CULPEPER WELLNESS FOUNDATION: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
CULPEPER WELLNESS FOUNDATION (EIN 52-1366700)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-07-26
IRS object ID
201742079349301014
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-07-26T17:09:27-05:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN540737372PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PBMARES LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1558 SOUTH MAIN STREETAddressLine1Txt
CityHARRISONBURGCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22801ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN521366700EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CULPEPER WELLNESS FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCULPBusinessNameControlTxt
Phone5407122763PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1311 S EAST STREET NO 100AddressLine1Txt
CityCULPEPERCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22701ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSHARI J LANDRYPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone5407122763PhoneNum
Signature2017-07-25SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKEVIN HUMPHRIESPreparerPersonNm
PTINP00168667PTIN
Phone5404345975PhoneNum
Preparation2017-07-25PreparationDt
Self EmployedYes (X)SelfEmployedInd

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address209.10.80.132IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-07-25IPDt
IP Tm16:45:38IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id6C9B1A35775087DBDB8A6D25ECA509C7F6C27838AtSubmissionCreationDeviceId
At Submission Filing Device Id5F959D9A16E0A040EA892075FF8FC87BA2D97E9EAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSHARI J LANDRYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1311 S EAST STREET NO 100AddressLine1Txt
CityCULPEPERCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22701ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,080,095GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CULPEPERWELLNESSFOUNDATION.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1985FormationYr
Legal Domicile StateVALegalDomicileStateCd
Activity Or MissionTHE MISSION OF THE CULPEPER WELLNESS FOUNDATION IS TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED OF CULPEPER, ORANGE, AND MADISON COUNTIES BY ESTABLISHING AND/OR SUPPORTING INITIATIVES CENTERED ON IMPROVING THE PHYSICAL, BEHAVORIAL AND SOCIAL HEALTH OF THOSE SERVED.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee112TotalEmployeeCnt
Total Volunteers58TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$218,962PYContributionsGrantsAmt
CY Contributions Grants$398,274CYContributionsGrantsAmt
PY Program Service Revenue$456,652PYProgramServiceRevenueAmt
CY Program Service Revenue$1,819,679CYProgramServiceRevenueAmt
PY Investment Income$589,924PYInvestmentIncomeAmt
CY Investment Income$437,616CYInvestmentIncomeAmt
PY Other Revenue$155,775PYOtherRevenueAmt
CY Other Revenue$531,559CYOtherRevenueAmt
PY Total Revenue$1,421,313PYTotalRevenueAmt
CY Total Revenue$3,187,128CYTotalRevenueAmt
PY Grants And Similar Paid$68,282PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$151,277CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$345,512PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,838,844CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$1,744CYTotalFundraisingExpenseAmt
PY Other Expenses$547,477PYOtherExpensesAmt
CY Other Expenses$1,596,342CYOtherExpensesAmt
PY Total Expenses$961,271PYTotalExpensesAmt
CY Total Expenses$3,586,463CYTotalExpensesAmt
PY Revenues Less Expenses$460,042PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$399,335CYRevenuesLessExpensesAmt
Total Assets BOY$33,618,402TotalAssetsBOYAmt
Total Assets EOY$33,571,108TotalAssetsEOYAmt
Total Liabilities BOY$270,880TotalLiabilitiesBOYAmt
Total Liabilities EOY$233,378TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$33,347,522NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$33,337,730NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE MISSION OF THE CULPEPER WELLNESS FOUNDATION IS TO IMPROVE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED OF CULPEPER, ORANGE, AND MADISON COUNTIES BY ESTABLISHING AND/OR SUPPORTING INITIATIVES CENTERED ON IMPROVING THE PHYSICAL, BEHAVORIAL AND SOCIAL HEALTH OF THOSE SERVED.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,278,923ExpenseAmt
Revenue$1,848,233RevenueAmt
DescPOWELL WELLNESS CENTER HELPS INDIVIDUALS ACHIEVE PHYSICAL AND EMOTIONAL WELL-BEING THROUGH EXERCISE, PHYSICAL ACTIVITY, AND MEDICALLY INTEGRATED SERVICES.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$557,125ExpenseAmt
DescTHE FREE CLINIC OF CULPEPER DELIVERS HIGH QUALITY MEDICAL CARE TO UNINSURED ADULTS IN CULPEPER COUNTY.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$151,277ExpenseAmt
Grant$151,277GrantAmt
