COLUMBIA COUNTY VOLUNTEERS INMEDICINE INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- COLUMBIA COUNTY VOLUNTEERS INMEDICINE INC (EIN 20-5695518)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-09
- IRS object ID
- 201603149349302135
- Schema version
- 2015v2.1
- 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 | 2016-11-09T15:36:24-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 464197657 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALL MIHALOS STRAUB & CO | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1426 WYOMING AVENUE | AddressLine1Txt |
| City | FORTY FORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18704 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205695518 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLUMBIA COUNTY VOLUNTEERS | BusinessNameLine1Txt |
| Business Name Line2 | IN MEDICINE CLINIC INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COLU | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 310 E THIRD ST PO BOX 416 | AddressLine1Txt |
| City | MIFFLINVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18631 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOY MCGINNIS | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5707521780 | PhoneNum |
| Signature | 2016-09-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARILYN A DEROLF | PreparerPersonNm |
| PTIN | P01484474 | PTIN |
| Phone | 5707145272 | PhoneNum |
| Preparation | 2016-11-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOY MCGINNIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 519 CEMETARY ROAD | AddressLine1Txt |
| City | BERWICK | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18603 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $150,231 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CCVIM.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE MEDICAL CARE TO THE WORKING UNINSURED OF THE ORGANIZATION'S SERVICE AREA BY OPERATING A VOLUNTEER CLINIC. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 8 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $450 | TotalGrossUBIAmt |
| PY Contributions Grants | $154,788 | PYContributionsGrantsAmt |
| CY Contributions Grants | $142,899 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $652 | CYProgramServiceRevenueAmt |
| CY Investment Income | $1,110 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,970 | PYOtherRevenueAmt |
| CY Other Revenue | $1,573 | CYOtherRevenueAmt |
| PY Total Revenue | $159,758 | PYTotalRevenueAmt |
| CY Total Revenue | $146,234 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $155,474 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $130,236 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $58,989 | PYOtherExpensesAmt |
| CY Other Expenses | $28,592 | CYOtherExpensesAmt |
| PY Total Expenses | $214,463 | PYTotalExpensesAmt |
| CY Total Expenses | $158,828 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$54,705 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$12,594 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $151,506 | TotalAssetsBOYAmt |
| Total Assets EOY | $136,427 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,982 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,708 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $147,524 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $133,719 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE MEDICAL CARE TO THE WORKING UNINSURED OF THE ORGANIZATION'S SERVICE AREA BY OPERATING A VOLUNTEER CLINIC. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $135,606 | ExpenseAmt |
| Desc | BY OPERATING A FREE MEDICAL CLINIC, THE CLINIC WAS ABLE TO PROVIDE THE AREA'S UNINSURED RESIDENTS WITH MEDICAL CARE FOR THE YEAR. THERE WERE OVER 2,000 PATIENT VISITS AND MANY WERE PROVIDED ADDITIONAL SERVICES SUCH AS SUPPORT FOR ONGOING DIRECTION TO OBTAIN MEDICINE, FOOD AND ASSISTANCE. | Desc |
| Total Program Service Expenses | $135,606 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | 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 | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 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 | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 8 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK DIEHL | PersonNm |
| Phone | 5707521780 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 310 E THIRD STREET | AddressLine1Txt |
| City | MIFFLINVILLE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18631 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| JOY MCGINNIS | ||||||
| PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| PATRICIA BARRETT | ||||||
| VICE PRESIDE | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CINDY LOMBARD | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BECKY AARDWEG | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DOROTHY GIRTON | ||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | ||
| DENNIS SITLER | ||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | ||
| ANDREW BURD HARRIS | ||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | ||
| SETH HOSTETLER | ||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | ||
| CINDY RUPP | ||||||
| BOARD MEMBER | Yes (X) | $0 | $0 | $0 | ||
| JAMES GALLAGHER | ||||||
| MEDICAL DIRE | 10.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $142,899 | AllOtherContributionsAmt |
| Total Contributions | $142,899 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| COPIES | 900099 | $450 | $450 | |
| MEDICAL TESTS | $202 | $202 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $652 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $101 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $101 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,009 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,009 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,009 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,009 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $5,570 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $3,997 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,573 | TotalRevenueColumnAmt |
| Exclusion | $1,573 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $146,234 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,312 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $450 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,573 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,631 | TotalAmt |
| Program Services | $107,223 | ProgramServicesAmt |
| Management And General | $13,408 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,605 | TotalAmt |
| Program Services | $8,524 | ProgramServicesAmt |
