LAFOLLETTE MEDICAL FOUNDATION INC: Form 990PF, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- LAFOLLETTE MEDICAL FOUNDATION INC (EIN 20-4901729)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-09-19
- IRS object ID
- 201812629349100606
- Schema version
- 2017v2.3
- 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
- Investments Corp Bonds Schedule
- Investments Corp Stock Schedule
- Investments Govt Obligations Sch
- Legal Fees Schedule
- Other Assets Schedule
- Other Expenses Schedule
- Other Increases Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-09-19T15:54:24-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 621142155 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUGH & COMPANY PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 315 N CEDAR BLUFF RD SUITE 200 | AddressLine1Txt |
| City | KNOXVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37923 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204901729 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAFOLLETTE MEDICAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAFO | BusinessNameControlTxt |
| Phone | 4239126963 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1Txt |
| City | JACKSBORO | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37757 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR JAMES FARRIS | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 4239126963 | PhoneNum |
| Signature | 2018-08-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KELLY A TUCKER CPA | PreparerPersonNm |
| PTIN | P01015909 | PTIN |
| Phone | 8657690660 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Initial Return Former Pub Chrty | Yes (X) | InitialReturnFormerPubChrtyInd |
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $10,359,951 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $424 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $424 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $206,816 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $206,816 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $19,170 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $2,060,516 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $19,170 | CapGainNetIncmNetInvstIncmAmt |
| Incm Modifications Adj Net Incm | $55,316 | IncmModificationsAdjNetIncmAmt |
| Total Rev And Expnss | $226,410 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $226,410 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $55,316 | TotalAdjNetIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $0 | CompOfcrDirTrstDsbrsChrtblAmt |
| Legal Fees Rev And Expnss | $1,564 | LegalFeesRevAndExpnssAmt |
| Legal Fees Net Invst Incm | $1,173 | LegalFeesNetInvstIncmAmt |
| Legal Fees Dsbrs Chrtbl | $391 | LegalFeesDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $14,585 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $10,939 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $3,646 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $66,868 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $66,868 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $6,946 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $3,926 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $19,012 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $7,500 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $11,512 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $108,975 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $90,406 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $15,549 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $478,422 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $533,738 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $587,397 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $90,406 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $549,287 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$360,987 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $136,004 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $55,316 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $342,415 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $344,121 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $344,121 | SavAndTempCashInvstEOYFMVAmt |
| US Government Obligations BOY | $652,196 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $600,046 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $600,046 | USGovtObligationsEOYFMVAmt |
| Corporate Stock BOY | $8,109,919 | CorporateStockBOYAmt |
| Corporate Stock EOY | $8,746,113 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $8,746,113 | CorporateStockEOYFMVAmt |
| Corporate Bonds BOY | $522,913 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $660,771 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $660,771 | CorporateBondsEOYFMVAmt |
| Other Assets BOY | $7,612 | OtherAssetsBOYAmt |
| Other Assets EOY | $8,900 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $8,900 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $9,635,055 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,359,951 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $10,359,951 | TotalAssetsEOYFMVAmt |
| Grants Payable BOY | $18,000 | GrantsPayableBOYAmt |
| Grants Payable EOY | $15,000 | GrantsPayableEOYAmt |