DescTHE FOUNDATION SEEKS TO CULTIVATE AND SUPPORT HEALTHY LIVING GRANTS TO LOCAL COMMUNITY CHARITIES IN THE FURTHERENCE OF ITS MISSION.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$2,987,325TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document27IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee112EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DEBRA DODSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5407122763PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1311 S EAST STREET SUITE 100AddressLine1Txt
CityCULPEPERCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22701ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
CATHY DALRYMPLE
CHAIR4.00Yes (X)Yes (X)$0$0$0
RICHARD HARRINGTON
VICE CHAIR2.00Yes (X)Yes (X)$0$0$0
CHARLES BARRELL
TREASURER4.00Yes (X)Yes (X)$0$0$0
CONNIE KINCHELOE
SECRETARY2.00Yes (X)Yes (X)$0$0$0
TRIPP BUTLER
DIRECTOR2.00Yes (X)$0$0$0
NANCY CANNON
DIRECTOR2.00Yes (X)$0$0$0
JAMIE CLANCEY
DIRECTOR2.00Yes (X)$0$0$0
LAURA GRIGSBY
DIRECTOR2.00Yes (X)$0$0$0
GREG NAPPS
DIRECTOR2.00Yes (X)$0$0$0
CHARLES PERRYMAN
DIRECTOR2.00Yes (X)$0$0$0
DR THOMAS REYNOLDS MD
DIRECTOR2.00Yes (X)$0$0$0
DR BREVARD WALLACE MD
DIRECTOR2.00Yes (X)$0$0$0
SHARI J LANDRY
PRESIDENT40.00Yes (X)$58,238$0$4,196
LILLY BUNCH
ACTING EXECUTIVE DIRECTOR (UNTIL JULY 2016)40.00Yes (X)$61,013$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$119,251TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$4,196TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$8,651FederatedCampaignsAmt
Fundraising$35,773FundraisingAmt
Government Grants$15,500GovernmentGrantsAmt
All Other Contributions$338,350AllOtherContributionsAmt
Noncash Contributions$164,479NoncashContributionsAmt
Total Contributions$398,274TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEMBERSHIP DUES713940$1,466,146$1,466,146
OTHER FEE REVENUE713940$353,533$353,533
FieldValueIRS element (for citing)
Total Program Service Revenue$1,819,679TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$312,930TotalRevenueColumnAmt
Exclusion$312,930ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$719,821RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$208,866RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$510,955RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$510,955TotalRevenueColumnAmt
Exclusion$510,955ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$750,036SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$598,157SecuritiesAmt
Other$27,193OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$151,879SecuritiesAmt
Other-$27,193OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$124,686TotalRevenueColumnAmt
Exclusion$124,686ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$18,147FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$35,773ContriRptFundraisingEventAmt
Fundraising Direct Expenses$26,097FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$7,950TotalRevenueColumnAmt
Exclusion-$7,950ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$61,208GrossSalesOfInventoryAmt
Cost Of Goods Sold$32,654CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$28,554TotalRevenueColumnAmt
Related Or Exempt Func Income$28,554RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,187,128TotalRevenueColumnAmt
Related Or Exempt Func Income$1,848,233RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$940,621ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$151,277TotalAmt
Program Services$151,277ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$123,447TotalAmt
Management And General$123,447ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,434,478TotalAmt
Program Services$1,363,140ProgramServicesAmt
Management And General$71,338ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$19,447TotalAmt
Program Services$15,125ProgramServicesAmt
Management And General$4,322ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$139,627TotalAmt
Program Services$138,785ProgramServicesAmt
Management And General$842ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$121,845TotalAmt
Program Services$95,046ProgramServicesAmt
Management And General$26,799ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$3,973TotalAmt
Program Services$996ProgramServicesAmt
Management And General$2,977ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$96,947TotalAmt
Program Services$70,736ProgramServicesAmt
Management And General$26,211ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$104,385TotalAmt
Management And General$104,385ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$132,724TotalAmt
Program Services$62,175ProgramServicesAmt
Management And General$70,549ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$57,251TotalAmt
Program Services$35,448ProgramServicesAmt
Management And General$20,059ManagementAndGeneralAmt
Fundraising$1,744FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$76,230TotalAmt
Program Services$54,903ProgramServicesAmt
Management And General$21,327ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$461,973TotalAmt
Program Services$391,572ProgramServicesAmt
Management And General$70,401ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$28,291TotalAmt
Program Services$10,364ProgramServicesAmt
Management And General$17,927ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$409,475TotalAmt
