FREE CLINIC OF ROME INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- FREE CLINIC OF ROME INC (EIN 20-5296305)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-17
- IRS object ID
- 201812909349300726
- Schema version
- 2017v2.2
- 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 | 2018-10-17T10:57:09-07:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RL JENNINGS AND ASSOCIATES PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 E 3rd St | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30161 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205296305 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Faith and Deeds Community Health Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAIT | BusinessNameControlTxt |
| Phone | 7062341331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101-B John Maddox Drive | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RENEE BLACKBURN | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 7062341331 | PhoneNum |
| Signature | 2018-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RICHARD L JENNINGS | PreparerPersonNm |
| PTIN | P00118987 | PTIN |
| Phone | 7068021945 | PhoneNum |
| Preparation | 2018-10-17 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RENEE BLACKBURN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101-B John Maddox Dr | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $152,775 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.faithanddeedshealthcare.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | TO SERVE THE ROME COMMUNITY BY PROVIDING QUALITY HEALTHCARE SERVICES TO PEOPLE WHO HAVE NO ACCESS TO BASIC HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 3 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $811,584 | PYContributionsGrantsAmt |
| CY Contributions Grants | $125,784 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,395 | PYInvestmentIncomeAmt |
| CY Investment Income | $934 | CYInvestmentIncomeAmt |
| CY Other Revenue | $26,057 | CYOtherRevenueAmt |
| PY Total Revenue | $817,979 | PYTotalRevenueAmt |
| CY Total Revenue | $152,775 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $206,064 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $209,824 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $8,049 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $570,696 | PYOtherExpensesAmt |
| CY Other Expenses | $763,893 | CYOtherExpensesAmt |
| PY Total Expenses | $776,760 | PYTotalExpensesAmt |
| CY Total Expenses | $973,717 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $41,219 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$820,942 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $43,510 | TotalAssetsBOYAmt |
| Total Assets EOY | $67,214 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,404 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,108 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,106 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $66,106 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To serve the Rome community by | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $930,810 | ExpenseAmt |
| Desc | TO PROVIDE FREE QUALITY HEALTHCARE AND TREATMENT TO INDIVIDUALS. | Desc |
| Total Program Service Expenses | $930,810 | 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 |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | 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 | Yes (true) | 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 With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | 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 |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 3 | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RENEE BLACKBURN | PersonNm |
| Phone | 7062341331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101-B John Maddox Dr | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| JENNIFER R BLACKBURN | |||||||
| Executive Director | 40.00 | Yes (X) | $33,380 | $0 | $0 | ||
| DR LEONARD D REEVES | |||||||
| President | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| JOHN PILLSBURY | |||||||
| Past President | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| LARRY ALFORD | |||||||
| Vice President | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DR CLAIRE HARPER | |||||||
| Secretary | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| TONI RHINEHART | |||||||
| Treasurer | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| JJ SEIFERT | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| CHRIS CAREY | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| VONETTA JORDAN | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| PJ LYNN | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| PENNE BALDWIN | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| RICK CHILDS | |||||||
| FMC Representative | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| JOE GLEASON | |||||||
| RRMC Representative | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $33,380 | TotalReportableCompFromOrgAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $14,978 | FundraisingAmt |
| All Other Contributions | $110,806 | AllOtherContributionsAmt |
| Total Contributions | $125,784 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $934 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $14,978 | ContriRptFundraisingEventAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,057 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,057 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $26,057 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $152,775 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,991 | RelatedOrExemptFuncIncomeAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,597 | TotalAmt |
| Program Services | $43,597 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,892 | TotalAmt |
| Program Services | $162,892 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,335 | TotalAmt |
