BETA

PHYSICIANS CARE CLINIC INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
PHYSICIANS CARE CLINIC INC (EIN 58-2107579)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-08-16
IRS object ID
201712289349300006
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)
Return2017-08-16T07:06:28-04:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN811336355PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Michelle L McGlaun CPABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12385 Emerald DriveAddressLine1Txt
CityJonesboroCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30236ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN582107579EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Physicians Care Clinic IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPHYSBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12675 N Decatur RoadAddressLine1Txt
CityDecaturCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30033ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCarole FortenberryPersonNm
Person TitleExecutive DirecPersonTitleTxt
Phone7702710453PhoneNum
Signature2017-08-15SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMichelle L McGlaunPreparerPersonNm
PTINP01273842PTIN
Phone7708658067PhoneNum
Preparation2017-08-16PreparationDt
Self EmployedYes (X)SelfEmployedInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address207.207.30.141IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-08-16IPDt
IP Tm07:06:54IPTm
Federal Original Submission Id5820282017228vqbb1yqFederalOriginalSubmissionId
Federal Original Submission Id2017-08-16FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdEF54249DA924441C0D4981A4F90F3C9ED1E328D4AtSubmissionCreationDeviceId
At Submission Filing Device IdEF54249DA924441C0D4981A4F90F3C9ED1E328D4AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts$463,803GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.physicianscareclinic.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1994FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionTo provide DeKalb Countys low income, uninsured adults quality, comprehensive, non-emergent medical care delivered with excellence, compassion and dignity.ActivityOrMissionDesc
Voting Members Governing Body17VotingMembersGoverningBodyCnt
Voting Members Independent17VotingMembersIndependentCnt
Total Employee7TotalEmployeeCnt
Total Volunteers314TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$472,510PYContributionsGrantsAmt
CY Contributions Grants$463,216CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$87PYInvestmentIncomeAmt
CY Investment Income$587CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$472,597PYTotalRevenueAmt
CY Total Revenue$463,803CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$139,814PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$157,867CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$24,952CYTotalFundraisingExpenseAmt
PY Other Expenses$194,482PYOtherExpensesAmt
CY Other Expenses$302,814CYOtherExpensesAmt
PY Total Expenses$334,296PYTotalExpensesAmt
CY Total Expenses$460,681CYTotalExpensesAmt
PY Revenues Less Expenses$138,301PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,122CYRevenuesLessExpensesAmt
Total Assets BOY$413,425TotalAssetsBOYAmt
Total Assets EOY$390,147TotalAssetsEOYAmt
Total Liabilities BOY$60,991TotalLiabilitiesBOYAmt
Total Liabilities EOY$32,017TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$352,434NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$358,130NetAssetsOrFundBalancesEOYAmt
MissionTo provide DeKalb Countys low income, uninsured adults quality, comprehensive, non-emergent medical care delivered with excellence, compassion and dignity.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$360,674ExpenseAmt
DescSee Schedule O.Desc
Total Program Service Expenses$360,674TotalProgramServiceExpensesAmt
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 FootnotefalseIncludeFIN48FootnoteInd
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 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 ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee7EmployeeCnt
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 Members17GoverningBodyVotingMembersCnt
Independent Voting Member17IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
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 EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCarole Fortenberry MHSA RNPersonNm
Phone7702710453PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12675 N Decatur RoadAddressLine1Txt
CityDecaturCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30033ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeInd
Duane Barclay
Member1.000.00Yes (X)$0$0$0
Diana Evans Berman
Member1.000.00Yes (X)$0$0$0
Michael Baron
Member1.000.00Yes (X)$0$0$0
Andrew Dixon
Member1.000.00Yes (X)$0$0$0
William Hutchinson
Member1.000.00Yes (X)$0$0$0
Beverly Hutchinson
Member1.000.00Yes (X)$0$0$0
John Kennedy
Member1.000.00Yes (X)$0$0$0
Raanan Pritzker
Member1.000.00Yes (X)$0$0$0
Adam Schnepp
Member1.000.00Yes (X)$0$0$0
Mark Stern
Member1.000.00Yes (X)$0$0$0
Roy Vandiver
Member1.000.00Yes (X)$0$0$0
Dan Silverboard
Member0.001.00Yes (X)$0$0$0
J W Holderfield
Treasurer1.000.00$0$0$0Yes (X)
Scott Arant
President1.000.00$0$0$0Yes (X)
Gary Botstein
Founder and Board Chairman1.000.00$0$0$0Yes (X)
Kenneth Hoose
Medical Director1.000.00$0$0$0Yes (X)
Stephen Leff
Founder and Secretary1.000.00$0$0$0Yes (X)
Carole Fortenberry
Executive Director40.000.00$0$0$0Yes (X)
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$10,700FundraisingAmt
All Other Contributions$452,516AllOtherContributionsAmt
Noncash Contributions$161,797NoncashContributionsAmt
Total Contributions$463,216TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$587TotalRevenueColumnAmt
Related Or Exempt Func Income$587RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Contri Rpt Fundraising Event$10,700ContriRptFundraisingEventAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$463,803TotalRevenueColumnAmt
Related Or Exempt Func Income$587RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$74,303TotalAmt
Program Services$40,063ProgramServicesAmt
Management And General$34,240ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$72,282TotalAmt
Program Services$72,282ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$11,282TotalAmt
Program Services$8,663ProgramServicesAmt
Management And General$2,619ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$42,102TotalAmt
Management And General$17,299ManagementAndGeneralAmt
Fundraising$24,803FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$7,000TotalAmt
Management And General$7,000ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,869TotalAmt
Management And General$4,869ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$39,598TotalAmt
Program Services$39,598ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$2,267TotalAmt
Management And General$2,267ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,788TotalAmt
Management And General$2,788ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$15,911TotalAmt
Program Services$13,293ProgramServicesAmt
Management And General$2,618ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Medical supplies$171,394$171,394
Volunteer costs$9,500$9,500
Printing and postage$991$842$149
Education and awareness$5,881$5,881