| Total Liabilities BOY | $18,000 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,000 | TotalLiabilitiesEOYAmt |
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
| Unrestricted BOY | $9,617,055 | UnrestrictedBOYAmt |
| Unrestricted EOY | $10,344,951 | UnrestrictedEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $9,617,055 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $10,344,951 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $9,635,055 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $10,359,951 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $9,617,055 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$360,987 | ExcessRevenueOverExpensesAmt |
| Other Increases | $1,088,883 | OtherIncreasesAmt |
| Subtotal | $10,344,951 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $10,344,951 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|
| PUBLICLY TRADED SECURITIES THROUGH A BROKER | P | $1,256,019 | $1,215,256 | $40,763 | $40,763 |
| PUBLICLY TRADED SECURITIES THROUGH A BROKER | P | $804,497 | $826,090 | -$21,593 | -$21,593 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $19,170 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | 0 | LiableSection4942TaxInd |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $2,720 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $2,720 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $2,720 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $3,020 | EstimatedPlusOvpmtIncmTxAmt |
| Extsn Request Income Tax Paid | $1,700 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $4,720 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $9 | EsPenaltyAmt |
| Overpayment | $1,991 | OverpaymentAmt |
| Applied To ES Tax | $1,991 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | 0 | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | TN | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | WWW.LAFOLLETTEMEDICALFOUNDATION.ORG | WebsiteAddressTxt |
| Individual With Books | JUNE WILBURN | IndividualWithBooksNm |
| Phone | 4239126963 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 RIVERVIEW DRIVE | AddressLine1Txt |
| City | LAFOLLETTE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | 0 | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|
| BRENDA ROBARDS | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | TREASURER | 1.00 | $0 | $0 | $0 |
| MAYOR MIKE STANFIELD | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| LUCY LOBERTINI | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| KATHY MYERS | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | SECRETARY | 1.00 | $0 | $0 | $0 |
| JUDGE SHAYNE SEXTON | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| ELIZABETH ASBURY | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| DR JAMES FARRIS | ||||||||
| PO BOX 128 | JACKSBORO | TN | 37757 | PRESIDENT AND CHAIRMAN | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $9,589,912 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $429,195 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $10,019,107 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $10,019,107 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $150,287 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $9,868,820 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $493,441 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $493,441 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $2,720 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $2,720 | TotalTaxAmt |
| Distributable Before Adj | $490,721 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $55,316 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $546,037 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $546,037 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $549,287 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $549,287 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $0 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $549,287 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $546,037 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $549,287 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $546,037 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $3,250 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $3,250 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $3,250 | ExcessDistriCyovToNextYrAmt |
| Excess From Current Year | $3,250 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | LAFOLLETTE MEDICAL FOUNDATION | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1Txt |
| City | JACKSBORO | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37757 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 4239126963 | RecipientPhoneNum |
| Recipient Email Address | GRANTS@LAFOLLETTEMEDICALFOUNDATION.ORG | RecipientEmailAddressTxt |
| Form And Info And Materials | PLEASE VISIT THE ORGANIZATION'S WEBSITE AT WWW.LAFOLLETTEMEDICALFOUNDATION.ORG TO OBTAIN THE GRANT APPLICATION | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | NONE | SubmissionDeadlinesTxt |
