COMMUNITY CARE CENTER FOR FORSYTH COUNTY: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY CARE CENTER FOR FORSYTH COUNTY (EIN 58-1403699)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-09
- IRS object ID
- 201613149349301866
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-09T11:11:00-08:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Brown Jenkins & Oneyear PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 326 South Main Street | AddressLine1Txt |
| City | WinstonSalem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27101 | 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 | 581403699 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Care Center for Forsyth County | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3367601235 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 New Walkertown Road | AddressLine1Txt |
| City | Winston Salem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27101 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES T ROBINSON | PersonNm |
| Person Title | SECRETARY/TREASURER | PersonTitleTxt |
| Phone | 3367601235 | PhoneNum |
| Signature | 2016-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | REBECCA A ONEYEAR CPA | PreparerPersonNm |
| Phone | 3367610366 | PhoneNum |
| 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 | ANTHONY BRETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 New Walkertown Road | AddressLine1Txt |
| City | WinstonSalem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,851,465 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CCCForsyth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1980 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | To provide free on-site medical and dental care to low-income families. | ActivityOrMissionDesc |
| Voting Members Governing Body | 24 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 24 | VotingMembersIndependentCnt |
| Total Employee | 27 | TotalEmployeeCnt |
| Total Volunteers | 280 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,486,738 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,811,231 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3 | PYInvestmentIncomeAmt |
| CY Investment Income | $27 | CYInvestmentIncomeAmt |
| PY Other Revenue | $29,290 | PYOtherRevenueAmt |
| CY Other Revenue | $40,207 | CYOtherRevenueAmt |
| PY Total Revenue | $2,516,031 | PYTotalRevenueAmt |
| CY Total Revenue | $1,851,465 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $827,845 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $815,172 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $17,878 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,714,750 | PYOtherExpensesAmt |
| CY Other Expenses | $982,053 | CYOtherExpensesAmt |
| PY Total Expenses | $2,542,595 | PYTotalExpensesAmt |
| CY Total Expenses | $1,797,225 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$26,564 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $54,240 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $715,086 | TotalAssetsBOYAmt |
| Total Assets EOY | $784,664 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $36,975 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $48,643 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $678,111 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $736,021 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide free on-site | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,628,970 | ExpenseAmt |
| Desc | COMMUNITY CARE CENTER OF FORSYTH COUNTY, INC. IS A FREE MEDICAL CLINIC FOR FAMILIES WHO EARN LESS THAN 200% OF THE FEDERAL PROVERTY LEVEL AND ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAMS AND HAVE NO MEDICAL INSURANCE. THE CENTER PROVIDES FREE ON-SITE MEDICAL AND DENTAL CARE TO LOW-INCOME FAMILIES, AS THE SOLE PROGRAM. | Desc |
| Total Program Service Expenses | $1,628,970 | 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 | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 27 | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 24 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 24 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | 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 | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES T ROBINSON | PersonNm |
| Phone | 3367601235 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 New Walkertown Rd | AddressLine1Txt |
| City | Winston Salem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| DR WILLIAM M SATTERWHITE JR | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JAMES T ROBINSON | ||||||
| Secretary/Treasurer/Executive Director | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DR CARL S PHIPPS | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| HAMPDEN D KENAN | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARK MEYER DDS | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL CLEMENTS | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR ERNESTO DE LA TORRE | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ANN FLYNT | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KATHY KENNEDY | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| WARD B MILLER | ||||||
| Board Chair | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DR ROBERT V FORD | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DAVID L MOUNT | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ANTHONY H BRETT | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SYLVIA OBERLE | ||||||
| Director | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR R TED TOBORG | ||||||
| Director | 0 | Yes (X) | ||||
| JULIA H FLOYD | ||||||
| Director | 0 | Yes (X) | ||||
| DONNA FARRAR | ||||||
| Director | 0 | Yes (X) | ||||
| MICHELLE MARTINEZ | ||||||
| Director | 0 | Yes (X) | ||||
| FELIPE VILLALON | ||||||
| Director | 0 | Yes (X) | ||||
| ANNE SLOWEY | ||||||
| Director | 0 | Yes (X) | ||||
| CAROLYN BREESE | ||||||
| Director | 0 | Yes (X) | ||||
| LUCINDA JONES | ||||||
| Director | 0 | Yes (X) | ||||
| GREGORY G HOLTHUSEN MD | ||||||
| Director | 0 | Yes (X) | ||||
| SILVIA V NILSEN | ||||||
| Vice Chair | 0 | Yes (X) | 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 |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Robinson Association Mgmt Svcs Inc | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 New Walkertown Road | AddressLine1Txt |
