WEST CALCASIEU CAMERON HOSPITAL FOUNDATION: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
WEST CALCASIEU CAMERON HOSPITAL FOUNDATION (EIN 72-1341439)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-07-24
IRS object ID
201702059349301265
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

FieldValueIRS element (for citing)
Return2017-07-24T18:32:27-04:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN800488055PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Steven M DeRouen & AssociatesBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1P O Box 4265AddressLine1Txt
CityLake CharlesCityNm
State AbbreviationLAStateAbbreviationCd
ZIP70606ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN721341439EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1West Calcasieu Cameron Hospital FoundationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlWESTBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1701 Cypress StreetAddressLine1Txt
CitySulphurCityNm
State AbbreviationLAStateAbbreviationCd
ZIP70663ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAlesia ComptonPersonNm
Person TitleExecutive DirecPersonTitleTxt
Phone3375274147PhoneNum
Signature2017-07-24SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSteven M DeRouenPreparerPersonNm
PTINP01050140PTIN
Phone3375134915PhoneNum
Preparation2017-07-24PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address74.194.10.52IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-07-24IPDt
IP Tm18:37:00IPTm
Federal Original Submission Id7278272017205a2taqkcFederalOriginalSubmissionId
Federal Original Submission Id2017-07-24FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdE8E2E97C1EC64351CAEDA191582A85C668C32207AtSubmissionCreationDeviceId
At Submission Filing Device IdE8E2E97C1EC64351CAEDA191582A85C668C32207AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts$531,784GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswcch.com/wcch_foundation.aspxWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1996FormationYr
Legal Domicile StateLALegalDomicileStateCd
Activity Or MissionIt is the mission of the West Calcasieu Cameron Hospital Foundation to raise charitable gifts to provide quality medical services, healthcare programs, and community betterment while fostering a long-term positive relationship between the hospital and community.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$38,454PYContributionsGrantsAmt
CY Contributions Grants$68,459CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$162,876PYOtherRevenueAmt
CY Other Revenue$144,453CYOtherRevenueAmt
PY Total Revenue$201,330PYTotalRevenueAmt
CY Total Revenue$212,912CYTotalRevenueAmt
PY Grants And Similar Paid$24,806PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$60,090CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$23,850PYOtherExpensesAmt
CY Other Expenses$24,162CYOtherExpensesAmt
PY Total Expenses$48,656PYTotalExpensesAmt
CY Total Expenses$84,252CYTotalExpensesAmt
PY Revenues Less Expenses$152,674PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$128,660CYRevenuesLessExpensesAmt
Total Assets BOY$4,640,860TotalAssetsBOYAmt
Total Assets EOY$4,551,395TotalAssetsEOYAmt
Total Liabilities BOY$3,906,338TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,688,213TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$734,522NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$863,182NetAssetsOrFundBalancesEOYAmt
MissionIt is the mission of the West Calcasieu Cameron Hospital Foundation to raise charitable gifts to provide quality medical services, healthcare programs, and community betterment while fostering a long-term positive relationship between the hospital and community.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$52,140ExpenseAmt
DescTo establish and perpetuate community wide health awareness and health status improvement programs.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$17,583ExpenseAmt
Revenue$38,205RevenueAmt
DescManagement of a gift shop by volunteer labor. Funds derived from the gift shop sales will be utilized for purchases of capital equipment for West Calcasieu Cameron Hospital.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$14,529ExpenseAmt
Revenue$14,529RevenueAmt
DescConduct and coordinate fundraising efforts for funds to be dedicated for the benefit of West Calcasieu Cameron Hospital.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Revenue$14,800RevenueAmt
DescGenesis Therapeutic Riding Center: Offers therapy programs for those with physical, mental, and/or developmental disabilities and works to improve mobility, posture, cognition and balance. Additionally, the Center focuses on improving sensorimotor integration of tactile, visual and auditory skills through specialized modalities.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Revenue$14,800TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$84,252TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnfalseAnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcfalseRegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonAlesia ComptonPersonNm
Phone3375274147PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1701 Cypress StreetAddressLine1Txt
CitySulphurCityNm
State AbbreviationLAStateAbbreviationCd
ZIP70663ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
Ken Broussard
Board Member2.000.00Yes (X)$0$0$0
George Clyde
Treasurer2.000.00Yes (X)$0$0$0Yes (X)
Marilyn Dawdy
Vice President2.000.00Yes (X)$0$0$0Yes (X)
Tom Henning
Board Member2.000.00Yes (X)$0$0$0
Janie Fruge
Ex-Officio Board Member2.000.00Yes (X)$0$0$0
Suzanne Nelson
Secretary2.000.00Yes (X)$0$0$0Yes (X)
Nina Vincent
Board Member2.000.00Yes (X)$0$0$0
Bobby Letard
Board Member2.000.00Yes (X)$0$0$0
Rick Watson
President2.000.00Yes (X)$0$0$0Yes (X)
Debby Nabours
Executive Director2.000.00Yes (X)$0$0$0Yes (X)
Alesia Compton
Ex-Officio Board Member2.000.00Yes (X)$0$0$0
Kathy Bourgeois
Board Member2.000.00Yes (X)$0$0$0
Mary Ann Redd
Board Member2.000.00Yes (X)$0$0$0
Denise Perry
Board Member2.000.00Yes (X)$0$0$0
Mike Granger
Board Member2.000.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Fundraising$34,860FundraisingAmt
All Other Contributions$33,599AllOtherContributionsAmt
Total Contributions$68,459TotalContributionsAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$410,038RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$286,760RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$123,278RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$123,278TotalRevenueColumnAmt
Related Or Exempt Func Income$123,278RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$14,529FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$34,860ContriRptFundraisingEventAmt
Fundraising Direct Expenses$14,529FundraisingDirectExpensesAmt
Gross Sales Of Inventory$38,205GrossSalesOfInventoryAmt
Cost Of Goods Sold$17,583CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,622TotalRevenueColumnAmt
Related Or Exempt Func Income$20,622RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMiscellaneous RevenueDesc
Business900099BusinessCd
Total Revenue Column$553TotalRevenueColumnAmt
Related Or Exempt Func Income$553RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$553OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$212,912TotalRevenueColumnAmt
Related Or Exempt Func Income$144,453RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$57,590TotalAmt
Program Services$57,590ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$2,500TotalAmt
Program Services$2,500ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$4,500TotalAmt
Program Services$4,500ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,496TotalAmt
Program Services$1,496ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,463TotalAmt
Program Services$3,463ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
Marketing$11,720$11,720
Miscellaneous$1,125$1,125
Supplies$734$734
Repairs and Maintenance$1,124$1,124