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$513TotalAmt
Management And General$513ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$460,681TotalAmt
Program Services$360,674ProgramServicesAmt
Management And General$75,055ManagementAndGeneralAmt
Fundraising$24,952FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$299,878BOYAmt
EOY$277,145EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$93,878BOYAmt
EOY$91,692EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$8,446BOYAmt
EOY$11,021EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,531BOYAmt
EOY$1,658EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$30,270LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$21,639LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,692BOYAmt
EOY$8,631EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$413,425BOYAmt
EOY$390,147EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,041BOYAmt
EOY$3,517EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$58,950BOYAmt
EOY$28,500EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$60,991BOYAmt
EOY$32,017EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$319,962BOYAmt
EOY$343,505EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$32,472BOYAmt
EOY$14,625EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$352,434BOYAmt
EOY$358,130EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$413,425BOYAmt
EOY$390,147EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,122ReconcilationRevenueExpnssAmt
Donated Services And Use Fclts$2,574DonatedServicesAndUseFcltsAmt
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)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$305,878CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$329,891CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$338,546CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$472,510CurrentTaxYearMinus1YearAmt
Current Tax Year$463,216CurrentTaxYearAmt
Total$1,910,041TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$305,878CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$329,891CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$338,546CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$472,510CurrentTaxYearMinus1YearAmt
Current Tax Year$463,216CurrentTaxYearAmt
Total$1,910,041TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$1,910,041PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$53CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$50CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$87CurrentTaxYearMinus1YearAmt
Current Tax Year$587CurrentTaxYearAmt
Total$846TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$53CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$50CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$87CurrentTaxYearMinus1YearAmt
Current Tax Year$587CurrentTaxYearAmt
Total$846TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$305,947CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$329,944CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$338,596CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$472,597CurrentTaxYearMinus1YearAmt
Current Tax Year$463,803CurrentTaxYearAmt
Total$1,910,887TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99960PublicSupportCY509Pct
Public Support PY5090.99980PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Investment Income PY0.00000InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