Program Services$390,046ProgramServicesAmt
Management And General$19,429ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$70,877TotalAmt
Program Services$56,334ProgramServicesAmt
Management And General$14,543ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES AND DR$95,305$95,305
PROGRAM SUPPLIES$50,076$50,076
DUES & SUBSCRIPTIONS$5,908$3,070$2,838
LAUNDRY$2,927$2,927

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,586,463TotalAmt
Program Services$2,987,325ProgramServicesAmt
Management And General$597,394ManagementAndGeneralAmt
Fundraising$1,744FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,361,217BOYAmt
EOY$855,562EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
EOY$100,000EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,833,400BOYAmt
EOY$3,349,000EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$29,529BOYAmt
EOY$23,103EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$10,000BOYAmt
EOY$19,835EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$52,576BOYAmt
EOY$43,543EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$19,108,403LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$6,635,383LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,159,965BOYAmt
EOY$12,473,020EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$16,171,715BOYAmt
EOY$16,707,045EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$33,618,402BOYAmt
EOY$33,571,108EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$126,570BOYAmt
EOY$162,479EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$68,282BOYAmt
EOY$34,195EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$17,745BOYAmt
EOY$9,367EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$58,283BOYAmt
EOY$27,337EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$270,880BOYAmt
EOY$233,378EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$29,054,261BOYAmt
EOY$29,988,730EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,293,261BOYAmt
EOY$3,349,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$33,347,522BOYAmt
EOY$33,337,730EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$33,618,402BOYAmt
EOY$33,571,108EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$399,335ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$424,943NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$35,400OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$430,790CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$453,777CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$861,426CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$218,962CurrentTaxYearMinus1YearAmt
Current Tax Year$398,274CurrentTaxYearAmt
Total$2,363,229TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,878,368CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,754,573CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,808,690CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$456,652CurrentTaxYearMinus1YearAmt
Current Tax Year$1,880,888CurrentTaxYearAmt
Total$9,779,171TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,309,158CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,208,350CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,670,116CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$675,614CurrentTaxYearMinus1YearAmt
Current Tax Year$2,279,162CurrentTaxYearAmt
Total$12,142,400TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$12,142,400PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,155,695CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,198,371CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,077,263CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$752,913CurrentTaxYearMinus1YearAmt
Current Tax Year$1,032,751CurrentTaxYearAmt
Total$5,216,993TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,155,695CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,198,371CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,077,263CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$752,913CurrentTaxYearMinus1YearAmt
Current Tax Year$1,032,751CurrentTaxYearAmt
Total$5,216,993TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,464,853CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,406,721CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,747,379CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,428,527CurrentTaxYearMinus1YearAmt
Current Tax Year$3,311,913CurrentTaxYearAmt
Total$17,359,393TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.69950PublicSupportCY509Pct
Investment Income CY0.30050InvestmentIncomeCYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART III, SECTION D, LINE 19ACULPEPER WELLNESS FOUNDATION CHANGED ITS TAX YEAR ENDING FROM SEPTEMBER 30 TO DECEMBER 31, EFFECTIVE DECEMBER 31, 2015. THE FOUNDATION FILED A SHORT YEAR RETURN FOR THE PRIOR PERIOD (OCTOBER 1, 2015 THROUGH DECEMBER 31, 2015). THE FOUNDATION IS FILING THIS RETURN BASED ON A CALENDAR YEAR ENDING DECEMBER 31 AND WILL FILE FUTURE RETURNS BASED ON THIS SAME CALENDAR YEAR ENDING. THIS CHANGE IS IN ACCORDANCE WITH REV. PROC. 85-58.
