OPEN ARMS FREE CLINIC INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- OPEN ARMS FREE CLINIC INC (EIN 45-4475625)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-10
- IRS object ID
- 201643159349302789
- 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 | 2016-11-10T13:48:42-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 391971296 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAMBERLAIN & HENNINGFIELD CPAS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1119 | AddressLine1Txt |
| City | LAKE GENEVA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53147 | 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 | 454475625 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OPEN ARMS FREE CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OPEN | BusinessNameControlTxt |
| Phone | 2623791401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 678 | AddressLine1Txt |
| City | ELKHORN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53121 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL SANDERS | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 2623791401 | PhoneNum |
| Signature | 2016-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | GARY OTTE CPA | PreparerPersonNm |
| PTIN | P01071963 | PTIN |
| Phone | 2622491100 | PhoneNum |
| Preparation | 2016-11-01 | 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 | DANIEL SANDERS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 678 | AddressLine1Txt |
| City | ELKHORN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53121 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,021,334 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.OPENARMSFREECLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | STRIVE TO BETTER UNDERSTAND AND SERVE THE HEALTH AND WELLNESS NEEDS OF THE UNINSURED, LOW INCOME AND UNDER-SERVED RESIDENTS OF WALWORTH COUNTY WITH COMPASSION AND UNDERSTANDING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 3 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $386,742 | PYContributionsGrantsAmt |
| CY Contributions Grants | $837,427 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $338 | PYInvestmentIncomeAmt |
| CY Investment Income | $713 | CYInvestmentIncomeAmt |
| PY Other Revenue | $89,080 | PYOtherRevenueAmt |
| CY Other Revenue | $111,059 | CYOtherRevenueAmt |
| PY Total Revenue | $476,160 | PYTotalRevenueAmt |
| CY Total Revenue | $949,199 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $38,796 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $67,132 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $294,998 | PYOtherExpensesAmt |
| CY Other Expenses | $572,606 | CYOtherExpensesAmt |
| PY Total Expenses | $333,794 | PYTotalExpensesAmt |
| CY Total Expenses | $639,738 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $142,366 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $309,461 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $376,302 | TotalAssetsBOYAmt |
| Total Assets EOY | $744,185 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $85 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,507 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $376,217 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $735,678 | NetAssetsOrFundBalancesEOYAmt |
| Mission | STRIVE TO BETTER UNDERSTAND AND SERVE THE HEALTH AND WELLNESS NEEDS OF THE UNINSURED, LOW INCOME AND UNDER-SERVED RESIDENTS OF WALWORTH COUNTY WITH COMPASSION AND UNDERSTANDING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $254,662 | ExpenseAmt |
| Revenue | $1,344 | RevenueAmt |
| Desc | CLINIC SERVICES | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $220,107 | ExpenseAmt |
| Desc | PHARMACY SERVICES | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $474,769 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SARA NICHOLS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2623791401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 678 | AddressLine1Txt |
| City | ELKHORN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53121 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|
| COLLEEN ANDERSON | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| WILLIAM CLARK | |||||
| TREASURER | 0.00 | Yes (X) | $0 | $0 | $0 |
| BOB DILLMAN | |||||
| PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 |
| NICHOLAS EGERT | |||||
| VICE PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 |
| ROBERT FASANO | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| DAN FEATHERSTONE | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| JOAN IVERSON | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| PATRICK KENNY | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| LISA KROLOW | |||||
| SECRETARY | 0.00 | Yes (X) | $0 | $0 | $0 |
| EILEEN KURINSKY | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| ALICIA MODJESKA | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| RICHARD MUELLER | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| DANIE SANDERS | |||||
| PAST PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $837,427 | AllOtherContributionsAmt |
| Noncash Contributions | $430,794 | NoncashContributionsAmt |
| Total Contributions | $837,427 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $713 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $713 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $182,563 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $72,135 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $110,428 | TotalRevenueColumnAmt |
| Exclusion | $110,428 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $631 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $631 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $631 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $949,199 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,344 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $110,428 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,833 | TotalAmt |
| Management And General | $48,833 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,628 | TotalAmt |
| Management And General | $13,628 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,671 | TotalAmt |
| Management And General | $4,671 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,582 | TotalAmt |
| Management And General | $14,582 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,056 | TotalAmt |
| Management And General | $6,056 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,814 | TotalAmt |
| Management And General | $2,814 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,480 | TotalAmt |
