CRESCENT OF HERNANDO INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
CRESCENT OF HERNANDO INC (EIN 30-0475982)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-05-14
IRS object ID
201711349349300401
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)
Return2017-05-14T06:32:02-07:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MYERS BUSINESS SERVICES INCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 10189AddressLine1Txt
CityBROOKSVILLECityNm
State AbbreviationFLStateAbbreviationCd
ZIP346030189ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN300475982EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Crescent of Hernando IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCRESBusinessNameControlTxt
Phone3526109916PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line15244 Commercial WayAddressLine1Txt
CitySpring HillCityNm
State AbbreviationFLStateAbbreviationCd
ZIP346061933ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonHUSAM ABUZARAD MDPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone3526109916PhoneNum
Signature2017-05-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonGK MYERSPreparerPersonNm
Phone3525440024PhoneNum
Preparation2017-05-14PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address108.191.72.115IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-05-14IPDt
IP Tm06:31:52IPTm
IP TimezonePDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id9BFC1AF28FEB60E1FCD7EFCB13F25BE97C456879AtSubmissionCreationDeviceId
At Submission Filing Device Id15E7D8B85FD7FA4E15BF379D4B71E400BFBDD0B9AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerHUSAM ABUZARAD MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line15244 Commercial WayAddressLine1Txt
CitySpring HillCityNm
State AbbreviationFLStateAbbreviationCd
ZIP346061933ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$111,808GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.crescentclinic.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2008FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionTo provide free quality healthcare to the uninsured and low income residents.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee1TotalEmployeeCnt
Total Volunteers110TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$135,125PYContributionsGrantsAmt
CY Contributions Grants$100,882CYContributionsGrantsAmt
PY Program Service Revenue$11,522PYProgramServiceRevenueAmt
CY Program Service Revenue$10,926CYProgramServiceRevenueAmt
CY Investment Income$0CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$146,647PYTotalRevenueAmt
CY Total Revenue$111,808CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$35,618PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,226CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$106,106PYOtherExpensesAmt
CY Other Expenses$110,537CYOtherExpensesAmt
PY Total Expenses$141,724PYTotalExpensesAmt
CY Total Expenses$122,763CYTotalExpensesAmt
PY Revenues Less Expenses$4,923PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$10,955CYRevenuesLessExpensesAmt
Total Assets BOY$401,072TotalAssetsBOYAmt
Total Assets EOY$0TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$401,072NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$0NetAssetsOrFundBalancesEOYAmt
MissionTo provide free quality healthcareMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$458ExpenseAmt
Revenue$2,456RevenueAmt
DescQUALITY HEALTHCARE TO THE UNINSURED & LOW INCOME.Desc
Total Program Service Expenses$458TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
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
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee1EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
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 Members10GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
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 PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcfalseRegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonHUSAM ABUZARAD MDPersonNm
Phone3526109927PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line15244 Commercial WayAddressLine1Txt
CitySpring HillCityNm
State AbbreviationFLStateAbbreviationCd
ZIP346061933ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
HUSAM ABUZARAD MD
President10.00Yes (X)$0$0$0
MOHAMMAD A JOUD MD
Secretary10.00Yes (X)$0$0$0
ABDUSALAM KHALIL
Treasurer5.00Yes (X)$0$0$0
RODNEY S ACKLEY DDS
Director5.00$0$0$0Yes (X)
AZZAM MUFTAH MD
Director5.00$0$0$0Yes (X)
SYED WAQAR HASAN MD
Director5.00$0$0$0Yes (X)
AMY CAPOOCIA MD
Director5.00$0$0$0Yes (X)
ELAINE MOORMAN DHSC ARNP
Director5.00$0$0$0Yes (X)
SYED W ALI MD
Director5.00$0$0$0Yes (X)
MUHAMMED R HIBA
Director5.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Fundraising$11,302FundraisingAmt
All Other Contributions$89,580AllOtherContributionsAmt
Total Contributions$100,882TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHealthcare ServicesDesc
Business621400BusinessCd
Total Revenue Column$10,926TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$10,926TotalProgramServiceRevenueAmt
Contri Rpt Fundraising Event$11,302ContriRptFundraisingEventAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$111,808TotalRevenueColumnAmt
Related Or Exempt Func Income$10,926RelatedOrExemptFuncIncomeAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$10,800TotalAmt
Program Services$0ProgramServicesAmt
Management And General$10,800ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,426TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,426ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$20,796TotalAmt
Program Services$0ProgramServicesAmt
Management And General$20,796ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$18,948TotalAmt
Program Services$0ProgramServicesAmt
Management And General$18,948ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,245TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,245ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Repairs & Maintenance$419$0$419$0
Supplies$61,817$458$61,359$0
Telephone$2,431$0$2,431$0
Utilities$4,881$0$4,881$0

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$122,763TotalAmt
Program Services$458ProgramServicesAmt
Management And General$122,305ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$57,362BOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$181,625BOYAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$107,783BOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$54,302BOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$401,072BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$401,072BOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$401,072BOYAmt
EOY$0EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$401,072BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$10,955ReconcilationRevenueExpnssAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
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)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind
Public Support Total170$0PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support CY1700PublicSupportCY170Pct

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$79,428CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$164,035CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$215,635CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$149,647CurrentTaxYearMinus1YearAmt
Current Tax Year$100,882CurrentTaxYearAmt
Total$709,627TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$9,194CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,587CurrentTaxYearMinus2YearsAmt
Current Tax Year$10,926CurrentTaxYearAmt
Total$25,707TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$79,428CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$173,229CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$221,222CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$149,647CurrentTaxYearMinus1YearAmt
Current Tax Year$111,808CurrentTaxYearAmt
Total$735,334TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$735,334PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$1,336CurrentTaxYearMinus2YearsAmt
Total$1,336TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$1,336CurrentTaxYearMinus2YearsAmt
Total$1,336TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Total$736,670TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99820PublicSupportCY509Pct
Public Support PY5090.99820PublicSupportPY509Pct
Investment Income CY0.00180InvestmentIncomeCYPct
Investment Income PY0.00180InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,302BeginningYearBalanceAmt
End Year Balance$54,302EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,302BeginningYearBalanceAmt
End Year Balance$54,302EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$54,302BeginningYearBalanceAmt
End Year Balance$54,302EndYearBalanceAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt VI, Line 7aN/A
Pt VI, Line 11bCopy available for review

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