FAYETTE CARE CLINIC INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- FAYETTE CARE CLINIC INC (EIN 20-0314897)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2017-02-21
- IRS object ID
- 201720529349300602
- Schema version
- 2015v3.0
- 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 | 2017-02-21T09:23:11-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANADY RICHBOURG WOODWARD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5302 FREDERICK ST SUITE 200 | AddressLine1Txt |
| City | SAVANNAH | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 314054823 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200314897 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE CARE CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAYE | BusinessNameControlTxt |
| Phone | 7707199620 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 HIGHWAY 54 W SUITE 101 | AddressLine1Txt |
| City | FAYETTEVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 302144514 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR NIMISH DHRUVA | PersonNm |
| Person Title | INTERIM BOARD CHAIR | PersonTitleTxt |
| Phone | 7707199620 | PhoneNum |
| Signature | 2017-01-23 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN F WOODWARD | PreparerPersonNm |
| PTIN | P00839971 | PTIN |
| Phone | 9123542910 | PhoneNum |
| Preparation | 2017-02-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Amended Return | Yes (X) | AmendedReturnInd |
| Principal Officer | DR NIMISH DHRUVA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 20 FRANCIS WAY SUITE 101 200 | AddressLine1Txt |
| City | SHARPSBURG | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30277 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $473,602 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAYETTECARECLINIC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE QUALITY HEALTHCARE TO THE UNINSURED RESIDENTS OF FAYETTE COUNTY WHOSE HOUSEHOLD INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY GUIDELINES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 6 | TotalEmployeeCnt |
| Total Volunteers | 140 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $254,993 | PYContributionsGrantsAmt |
| CY Contributions Grants | $419,707 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $790 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,716 | CYProgramServiceRevenueAmt |
| PY Investment Income | $47 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $60,584 | PYOtherRevenueAmt |
| CY Other Revenue | $29,427 | CYOtherRevenueAmt |
| PY Total Revenue | $316,414 | PYTotalRevenueAmt |
| CY Total Revenue | $454,850 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $145,134 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $113,617 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $438 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $239,406 | PYOtherExpensesAmt |
| CY Other Expenses | $252,752 | CYOtherExpensesAmt |
| PY Total Expenses | $384,540 | PYTotalExpensesAmt |
| CY Total Expenses | $366,369 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$68,126 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $88,481 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $60,522 | TotalAssetsBOYAmt |
| Total Assets EOY | $148,961 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $791 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $749 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $59,731 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $148,212 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDE QUALITY HEALTHCARE TO THE UNINSURED RESIDENTS OF FAYETTE COUNTY WHOSE HOUSEHOLD INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY GUIDELINES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $235,851 | ExpenseAmt |
| Revenue | $5,716 | RevenueAmt |
| Desc | OUR MISSION IS TO PROMOTE HEALTH AND WELL-BEING BY REDUCING THE BARRIERS TO ACCESS HEALTHCARE FOR THE WORKING POOR AND UNINSURED POPULATION OF FAYETTE COUNTY, THAT MEET INCOME REQUIREMENTS, THROUGH COMPASSIONATE HEALTH CARE AND EDUCATION AND TO PROVIDE A GATEWAY TO OTHER COMMUNITY RESOURCES. | Desc |
| Total Program Service Expenses | $235,851 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 6 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | false | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JANIS WILLIAMS | PersonNm |
| Phone | 7707194620 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 HWY 54 W | AddressLine1Txt |
| Address Line2 | SUITE 101 | AddressLine2Txt |
| City | FAYETTEVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30214 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| DR CHARLES BARBER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAYE BEXLEY | ||||||
| BOARD VICE C | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| ELIZABETH J CARAWAY | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DR NIMISH DHRUVA | ||||||
| INTERIM BOAR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| TONY FERGUSON | ||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| ALICE JONES | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SHERYL KLINK | ||||||
| FINANCE CHAI | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| GREGORY ALVAREZ MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARYANNE MUJICA | ||||||