| Management And General | $6,480 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,715 | TotalAmt |
| Management And General | $23,715 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,432 | TotalAmt |
| Management And General | $16,432 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,767 | TotalAmt |
| Management And General | $2,767 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| DONATED SERVICES | $254,662 | $254,662 |
| MEDICATIONS | $153,889 | $153,889 |
| PHARMACY AND LAB | $56,423 | $56,423 |
| SUPPLIES | $9,559 | $9,559 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,227 | TotalAmt |
| Program Services | $236 | ProgramServicesAmt |
| Management And General | $24,991 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $639,738 | TotalAmt |
| Program Services | $474,769 | ProgramServicesAmt |
| Management And General | $164,969 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,201 | BOYAmt |
| EOY | $55,038 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $282,881 | BOYAmt |
| EOY | $594,165 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,367 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $197,685 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $102,703 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,853 | BOYAmt |
| EOY | $94,982 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,302 | BOYAmt |
| EOY | $744,185 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85 | BOYAmt |
| EOY | $8,507 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85 | BOYAmt |
| EOY | $8,507 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,217 | BOYAmt |
| EOY | $685,678 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $50,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,217 | BOYAmt |
| EOY | $735,678 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,302 | BOYAmt |
| EOY | $744,185 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $309,461 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $50,000 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $229,894 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $454,167 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $475,822 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $948,486 | CurrentTaxYearAmt |
| Total | $2,108,369 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $229,894 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $454,167 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $475,822 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $948,486 | CurrentTaxYearAmt |
| Total | $2,108,369 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $2,108,369 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $25 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $129 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $338 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $713 | CurrentTaxYearAmt |
| Total | $1,205 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $2,109,574 | TotalSupportAmt |
| Public Support CY170 | 0.99940 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99960 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $33,520 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,567 | DepreciationAmt |
| Book Value | $31,953 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $164,165 | OtherCostOrOtherBasisAmt |
| Depreciation | $101,136 | DepreciationAmt |
| Book Value | $63,029 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $94,982 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $1,021,334 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $72,135 | OtherRevenueAmt |
| Revenue Not Reported | $72,135 | RevenueNotReportedAmt |
| Revenue Subtotal | $949,199 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $949,199 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $711,873 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $72,135 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $72,135 | ExpensesNotReportedAmt |
| Expenses Subtotal | $639,738 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $639,738 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION HAS ADOPTED ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, ASC 740-10 EFFECTIVE JANUARY 1, 2009. THE COMMITTEE'S POLICY IS TO EVALUATE, AT LEAST ANNUALLY, THE POTENTIAL FOR INCOME TAX EXPOSURE. ANY EXPOSURE FROM SUCH POSITIONS IS RECORDED BASED ON THE LARGEST COST THAT HAS A GREATER THEN 50% LIKELIHOOD OF BEING INCURRED UPON ULTIMATE SETTLEMENT. THE ADOPTION OF ASC 740-10 DID NOT HAVE A MATERIAL EFFECT ON ITS FINANCIAL POSITION, RESULTS OF OPERATIONS OR CASH FLOWS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS REVENUE IS REDUCED BY THE ATTRIBUTABLE EXPENSE |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENTS REVENUE IS REDUCED BY THE ATTRIBUTABLE EXPENSE |
| SCHEDULE D PARTS XII AND XIII LINES 2D AND 2D. | SPECIAL EVENTS REVENUE IS REDUCED BY THE ATTRIBUTABLE EXPENSE OF $72,135. TOTAL EXPENSES ARE REDUCED BY $72,135 TO BE NETTED WITH SPECIAL EVENTS REVENUE. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $50,110 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $50,110 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $18,099 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $17,163 | OtherDirectExpensesEvent1Amt |
| Event2 | BIRTHDAY EVENT | Event2Nm |
| Gross Receipts Event2 | $105,904 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $105,904 | GrossRevenueEvent2Amt |
| Food And Beverage Event2 | $25,093 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $11,780 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $26,549 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $26,549 | GrossRevenueOtherEventsAmt |
| Gross Receipts Total | $182,563 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $182,563 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $43,192 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $28,943 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $72,135 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $110,428 | NetIncomeSummaryAmt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Noncash Contributions Rpt F990 | $153,889 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED, SIGNED, AND FILED BY THE PRESIDENT WHO THEN PRESENTS A COPY TO EACH MEMBER OF THE BOARD OF DIRECTORS. SHOULD ANY MATERIAL REASON BE FOUND, AMENDMENTS TO THE RETURN WOULD BE MADE UNDER BOARD DIRECTION AND APPROVAL. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 50,000. |
| FORM 990, PART XII, LINE 2C: | NO CHANGE FROM PRIOR YEAR. |
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