| Management And General | $1,081 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,175 | TotalAmt |
| Management And General | $2,175 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,771 | TotalAmt |
| Program Services | $11,022 | ProgramServicesAmt |
| Management And General | $1,749 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $958 | TotalAmt |
| Management And General | $958 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,213 | TotalAmt |
| Management And General | $2,213 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,016 | TotalAmt |
| Program Services | $5,016 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,459 | TotalAmt |
| Program Services | $3,821 | ProgramServicesAmt |
| Management And General | $1,638 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,828 | TotalAmt |
| Program Services | $135,606 | ProgramServicesAmt |
| Management And General | $23,222 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,066 | BOYAmt |
| EOY | $4,106 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $151,433 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $36,281 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,168 | BOYAmt |
| EOY | $115,152 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,272 | BOYAmt |
| EOY | $17,169 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,506 | BOYAmt |
| EOY | $136,427 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,982 | BOYAmt |
| EOY | $2,708 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,982 | BOYAmt |
| EOY | $2,708 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,524 | BOYAmt |
| EOY | $133,719 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,524 | BOYAmt |
| EOY | $133,719 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,506 | BOYAmt |
| EOY | $136,427 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$12,594 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,211 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Other | Yes (X) | MethodOfAccountingOtherInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $316,034 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $183,374 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $288,099 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $154,788 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $132,034 | CurrentTaxYearAmt |
| Total | $1,074,329 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $450 | CurrentTaxYearAmt |
| Total | $450 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $5,570 | CurrentTaxYearAmt |
| Total | $5,570 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $316,034 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $183,374 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $288,099 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $154,788 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $138,054 | CurrentTaxYearAmt |
| Total | $1,080,349 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $1,080,349 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $394 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $147 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $33 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $317 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $337 | CurrentTaxYearAmt |
| Total | $1,228 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $394 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $147 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $33 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $317 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $337 | CurrentTaxYearAmt |
| Total | $1,228 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $316,428 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $183,521 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $288,132 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $155,105 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $138,391 | CurrentTaxYearAmt |
| Total | $1,081,577 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99890 | PublicSupportCY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,000 | OtherCostOrOtherBasisAmt |
| Book Value | $10,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $124,843 | OtherCostOrOtherBasisAmt |
| Book Value | $124,843 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,090 | OtherCostOrOtherBasisAmt |
| Book Value | $13,090 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,500 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,281 | DepreciationAmt |
| Book Value | -$32,781 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $115,152 | TotalBookValueLandBuildingsAmt |
Closely Held Equity Interests CloselyHeldEquityInterestsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $17,169 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $17,169 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PAYROLL TAXES PAYABLE | Desc |
| Amt | $2,708 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,708 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $149,020 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$1,211 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $3,997 | OtherRevenueAmt |
| Revenue Not Reported | $2,786 | RevenueNotReportedAmt |
| Revenue Subtotal | $146,234 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $146,234 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $162,825 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $3,997 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $3,997 | ExpensesNotReportedAmt |
| Expenses Subtotal | $158,828 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $158,828 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | FUNDRAISING EXPENSES 3,997 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | FUNDRAISING EXPENSES 3,997 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | VOLUNTEERS PERFORM VARIOUS FUNCTIONS INCLUDING OFFERING MEDICAL CARE FOR PATIENTS,ADMINISTRATIVE DUTIES AND VARIOUS FUNCTIONS TO OPERATE THE CLINIC. |
| FORM 990, PAGE 6, PART VI, LINE 2 | BETTE GREY BETTE GREY DIRECTOR BOARD SHE WAS THE DIRECTOR AND PRES |
| FORM 990, PAGE 6, PART VI, LINE 11B | ORGANIZATION REVIEW HTE FINANCIAL STATEMENTS DRAFT, THEN THE DRAFT OF THE 990 UPON APPROVAL IT IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE DIRECTORS COMPENSATION IS SUBJECT TO APPROVAL BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15B | ALL EMPLOYEES COMPENSATION IS APPROVED BY THE BOARD, THE BOARD DOES NOT RECEIVE PAY. |
| FORM 990, PAGE 6, PART VI, LINE 19 | UPON REQUEST |
| FORM 990, PART XI, LINE 9 | FUNDRAISING EXPENSES 3,997 FUNDRAISING EXPENSES -3,997 |
Comments