PHYSICIANS MEDICAL FORUM: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PHYSICIANS MEDICAL FORUM (EIN 30-0086728)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2017-11-15
- IRS object ID
- 201713209349300706
- Schema version
- 2016v3.0
- 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 | 2017-11-15T20:41:59-08:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grigsby Finance and Tax Services | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8050 Hansom Drive | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94605 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300086728 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Physicians Medical Forum | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PHYS | BusinessNameControlTxt |
| Phone | 5105625560 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6114 LaSalle Ave | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94611 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WARREN STRUDWICK MD | PersonNm |
| Person Title | BOARD OFFICER | PersonTitleTxt |
| Phone | 5105625560 | PhoneNum |
| Signature | 2017-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MITTIE GRIGSBY | PreparerPersonNm |
| Phone | 5106384878 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.91.28.40 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-15 | IPDt |
| IP Tm | 20:41:36 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | E4A8D100C216F022B8EBAAA751A3291AFCDF126A | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | E4A8D100C216F022B8EBAAA751A3291AFCDF126A | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | STALFANA BELLO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6114 La Salle | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94611 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $233,176 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | Encourage the recruitment and retention of African American physicians, and thereby help to eliminate health disparities, improve access to care and improve the quality of life and medical care for citizens in the Northern CA Bay Area | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 1 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $273,600 | PYContributionsGrantsAmt |
| CY Contributions Grants | $233,176 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $273,600 | PYTotalRevenueAmt |
| CY Total Revenue | $233,176 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $66,925 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $85,560 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $208,921 | PYOtherExpensesAmt |
| CY Other Expenses | $163,364 | CYOtherExpensesAmt |
| PY Total Expenses | $275,846 | PYTotalExpensesAmt |
| CY Total Expenses | $248,924 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,246 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$15,748 | CYRevenuesLessExpensesAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Encourage the recruitment and | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $58,241 | ExpenseAmt |
| Desc | THE PMF "DOCTOR ON BOARD" PROGRAM (DOB)AND COMMUNITY HEALTH AMBASSADOR INTERNSHIP (CHA) ARE PIPELINE PROGRAMS TO ENCOURAGE YOUNG, AFRICAN AMERICAN PRE-MED, COLLEGE/UNIVERSITY, COMMUNITY COLLEGE, POST-BACCALAUREATE STUDENTS AND HIGH SCHOOL JUNIORS AND SENIORS WHO WANT TO BECOME PHYSICIANS TO ATTEND AN INNOVATIVE ALL DAY CONFERENCE. STUDENTS RECEIVE INFORMATION ON APPLYING FOR MEDICAL SCHOOLS, MCAT, FINANCIAL AID, NETWORK WITH FACULTY, MEDICAL SCHOOL ADMINISTRATORS, PHYSICIANS IN THE COMMUNITY, ATTEND MOCK MEDICAL CLINICS AND MOCK KNOT TYING/SUTURING CLINICS, AND RECEIVE MATERIAL ON BECOMING PHYSICIANS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $20,544 | ExpenseAmt |
| Desc | RECRUITMENT OF AFRICAN AMERICAN RESIDENTS AND MEDICAL STUDENTS THAT UPON THEIR COMPLETION OF THEIR ENDUCATION AND TRAINING, TO PURSE CAREERS AS PHYSICIANS AND REMAIN IN OR COME TO ALAMEDA, CONTRA COSTA OR SAN FRANCISCO COUNTIES AND NORTHERN CA BAY AREA TO PRACTICE MEDICINE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,611 | ExpenseAmt |
| Desc | TO MAINTAIN STRATEGIC OPERATONS, OUTREACH, EDUCATION AND FUND DEVELOPMENT TO SUPPORT THE ORGANIZATIONS' VISION, MISSION, GOALS AND OBJECTIVES OF AFRICAN AMERICANS PHYSICIANS, RESIDENTS, MEDICAL STUDENTS AND PIPELINE PROGRAMS PURSING CAREERS AS PHYSICIANS IN ALAMEDA, CONTRA COSTA AND SAN FRANCISCO COUNTIES AND NORTHERN CA BAY AREA | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (3 entries)
| ExpenseExpenseAmt | GrantGrantAmt | DescDesc |
|---|---|---|
| $131,279 | $195,000 | 1. Increased the outreach, education, scholarships and mentoring of African American/Black and and mentoring of African American/Black and and mentoring of African American/Black and and mentoring of African American/Black and and mentoring of African American/Black and and mentoring of African American/Black and |
| 3. PARTNERING WITH PRINCETON REVIEW'S WESTERN REGION 3. PARTNERING WITH PRINCETON REVIEW'S WESTERN REGION 3. PARTNERING WITH PRINCETON REVIEW'S WESTERN REGION 3. PARTNERING WITH PRINCETON REVIEW'S WESTERN REGION 3. PARTNERING WITH PRINCETON REVIEW'S WESTERN REGION 3. PARTNERING WITH PRINCETON REVIEW'S WESTERN REGION | ||
