FREE CLINIC OF POWHATAN: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- FREE CLINIC OF POWHATAN (EIN 26-1275136)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-06-07
- IRS object ID
- 201621599349300322
- 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 | 2016-06-07T09:16:58-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 300679057 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHARD W MCMINN III CPA PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3806 OLD BUCKINGHAM RD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 231397019 | 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 | 261275136 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FREE CLINIC OF POWHATAN INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 8043796484 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3908 OLD BUCKINGHAM RD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CONNIE MOSLOW | PersonNm |
| Person Title | DIRECTOR | PersonTitleTxt |
| Phone | 8043796484 | PhoneNum |
| Signature | 2016-05-19 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RICHARD W MCMINNIII CPA | PreparerPersonNm |
| PTIN | P01238723 | PTIN |
| Phone | 8045986662 | PhoneNum |
| Preparation | 2016-05-19 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CONNIE MOSLOW | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2364 HUGUENOT TRAIL | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $343,613 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FREECLINICOFPOWHATAN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Activity Or Mission | TO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUES | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 8 | TotalEmployeeCnt |
| Total Volunteers | 60 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $259,361 | PYContributionsGrantsAmt |
| CY Contributions Grants | $342,816 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $770 | PYInvestmentIncomeAmt |
| CY Investment Income | $768 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $260,131 | PYTotalRevenueAmt |
| CY Total Revenue | $343,584 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $116,033 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $129,949 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $85,503 | PYOtherExpensesAmt |
| CY Other Expenses | $84,681 | CYOtherExpensesAmt |
| PY Total Expenses | $201,536 | PYTotalExpensesAmt |
| CY Total Expenses | $214,630 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $58,595 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $128,954 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $453,520 | TotalAssetsBOYAmt |
| Total Assets EOY | $582,474 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $453,520 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $582,474 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUES | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $54,592 | ExpenseAmt |
| Desc | ORGANIZATION FACILITATES THE AVAILABILITY OF MEDICAL AND DENTAL SERVICES TO THE RESIDENTS OF POWHATAN, VIRGINIA THAT DO NOT HAVE THE RESOURCES TO GET THE SERVICES ELSEWHERE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $73,403 | ExpenseAmt |
| Desc | ORGANIZATION FACILITATES THE AVAILABILITY OF MEDICAL AND DENTAL SERVICES TO THE RESIDENTS OF POWHATAN, VIRGINIA THAT DO NOT HAVE THE RESOURCES TO GET THE SERVICES ELSEWHERE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $73,403 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $127,995 | 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 | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | 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 |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | 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 | Yes (true) | RegularMonitoringEnfrcInd |
| 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CONNIE MOSLOW | PersonNm |
| Phone | 8045985637 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3908 OLD BUCKINGHAM RD | AddressLine1Txt |
| City | POWHATAN | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 23139 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| JOHN CARMACK MD | ||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| INDIA COX | ||||||
| VICE-PRES | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CARSON TUCKER | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| LARRY LYONS | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CONNIE MOSLOW | ||||||
| DIRECTOR | 40.00 | Yes (X) | $0 | $0 | $0 | |
| SISTER ELENA HENDERSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TINA BUSTOS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RONALD SPEARS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| REBECCA GWILT | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| STEVEN HARRIS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LINDA DALCH JONES | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TIMOTHY G BENUSA | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JAY TURNER III | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BETSY WILTON | ||||||
| DIRECTOR | 1.00 | 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 | $342,816 | AllOtherContributionsAmt |
| Total Contributions | $342,816 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $797 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $797 | RelatedOrExemptFuncIncomeAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $29 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$29 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$29 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$29 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $343,584 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $768 | RelatedOrExemptFuncIncomeAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,439 | TotalAmt |
| Program Services | $70,171 | ProgramServicesAmt |
| Management And General | $49,268 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,510 | TotalAmt |
| Program Services | $5,712 | ProgramServicesAmt |
| Management And General | $4,798 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,632 | TotalAmt |
| Management And General | $2,632 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,550 | TotalAmt |
| Management And General | $1,550 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,001 | TotalAmt |
| Management And General | $6,001 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,531 | TotalAmt |
| Program Services | $1,934 | ProgramServicesAmt |
| Management And General | $7,597 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,286 | TotalAmt |
| Management And General | $3,286 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,604 | TotalAmt |
| Program Services | $5,604 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,298 | TotalAmt |
| Program Services | $1,298 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,143 | TotalAmt |
| Management And General | $1,143 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PRESCRIPTIONS ASSISTANCE | $26,377 | $26,377 | |
| DENTAL SUPPLIES | $11,312 | $11,312 | |
| DUES/MEMBERSHIPS | $7,343 | $7,343 | |
| OTHER | $4,504 | $4,504 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,100 | TotalAmt |
| Program Services | $1,083 | ProgramServicesAmt |
| Management And General | $3,017 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $214,630 | TotalAmt |
| Program Services | $127,995 | ProgramServicesAmt |
| Management And General | $86,635 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $451,977 | BOYAmt |
| EOY | $578,986 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,058 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,570 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,543 | BOYAmt |
| EOY | $3,488 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,520 | BOYAmt |
| EOY | $582,474 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $291,973 | BOYAmt |
| EOY | $383,295 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $161,547 | BOYAmt |
| EOY | $199,179 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,520 | BOYAmt |
| EOY | $582,474 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,520 | BOYAmt |
| EOY | $582,474 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $128,954 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $150,026 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $201,135 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $279,265 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $259,361 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $342,816 | CurrentTaxYearAmt |
| Total | $1,232,603 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $150,026 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $201,135 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $279,265 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $259,361 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $342,816 | CurrentTaxYearAmt |
| Total | $1,232,603 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,232,603 | PublicSupportTotal170Amt |
| Total Support | $1,232,603 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $797 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | 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
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,058 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,570 | DepreciationAmt |
| Book Value | $3,488 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,488 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $366,569 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $22,985 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $22,985 | RevenueNotReportedAmt |
| Revenue Subtotal | $343,584 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $343,584 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $237,615 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $22,985 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $22,985 | ExpensesNotReportedAmt |
| Expenses Subtotal | $214,630 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $214,630 | TotalExpensesPerForm990Amt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | ORGANIZATION FACILITATES THE AVAILABILITY OF MEDICAL AND DENTAL SERVICES TO THE RESIDENTS OF POWHATAN, VIRGINIA THAT DO NOT HAVE THE RESOURCES TO GET THE SERVICES ELSEWHERE. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE EXECUTIVE BOARD NOMINATES DIRECTORS EVERY THREE YEARS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | OFFICERS REVIEW ON ANNUAL BASIS |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE OFFICER'S REVIEW FOR POTENTIAL CONFLICTS CONTINUOUSLY |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION REVIEWED ON AN ANNUAL BASIS |
| FORM 990, PAGE 6, PART VI, LINE 15B | COMPENSATION REVIEWED ON AN ANNUAL BASIS |
| FORM 990, PAGE 6, PART VI, LINE 19 | AVAILABLE UPON REQUEST |
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