PENN YAN VOLUNTEER AMBULANCE CORPS INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- PENN YAN VOLUNTEER AMBULANCE CORPS INC (EIN 23-7216568)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-04-01
- IRS object ID
- 201730919349300603
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-04-01T10:13:38-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161092347 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENGEL METZGER BARR & CO LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 475 N MAIN STREET | AddressLine1Txt |
| City | CANANDAIGUA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14424 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237216568 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PENN YAN VOLUNTEER AMBULANCE CORPS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PENN | BusinessNameControlTxt |
| Phone | 3155362714 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 272 | AddressLine1Txt |
| City | PENN YAN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14527 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRIAN CHAMPLIN | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 3155362714 | PhoneNum |
| Signature | 2017-03-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KRISTINA STAMATIS | PreparerPersonNm |
| PTIN | P00967056 | PTIN |
| Phone | 5854231860 | PhoneNum |
| Preparation | 2017-03-21 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 24.39.170.122 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-03-21 | IPDt |
| IP Tm | 10:27:30 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 47C8FC3DBD232B65738599601FF5DFA505C221FA | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A826D7F100B0D615BD79AA9ED228F6E5404D4862 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BRIAN CHAMPLIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 272 | AddressLine1Txt |
| City | PENN YAN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14527 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $469,536 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | PENNYANAMBULANCE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | VOLUNTEER AMBULANCE SERVICES TO RESIDENTS OF PENN YAN NY AND THE SURROUNDING TOWNS AND VILLAGES VIA THE MUTUAL AID SYSTEM | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Volunteers | 45 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,562 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,315 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $452,188 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $388,262 | CYProgramServiceRevenueAmt |
| PY Investment Income | $53,001 | PYInvestmentIncomeAmt |
| CY Investment Income | $67,561 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $509,751 | PYTotalRevenueAmt |
| CY Total Revenue | $459,138 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $45,594 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $42,321 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $390,435 | PYOtherExpensesAmt |
| CY Other Expenses | $401,257 | CYOtherExpensesAmt |
| PY Total Expenses | $436,029 | PYTotalExpensesAmt |
| CY Total Expenses | $443,578 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $73,722 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $15,560 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,054,745 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,145,882 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,406 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $786 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,039,339 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,145,096 | NetAssetsOrFundBalancesEOYAmt |
| Mission | VOLUNTEER AMBULANCE SERVICES TO RESIDENTS OF PENN YAN NY AND THE SURROUNDING TOWNS AND VILLAGES VIA THE MUTUAL AID SYSTEM | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $290,256 | ExpenseAmt |
| Revenue | $388,262 | RevenueAmt |
| Desc | PROVIDED EMERGENCY AND NON EMERGENCY TRANSPORTATION AND INITIAL MEDICAL ASSISTANCE TO MEMBERS OF THE SERVICED COMMUNITY | Desc |
| Total Program Service Expenses | $290,256 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 2 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | 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 | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BETH FAHNESTOCK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3156942625 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3275 E SHERMAN HOLLOW RD | AddressLine1Txt |
| City | PENN YAN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14527 | 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 |
|---|---|---|---|---|---|---|
| MICHAEL T HEALY | ||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |
| NATE HOFFMAN | ||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |
| CYNDI DAVIS | ||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | |
| JASON JOHNSON | ||||||
| DIRECTOR | 40.00 | Yes (X) | $0 | $0 | $0 | |
| WESLEY YOUNGMAN | ||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |
| BRIAN LAURSEN | ||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |
| LEEANN OVENS | ||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | |
| BRIAN CHAMPLIN | ||||||
| PRESIDENT | 5.00 | $0 | $0 | $0 | Yes (X) | |
| BETH FAHNESTOCK | ||||||
| VICE PRESIDENT | 8.00 | $0 | $0 | $0 | Yes (X) | |
| DOMINIC FONTE | ||||||
| TREASURER | 8.00 | $0 | $0 | $0 | Yes (X) | |
| KIM WILLIAMS | ||||||
| SECRETARY | 5.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOLDIERS & SAILORS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 418 NORTH MAIN STREET | AddressLine1Txt |
| City | PENN YAN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14527 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | STAFF LEASING | ServicesDesc |
| Compensation | $105,800 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $3,315 | AllOtherContributionsAmt |
| Total Contributions | $3,315 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENU | Desc |
| Business | 621910 | BusinessCd |
| Total Revenue Column | $388,262 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $388,262 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $388,262 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $67,959 | TotalRevenueColumnAmt |
| Exclusion | $67,959 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,000 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,398 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$398 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$398 | TotalRevenueColumnAmt |
| Exclusion | -$398 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $459,138 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $388,262 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $67,561 | 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 | $36,484 | TotalAmt |
