CLARKSVILLE MONTGOMERY COUNTYCOMMUNITY HEALTH FOUNDATION INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CLARKSVILLE MONTGOMERY COUNTYCOMMUNITY HEALTH FOUNDATION INC (EIN 20-4862825)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201733199349309293
- 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 | 2017-11-15T15:48:23-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 263683574 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THURMAN CAMPBELL GROUP PLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 324 FRANKLIN ST | AddressLine1Txt |
| City | CLARKSVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37040 | 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 | 204862825 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARKSVILLE-MONTGOMERY COUNTY | BusinessNameLine1Txt |
| Business Name Line2 | COMMUNITY HEALTH FOUNDATION INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLAR | BusinessNameControlTxt |
| Phone | 9318962744 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 SOUTH 2ND ST | AddressLine1Txt |
| City | CLARKSVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37040 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PRISCILLA G STORY | PersonNm |
| Person Title | CHAIRMAN | PersonTitleTxt |
| Phone | 9312212492 | PhoneNum |
| Signature | 2017-10-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JEFFERY PROCTOR | PreparerPersonNm |
| PTIN | P00854519 | PTIN |
| Phone | 9315527474 | PhoneNum |
| Preparation | 2017-11-03 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | A42E0CF4B0CFABFAFDAD50D00CF409967B1ADB50 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 19C3764FD7E16FB4ACA36044FF05FC5449D87197 | 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 | PRISCILLA G STORY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 31003 | AddressLine1Txt |
| City | CLARKSVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37040 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,320,673 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.COMMUNITYHEALTHFOUNDATION.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | TN | LegalDomicileStateCd |
| Activity Or Mission | THE ORGANIZATION IS OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE RESIDENTS OF CLARKSVILLE,TN; MONTGOMERY COUNTY, TN; AND THE COUNTIES OF NORTHERN MIDDLE TN AND FORT CAMPBELL, KY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $2,500,538 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $456,240 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,103,122 | CYInvestmentIncomeAmt |
| PY Other Revenue | $611,017 | PYOtherRevenueAmt |
| CY Other Revenue | $506,702 | CYOtherRevenueAmt |
| PY Total Revenue | $1,067,257 | PYTotalRevenueAmt |
| CY Total Revenue | $4,110,362 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,240,690 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,106,806 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $52,200 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $85,286 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $151,208 | PYOtherExpensesAmt |
| CY Other Expenses | $163,165 | CYOtherExpensesAmt |
| PY Total Expenses | $1,444,098 | PYTotalExpensesAmt |
| CY Total Expenses | $1,355,257 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$376,841 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,755,105 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,171,721 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,070,476 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,758 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $30,637 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,159,963 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,039,839 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE ORGANIZATION IS OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE RESIDENTS OF CLARKSVILLE,TN; MONTGOMERY COUNTY, TN; AND THE COUNTIES OF NORTHERN MIDDLE TN AND FORT CAMPBELL, KY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,139,220 | ExpenseAmt |
| Grant | $1,106,806 | GrantAmt |
| Desc | HEALTH INITIATIVES, EDUCATION, AND PROJECTS SUPPORTING THE COMMUNITY. | Desc |
| Total Program Service Expenses | $1,139,220 | 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 | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | 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 | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | 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 | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | 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 | false | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 2 | EmployeeCnt |
| Employment Tax Returns Filed | false | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | false | 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 | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAULA JOHNSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9318962744 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 SOUTH SECOND ST | AddressLine1Txt |
| City | CLARKSVILLE | CityNm |
| State Abbreviation | TN | StateAbbreviationCd |
| ZIP | 37040 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|
| MARCOS A ARANCIBIA | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| TOMMY BATES | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| JEFF BIBB | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| MICKI DAUGHERTY | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| DAVID DENTON | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JIM DURRETT | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| BEN KIMBROUGH | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| ROSALIND KURITA | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| KYLE LUTHER | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| KIM MCMILLAN | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| KHANDRA SMALLEY | |||||
