COLUMBUS-LOWDES FREE MEDICAL CLINIC INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- COLUMBUS-LOWDES FREE MEDICAL CLINIC INC (EIN 64-0926626)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201743189349310574
- 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 | 2017-11-14T16:20:51-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 640575804 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | T E LOTT & COMPANY PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 471 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 397030471 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 640926626 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLUMBUS-LOWNDES FREE MEDICAL CLINIC INC | BusinessNameLine1Txt |
| Business Name Line2 | c/o T E LOTT JR | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COLU | BusinessNameControlTxt |
| Phone | 6623285387 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 471 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 397030471 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALAN T WILLIAMS | PersonNm |
| Person Title | CHAIRMAN OF THE BOARD | PersonTitleTxt |
| Phone | 6623285387 | PhoneNum |
| Signature | 2017-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TE LOTT JR CPA | PreparerPersonNm |
| PTIN | P00293180 | PTIN |
| Phone | 6623285387 | PhoneNum |
| Preparation | 2017-11-10 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 50.86.22.2 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-10 | IPDt |
| IP Tm | 08:29:39 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 5485BF4CBAEA1CCED36E9B3C9BFA9E4A5E10EC32 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARATIN MEDICAL CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALAN T WILLIAMS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 687 GREENBRIAR | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 39705 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $116,635 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | MS | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE FREE MEDICAL PRIMARY HEALTHCARE FOR 267 INDIGENT PATIENTS, PRIMARILY THROUGH VOLUNTEER HEALTHCARE PROFESSIONALS SERVING AT THE CLINIC'S LEASED FACILITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $108,194 | PYContributionsGrantsAmt |
| CY Contributions Grants | $116,097 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $530 | PYInvestmentIncomeAmt |
| CY Investment Income | $538 | CYInvestmentIncomeAmt |
| PY Other Revenue | $41 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $108,765 | PYTotalRevenueAmt |
| CY Total Revenue | $116,635 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $14,879 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $8,478 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $66,927 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $64,837 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $3,864 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,716 | PYOtherExpensesAmt |
| CY Other Expenses | $25,406 | CYOtherExpensesAmt |
| PY Total Expenses | $109,522 | PYTotalExpensesAmt |
| CY Total Expenses | $98,721 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$757 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $17,914 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $184,246 | TotalAssetsBOYAmt |
| Total Assets EOY | $200,206 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,344 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,306 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $181,902 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $197,900 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVDIE PRIMARY HEALTH CARE FOR 267 INDIGENT PATIENTS, AS WELL AS PROVIDE PRESCRIPTION DRUGS OBTAINED PRIMARILY FROM THE MANUFACTURERS WITH PATIENT CARE PLANS, AND SECURED MAMMOGRAMS FOR FEMALE PATIENTS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $83,043 | ExpenseAmt |
| Grant | $8,478 | GrantAmt |
| Desc | PROVDIE PRIMARY HEALTH CARE FOR 267 INDIGENT PATIENTS, AS WELL AS PROVIDE PRESCRIPTION DRUGS OBTAINED PRIMARILY FROM THE MANUFACTURERS WITH PATIENT CARE PLANS, AND SECURED MAMMOGRAMS FOR FEMALE PATIENTS. | Desc |
| Total Program Service Expenses | $83,043 | 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 | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | 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 | 2 | 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 | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| DAF Excess Business Holdings | 0 | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | 0 | TaxableDistributionsInd |
| Distribution To Donor | 0 | DistributionToDonorInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | 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 | 0 | 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 | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MS | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TE LOTT JR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6623285387 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 221 NORTH 7TH STREET | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | MS | StateAbbreviationCd |
| ZIP | 39701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| ALAN T WILLIAMS | ||||||
| CHAIRMAN BOARD OF DIRECT | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN DAVIS | ||||||
| VICE-CHAIR BOARD OF DIRECT | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RONNY ROBERTS | ||||||
| SECRETARY BOARD OF DIRECTO | 0.00 | Yes (X) | $0 | $0 | $0 | |
| T E LOTT JR | ||||||
| TREASURER BOARD OF DIRECTO | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JAMES S WOODARD | ||||||
| MEDICAL DIRECTOR, B.O.D. | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BILL WEST | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DUFF JEFFERS | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARY ELLEN SUMRALL | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MAXINE JUNKIN | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JOHNNY JUDSON | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RICK GARNER | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ROBERT WHITE | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SAMMY SMITH | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RANDY BURRIS | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARY LOU SPENCER | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DAVID CURTIS | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| STEVE PORTER | ||||||
| MEMBER, BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KATHERINE M TENTONI | ||||||