| Management And General | $36,484 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,250 | TotalAmt |
| Management And General | $2,250 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,587 | TotalAmt |
| Management And General | $3,587 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,058 | TotalAmt |
| Management And General | $5,058 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,135 | TotalAmt |
| Management And General | $2,135 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,773 | TotalAmt |
| Program Services | $96,773 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,220 | TotalAmt |
| Management And General | $8,220 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,629 | TotalAmt |
| Management And General | $5,629 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,037 | TotalAmt |
| Management And General | $10,037 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,366 | TotalAmt |
| Program Services | $8,366 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,278 | TotalAmt |
| Management And General | $23,278 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,454 | TotalAmt |
| Program Services | $67,598 | ProgramServicesAmt |
| Management And General | $856 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,107 | TotalAmt |
| Program Services | $28,107 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $54,193 | $54,193 | |
| BILLING SERVICE COSTS | $38,197 | $38,197 | |
| EQUIPMENT REPAIRS | $35,219 | $35,219 | |
| SHARED FEES ALS | $12,840 | $12,840 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,751 | TotalAmt |
| Management And General | $4,751 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $443,578 | TotalAmt |
| Program Services | $290,256 | ProgramServicesAmt |
| Management And General | $153,322 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$10,727 | BOYAmt |
| EOY | -$9,083 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,845 | BOYAmt |
| EOY | $111,730 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,583 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,000 | BOYAmt |
| EOY | $26,000 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,387,899 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $990,154 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $423,304 | BOYAmt |
| EOY | $397,745 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,471,740 | BOYAmt |
| EOY | $1,619,490 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,054,745 | BOYAmt |
| EOY | $2,145,882 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,406 | BOYAmt |
| EOY | $786 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,406 | BOYAmt |
| EOY | $786 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,039,339 | BOYAmt |
| EOY | $2,145,096 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,039,339 | BOYAmt |
| EOY | $2,145,096 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,054,745 | BOYAmt |
| EOY | $2,145,882 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $15,560 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $90,197 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,490 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,140 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,245 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,562 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,315 | CurrentTaxYearAmt |
| Total | $21,752 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $383,063 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $395,396 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $388,883 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $452,188 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $388,262 | CurrentTaxYearAmt |
| Total | $2,007,792 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $389,553 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $401,536 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $390,128 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $456,750 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $391,577 | CurrentTaxYearAmt |
| Total | $2,029,544 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $2,029,544 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $123,683 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $98,799 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $60,533 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $57,832 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $67,959 | CurrentTaxYearAmt |
| Total | $408,806 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $123,683 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $98,799 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $60,533 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $57,832 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $67,959 | CurrentTaxYearAmt |
| Total | $408,806 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $513,236 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $500,335 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $450,661 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $514,582 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $459,536 | CurrentTaxYearAmt |
| Total | $2,438,350 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.83230 | PublicSupportCY509Pct |
| Public Support PY509 | 0.84240 | PublicSupportPY509Pct |
| Investment Income CY | 0.16770 | InvestmentIncomeCYPct |
| Investment Income PY | 0.15760 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $45,532 | InvestmentCostOrOtherBasisAmt |
| Book Value | $45,532 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $522,984 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $396,888 | DepreciationAmt |
| Book Value | $126,096 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $218,316 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $167,953 | DepreciationAmt |
| Book Value | $50,363 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $601,067 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $425,313 | DepreciationAmt |
| Book Value | $175,754 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $397,745 | TotalBookValueLandBuildingsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | OFFICERS REVIEW AND ACKNOWLEDGE REVIEW OF TAX RETURN PRIOR TO FILING |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY IS REVIEWED AT BOARD MEETING |
| FORM 990, PART VI, SECTION B, LINE 15 | AMONG OTHER INFORMATION, THE BOARD CONSIDERS WAGES PAID BY SIMILAR ORGANIZATIONS IN DETERMINING COMPENSATION |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST AT THE AMBULANCE OFFICE THE TAX DOCUMENTS CAN ALSO BE VIEWED AT GUIDESTAR ORG |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 96,773. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96,773. |
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