PART III, SECTION C, LINE 162016 IS THE FIRST YEAR FOR WHICH THE ORGANIZATION IS FILING AS A PUBLIC CHARITY UNDER SECTION 509(A)(2). AS SUCH, THE PUBLIC SUPPORT SCHEDULE WAS COMPILED USING THE ORGANIZATION'S FORM 990 FOR THE PAST FOUR YEARS AS WELL AS CURRENT YEAR ACCOUNTING RECORDS. BECAUSE THIS IS THE FIRST YEAR FOR THE PUBLIC SUPPORT CALCULATIONS THERE ARE NO PRIOR YEAR PERCENTAGES.

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,413,628BeginningYearBalanceAmt
Investment Earnings Or Losses$216,855InvestmentEarningsOrLossesAmt
Other Expenditures$223,699OtherExpendituresAmt
End Year Balance$2,406,784EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,399,295BeginningYearBalanceAmt
Investment Earnings Or Losses$28,018InvestmentEarningsOrLossesAmt
Other Expenditures$13,685OtherExpendituresAmt
End Year Balance$2,413,628EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$201,667BeginningYearBalanceAmt
Contributions-$201,667ContributionsAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$195,052BeginningYearBalanceAmt
Investment Earnings Or Losses$6,615InvestmentEarningsOrLossesAmt
End Year Balance$201,667EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$197,250BeginningYearBalanceAmt
Investment Earnings Or Losses-$2,198InvestmentEarningsOrLossesAmt
End Year Balance$195,052EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,378,632OtherCostOrOtherBasisAmt
Book Value$2,378,632BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,505,732OtherCostOrOtherBasisAmt
Depreciation$5,754,823DepreciationAmt
Book Value$9,750,909BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,798OtherCostOrOtherBasisAmt
Depreciation$824DepreciationAmt
Book Value$18,974BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,060,831OtherCostOrOtherBasisAmt
Depreciation$781,676DepreciationAmt
Book Value$279,155BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$143,410OtherCostOrOtherBasisAmt
Depreciation$98,060DepreciationAmt
Book Value$45,350BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$12,473,020TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescANNUITY PAYABLEDesc
Amt$27,337Amt
FieldValueIRS element (for citing)
Total Liability$27,337TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$4,408,998TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$424,943NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts$633,695DonatedServicesAndUseFcltsAmt
Other Revenue$267,617OtherRevenueAmt
Revenue Not Reported$1,326,255RevenueNotReportedAmt
Revenue Subtotal$3,082,743RevenueSubtotalAmt
Investment Expenses Not Incld$104,385InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$104,385RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$3,187,128TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$4,418,790TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$633,695DonatedServicesUseFcltsAmt
Other Expenses Included$303,017OtherExpensesIncludedAmt
Expenses Not Reported$936,712ExpensesNotReportedAmt
Expenses Subtotal$3,482,078ExpensesSubtotalAmt