| EXECUTIVE DIRECTOR | 40.00 | $57,146 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $57,146 | 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 |
| All Other Contributions | $116,097 | AllOtherContributionsAmt |
| Total Contributions | $116,097 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $538 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $538 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $116,635 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $538 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,478 | TotalAmt |
| Program Services | $8,478 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,146 | TotalAmt |
| Program Services | $45,717 | ProgramServicesAmt |
| Management And General | $8,572 | ManagementAndGeneralAmt |
| Fundraising | $2,857 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $719 | TotalAmt |
| Program Services | $575 | ProgramServicesAmt |
| Management And General | $107 | ManagementAndGeneralAmt |
| Fundraising | $37 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,972 | TotalAmt |
| Program Services | $5,577 | ProgramServicesAmt |
| Management And General | $1,045 | ManagementAndGeneralAmt |
| Fundraising | $350 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,551 | TotalAmt |
| Program Services | $1,318 | ProgramServicesAmt |
| Management And General | $233 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50 | TotalAmt |
| Program Services | $50 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,738 | TotalAmt |
| Program Services | $2,990 | ProgramServicesAmt |
| Management And General | $561 | ManagementAndGeneralAmt |
| Fundraising | $187 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,469 | TotalAmt |
| Program Services | $1,175 | ProgramServicesAmt |
| Management And General | $220 | ManagementAndGeneralAmt |
| Fundraising | $74 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $980 | TotalAmt |
| Program Services | $980 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| INSURANCE | $10,213 | $10,213 | ||
| UTILITIES | $7,171 | $5,736 | $1,076 | $359 |
| REPAIRS & MAINTENANCE | $125 | $125 | ||
| SUPPLIES | $109 | $109 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,721 | TotalAmt |
| Program Services | $83,043 | ProgramServicesAmt |
| Management And General | $11,814 | ManagementAndGeneralAmt |
| Fundraising | $3,864 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,913 | BOYAmt |
| EOY | $5,318 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,326 | BOYAmt |
| EOY | $193,961 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $42,055 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $41,128 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,007 | BOYAmt |
| EOY | $927 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,246 | BOYAmt |
| EOY | $200,206 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,344 | BOYAmt |
| EOY | $2,306 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,344 | BOYAmt |
| EOY | $2,306 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,902 | BOYAmt |
| EOY | $197,900 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $181,902 | BOYAmt |
| EOY | $197,900 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,246 | BOYAmt |
| EOY | $200,206 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $17,914 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$1,916 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| 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 | $74,301 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $81,512 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $138,211 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $108,194 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $116,097 | CurrentTaxYearAmt |
| Total | $518,315 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $74,301 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $81,512 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $138,211 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $108,194 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $116,097 | CurrentTaxYearAmt |
| Total | $518,315 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $331,675 | SubstantialContributorsTotAmt |
| Public Support Total170 | $186,640 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $689 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $599 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $360 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $571 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $538 | CurrentTaxYearAmt |
| Total | $2,757 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $521,072 | TotalSupportAmt |
| Public Support CY170 | 0.35820 | 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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,952 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,025 | DepreciationAmt |
| Book Value | $927 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,103 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,103 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $927 | TotalBookValueLandBuildingsAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|
| PRESCRIPTION DRUGS | $4,105 | COST | PRESCRIPTION DRUGS ARE PROVIDED DIRECTLY TO THE PATIENTS AT NO COST |
| MAMMOGRAMS AND OTHER SERVICES | $4,373 | COST | MAMMOGRAMS AND OTHER SERVICES ARE PROVIDED AT NO COST TO PATIENTS |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS PAID INCLUDE $4,105 IN DIAGNOSTIC SERVICES (PRIMARILY MAMMOGRAMS) AND $4,373 IN PRESCRIPTION MEDICATIONS MADE AVAILABLE TO SPECIFIC INDIGENT PATIENTS BY ORDERS OF LICENSED MEDICAL PROFESSIONALS | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | The Form 990 is reviewed by the Chairman of the Board of Directors, the Executive Director and the Treasurer, before filing. |
| Form 990, Part VI, Section B, line 15 | The entire Board of Directors meets at least annually to determine compensation for the executive director including salary and fringe benefits |
| Form 990, Part VI, Section C, line 18 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC DURING THE TAX YEAR BY WAY OF RECORDS FILED WITH THE MS SECRETARY OF STATE AND IRS. |
| Form 990, Part VI, Section C, line 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC DURING THE TAX YEAR BY WAY OF RECORDS FILED WITH THE MS SECRETARY OF STATE AND IRS. |
| Form 990, Part VII Contact Addresses for Officers, Directors, Etc | RANDY BURRIS - 128 WOODRIDGE PLACE, COLUMBUS, MS 39702. MARY LOU SPENCER - 1409 BRIARWOOD, COLUMBUS, MS 39705. |
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