| PAST BOARD C | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SCOTT ROWLAND | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| GIL WILLIAMS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Federated Campaigns | $60,200 | FederatedCampaignsAmt |
| All Other Contributions | $359,507 | AllOtherContributionsAmt |
| Noncash Contributions | $108,464 | NoncashContributionsAmt |
| Total Contributions | $419,707 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| CLINIC FEES | $4,843 | $4,843 |
| PATIENT RECORD COPIES | $873 | $873 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,716 | TotalProgramServiceRevenueAmt |
| Fundraising Gross Income | $48,179 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $18,752 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,427 | TotalRevenueColumnAmt |
| Exclusion | $29,427 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $454,850 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,716 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $29,427 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,897 | TotalAmt |
| Program Services | $46,254 | ProgramServicesAmt |
| Management And General | $56,643 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,720 | TotalAmt |
| Program Services | $4,819 | ProgramServicesAmt |
| Management And General | $5,901 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,125 | TotalAmt |
| Management And General | $12,125 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,560 | TotalAmt |
| Program Services | $43,979 | ProgramServicesAmt |
| Management And General | $23,581 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $584 | TotalAmt |
| Management And General | $146 | ManagementAndGeneralAmt |
| Fundraising | $438 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,901 | TotalAmt |
| Management And General | $9,901 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,590 | TotalAmt |
| Program Services | $19,672 | ProgramServicesAmt |
| Management And General | $4,918 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $794 | TotalAmt |
| Management And General | $794 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,684 | TotalAmt |
| Program Services | $8,715 | ProgramServicesAmt |
| Management And General | $969 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,123 | TotalAmt |
| Management And General | $6,123 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DONATED SUPPLIES | $100,434 | $100,434 | |
| SUPPLIES | $7,471 | $2,564 | $4,907 |
| TELEPHONE/COMMUNICATIONS | $4,453 | $4,453 | |
| BLDG MAINTENANCE/JANITOR | $4,254 | $3,750 | $504 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,779 | TotalAmt |
| Program Services | $1,211 | ProgramServicesAmt |
| Management And General | $3,568 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366,369 | TotalAmt |
| Program Services | $235,851 | ProgramServicesAmt |
| Management And General | $130,080 | ManagementAndGeneralAmt |
| Fundraising | $438 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,138 | BOYAmt |
| EOY | $122,774 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,250 | BOYAmt |
| EOY | $12,124 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,500 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $99,663 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $88,100 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,134 | BOYAmt |
| EOY | $11,563 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,522 | BOYAmt |
| EOY | $148,961 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $791 | BOYAmt |
| EOY | $749 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $791 | BOYAmt |
| EOY | $749 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,731 | BOYAmt |
| EOY | $54,287 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $93,925 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,731 | BOYAmt |
| EOY | $148,212 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,522 | BOYAmt |
| EOY | $148,961 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $88,481 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | $190,785 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $181,259 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $274,061 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $189,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $419,707 | CurrentTaxYearAmt |
| Total | $1,255,312 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $190,785 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $181,259 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $274,061 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $189,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $419,707 | CurrentTaxYearAmt |
| Total | $1,255,312 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,255,312 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $74 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus1 Year | $47 | CurrentTaxYearMinus1YearAmt |
| Total | $121 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $42,085 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $45,478 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $66,463 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $64,822 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $48,179 | CurrentTaxYearAmt |