| City | WinstonSalem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Management Company | ServicesDesc |
| Compensation | $130,000 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $229,055 | FederatedCampaignsAmt |
| Fundraising | $108,425 | FundraisingAmt |
| Government Grants | $193,592 | GovernmentGrantsAmt |
| All Other Contributions | $1,280,159 | AllOtherContributionsAmt |
| Noncash Contributions | $523,903 | NoncashContributionsAmt |
| Total Contributions | $1,811,231 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27 | TotalRevenueColumnAmt |
| Exclusion | $27 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,000 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,000 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,000 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $108,425 | ContriRptFundraisingEventAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Misc. Revenue - Related | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $23,207 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,207 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $23,207 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,851,465 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,207 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $27 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $655,547 | TotalAmt |
| Program Services | $655,547 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,845 | TotalAmt |
| Program Services | $105,845 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,780 | TotalAmt |
| Program Services | $53,780 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,000 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $130,000 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,073 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $15,073 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,083 | TotalAmt |
| Program Services | $14,779 | ProgramServicesAmt |
| Management And General | $5,304 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $790 | TotalAmt |
| Program Services | $790 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,262 | TotalAmt |
| Program Services | $59,262 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,828 | TotalAmt |
| Program Services | $31,828 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $860 | TotalAmt |
| Program Services | $860 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,130 | TotalAmt |
| Program Services | $21,130 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,041 | TotalAmt |
| Program Services | $16,041 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Medicines & Medical Supplies | $581,349 | $581,349 | $0 | $0 |
| Miscellaneous | $25,773 | $25,773 | $0 | $0 |
| Outside Services | $137 | $137 | $0 | $0 |
| Repairs | $47,328 | $47,328 | $0 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,399 | TotalAmt |
| Program Services | $14,521 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $17,878 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,797,225 | TotalAmt |
| Program Services | $1,628,970 | ProgramServicesAmt |
| Management And General | $150,377 | ManagementAndGeneralAmt |
| Fundraising | $17,878 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $163,643 | BOYAmt |
| EOY | $234,443 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,027 | BOYAmt |
| EOY | $9,980 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,698 | BOYAmt |
| EOY | $320,850 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,766 | BOYAmt |
| EOY | $19,766 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,722 | BOYAmt |
| EOY | $9,555 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $636,903 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $573,307 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,727 | BOYAmt |
| EOY | $63,596 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,503 | BOYAmt |
| EOY | $126,474 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $715,086 | BOYAmt |
| EOY | $784,664 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,975 | BOYAmt |
| EOY | $48,643 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,975 | BOYAmt |
| EOY | $48,643 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $395,246 | BOYAmt |
| EOY | $437,301 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $282,865 | BOYAmt |
| EOY | $298,720 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $678,111 | BOYAmt |
| EOY | $736,021 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $715,086 | BOYAmt |
| EOY | $784,664 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $54,240 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,210,073 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,843,824 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,797,513 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,486,738 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,811,231 | CurrentTaxYearAmt |
| Total | $12,149,379 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,210,073 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,843,824 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,797,513 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,486,738 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,811,231 | CurrentTaxYearAmt |
| Total | $12,149,379 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $12,149,379 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,395 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,180 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $15,341 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,903 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,670 | CurrentTaxYearAmt |
| Total | $42,489 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $57,361 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $32,706 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $34,914 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,290 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $40,207 | CurrentTaxYearAmt |
| Total | $194,478 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $12,386,346 | TotalSupportAmt |
| Public Support CY170 | 0.98090 | PublicSupportCY170Pct |
| Public Support PY170 | 0.98320 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt II Ln 10 | FormAndLineReferenceDesc |