Investment Expenses Not Incld2$104,385InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$104,385ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$3,586,463TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER CODE SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE). IN ADDITION, CWF QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) OF THE CODE AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE ORGANIZATION UNDER CODE SECTION 509(A)(2). PWC IS A LIMITED LIABILITY COMPANY THAT HAS NOT ELECTED TO BE TAXED AS A CORPORATION UNDER CURRENT INTERNAL REVENUE SERVICE REGULATIONS. AS SUCH, PWC IS A DISREGARDED ENTITY FOR FEDERAL INCOME TAX PURPOSES AND DOES NOT HAVE TO FILE AN ANNUAL FEDERAL RETURN. RATHER, ITS TAX RESULTS ARE REFLECTED ON THE ANNUAL TAX FILINGS OF ITS MEMBER AS IF THE ACTIVITIES OF PWC WERE ACTIVITIES OF THE MEMBER. PRIOR TO OCTOBER 1, 2014, THE ORGANIZATION WAS CLASSIFIED AS A FUNCTIONALLY RELATED SUPPORTING ORGANIZATION OF CULPEPER REGIONAL HOSPITAL. DURING 2014, THE ORGANIZATION'S INTEREST IN THE HOSPITAL WAS ACQUIRED BY ANOTHER HOSPITAL SYSTEM. THE ORGANIZATION HAS SINCE TRANSITIONED TO SERVE A GREATER PUBLIC INTEREST AND RECEIVED A CHANGE IN EXEMPT CLASSIFICATION WITH THE INTERNAL REVENUE SERVICE TO ACCOMMODATE ITS CHANGE IN MISSION. MANAGEMENT EVALUATED THE ORGANIZATION'S TAX POSITIONS AND DETERMINED THAT THE ORGANIZATION HAS NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AT DECEMBER 31, 2016. THE ORGANIZATION FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, ANNUALLY WITH THE UNITED STATES DEPARTMENT OF THE TREASURY.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 208,866. FUNDRAISING EVENT EXPENSES 26,097. COST OF GOODS SOLD 32,654.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 208,866. FUNDRAISING EVENT EXPENSES 26,097. COST OF GOODS SOLD 32,654. LOSS ON UNCOLLECTIBLE PLEDGES 35,400.
SCHEDULE D, PART V, LINE 4QUASI-ENDOWMENT FUNDS ARE INTENDED TO PROVIDE INCOME TO SUPPLEMENT GRANTS AWARDED AND OTHER GENERAL FOUNDATION OPERATIONS.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1OYSTER FESTEvent1Nm
Gross Receipts Event1$53,920GrossReceiptsEvent1Amt
Charitable Contri Event1$35,773CharitableContriEvent1Amt
Gross Revenue Event1$18,147GrossRevenueEvent1Amt
Rent Facility Costs Event1$5,502RentFacilityCostsEvent1Amt
Food And Beverage Event1$18,346FoodAndBeverageEvent1Amt
Entertainment Event1$500EntertainmentEvent1Amt
Other Direct Expenses Event1$1,749OtherDirectExpensesEvent1Amt
Gross Receipts Total$53,920GrossReceiptsTotalAmt
Charitable Contributions Tot$35,773CharitableContributionsTotAmt
Gross Revenue Total Events$18,147GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$5,502RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$18,346FoodAndBeverageTotalEventsAmt
Entertainment Total Events$500EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$1,749OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$26,097DirectExpenseSummaryEventsAmt
Net Income Summary-$7,950NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
AG RICHARDSON ELEMENTARY SCHOOL
18370 SIMMS DRIVECULPEPERVA22701546001238$8,576PROJECT DRUMFIT: PHYSICAL ACTIVITY PROGRAM.
CULPEPER WINTER HEAT SHELTER PROGRAM
1200 OLD RIXEYVILLE ROADCULPEPERVA22701541704431$7,500INCREASE SHELTER CAPACITY: INCREASE CAPACITY AT THE WINTER HEAT SHELTER AT ST. LUKE'S.