| Total | $267,027 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,522,460 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $5,716 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.82450 | PublicSupportCY170Pct |
| Public Support PY170 | 0.81010 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, LINE 10 | FormAndLineReferenceDesc |
| Explanation | GROSS FUND RAISING 218,848 | ExplanationTxt |
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
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $99,663 | OtherCostOrOtherBasisAmt |
| Depreciation | $88,100 | DepreciationAmt |
| Book Value | $11,563 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,563 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $1,485,800 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $1,000,898 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $30,052 | OtherRevenueAmt |
| Revenue Not Reported | $1,030,950 | RevenueNotReportedAmt |
| Revenue Subtotal | $454,850 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $454,850 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,397,319 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $1,000,898 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $30,052 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,030,950 | ExpensesNotReportedAmt |
| Expenses Subtotal | $366,369 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $366,369 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | DIRECT COST OF FUND RAISING EVENTS 30,052 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | DIRECT COST OF FUND RAISING EVENTS 30,052 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | DANCE | Event1Nm |
| Gross Receipts Event1 | $27,930 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $27,930 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $4,524 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF TOURNMENT | Event2Nm |
| Gross Receipts Event2 | $20,249 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $20,249 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $14,228 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $48,179 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $48,179 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $18,752 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $18,752 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $29,427 | NetIncomeSummaryAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GROUP SIX PROPERTIES 1 LTD LP | BusinessNameLine1Txt |
| Business Name Line2 | 57529 | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | MEMBER | RelationshipDescriptionTxt |
| Transaction | $93,891 | TransactionAmt |
| Transaction | RENT OF FACILITIES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $100,434 | NoncashContributionsRptF990Amt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | SOFTWARE | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $8,030 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE M, PAGE 2, PART II | FormAndLineReferenceDesc |
| Explanation | NUMBER OF CONTRIBUTIONS BEING REPORTED | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, ITEM B | AUDIT COMPLETED SUBSEQUENT TO ORIGINAL RETURN BEING FILED. RETURN AMENDED TO REFLECT AUDITED AMOUNTS. NO MATERIAL CHANGE IN REVENUES LESS EXPENSES, ASSETS,OR LIABILITIES. A PORTION OF UNRESTRICTED NET ASSETS WERE RECLASSIFIED TO RESTRICTED NET ASSETS. |
| FORM 990 | OUR MEDICAL PARTNERS PROVIDED OVER 907,000 IN SERVICES TO OUR PATIENTS IN 2015 CALCULATION OF ADMINISTRATIVE/FUNDRAISING EXPENSE PERCENTAGE: THIS CALCULATION AS PERFORMED ON PART IX STATEMENT OF FUNCTIONAL EXPENSES OF THIS FORM 990, RESULTS IN A PERCENTAGE OF 35.6%. HOWEVER, THE FAYETE CARE CLINIC IS DEPENDENT UNPON IT'S VOLUNTEERS AND HEALTH CARE PARTNERS DONATING SERVICES TO ACHIEVE IT'S MISSION. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THESE DONATED SERVICES TO BE RECORDED INTO FAYETTE CARE CLINIC'S FINANCIAL STATEMENTS. HOWEVER PER INTERNAL REVENUE SERVICE REGULATIONS THESE SERVICES ARE NOT REPORTED AS PROGRAM EXPENSES ON THE FORM 990. SEE SCHEDULE D PARTS XI AND XII FOR A RECONCILATION OF THE AUDITED FINANCIAL STATEMENTS TO THIS FORM 990. CALCULATING THE ADMINSTRATIVE/FUNDRAISING PERCENTAGE PER THE STATEMENT OF FUNCTIONAL EXPENSES INCLUDED IN THE AUDITED FINANCIAL STATEMENTS, RESULTS IN AN ADMINISTRATIVE/FUNDRAISING EXPENSE PERCENTAGE OF 12.8%, WHICH FAYETTE CARE CLINIC BELIEVES TO BE A TRUE REPRESENTATION OF ITS ADMINISTRATIVE/FUNDRAISING PERCENTAGE. |
| FORM 990, PAGE 1, PART I, LINE 6 | FATETTE CARE CLINIC, INC IS DEPENDENT ON ITS VOLUNTEERS. VOLUNTEERS PROVIDE MEDICAL, DENTAL, EDUCATIONAL AND ADMINISTRATIVE SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE RETURN IS GIVEN TO EACH MEMBER OF THE BOARD BEFORE THE RETURN IS FILED. IF NO CORRECTIONS ARE SUGGESTED, THE RETURN IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION OF THE EXECUTIVE DIRECTOR IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. REFERENCE IS MADE TO COMPENSATION PAID BY COMPARABLE ORGANIZATIONS,BUT LIMITED BY BUDGET RESTRAINTS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | N/A |
| FORM 990, PAGE 6, PART VI, LINE 19 | COPIED AND DISTRIBUTED UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | SUB-CONTRACTOR FEE 43,979 23,581 0 |
| FORM 990, PART XI, LINE 9 | DIRECT COST OF FUND RAISING EVENTS 30,052 DIRECT COST OF FUND RAISING EVENTS -30,052 |