| Program Services | $3,335 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,860 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $7,860 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,049 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $8,049 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,278 | TotalAmt |
| Program Services | $123 | ProgramServicesAmt |
| Management And General | $2,155 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,039 | TotalAmt |
| Program Services | $5,435 | ProgramServicesAmt |
| Management And General | $18,604 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $979 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $979 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $526 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $526 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,316 | TotalAmt |
| Program Services | $658 | ProgramServicesAmt |
| Management And General | $658 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Dues | $1,279 | $0 | $1,279 | $0 |
| Equipment Rental | $1,774 | $1,774 | $0 | $0 |
| Laboratory Services | $336,000 | $336,000 | $0 | $0 |
| Maintenance | $90 | $0 | $90 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $379,703 | TotalAmt |
| Program Services | $376,996 | ProgramServicesAmt |
| Management And General | $2,707 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $973,717 | TotalAmt |
| Program Services | $930,810 | ProgramServicesAmt |
| Management And General | $34,858 | ManagementAndGeneralAmt |
| Fundraising | $8,049 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,441 | BOYAmt |
| EOY | $52,337 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,079 | BOYAmt |
| EOY | $1,530 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,830 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,408 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,948 | BOYAmt |
| EOY | $1,422 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,042 | BOYAmt |
| EOY | $11,925 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,510 | BOYAmt |
| EOY | $67,214 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,404 | BOYAmt |
| EOY | $1,108 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,404 | BOYAmt |
| EOY | $1,108 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,106 | BOYAmt |
| EOY | $45,794 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $20,312 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,106 | BOYAmt |
| EOY | $66,106 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,510 | BOYAmt |
| EOY | $67,214 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$820,942 | ReconcilationRevenueExpnssAmt |
| Donated Services And Use Fclts | $870,942 | DonatedServicesAndUseFcltsAmt |
| 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 |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
| Public Support Total170 | $0 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY170 | 0 | PublicSupportCY170Pct |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $184,572 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $159,316 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $138,675 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $125,784 | CurrentTaxYearAmt |
| Total | $608,347 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $184,572 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $159,316 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $138,675 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $125,784 | CurrentTaxYearAmt |
| Total | $608,347 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $608,347 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $59 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,395 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $934 | CurrentTaxYearAmt |
| Total | $7,392 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $59 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,395 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $934 | CurrentTaxYearAmt |
| Total | $7,392 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $615,739 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98800 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98680 | PublicSupportPY509Pct |
| Investment Income CY | 0.01200 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01320 | 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
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,830 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,408 | DepreciationAmt |
| Book Value | $1,422 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,422 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $1,023,717 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $870,942 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $870,942 | RevenueNotReportedAmt |
| Revenue Subtotal | $152,775 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $152,775 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $973,717 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $973,717 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $973,717 | TotalExpensesPerForm990Amt |
Schedule G IRS990ScheduleG
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 11b | A copy of the 990 is given to all board members for review. |
| Pt VI, Line 12c | All policies are reviewed by board members on scheduled basis. |
| Pt VI, Line 15b | Officer salary is reviewed based on current standards. |
| Pt VI, Line 15a | Salary is reviewed based on current standards. |
| Form 990, Part IX, Line 24e | Medical Services 360000. 360000. 0. 0. |
| Form 990, Part IX, Line 24e | Medical Supplies 4843. 4843. 0. 0. |
| Form 990, Part IX, Line 24e | Medication 4884. 4884. 0. 0. |
| Form 990, Part IX, Line 24e | Misc 358. 0. 358. 0. |
| Form 990, Part IX, Line 24e | Postage 196. 0. 196. 0. |
| Form 990, Part IX, Line 24e | Security 2607. 2349. 258. 0. |
| Form 990, Part IX, Line 24e | Supplies 1269. 0. 1269. 0. |
| Form 990, Part IX, Line 24e | Telephone 3088. 2779. 309. 0. |
| Form 990, Part IX, Line 24e | Computer 90. 0. 90. 0. |
| Form 990, Part IX, Line 24e | Grant expese 2141. 2141. 0. 0. |
| Form 990, Part IX, Line 24e | Printing and copying 227. 0. 227. 0. |