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$84,252TotalAmt
Program Services$84,252ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$224,005BOYAmt
EOY$241,180EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$18,636BOYAmt
EOY$17,407EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,713,287LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$420,479LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,398,219BOYAmt
EOY$4,292,808EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,640,860BOYAmt
EOY$4,551,395EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$39,844BOYAmt
EOY$56,466EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$78,158BOYAmt
EOY$65,132EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$3,788,336BOYAmt
EOY$3,566,615EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,906,338BOYAmt
EOY$3,688,213EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$691,149BOYAmt
EOY$830,733EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$43,373BOYAmt
EOY$32,449EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$734,522BOYAmt
EOY$863,182EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,640,860BOYAmt
EOY$4,551,395EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$128,660ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69,253CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$91,527CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$30,749CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$38,454CurrentTaxYearMinus1YearAmt
Current Tax Year$68,459CurrentTaxYearAmt
Total$298,442TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69,253CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$91,527CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$30,749CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$38,454CurrentTaxYearMinus1YearAmt
Current Tax Year$68,459CurrentTaxYearAmt
Total$298,442TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$6,587SubstantialContributorsTotAmt
Public Support Total170$291,855PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$123CurrentTaxYearMinus4YearsAmt
Total$123TotalAmt
FieldValueIRS element (for citing)
Total Support$298,565TotalSupportAmt
Gross Receipts Rltd Activities$966,826GrossReceiptsRltdActivitiesAmt
Public Support CY1700.97750PublicSupportCY170Pct
Public Support PY1700.99820PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$932,500OtherCostOrOtherBasisAmt
Book Value$932,500BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,780,787OtherCostOrOtherBasisAmt
Depreciation$420,479DepreciationAmt
Book Value$3,360,308BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,292,808TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$531,784TotalRevEtcAuditedFinclStmtAmt
Other Revenue$318,872OtherRevenueAmt
Revenue Not Reported$318,872RevenueNotReportedAmt
Revenue Subtotal$212,912RevenueSubtotalAmt
Total Revenue Per Form990$212,912TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$403,124TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$318,872OtherExpensesIncludedAmt
Expenses Not Reported$318,872ExpensesNotReportedAmt
Expenses Subtotal$84,252ExpensesSubtotalAmt
Total Expenses Per Form990$84,252TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Other revenues not included on Form 990 (Part XI, line 2d)Fundraising, rental expenses and cost of goods sold reported on Form 990, Part VIII, line 6b, 8b and 10b.
Other expenses not included on Form 990 (Part XII, line 2d)Fundraising, rental expenses and cost of goods sold included on Form 990, Part VIII, line 6b, 8b and 10b.
Footnote for uncertain tax position under FIN 48 (Part X)The Organization is exempt from federal income taxes under Section 501 (c) (3) of the Internal Revenue Code and applicable state codes. According, no provision for federal and state income taxes is included in the financial statements. The Foundation had no uncertain tax positions that qualify for recognition or disclosure in the financial statements.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1Golf TournamEvent1Nm
Gross Receipts Event1$24,160GrossReceiptsEvent1Amt
Charitable Contri Event1$9,788CharitableContriEvent1Amt
Gross Revenue Event1$14,372GrossRevenueEvent1Amt
Other Direct Expenses Event1$14,372OtherDirectExpensesEvent1Amt
Gross Receipts Total$24,160GrossReceiptsTotalAmt
Charitable Contributions Tot$9,788CharitableContributionsTotAmt
Gross Revenue Total Events$14,372GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$14,372OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$14,372DirectExpenseSummaryEventsAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
West Cal-Cam Hospital
701 Cypress StreetSulphurLA70663726008355West Cal-Cam Ho$20,128Support Hospital
American Cancer Society
250 Williams Street NWAtlantaGA30303131788491501c3$12,302Support Society
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceMonitoring procedures (Part I, line 2)FormAndLineReferenceDesc
ExplanationThe Organization maintains grant and receipient eligibility review documentation. This information is utilized when evaluating and approving grantees.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990 governing body review Part VI line 11The Form 990 is reviewed by the board of directors prior to issuance.
Governing documents etc available to public Part VI line 19The Organizations governing documents, conflict of interest policy, and financial statements are made available to the public upon request.

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