FAYETTE CARE CLINIC INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- FAYETTE CARE CLINIC INC (EIN 20-0314897)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-08-14
- IRS object ID
- 201412269349301941
- Schema version
- 2013v3.1
- 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 | 2014-08-14T13:30:31-04:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 611659301 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jeffrey S Edwards CPA LLC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 125 Flat Creek Trail Suite 140 | AddressLine1 |
| City | Fayetteville | City |
| State | GA | State |
| ZIP Code | 30214 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200314897 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE CARE CLINIC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAYE | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 HIGHWAY 54 W | AddressLine1 |
| City | FAYETTEVILLE | City |
| State | GA | State |
| ZIP Code | 30214 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHERYL WATFORD | PersonNm |
| Person Title | EXECUTIVE DIREC | PersonTitleTxt |
| Phone | 7707194620 | PhoneNum |
| Signature | 2014-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeffrey S Edwards | PreparerPersonNm |
| PTIN | P01580503 | PTIN |
| Phone | 7705989137 | PhoneNum |
| Preparation | 2014-08-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SHERYL L WATFORD | PrincipalOfficerNm |
| Gross Receipts | $341,448 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAYETTECARECLINIC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE QUALITY HEALTHCARE TO THE UNINSURED AND UNDERINSURED RESIDENTS OF FAYETTE COUNTY, GA WHOSE HOUSEHOLD INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY GUIDELINES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 6 | TotalEmployeeCnt |
| Total Volunteers | 140 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $181,259 | PYContributionsGrantsAmt |
| CY Contributions Grants | $274,061 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $688 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $810 | CYProgramServiceRevenueAmt |
| CY Investment Income | $114 | CYInvestmentIncomeAmt |
| PY Other Revenue | $43,762 | PYOtherRevenueAmt |
| CY Other Revenue | $59,649 | CYOtherRevenueAmt |
| PY Total Revenue | $225,709 | PYTotalRevenueAmt |
| CY Total Revenue | $334,634 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $155,429 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $149,693 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $19,896 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $116,537 | PYOtherExpensesAmt |
| CY Other Expenses | $190,115 | CYOtherExpensesAmt |
| PY Total Expenses | $271,966 | PYTotalExpensesAmt |
| CY Total Expenses | $339,808 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$46,257 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$5,174 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $134,122 | TotalAssetsBOYAmt |
| Total Assets EOY | $127,856 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,092 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $133,030 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $127,856 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDE QUALITY HEALTHCARE TO THE UNINSURED AND UNDERINSURED RESIDENTS OF FAYETTE COUNTY, GA WHOSE HOUSEHOLD INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY GUIDELINES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $230,375 | ExpenseAmt |
| Desc | OUR MISSION IS TO PROMOTE HEALTH AND WELL-BEING BY REDUCING THE BARRIERS TO ACCESS HEALTHCARE FOR THE WORKING POOR AND UNDERINSURED POPULATION OF FAYETTE COUNTY, GA, THAT MEET INCOME REQUIREMENTS THROUGH COMPASSIONATE HEALTH CARE AND EDUCATION AND TO PROVIDE A GATEWAY TO OTHER COMMUNITY RESOURCES. | Desc |
| Total Program Service Expenses | $230,375 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | 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 | 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 | Yes (true) | 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 | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 6 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | false | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | 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 |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHERYL L WATFORD | PersonNm |
| Phone | 7707194620 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1260 HIGHWAY 54 W | AddressLine1 |
| City | FAYETTEVILLE | City |
| State | GA | State |
| ZIP Code | 30214 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| GREGORY ALVAREZ MD | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR CHARLES BARBER | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ELIZABETH J CARAWAY | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR NIMISH DHRUVA | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SHERYL KLINK | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KIM LEARNARD | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MEGAN LIDDY | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARY ANNE MUIJCA | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TREY RAGSDALE | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| LISA SMITH | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DAYE BEXLEY | |||||||
| SECRETARY | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| JIMMY PACE | |||||||
| BOARD CHAIR | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| SCOTT ROWLAND | |||||||
| TREASURER | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| SHERYL L WATFORD | |||||||
| EXECUTIVE DIRECTOR | 0.00 | 0.00 | $71,791 | $0 | $8,390 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $71,791 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $8,390 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Federated Campaigns | $45,000 | FederatedCampaignsAmt |
| All Other Contributions | $229,061 | AllOtherContributionsAmt |
| Total Contributions | $274,061 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT RECORD COPIES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $810 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $810 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $810 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $114 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $114 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $66,463 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $6,814 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,649 | TotalRevenueColumnAmt |
| Exclusion | $59,649 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $334,634 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $924 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $59,649 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,791 | TotalAmt |
| Program Services | $17,948 | ProgramServicesAmt |
| Management And General | $39,485 | ManagementAndGeneralAmt |
| Fundraising | $14,358 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,682 | TotalAmt |
| Program Services | $46,597 | ProgramServicesAmt |
| Management And General | $10,944 | ManagementAndGeneralAmt |
| Fundraising | $1,141 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,389 | TotalAmt |