| Restrictions On Awards | IN ORDER TO BE ELIGIBLE FOR A GRANT FROM THE FOUNDATION, AN ORGANIZATION MUST QUALIFY FOR EXEMPTION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND MUST NOT BE A PRIVATE FOUNDATION AS DEFINED BY SECTION 509(A) OF THE CODE, OR IT MUST BE A PUBLIC INSTRUMENTALITY. GRANTS MAY NOT BE MADE TO INDIVIDUALS. THE FOUNDATION MAY MAKE GRANTS TO ORGANIZATIONS PROVIDING SERVICES TO CAMPBELL COUNTY, TN RESIDENTS FOR THE FOLLOWING PURPOSES: HEALTH SERVICES, PREVENTATIVE ILLNESS, CHILDREN HEALTH AND WELL-BEING, SENIOR SAFETY AND WELLNESS AND ANY HEALTH PROGRAM THAT HAS MERIT AND IS RELATED TO THE FOUNDATION'S MISSION AND OBJECTIVES. | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (14 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| FOOD LIFE SERVICES OF CAMPBELL COUNTY | |||||||
| 206 S INDIANA AVENUE | LAFOLLETTE | TN | 37766 | NONE | 501(C)(3) | EXPANDED NUTRITIONAL DISTRIBUTION | $65,000 |
| CAMPBELL COUNTY SENIOR CITIZENS | |||||||
| 102 8TH STREET | LAFOLLETTE | TN | 37766 | NONE | 501(C)(3) | HOME DELIVERED MEALS FOR ELIGIBLE SENIORS | $61,308 |
| CAMPBELL COUNTY CHILDREN'S CENTER | |||||||
| 203 INDEPENDENCE LANE | LAFOLLETTE | TN | 37766 | NONE | 501(C)(3) | HEALTH EDUCATION/PREVENTION PROGRAM | $37,922 |
| COMMUNITY HEALTH OF EAST TENNESSEE | |||||||
| PO BOX 209 507 MAIN STREET | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | DRUG COURT PROGRAM, GENERATION X, PATIENT CARE | $96,000 |
| TN BAPTIST ADULT HOMES | |||||||
| PO BOX 728 | BRENTWOOD | TN | 37024 | NONE | 501(C)(3) | RAINBOW ACRES, JACKSBORO RESIDENT HARDSHIP & WELLNESS | $20,500 |
| CASA OF CAMPBELL COUNTY | |||||||
| PO BOX 1054 | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | VOLUNTEER OUTREACH SERVICES | $15,000 |
| CATHOLIC CHARITIES OF EAST TENNESSEE | |||||||
| 3009 LAKE BROOK BLVD | KNOXVILLE | TN | 37909 | NONE | 501(C)(3) | PREGNANCY HELP CENTER | $15,000 |
| CAMPBELL COUNTY BOARD OF EDUCATION | |||||||
| 172 VALLEY STREET | JACKSBORO | TN | 37757 | NONE | GOVERNMENT AGENCY | INFLUENZA VACCINATION PROGRAM, JELLICO HIGH SCHOOL ATHLETIC PERSONAL TRAINER | $42,000 |
| EAST TENNESSEE HUMAN RESOURCES AGENCY | |||||||
| 9111 CROSS PARK DR STE D10 | KNOXVILLE | TN | 37766 | NONE | 501(C)(3) | SENIOR SAFETY AND WELLNESS SUPPORT | $22,000 |
| CITY OF LAFOLLETTE FIRE DEPARTMENT | |||||||
| 105 E BEECH STREET | LAFOLLETTE | TN | 37766 | NONE | GOVERNMENT AGENCY | FIRE PROTECTION FOR THE CITY OF LAFOLLETTE | $26,270 |
| CAMPBELL COUNTY RURAL FIRE SERVICE | |||||||
| 4422 VICTORY ROAD | LAFOLLETTE | TN | 37766 | NONE | GOVERNMENT AGENCY | FIRE PROTECTION FOR CAMPBELL COUNTY | $22,388 |
| THE SHEPHERDS HOME | |||||||
| 2221 JACKSBORO PIKE | LAFOLLETTE | TN | 37766 | NONE | 501(C)(3) | ADDICTION RECOVERY | $39,350 |
| SPRINGS OF LIFE RECOVERY CENTER | |||||||
| PO BOX 893 | JELLICO | TN | 37762 | NONE | 501(C)(3) | RECOVERY CENTER FOR MEN | $21,000 |
| A NEW BEGINNING INC | |||||||
| 180 MT PARAN ROAD | JACKSBORO | TN | 37757 | NONE | 501(C)(3) | JAIL TO JOB TRAINING PROGRAM | $50,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $533,738 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $424 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $206,816 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $19,170 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $226,410 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $226,410 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $14,585 | Amt |
| Net Investment Income | $10,939 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $3,646 | DisbursementsCharitablePrpsAmt |
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond | UBS - CORPORATE BONDS (ADDITIONAL DETAIL AVAILABLE UPON REQUEST) | BondNm |
| EOY Book Value | $660,771 | EOYBookValueAmt |
| EOYFMV | $660,771 | EOYFMVAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Stock | UBS - EQUITIES (ADDITIONAL DETAIL AVAILABLE UPON REQUEST) | StockNm |
| EOY Book Value | $8,746,113 | EOYBookValueAmt |
| EOYFMV | $8,746,113 | EOYFMVAmt |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $600,046 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $600,046 | USGovtObligationsEOYFMVAmt |
| State Local Sec Book Vl EOY | $0 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $0 | StateLocalSecEOYFMVAmt |
Legal Fees Schedule LegalFeesSchedule
Legal Fees LegalFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | LEGAL FEES | CategoryTxt |
| Legal Fees | $1,564 | LegalFeesAmt |
| Net Investment Income | $1,173 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $391 | DisbursementsCharitablePrpsAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED INTEREST RECEIVABLE | Desc |
| BOY Book Value | $7,612 | BOYBookValueAmt |
| EOY Book Value | $8,900 | EOYBookValueAmt |
| EOYFMV | $8,900 | EOYFMVAmt |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (3 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| INSURANCE | $1,959 | $0 | $1,959 |
| OFFICE EXPENSES | $2,053 | $0 | $2,053 |
| CONTRACT LABOR | $15,000 | $7,500 | $7,500 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | UNREALIZED GAIN | Desc |
| Amt | $1,088,883 | Amt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | UBS FEES | CategoryTxt |
| Amt | $66,868 | Amt |
| Net Investment Income | $66,868 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| FEDERAL EXCISE TAX | $3,020 | $0 | $0 |
| FOREIGN TAX WITHHOLDING | $3,926 | $3,926 | $0 |
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