FREE CLINIC OF POWHATAN: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- FREE CLINIC OF POWHATAN (EIN 26-1275136)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-05-18
- IRS object ID
- 201841389349300524
- 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 | 2018-05-18T12:16:01-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 541953476 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVIDSON DOYLE & HILTON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 800 | AddressLine1Txt |
| City | LYNCHBURG | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 245050800 | 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 | 261275136 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREE CLINIC OF POWHATAN | BusinessNameLine1Txt |
| Business Name Line2 | FREE CLINIC OF POWHATAN INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 8045985637 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3908 OLD BUCKINGHAM ROAD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CONNIE MOSLOW | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 8045985637 | PhoneNum |
| Signature | 2018-05-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVIDSON DOYLE HILTON LLP | PreparerPersonNm |
| PTIN | P00884747 | PTIN |
| Phone | 4348467611 | PhoneNum |
| 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 | CONNIE MOSLOW | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3908 OLD BUCKINGHAM RD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $422,927 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.freeclinicofpowhatan.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUES | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 8 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $380,799 | PYContributionsGrantsAmt |
| CY Contributions Grants | $354,111 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,480 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,378 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $47,549 | CYOtherRevenueAmt |
| PY Total Revenue | $382,279 | PYTotalRevenueAmt |
| CY Total Revenue | $405,038 | 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 | $144,474 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $155,602 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $3,508 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $126,068 | PYOtherExpensesAmt |
| CY Other Expenses | $111,825 | CYOtherExpensesAmt |
| PY Total Expenses | $270,542 | PYTotalExpensesAmt |
| CY Total Expenses | $267,427 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $111,737 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $137,611 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $694,211 | TotalAssetsBOYAmt |
| Total Assets EOY | $838,571 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,950 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $694,211 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $827,621 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUES | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $166,613 | ExpenseAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $166,613 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 8 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONNIE MOSLOW | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8045985637 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3908 OLD BUCKINGHAM RD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| TINA BUSTOS | ||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| INDIA COX | ||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JAY TURNER III | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| LARRY LYONS | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TIMOTHY G BENUSA CPA | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN CARMACK | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KARLA CURTIS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| REBECCA GWILT | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| STEVE HARRIS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SISTER ELENA HENDERSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LINDA DALCH JONES | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| HERMES KONTOS MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CONNIE MOSLOW | ||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $0 | $0 | $0 | |
| RONALD SPEARS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BETSY WILTON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $34,220 | GovernmentGrantsAmt |
| All Other Contributions | $319,891 | AllOtherContributionsAmt |
| Total Contributions | $354,111 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,378 | TotalRevenueColumnAmt |
| Exclusion | $3,378 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $65,438 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $17,889 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,549 | TotalRevenueColumnAmt |
| Exclusion | $47,549 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $405,038 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $50,927 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,548 | TotalAmt |
| Program Services | $83,838 | ProgramServicesAmt |
| Management And General | $57,819 | ManagementAndGeneralAmt |
| Fundraising | $2,891 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,054 | TotalAmt |
| Program Services | $6,522 | ProgramServicesAmt |
| Management And General | $4,532 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,022 | TotalAmt |
| Management And General | $8,022 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,989 | TotalAmt |
| Management And General | $5,690 | ManagementAndGeneralAmt |
| Fundraising | $299 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,250 | TotalAmt |
| Program Services | $1,650 | ProgramServicesAmt |
| Management And General | $6,600 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,324 | TotalAmt |
| Management And General | $1,324 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,963 | TotalAmt |
| Program Services | $1,963 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,210 | TotalAmt |
| Management And General | $2,210 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DENTAL SUPPLIES | $32,089 | $32,089 | |
| PRESCRIPTIONS | $23,199 | $23,199 | |
| MEDICAL SUPPLIES | $10,502 | $10,502 | |
| MISCELLANEOUS | $6,476 | $4,209 | $2,267 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,801 | TotalAmt |
| Program Services | $2,641 | ProgramServicesAmt |
| Management And General | $8,842 | ManagementAndGeneralAmt |
| Fundraising | $318 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $267,427 | TotalAmt |
| Program Services | $166,613 | ProgramServicesAmt |
| Management And General | $97,306 | ManagementAndGeneralAmt |
| Fundraising | $3,508 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $691,333 | BOYAmt |
| EOY | $833,659 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,152 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,240 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,878 | BOYAmt |
| EOY | $4,912 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $694,211 | BOYAmt |
| EOY | $838,571 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $10,950 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $10,950 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $489,512 | BOYAmt |
| EOY | $775,802 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $204,699 | BOYAmt |
| EOY | $51,819 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $694,211 | BOYAmt |
| EOY | $827,621 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $694,211 | BOYAmt |
| EOY | $838,571 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $137,611 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$4,201 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $279,265 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $259,361 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $342,816 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $380,799 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $425,335 | CurrentTaxYearAmt |
| Total | $1,687,576 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $279,265 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $259,361 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $342,816 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $380,799 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $425,335 | CurrentTaxYearAmt |
| Total | $1,687,576 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,687,576 | PublicSupportTotal170Amt |
| Total Support | $1,687,576 | TotalSupportAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,152 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,240 | DepreciationAmt |
| Book Value | $4,912 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,912 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $428,713 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $23,675 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $23,675 | RevenueNotReportedAmt |
| Revenue Subtotal | $405,038 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $405,038 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $291,102 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $23,675 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $23,675 | ExpensesNotReportedAmt |
| Expenses Subtotal | $267,427 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $267,427 | TotalExpensesPerForm990Amt |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | Yes (X) | MailSolicitationsInd |
| In Person Solicitations | Yes (X) | InPersonSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Special Fundraising Events | Yes (X) | SpecialFundraisingEventsInd |
| Agrmt Prof Fundraising Acty | 0 | AgrmtProfFundraisingActyInd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | DINNER | Event1Nm |
| Gross Receipts Event1 | $45,807 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $45,807 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $12,522 | OtherDirectExpensesEvent1Amt |
| Event2 | BIKE TOUR | Event2Nm |
| Gross Receipts Event2 | $19,631 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $19,631 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $5,367 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $65,438 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $65,438 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $17,889 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $17,889 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $47,549 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 |
| Form 990, Part XII, Line 2c: | OFFICERS REVIEW ON AN ANNUAL BASIS |
Comments