| Program Services | $2,097 | ProgramServicesAmt |
| Management And General | $4,614 | ManagementAndGeneralAmt |
| Fundraising | $1,678 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,831 | TotalAmt |
| Program Services | $5,339 | ProgramServicesAmt |
| Management And General | $4,258 | ManagementAndGeneralAmt |
| Fundraising | $1,234 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,398 | TotalAmt |
| Management And General | $12,398 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,745 | TotalAmt |
| Program Services | $60,745 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,356 | TotalAmt |
| Management And General | $2,356 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,357 | TotalAmt |
| Program Services | $9,618 | ProgramServicesAmt |
| Management And General | $7,739 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,397 | TotalAmt |
| Program Services | $60,397 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,953 | TotalAmt |
| Management And General | $2,953 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,123 | TotalAmt |
| Program Services | $11,148 | ProgramServicesAmt |
| Management And General | $975 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,577 | TotalAmt |
| Management And General | $1,577 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | FundraisingFundraisingAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|---|
| FUNDRAISING EVENT EXPENSE | $1,485 | $1,485 | ||
| DUES & MEMBERSHIPS | $2,238 | $2,238 | ||
| SUPPLIES | $11,529 | $11,529 | ||
| EQUIPMENT REPAIR & MAINT | $4,957 | $4,957 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $339,808 | TotalAmt |
| Program Services | $230,375 | ProgramServicesAmt |
| Management And General | $89,537 | ManagementAndGeneralAmt |
| Fundraising | $19,896 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,195 | BOYAmt |
| EOY | $41,938 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,099 | BOYAmt |
| EOY | $57,213 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $96,766 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $68,061 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,828 | BOYAmt |
| EOY | $28,705 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $134,122 | BOYAmt |
| EOY | $127,856 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,092 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,092 | 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 | $133,030 | BOYAmt |
| EOY | $127,856 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,030 | BOYAmt |
| EOY | $127,856 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $134,122 | BOYAmt |
| EOY | $127,856 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$5,174 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| 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 | false | 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 | $125,624 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $282,663 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $190,785 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $181,259 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $274,061 | CurrentTaxYearAmt |
| Total | $1,054,392 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $125,624 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $282,663 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $190,785 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $181,259 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $274,061 | CurrentTaxYearAmt |
| Total | $1,054,392 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $1,054,392 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $1,408 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $74 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $208 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $114 | CurrentTaxYearAmt |
| Total | $1,804 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $41,768 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $42,085 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $45,478 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $66,463 | CurrentTaxYearAmt |
| Total | $195,794 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,251,990 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $810 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.84220 | PublicSupportCY170Pct |
| Public Support PY170 | 0.87410 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $96,766 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $68,061 | DepreciationAmt |
| Book Value | $28,705 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,705 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $1,646,149 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $1,311,515 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $1,311,515 | RevenueNotReportedAmt |
| Revenue Subtotal | $334,634 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $334,634 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,651,323 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $1,311,515 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $1,311,515 | ExpensesNotReportedAmt |
| Expenses Subtotal | $339,808 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $339,808 | TotalExpensesPerForm990Amt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | DANCE | NameOfEvent1Amt |
| Gross Receipts Event1 | $41,908 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $41,908 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $3,174 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | GOLF TOURNAM | NameOfEvent2Amt |
| Gross Receipts Event2 | $24,555 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $24,555 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $3,640 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $66,463 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $66,463 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $6,814 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $6,814 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $59,649 | NetIncomeSummaryAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GROUP VI PROPERTIES LTD | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD CHAIR | RelationshipDescriptionTxt |
| Transaction | $57,529 | TransactionAmt |
| Transaction | RENT OF FACILITIES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 governing body review Part VI line 11 | A COPY OF THE RETURN IS GIVEN TO EACH BOARD MEMBER BEFORE THE RETURN IS FILED. IF NO CORRECTIONS ARE SUGGESTED, THE RETURN IS FILED. |
| CEO executive director top management comp Part VI line 15a | COMPENSATION OF THE EXECUTIVE DIRECTOR IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. REFERENCE IS MADE TO COMPENSATION BY COMPARABLE ORGANIZATIONS, BUT LIMITED TO BUDGET CONSTRAINTS. |
| Other officer or key employee compensation Part VI line 15b | N/A |
| Governing documents etc available to public Part VI line 19 | COPIED AND DISTRIBUTED UPON REQUEST |
| List of other fees for services expenses Part IX line 11g | PHYSICIAN AND NURSE PROGRAM - $37,867PROGRAM SERVICE SUBCONTRACTOR - $19,649DENTIST AND DENTAL HYGENE PROGRAM - $1,912DATANET CONSULTANT - $1,317 |