| SECRETARY/TR | Yes (X) | $0 | $0 | $0 | |
| JOEY SMITH | |||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | |
| PRISCILLA G STORY | |||||
| CHAIRMAN | $0 | $0 | $0 | Yes (X) | |
| 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 |
| Related Organizations | $2,500,538 | RelatedOrganizationsAmt |
| Total Contributions | $2,500,538 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,103,122 | TotalRevenueColumnAmt |
| Exclusion | $1,103,122 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $649,713 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $210,311 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $439,402 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $439,402 | TotalRevenueColumnAmt |
| Exclusion | $439,402 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|
| GRANT MONIES RETURNED | $61,806 | $61,806 |
| OTHER INCOME | $5,494 | $5,494 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $67,300 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,110,362 | TotalRevenueColumnAmt |
| Exclusion | $1,609,824 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,106,806 | TotalAmt |
| Program Services | $1,106,806 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,225 | TotalAmt |
| Program Services | $29,274 | ProgramServicesAmt |
| Management And General | $49,951 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,061 | TotalAmt |
| Program Services | $2,240 | ProgramServicesAmt |
| Management And General | $3,821 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,655 | TotalAmt |
| Management And General | $12,655 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,500 | TotalAmt |
| Management And General | $26,500 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,541 | TotalAmt |
| Management And General | $100,541 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,480 | TotalAmt |
| Management And General | $3,480 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,355 | TotalAmt |
| Program Services | $900 | ProgramServicesAmt |
| Management And General | $2,455 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,000 | TotalAmt |
| Management And General | $12,000 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $307 | TotalAmt |
| Management And General | $307 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,327 | TotalAmt |
| Management And General | $4,327 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,355,257 | TotalAmt |
| Program Services | $1,139,220 | ProgramServicesAmt |
| Management And General | $216,037 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,704 | BOYAmt |
| EOY | $1,347,952 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,248,604 | BOYAmt |
| EOY | $542,993 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $538 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,320 | BOYAmt |
| EOY | $34,281 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,492,920 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,092,039 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,700,770 | BOYAmt |
| EOY | $3,400,881 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,128,392 | BOYAmt |
| EOY | $13,837,950 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,940,931 | BOYAmt |
| EOY | $3,905,881 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,171,721 | BOYAmt |
| EOY | $23,070,476 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,758 | BOYAmt |
| EOY | $30,637 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,758 | BOYAmt |
| EOY | $30,637 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,269,975 | BOYAmt |
| EOY | $19,122,371 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,332,570 | BOYAmt |
| EOY | $3,328,599 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $557,418 | BOYAmt |
| EOY | $588,869 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,159,963 | BOYAmt |
| EOY | $23,039,839 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,171,721 | BOYAmt |
| EOY | $23,070,476 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,755,105 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $126,869 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$2,098 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Community Trust | Yes (X) | CommunityTrustInd |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,000,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,077,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,203,349 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $2,500,538 | CurrentTaxYearAmt |
| Total | $7,780,887 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,000,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,077,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,203,349 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $2,500,538 | CurrentTaxYearAmt |
| Total | $7,780,887 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $7,780,887 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,081,805 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,317,699 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,606,184 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,221,557 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,752,835 | CurrentTaxYearAmt |
| Total | $6,980,080 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $142,088 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $37,518 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $54,583 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $66,300 | CurrentTaxYearAmt |
| Total | $300,489 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $15,061,456 | TotalSupportAmt |
| Public Support CY170 | 0.51660 | PublicSupportCY170Pct |