| EXPANDED OPPORTUNITIES SCHOLARSHIPS AND INTERNSHIPS EXPANDED OPPORTUNITIES SCHOLARSHIPS AND INTERNSHIPS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $131,279 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $195,000 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $218,675 | 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 | false | 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 | false | 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 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 |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | 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 | Yes (true) | 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 | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STALFANO BELLO BROADHEAD | PersonNm |
| Phone | 5105625560 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6114 LaSalle Ave 601 | AddressLine1Txt |
| City | Oakland | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94611 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| STALFANA BELLO BROADHEAD | |||||||
| Executive Director | 37.50 | Yes (X) | $64,000 | $0 | $0 | ||
| ALBERT L BROOKS MD | |||||||
| President | 15.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| WARREN J STRUDWICK MD | |||||||
| Chief financial Officer | 8.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MICHELLE SHUTE MD | |||||||
| Secretary | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| CAROL MILLER MD | |||||||
| Director | 6.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| THURMAN HUNT MD | |||||||
| Director | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| KATHRYN MALONE MD | |||||||
| Director | 8.00 | $0 | $0 | $0 | Yes (X) | ||
| RENEE NAVARRO MD | |||||||
| RENEE NAVARRO MD | |||||||
| Director | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $64,000 | TotalReportableCompFromOrgAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $233,176 | AllOtherContributionsAmt |
| Total Contributions | $233,176 | TotalContributionsAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $233,176 | TotalRevenueColumnAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,000 | TotalAmt |
| Program Services | $57,600 | ProgramServicesAmt |
| Management And General | $6,400 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,635 | TotalAmt |
| Program Services | $5,329 | ProgramServicesAmt |
| Management And General | $3,306 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,925 | TotalAmt |
| Program Services | $11,632 | ProgramServicesAmt |
| Management And General | $1,293 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,815 | TotalAmt |
| Program Services | $19,815 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,600 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $3,600 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,829 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $3,829 | 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 | $35,526 | TotalAmt |
| Program Services | $31,973 | ProgramServicesAmt |
| Management And General | $3,553 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,357 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $2,357 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,786 | TotalAmt |
| Program Services | $78,786 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Bank charges | $1,293 | $0 | $1,293 | $0 |
| Other | $14,158 | $9,540 | $4,618 | $0 |
| scholarships | $4,000 | $4,000 | $0 | $0 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,924 | TotalAmt |
| Program Services | $218,675 | ProgramServicesAmt |
| Management And General | $30,249 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$15,748 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| 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 Minus4 Years | $275,500 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $480,450 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $512,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $463,600 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $195,000 | CurrentTaxYearAmt |
| Total | $1,927,050 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $275,500 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $480,450 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $512,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $463,600 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $195,000 | CurrentTaxYearAmt |
| Total | $1,927,050 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $1,927,050 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $6,292 | CurrentTaxYearMinus2YearsAmt |
| Total | $6,292 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $6,292 | CurrentTaxYearMinus2YearsAmt |
| Total | $6,292 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,933,342 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99670 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99700 | PublicSupportPY509Pct |
| Investment Income CY | 0.00330 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00300 | 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 M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 7a | Acct prepares return; reviewed by E, Pres & CFO |
| Pt VI, Line 12c | Annual reviews are completed with legal review |
| Pt VI, Line 15a | business attorney recommendation based on non-profit model |
| Pt VI, Line 19 | Interest parties contact org; appt is set for review |
| Pt XI | Net change in investment income |
| Pt VI, Line 15b | Review performed by board members |
| Pt V, Line 3b | Organization does not have this type of income |
| Pt V, Line 14b | organization does not have this type of service |
| Pt VI, Line 11b | Organization did not have this type of income |
| Form 990, Part III, Line 4d | 1. Increased the outreach, education, scholarships 131279. 195000. 0. |
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