PIEDMONT REGIONAL DENTAL CLINIC
13296 JAMES MADISON HIGHWAY SUITE BORANGEVA22960270625764$7,600EQUIPMENT FOR OFFSITE WORK: PROVIDE DENTAL HYGIENE SERVICES INCLUDING ADULT TEETH CLEANING AND EDUCATION OUTSIDE THE DENTAL CLINIC LOCATION ($2,600), DENTAL CARE ($5,000)
RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES
PO BOX 1568CULPEPERVA22701237238218$17,000UNDER AGE TOBACCO & NICOTINE USE EDUCATION INITIATIVE ($10,000), CIT COORDINATOR ($7,000)
THE MANNA MINISTRY
215 S MAIN STREETCULPEPERVA22701546044240$10,000KITCHEN EQUIPMENT: TO FACILITATE THE PREPARATION OF FOOD FOR THE WEEKLY MINISTRY, FACILITATE BETTER REFRIGERATION, AND ELIMINATE RECURRING REPAIR COSTS.
VERDUN ADVENTURE BOUND
17044 ADVENTURE BOUND TRAILRIXEYVILLEVA22737541937517$10,000PILOT PROGRAM FOR UPCOMING MIDDLE SCHOOL CHILDREN: TRANSITIONING CULPEPER COUNTY PUBLIC SCHOOLS 5TH GRADERS TO MIDDLE SCHOOL.
CULPEPER COUNTY PUBLIC SCHOOLS
450 RADIO LANECULPEPERVA22701546001238$14,195YOUTH RISK BEHAVIOR SURVEY
FieldValueIRS element (for citing)
Total501c3 Org7Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION MAINTAINS CLEAR CRITERIA FOR THE HEALTHY LIVING GRANT PROGRAM AND STRATEGIC GRANTS ARE MADE ONLY BY BOARD APPROVAL. THE ORGANIZATION MANDATES THAT FUNDS AWARDED MUST BE USED WITHIN 90 DAYS OF BEING GRANTED AND STAYS IN CLOSE COMMUNICATION WITH GRANTEES TO MONITOR THEIR USE. GRANTEES MUST PROVIDE A FINAL ACCOUNTING ON THE USE OF FUNDS, INCLUDING THE POPULATION SERVED AND HEALTH IMPACT. REPORTS MUST BE COMPLETED WITHIN 30 DAYS OF PROJECT COMPLETION.ExplanationTxt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution28ContributionCnt
Noncash Contributions Rpt F990$164,479NoncashContributionsRptF990Amt
Method Of Determining RevenuesFREE CLINIC RECORDSMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, COLUMN (B):FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION IS REPORTING IN PART I, COLUMN (B), THE NUMBER OF CONTRIBUTIONS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BFORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM, REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND MADE AVAILABLE TO THE BOARD MEMBERS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CBOARD MEMBERS ARE REQUIRED TO AFFIRM THEIR COMMITMENT TO UPHOLD THE CONFLICT OF INTEREST POLICY ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15ATHE BOARD WILL REVIEW AND DETERMINE ANNUALLY COMPENSATION OF OFFICERS OR KEY EMPLOYEES. FOR THIS REPORTING PERIOD, COMPENSATION WAS DETERMINED BY BOARD APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:LOSS ON UNCOLLECTIBLE PLEDGES -35,400.
FORM 990, PART XII, LINE 2CTHE ORGANIZATION HAS NOT CHANGED ITS PROCESS FOR THE SELECTION AND OVERSIGHT OF AN INDEPENDENT ACCOUNTANT.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1POWELL WELLNESS CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11005 GOLF DRIVEAddressLine1Txt
CityCULPEPERCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22701ZIPCd
FieldValueIRS element (for citing)
EIN204803079EIN
Primary ActivitiesWELLNESS CENTERPrimaryActivitiesTxt
Legal Domicile StateVALegalDomicileStateCd
Total Income$752,687TotalIncomeAmt
End Of Year Assets$8,805,175EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CWFBusinessNameLine1Txt

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