DAVIS VOLUNTEER MEDICAL CLINIC: Form 990EZ, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
DAVIS VOLUNTEER MEDICAL CLINIC (EIN 20-1232463)
Tax period
2016-07-01 to 2017-06-30
Filed
2017-09-15
IRS object ID
201702589349200885
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)
Return2017-09-15T18:39:57-07:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Hansen Bradshaw Malmrose & Erickson PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1559 West 500 SouthAddressLine1Txt
CityBountifulCityNm
State AbbreviationUTStateAbbreviationCd
ZIP84010ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN201232463EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DAVIS VOLUNTEER MEDICAL CLINICBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDAVIBusinessNameControlTxt
Phone8015938027PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1721 E BROOKSHIRE HOLLOW DRAddressLine1Txt
CityKAYSVILLECityNm
State AbbreviationUTStateAbbreviationCd
ZIP84037ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCLARKE BRADSHAWPersonNm
Person TitleTreasurerPersonTitleTxt
Signature2017-09-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCLARKE R BRADSHAWPreparerPersonNm
PTINP00072488PTIN
Phone8012960200PhoneNum
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Website AddressN/AWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Gross Receipts$222GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Contributions Gifts Grants Etc$74ContributionsGiftsGrantsEtcAmt
Investment Income$148InvestmentIncomeAmt
Cost Or Other Basis Expense Sale$0CostOrOtherBasisExpenseSaleAmt
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Special Events Direct Expenses$0SpecialEventsDirectExpensesAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt
Total Revenue$222TotalRevenueAmt
Other Expenses Total$1,233OtherExpensesTotalAmt
Total Expenses$1,233TotalExpensesAmt
Excess Or Deficit For Year-$1,011ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY$54,692NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$53,681NetAssetsOrFundBalancesEOYAmt

Cash Savings And Investments CashSavingsAndInvestmentsGrp

FieldValueIRS element (for citing)
BOY$54,692BOYAmt
EOY$53,681EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$54,692BOYAmt
EOY$53,681EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY$54,692BOYAmt
EOY$53,681EOYAmt
FieldValueIRS element (for citing)
Primary Exempt PurposeDAVIS VOLUNTEER MEDICAL CLINIC WAS FORMED FOR THE PURPOSE OF PROVIDING EMERGENCY AND MEDICAL HEALTH CLINICAL SERVICES TO INDIGENT AND LOW INCOME PATIENTS IN DAVIS COUNTY, UTAH. THE ORGANIZATION OPERATES FROM SPECIFICALLY DESIGNATED FUNDS RECEIVED FROM THE UNITED WAY OF SALT LAKE AND FROM DONATED MEDICAL SERVICES AND SUPPLIES PROVIDED BY MEDICAL PROFESSIONALS WITHIN THE DAVIS COUNTY COMMUNITY.PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp

FieldValueIRS element (for citing)
Description Program Srvc AccomPROVIDED EMERGENCY AND MEDICAL HEALTH SERVICES TO INDIGENT AND LOW INCOME PATIENTS.DescriptionProgramSrvcAccomTxt
Grants And Allocations$1,233GrantsAndAllocationsAmt
FieldValueIRS element (for citing)
Total Program Service Expenses$1,233TotalProgramServiceExpensesAmt
Info In Schedule O Part IVYes (X)InfoInScheduleOPartIVInd

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (20 entries)

TitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmt
LARRY BURDETT
VICE CHAIR2.00$0
GEORGE SNELL
BOARD2.00$0
CLAIRE HARRIS
BOARD2.00$0
CLARA SNELL
BOARD2.00$0
ERIC LANCASTER
BOARD2.00$0
GLENDA SMITH
NURSING DIRCTR2.00$0
MELISSA HOLBROOK
PHARMACY DIRCTR2.00$0
CLARKE BRADSHAW
Treasurer2.00$0
STEWART BARLOW
BOARD2.00$0
CLEOPATRA ROCHA
BOARD2.00$0
BECKY WEISNER
BOARD2.00$0
DIANE TOWNSEND
BOARD2.00$0
MAUREEN COOK
Secretary2.00$0
MARK HOUSLEY
BOARD2.00$0
RYAN STEWART
BOARD2.00$0
ADAM NEBEKER
BOARD2.00$0
TERESA DURBIN
BOARD2.00$0
MEG KNEEDY WOOTON
BOARD2.00$0
JOHNNIE COOK
President & CEO2.00$0
LISA NICHOLS
BOARD2.00$0
FieldValueIRS element (for citing)
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not RptfalseChgMadeToOrgnzngDocNotRptInd
Organization Had UBIfalseOrganizationHadUBIInd
Organization Filed990 TfalseOrganizationFiled990TInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Form1120 Pol FiledfalseForm1120PolFiledInd
Made Loans To From OfficersfalseMadeLoansToFromOfficersInd
Initiation Fees And Cap Contri$0InitiationFeesAndCapContriAmt
Gross Receipts For Public Use$0GrossReceiptsForPublicUseAmt
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCLARKE BRADSHAWPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1559 W 500 SAddressLine1Txt
CityBOUNTIFULCityNm
State AbbreviationUTStateAbbreviationCd
ZIP84010ZIPCd
FieldValueIRS element (for citing)
Phone8012960200PhoneNum
FieldValueIRS element (for citing)
Foreign Financial AccountfalseForeignFinancialAccountInd
Foreign OfficefalseForeignOfficeInd
Donor Advised FndsfalseDonorAdvisedFndsInd
Operate HospitalfalseOperateHospitalInd
Tanning Services ProvidedfalseTanningServicesProvidedInd
Form720 FiledfalseForm720FiledInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
School OperatingfalseSchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Related Org Sect527 OrgfalseRelatedOrgSect527OrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof SrvcNONEPartVIHghstPdCntrctProfSrvcTxt
Filed Schedule AYes (true)FiledScheduleAInd

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$85CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21CurrentTaxYearMinus1YearAmt
Current Tax Year$74CurrentTaxYearAmt
Total$189TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$85CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$21CurrentTaxYearMinus1YearAmt
Current Tax Year$74CurrentTaxYearAmt
Total$189TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$0SubstantialContributorsTotAmt
Public Support Total170$189PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$145CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$146CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$158CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$134CurrentTaxYearMinus1YearAmt
Current Tax Year$148CurrentTaxYearAmt
Total$731TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Total Support$920TotalSupportAmt
Public Support CY1700.20540PublicSupportCY170Pct
Public Support PY1700.60820PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests PY170Yes (X)ThirtyThrPctSuprtTestsPY170Ind

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceOther Expenses.1FormAndLineReferenceDesc
Explanation$1233ExplanationTxt

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