| Explanation | Other Income Part II, Line 10 Description: Other Income 2011: 57361. 2012: 32706. 2013: 34914. 2014: 29290. 2015: 40207. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,695 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,694 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,872 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $1,283 | AdministrativeExpensesAmt |
| End Year Balance | $125,234 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $120,825 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $12,903 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,792 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $1,241 | AdministrativeExpensesAmt |
| End Year Balance | $127,695 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $110,917 | BeginningYearBalanceAmt |
| Contributions | $25 | ContributionsAmt |
| Investment Earnings Or Losses | $15,344 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,604 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $857 | AdministrativeExpensesAmt |
| End Year Balance | $120,825 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $107,167 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $9,209 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,636 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $823 | AdministrativeExpensesAmt |
| End Year Balance | $110,917 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $111,007 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,404 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $4,416 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $828 | AdministrativeExpensesAmt |
| End Year Balance | $107,167 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,776 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,298 | DepreciationAmt |
| Book Value | $29,478 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $589,232 | OtherCostOrOtherBasisAmt |
| Depreciation | $556,575 | DepreciationAmt |
| Book Value | $32,657 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,895 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,434 | DepreciationAmt |
| Book Value | $1,461 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $63,596 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other Assets | $1,240 |
| Funds Held in Trust - Endowment | $125,234 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $126,474 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $7,754,266 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $3,670 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $5,899,131 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $5,902,801 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,851,465 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,851,465 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $7,696,356 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $5,899,131 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $5,899,131 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,797,225 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,797,225 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt V, Line 4 | FormAndLineReferenceDesc |
| Explanation | The purpose of the endowment fund is to provide a permanent fund which may be used by the organization to support the provision of healthcare services to the medically uninsured and underserved who meet the eligibility requirement guidelines of the organization. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Dinner | Event1Nm |
| Gross Receipts Event1 | $108,425 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $108,425 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $17,878 | FoodAndBeverageEvent1Amt |
| Gross Receipts Total | $108,425 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $108,425 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $17,878 | FoodAndBeverageTotalEventsAmt |
| Direct Expense Summary Events | $17,878 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $90,547 | NetIncomeSummaryAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Robinson Association Mgmt | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Owned by Executive Director | RelationshipDescriptionTxt |
| Transaction | $130,000 | TransactionAmt |
| Transaction | Management | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $504,165 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Donor Provided | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | Food for Volunteers | 0 | $18,400 | Cost |
| Yes (X) | Advertising | 1 | $635 | Cost |
| Yes (X) | Small Office Equip | 2 | $703 | Cost |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 3 | The organization receives management services under a board approved contract from Robinson Association Management Services, Inc. An entity owned by James T. Robinson, Executive Director. |
| Pt VI, Line 11b | A copy of the 990 is provided to the Executive Director and Treasurer for their review prior to the return being filed. The 990 is subsequently reviewed by the finance committee. |
| Pt VI, Line 15a | Salaries and management contracts are reviewed and recommendations made by the personnel committee which is made up of independent persons. Those recommendations then go to the finance committee for review and finally to the board for approval. |
| Pt VI, Line 15b | Salaries and management contracts are reviewed and recommendations made by the personnel committee which is made up of independent persons. Those recommendations then go to the finance committee for review and finally to the board for approval. |
| Pt VI, Line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to anyone that request a copy of the information. |
| Form 990, Part IX, Line 24e | Security 14521. 14521. 0. 0. |
| Form 990, Part IX, Line 24e | Special Event Cost 17878. 0. 0. 17878. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Forsyth-Stokes-Davie County Medical Society | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 New Walkertown Road | AddressLine1Txt |
| City | WinstonSalem | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 566047612 | EIN |
| Primary Activities | MEDICAL | PrimaryActivitiesTxt |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Exempt Code Section | 501 (c)(6) | ExemptCodeSectionTxt |
| Public Charity Status | N/A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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