OPEN ARMS FREE CLINIC INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- OPEN ARMS FREE CLINIC INC (EIN 45-4475625)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-09-29
- IRS object ID
- 201522729349301402
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-09-29T16:25:03-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 2014-01-01 | 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 | 2015-09-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID J HENNINGFIELD CPA | PreparerPersonNm |
| PTIN | P00188242 | PTIN |
| Phone | 2622491100 | PhoneNum |
| Preparation | 2015-09-25 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | 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 | $563,856 | 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 | 1 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $396,014 | PYContributionsGrantsAmt |
| CY Contributions Grants | $395,865 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $129 | PYInvestmentIncomeAmt |
| CY Investment Income | $338 | CYInvestmentIncomeAmt |
| PY Other Revenue | $58,153 | PYOtherRevenueAmt |
| CY Other Revenue | $67,747 | CYOtherRevenueAmt |
| PY Total Revenue | $454,296 | PYTotalRevenueAmt |
| CY Total Revenue | $463,950 | 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 | $30,997 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $38,796 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $338,589 | PYOtherExpensesAmt |
| CY Other Expenses | $312,087 | CYOtherExpensesAmt |
| PY Total Expenses | $369,586 | PYTotalExpensesAmt |
| CY Total Expenses | $350,883 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $84,710 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $113,067 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $266,486 | TotalAssetsBOYAmt |
| Total Assets EOY | $373,956 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $32,635 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,038 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $233,851 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $346,918 | 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 | $196,390 | ExpenseAmt |
| Revenue | $3,443 | RevenueAmt |
| Desc | CLINIC SERVICES | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $52,737 | ExpenseAmt |
| Desc | PHARMACY SERVICES | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $249,127 | 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 | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 |
| Employee | 1 | 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 | |||||
| ASSISTAND MED DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| REBECCA BRUSA | |||||
| SECRETARY | 0.00 | Yes (X) | $0 | $0 | $0 |
| WILLIAM CLARK | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| PATRICK KENNY | |||||
| TREASURER | 0.00 | Yes (X) | $0 | $0 | $0 |
| BOB DILLMAN | |||||
| VICE PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 |
| NICHOLAS EGERT | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| ROBERT FASANO | |||||
| MEDICAL DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| JUDY JOHNSON | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| LISA KROLOW | |||||
| CATHOLIC CHARITIES | 0.00 | Yes (X) | $0 | $0 | $0 |
| ALICIA MODJESKA | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| DANIEL SANDERS | |||||
| PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 |
| DAN FEATHERSTONE | |||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 |
| RICHARD MUELLER | |||||
| DIRECTOR | 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 | $395,865 | AllOtherContributionsAmt |
| Noncash Contributions | $211,600 | NoncashContributionsAmt |
| Total Contributions | $395,865 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $338 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $338 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $164,548 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $99,906 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,642 | TotalRevenueColumnAmt |
| Exclusion | $64,642 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $3,105 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,105 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,105 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $463,950 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,443 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $64,642 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,000 | TotalAmt |
| Management And General | $36,000 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,796 | TotalAmt |
| Management And General | $2,796 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,729 | TotalAmt |
| Management And General | $3,729 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,450 | TotalAmt |
| Management And General | $1,450 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,426 | TotalAmt |
| Management And General | $4,426 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,860 | TotalAmt |
| Management And General | $19,860 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,064 | TotalAmt |
| Management And General | $16,064 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,789 | TotalAmt |
| Management And General | $2,789 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| VOLUNTEER SERVICES | $185,145 | $185,145 | |
| PHARMACY AND LAB | $52,142 | $52,142 | |
| EQUIPMENT | $9,124 | $9,124 | |
| TELEPHONE | $2,936 | $2,936 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,422 | TotalAmt |
| Program Services | $2,716 | ProgramServicesAmt |
| Management And General | $11,706 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $350,883 | TotalAmt |
| Program Services | $249,127 | ProgramServicesAmt |
| Management And General | $101,756 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,577 | BOYAmt |
| EOY | $28,222 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $173,116 | BOYAmt |
| EOY | $282,881 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $149,124 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $86,271 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,793 | BOYAmt |
| EOY | $62,853 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $266,486 | BOYAmt |
| EOY | $373,956 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,635 | BOYAmt |
| EOY | $27,038 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,635 | BOYAmt |
| EOY | $27,038 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,851 | BOYAmt |
| EOY | $346,918 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,851 | BOYAmt |
| EOY | $346,918 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $266,486 | BOYAmt |
| EOY | $373,956 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $113,067 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| 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 Minus2 Years | $229,894 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $454,167 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $463,612 | CurrentTaxYearAmt |
| Total | $1,147,673 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $229,894 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $454,167 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $463,612 | CurrentTaxYearAmt |
| Total | $1,147,673 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,147,673 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $25 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $129 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $338 | CurrentTaxYearAmt |
| Total | $492 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,148,165 | TotalSupportAmt |
| Public Support CY170 | 0.99960 | PublicSupportCY170Pct |
| 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 | $149,124 | OtherCostOrOtherBasisAmt |
| Depreciation | $86,271 | DepreciationAmt |
| Book Value | $62,853 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $62,853 | TotalBookValueLandBuildingsAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $65,818 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $65,818 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $19,514 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $26,988 | OtherDirectExpensesEvent1Amt |
| Event2 | BIRTHDAY EVENT | Event2Nm |
| Gross Receipts Event2 | $81,670 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $81,670 | GrossRevenueEvent2Amt |
| Food And Beverage Event2 | $38,820 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $8,853 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $17,060 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $17,060 | GrossRevenueOtherEventsAmt |
| Oth Direct Expnss Other Events | $5,721 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $164,548 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $164,548 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $58,334 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $41,562 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $99,896 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $64,652 | 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 | $5,000 | 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 (2 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. |
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