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

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,733OtherCostOrOtherBasisAmt
Depreciation$12,899DepreciationAmt
Book Value$4,834BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,537OtherCostOrOtherBasisAmt
Depreciation$8,740DepreciationAmt
Book Value$3,797BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,631TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$1,715,499TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts$1,251,696DonatedServicesAndUseFcltsAmt
Revenue Not Reported$1,251,696RevenueNotReportedAmt
Revenue Subtotal$463,803RevenueSubtotalAmt
Total Revenue Per Form990$463,803TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$1,709,803TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$1,249,122DonatedServicesUseFcltsAmt
Expenses Not Reported$1,249,122ExpensesNotReportedAmt
Expenses Subtotal$460,681ExpensesSubtotalAmt
Total Expenses Per Form990$460,681TotalExpensesPerForm990Amt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Noncash Contributions Rpt F990$163,830NoncashContributionsRptF990Amt
Method Of Determining RevenuesFMV from VendorMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGiftsInd
Third Parties UsedfalseThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Officer directors etc family relationship Part VI line 2William and Beverly Hutchinson are married.
Form 990 governing body review Part VI line 11The organizations accountant provides a copy of Form 990 to the Board of Directors for review and approval prior to filing.
Conflict of interest policy compliance Part VI line 12cBoard of Directors sign a conflict of interest statement annually. This statement requires the directors to disclose any potential conflicts that may exist.
CEO executive director top management comp Part VI line 15aIn setting compensation, the organization may consider, among other things, external labor market rates, equuitable relationship with other jobs within the organization, and the organizations ability to pay. Each employee may be eligible for a salary review at the beginning of each fiscal year. The Board of Directors will determine the executive directors salary.
Governing documents etc available to public Part VI line 19The organizations accountant provides a cpy of Form 990 specifically for public inspection. This copy is available upon request.
List of other fees for services expenses Part IX line 11gOther fees consist of fees for professional services.
General explanation attachment2016 Highlights- PCC raised over $200,000 from foundations, individuals and direct support, and over $1M in in-kind contributions enabling us to maintain a strong balance sheet and absorb the increased demand for services. 2016 Statistics- Total patients enrolled 1,183- Total patient visits to the clinic 2,155- Total unduplicated visits 460- Referrals to specialty care 699- Prescriptions filled 3,086- Diagnostic tests provided 3,390- Surgeries provided 16 valued at $103,104- Secured 150 flu vaccine vouchers for patients from Publix pharmacies- DM/HTN education: 611 encounters (classes and/or one-on-one) Demographics- Ethnic origin at clinic: 14% Caucasian; 70% Black including African-Americans; 13% Asian; 3% Hispanic- Age distribution: 18-54 years 56%; 55+ years 44%- Sexual orientation: 74% Female; 26% Male- Top five zip codes served: 30083; 30058; 30032; 30034; 30021- Top four diagnosis: HTN 44%; HLD 20%; DJD/OA 16%; DM 14% Volunteer information:- PCC volunteers logged 4,471 in-clinic volunteer hours- Total in-clinic volunteers 267- Specialty care physician volunteers 65 Growth and sustainability- Ads placed in The Pulse and Neighbor Newspapers in Dekalb for nursing volunteers, which helped us recruit an additional 98 new volunteers and 156 new patients in 2016- Continued collboration with Dekalb Medical and the Dekalb Board of Health to ensure our patients received optimum health care- New partnerships with Northside FASP program for indigent care; Ben Massell dental clinic; Dekalb Community Service Board; Ryan Cameron Foundation; GA Lions Lighthouse Foundation.- Mercer pharmacy students created a Know your Numbers app and promoted it weekly with patients at the clinic who need to follow their BP or blood glucose on a daily basis.- Participated in a health fair at the FDHA annual health summit in October. Growth and sustainability (cont)- Served on the United Way DeKalb Thrive think group.- Continuous updates of website with patient information/links and patient newsletters.- Participated in social media with a FB account.- Contacted state representatives on behalf of legislation affecting GA charitable clinics.- Completed: Succession Plan; Board of Directors Manual w/ job descriptions, new strategic plan, committee charters, governance documents and Board orientation manual- Participated in NCQA customer survey in June.- Successful 2015 audit.- Participated in GA Gives Day 2016, raising over $12,000 for the clinic. ADA quality Indicators for diabetes 2015: (48 of 94 diabetic chart surveyed) 1. 46% had A1C less than 7 2. 55% had b/p less than 140/80 3. 54% had triglycerides less than 150 4. 33% had HDL greater than 50 5. 47% had LDL less than 100 6. 62% received eye exams - Continued improvement in chronic disease management program and quality measuresa. Hypertension: Audits of 93 hypertensive patients who came to clinic at least twice in 2016 showed 62.4% decreased diastolic and 59.14% decreased systolic range and 70% improved overall.b. Diabetes (using ADA guidelines): of 85 patients who came to clinic 2 x or more in 2016:52% hand A1C 7; 35% had BP 140/80; 58% had triglycerides 150; 38% had HDL >50; 49% had LDL 100; 51% received annual eye exam; 56% received a foot exam; and 86% received one on one or classroom education.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Dekalb Medical Society IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line14850 Golden Parkway No B-418AddressLine1Txt
CityBufordCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30518ZIPCd
FieldValueIRS element (for citing)
EIN580961919EIN
Primary ActivitiesHealthcarePrimaryActivitiesTxt
Exempt Code Section501c6ExemptCodeSectionTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd

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