesAmt |
| Management And General | $4,100 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,605 | TotalAmt |
| Program Services | $7,314 | ProgramServicesAmt |
| Management And General | $1,291 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,529 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $4,529 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,367 | TotalAmt |
| Program Services | $3,367 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $689 | TotalAmt |
| Program Services | $689 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $218 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,219 | TotalAmt |
| Program Services | $6,219 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,327 | TotalAmt |
| Program Services | $4,327 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,657 | TotalAmt |
| Program Services | $3,390 | ProgramServicesAmt |
| Management And General | $1,267 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $770 | $770 | $0 | $0 |
| PERMITS | $300 | $300 | $0 | $0 |
| BANK FEES | $120 | $0 | $120 | $0 |
| POSTAGE | $648 | $648 | $0 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,395 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $6,892 | ManagementAndGeneralAmt |
| Fundraising | $503 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,812 | TotalAmt |
| Program Services | $125,597 | ProgramServicesAmt |
| Management And General | $31,712 | ManagementAndGeneralAmt |
| Fundraising | $503 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,843 | BOYAmt |
| EOY | $25,439 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $269,011 | BOYAmt |
| EOY | $56,896 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $188,172 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $55,273 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,737 | BOYAmt |
| EOY | $132,899 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,030 | BOYAmt |
| EOY | $461,045 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $515,621 | BOYAmt |
| EOY | $676,279 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,402 | BOYAmt |
| EOY | $3,454 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,402 | BOYAmt |
| EOY | $3,454 | 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 | $511,219 | BOYAmt |
| EOY | $563,247 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $109,578 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $511,219 | BOYAmt |
| EOY | $672,825 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $515,621 | BOYAmt |
| EOY | $676,279 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $138,453 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $23,172 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$19 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Other | Yes (X) | MethodOfAccountingOtherInd |
| 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 |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support CY170 | 0 | PublicSupportCY170Pct |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $132,034 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $239,076 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $143,983 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $470,959 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $301,139 | CurrentTaxYearAmt |
| Total | $1,287,191 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $450 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,449 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $435 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,254 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $437 | CurrentTaxYearAmt |
| Total | $12,025 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $5,570 | CurrentTaxYearMinus3YearsAmt |
| Total | $5,570 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $132,484 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $246,095 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $144,418 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $480,213 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $301,576 | CurrentTaxYearAmt |
| Total | $1,304,786 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $1,304,786 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $337 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus1 Year | $3,440 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,916 | CurrentTaxYearAmt |
| Total | $11,693 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $337 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus1 Year | $3,440 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,916 | CurrentTaxYearAmt |
| Total | $11,693 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,316,479 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99110 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99940 | PublicSupportPY509Pct |
| Investment Income CY | 0.00890 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00840 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Org Leg Ctrl | Yes (true) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (true) | DisclosedForCharitablePrpsInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $39,250 | OtherCostOrOtherBasisAmt |
| Book Value | $39,250 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $124,843 | OtherCostOrOtherBasisAmt |
| Depreciation | $37,894 | DepreciationAmt |
| Book Value | $86,949 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,590 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,590 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,489 | OtherCostOrOtherBasisAmt |
| Depreciation | $789 | DepreciationAmt |
| Book Value | $6,700 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $132,899 | TotalBookValueLandBuildingsAmt |
Closely Held Equity Interests CloselyHeldEquityInterestsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $115,120 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ENDOWMENT | Desc |
| Book Value | $345,925 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $461,045 | TotalBookValueSecuritiesAmt |
| Total Rev Etc Audited Fincl Stmt | $316,071 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $23,172 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $23,172 | RevenueNotReportedAmt |
| Revenue Subtotal | $292,899 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $3,366 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $3,366 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $296,265 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $122,230 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $122,230 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $3,367 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $3,367 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $125,597 | TotalExpensesPerForm990Amt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 11b | THE ORGANIZATION'S PROCESS TO REVIEW THE 990 IS TO REVIEW THE DRAFT FINANCIAL STATEMENTS AND THE DRAFT 990, APPROVE AT A MEETING BY THE BOARD |
| Pt VI, Line 15a | COMPENSATION IS SUBJECT TO BOARD APPROVAL AND REVIEW |
| Pt VI, Line 15b | THE BOARD DOES NOT RECEIVE PAY |
| Pt VI, Line 19 | GOVERNING DOCUMENTS DISCLOSE EXPLANATION UPON REQUEST |
| Pt VI, Line 8a | SEE BOARD DOCUMENTS FOR MINUTES |
| Pt VI, Line 8b | SEE BOARD DOCUMENTS FOR MINUTES |
| Pt XII, Line 1 | OTHER ADJUSTMENT |
| Form 990, Part III, Line 4d | 1 BY OPERATING A FREE MEDICAL CLINIC THE CLINIC PROVIDES UNINSURED 0. 0. 0. |
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