| Public Support PY170 | 0.46160 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,701,412 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $227,177 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $161,484 | OtherExpendituresAmt |
| Administrative Expenses | $38,362 | AdministrativeExpensesAmt |
| End Year Balance | $3,728,743 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,856,472 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $41,183 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $162,216 | OtherExpendituresAmt |
| Administrative Expenses | $34,027 | AdministrativeExpensesAmt |
| End Year Balance | $3,701,412 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,957,937 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $246,077 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $316,767 | OtherExpendituresAmt |
| Administrative Expenses | $30,775 | AdministrativeExpensesAmt |
| End Year Balance | $3,856,472 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,480,142 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $657,995 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $148,233 | OtherExpendituresAmt |
| Administrative Expenses | $31,967 | AdministrativeExpensesAmt |
| End Year Balance | $3,957,937 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,241,066 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $384,072 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $116,596 | OtherExpendituresAmt |
| Administrative Expenses | $28,400 | AdministrativeExpensesAmt |
| End Year Balance | $3,480,142 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $2,321,020 | InvestmentCostOrOtherBasisAmt |
| Book Value | $2,321,020 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,381,491 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $1,051,198 | DepreciationAmt |
| Book Value | $330,293 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $64,139 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $32,605 | DepreciationAmt |
| Book Value | $31,534 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $721,909 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $4,361 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,236 | DepreciationAmt |
| Book Value | $718,034 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,400,881 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN TRUSTS HELD BY OTHERS | $3,139,874 |
| BENEFICIAL INTEREST IN PERPETUAL TRU | $588,869 |
| CONSTRUCTION IN PROGRESS | $177,138 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,905,881 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $4,347,001 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $126,869 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $109,770 | OtherRevenueAmt |
| Revenue Not Reported | $236,639 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,110,362 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $4,110,362 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,467,125 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $111,868 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $111,868 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,355,257 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,355,257 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | RENTAL EXPENSES NETTED ON TAX RETURN WITH INCOME 210,311 INVESTMENT MGMT FEES NETTED WITH INCOME ON F/S -100,541 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | RENTAL EXPENSES NETTED ON TAX RETURN WITH INCOME 210,311 INVESTMENT MGMT FEES NETTED WITH INCOME ON F/S -100,541 BOOK / TAX DEPRECIATION DIFFERENCE 2,098 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Business Name Line2RecipientBusinessName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|
| AUSTIN PEAY FOUNDATION | ||||||
| PO BOX 4417 | CLARKSVILLE | TN | 37044 | $187,000 | NURSING EDUCATION | |
| FOOD INITIATIVE | ||||||
| 1230 ROSSVIEW ROAD | CLARKSVILLE | TN | 37043 | $64,100 | FOOD INITIATIVE | |
| SAFE SOLDIERS AND FAMILIES | ||||||
| PO BOX 4008 | CLARKSVILLE | TN | 37043 | $142,000 | COUNSELING | EMBRACED |
| YMCA | ||||||
| 260 HILLCREST DR | CLARKSVILLE | TN | 37043 | $67,735 | ABC PROGRAM/RESTORE | |
| LEAP | ||||||
| 1860 WILMA RUDOPH BLVD | CLARKSVILLE | TN | 37040 | $120,000 | INTERVENTION PROGRAM | |
| MANNA CAFE | ||||||
| 1960-J MADISON ST | CLARKSVILLE | TN | 37043 | $69,511 | NUTRITION EDUCATION | |
| REBOOT COMBAT RECOVERY | ||||||
| PO BOX 1223 | FT CAMPBELL | KY | 42223 | $112,500 | PTSD & COMBAT TRAUMA | |
| SEXUAL ASSAULT CENTER | ||||||
| 101 FRENCH LANDING DR | NASHVILLE | TN | 37228 | $136,758 | COUNSELING | |
| AUSTIN PEAY FOUNDATION | ||||||
| PO BOX 4417 | CLARKSVILLE | TN | 37044 | $14,550 | PRIMARY CARE PROGRAM | |
| REBRA BONE DRAPER EVANGELISTIC | ||||||
| 6305 MOON RD | COLUMBUS | GA | 31909 | $15,000 | DRUG/ALCOHOL REHAB | MINISTRIES |
| CMC EDUCATION FOUNDATION | ||||||
| 621 GRACEY AVE | CLARKSVILLE | TN | 37040 | $35,000 | AMBULANCE SIMULATOR | |
| CLARKSVILLE ACADEMY | ||||||
| 710 NORTH 2ND ST | CLARKSVILLE | TN | 37040 | $29,000 | DISC GOLF ROTARY | |
| TN CLEAN WATER | ||||||
| 625 MARKET ST | KNOXVILLE | TN | 37902 | $103,702 | SCHOOL WATER REFILL | BRING TAP BACK |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE ORGANIZATION IS OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE RESIDENTS OF CLARKSVILLE,TN; MONTGOMERY COUNTY, TN; AND THE COUNTIES OF NORTHERN MIDDLE TN AND FORT CAMPBELL, KY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 WAS REVIEWED BY THE CHAIRMAN OF THE BOARD |
| FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC |
| FORM 990, PART XI, LINE 9 | RENTAL EXPENSES NETTED ON TAX RETURN WITH INCOME 210,311 INVESTMENT MGMT FEES NETTED WITH INCOME ON F/S -100,541 RENTAL EXPENSES NETTED ON TAX RETURN WITH INCOME -210,311 INVESTMENT MGMT FEES NETTED WITH INCOME ON F/S 100,541 BOOK / TAX DEPRECIATION DIFFERENCE -2,098 TOTAL -2,098 |
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