2019-05-29T13:04:06-05:00 2018-12-31 541953476 DAVIDSON DOYLE & HILTON LLP PO BOX 800 LYNCHBURG VA 245050800 990 2018-01-01 261275136 FREE CLINIC OF POWHATAN INC FREE 8045985637 3908 OLD BUCKINGHAM ROAD POWHATAN VA 23139 CONNIE MOSLOW EXECUTIVE DIRECTOR 8045985637 2019-05-21 1 AMY A GALLAGHER CPA P00884747 4348467611 23.25.106.77 2019-05-21 14:40:14 ED P 6A70D793A2B1F0F7FA299DDACECF837343D29454 D7E835DFE6EDCBC02F02E9B5372D4030E9B5886E 2018 2019-02-21 02:37:17Z CONNIE MOSLOW 3908 OLD BUCKINGHAM RD POWHATAN VA 23139 531557 0 X www.freeclinicofpowhatan.org X 2007 VA TO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUES 14 13 8 40 0 0 354111 491076 0 0 3378 9390 47549 11081 405038 511547 0 0 0 0 155602 179942 0 0 3648 111825 102830 267427 282772 137611 228775 838571 1055413 10950 4526 827621 1050887 TO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUES 0 0 171655 325 ORGANIZATION FACILITATES THE AVAILABILITY OF MEDICAL AND DENTAL SERVICES TO THE RESIDENTS OF POWHATAN, VIRGINIA THAT DO NOT HAVE THE RESOURCES TO THE SERVICES ELSEWHERE. 171655 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 8 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 0 1 1 0 X CONNIE MOSLOW 8045985637 3908 OLD BUCKINGHAM RD POWHATAN VA 23139 X TINA BUSTOS PRESIDENT 1.00 X X 0 0 0 INDIA COX VICE PRESIDENT 1.00 X X 0 0 0 JAY TURNER III SECRETARY 1.00 X X 0 0 0 TIMOTHY G BENUSA CPA TREASURER 1.00 X X 0 0 0 KARLA CURTIS DIRECTOR 1.00 X 0 0 0 STEVE HARRIS DIRECTOR 1.00 X 0 0 0 SISTER ELENA HENDERSON DIRECTOR 1.00 X 0 0 0 HERMES KONTOS MD DIRECTOR 1.00 X 0 0 0 CONNIE MOSLOW EXECUTIVE DIRECTOR 40.00 X 0 0 0 RONALD SPEARS DIRECTOR 1.00 X 0 0 0 WILL PERKINSON DDS DIRECTOR 1.00 X 0 0 0 ROBB STALLWORTH DIRECTOR 1.00 X 0 0 0 REV BRYAN STEVENS DIRECTOR 1.00 X 0 0 0 DEMETRIUS VENABLE PHD DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 0 50200 25105 415771 491076 9390 9390 30766 50200 20010 10756 10756 OTHER INCOME 900099 325 325 325 511547 325 0 20146 167154 96949 66862 3343 12788 7545 5243 5500 5500 176 167 9 17846 3569 14277 1816 1816 4411 4411 2697 2697 1715 1715 PRESCRIPTIONS 25587 25587 DENTAL SUPPLIES 23051 23051 MISCELLANEOUS 6520 4238 2282 DUES & SUBSCRIPTIONS 5924 5628 296 7587 3608 3979 282772 171655 107469 3648 833659 716218 134788 507 15654 9937 4912 5717 198183 838571 1055413 10950 4526 10950 4526 X 775802 1003804 51819 47083 827621 1050887 838571 1055413 228775 -5509 0 X 0 1 X 1 0 X 259361 342816 380799 425335 325309 1733620 259361 342816 380799 425335 325309 1733620 365994 1367626 325 325 1733945 0.78870 1.00000 X 15654 9937 5717 5717 X 528124 -5509 23675 -1589 16577 511547 0 511547 304858 23675 -1589 22086 282772 0 282772 Part X, Line 2: Accounting principles generally accepted in the United States of America require corporation management to evaluate tax positions taken by the corporation and recognize a tax liability (or asset) if the corporation has taken an uncertain tax position that more likely than not would be sustained upon examination by the Internal Revenue Service. Free Clinic of Powhatan's management has analyzed the tax positions taken by the clinic, and has concluded that as of December 31, 2018, no uncertain positions are taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The clinic is subject to routine audits by taxing jurisdictions; however, there are currently no audits of any tax periods in progress. The clinic believes it is no longer subject to income tax examinations for years prior to 2015. Part XI, Line 2d - Other Adjustments: INVESTMENT EXPENSE -1,589. Part XII, Line 2d - Other Adjustments: INVESTMENT EXPENSE -1,589. X X X X X DINNER 60098 39300 20798 15255 BIKE TOUR 20868 10900 9968 4755 80966 50200 30766 20010 20010 10756 Form 990, Part VI, Section A, line 7a THE EXECUTIVE BOARD NOMINATES DIRECTORS EVERY THREE YEARS. Form 990, Part VI, Section B, line 11b OFFICERS REVIEW ON AN ANNUAL BASIS Form 990, Part VI, Section B, line 12c THE OFFICER'S REVIEW FOR POTENTIAL CONFLICTS CONTINUOUSLY Form 990, Part VI, Section B, line 15 OFFICERS REVIEW ON ANNUAL BASIS Form 990, Part VI, Section C, line 19 AVAILABLE UPON REQUEST