2014-02-28T14:52:18-06:00 2013-09-30 273605969 CBIZ MHM LLC 13577 FEATHER SOUND DRIVE 400 CLEARWATER FL 33762 990 2012-10-01 237208280 ST PETERSBURG FREE CLINIC INC STPE 7278211200 863 THIRD AVENUE NORTH ST PETERSBURG FL 33701 TIMOTHY COOP 7278211200 2014-02-28 ROBERT BALDREE P00746379 7275721400 2012 2015-11-30 17:44:51Z BETH A HOUGHTON 863 THIRD AVENUE NORTH ST PETERSBURG FL 33701 6742463 0 X WWW.STPETERSBURGFREECLINIC.ORG X 1970 FL PROVIDE TEMPORARY ASSISTANCE FOR FAMILIES AND INDIVIDUALS IN NEED OF FOOD, SHELTER, AND HEALTH CARE. 20 20 34 4232 0 0 5295379 6382542 0 0 -4320 5177 258088 281891 5549147 6669610 199098 200597 0 0 1150416 1305309 0 0 286462 3956964 5197016 5306478 6702922 242669 -33312 2375551 2486235 397150 530063 1978401 1956172 ST. PETERSBURG FREE CLINIC IS A MULTI-SERVICE, INDEPENDENT, NOT-FOR-PROFIT HUMAN SERVICES AGENCY PROVIDING OUR COMMUNITY NEIGHBORS ASSISTANCE WITH FOOD, SHELTER AND HEALTH CARE. 0 0 582197 31709 HEALTH CARE: FREE CLINIC HEALTH CENTER PROVIDES PRIMARY HEALTH CARE SERVICES FOR ADULTS AGED 18-64 WITHOUT PRIVATE INSURANCE, MEDICARE OR MEDICAID AND WHO DO NOT QUALIFY FOR COUNTY-SUBSIDIZED HEALTH CARE. FREE CLINIC HEALTH CENTER OFFERS BASIC HEALTH AND WELLNESS SERVICES BY A FULL-TIME NURSE PRACTITIONER, A FULL-TIME HEALTH EDUCATOR, FULL-TIME NURSE COORDINATOR, PLUS VOLUNTEER PHYSICIANS AND NURSES. IN FISCAL YEAR 2013, FREE CLINIC HEALTH CENTER PROVIDED OVER 6,700 DOCTOR AND ARNP VISITS. THE DRUG ASSISTANCE PROGRAM FILLED OVER 8,000 PRESCRIPTIONS VALUED AT $1.5 MILLION. FREE CLINIC DENTAL CLINIC OFFERS DENTAL SERVICES TO UNINSURED ADULTS WHO HAVE NO OTHER ACCESS. IN THE PAST TWO FISCAL YEARS THE FREE CLINIC DENTAL PROGRAM SERVED 444 CLIENTS. 4866854 158182 FOOD: FREE CLINIC FOOD BANK SOLICITS AND THEN DISTRIBUTES FOOD FREE OF CHARGE TO OVER 63 PARTNER AGENCIES THROUGHOUT OUR COMMUNITY, INCLUDING FOOD PANTRIES, SHELTERS, COMMUNITY KITCHENS AND CHILD CARE CENTERS. THE FOOD BANK COLLECTED AND DISTRIBUTED OVER 2.5 MILLION POUNDS OF FOOD IN FISCAL YEAR 2013. EVERY MONTH, OVER 40,000 OF OUR NEIGHBORS IN NEED RECEIVE FOOD ASSISTANCE THROUGH THESE EFFORTS. FREE CLINIC WE HELP SERVICES PROVIDES EMERGENCY FOOD AND FINANCIAL ASSISTANCE, PERSONAL HYGIENE ITEMS, ASSISTANCE WITH OBTAINING PROPER IDENTIFICATION, AND REFERRAL INFORMATION. IN FISCAL YEAR 2013 FREE CLINIC WE HELP SERVICES PROVIDED 42,000 SERVICES. LOCATED AT FREE CLINIC BEACON HOUSE THE COMMUNITY KITCHEN PROVIDES DINNER SIX NIGHTS A WEEK TO ANYONE WHO IS HUNGRY. IN FISCAL YEAR 2013 OVER 39,000 WERE SERVED A HOT MEAL. 763298 10706 SHELTER: FREE CLINIC BEACON HOUSE PROVIDES TRANSITIONAL SHELTER TO SINGLE, HOMELESS MEN. OVER 62 MEN WERE ASSISTED AT BEACON HOUSE IN FISCAL YEAR 2013. IN FEBRUARY OF 2013, THE FREE CLINIC ACQUIRED PROPERTY FOR THE PURPOSE OF BETTER SERVING HOMELESS FAMILIES. THE NEWLY LAUNCHED FAMILY RESIDENCE IS ABLE TO PROVIDE 14 FAMILIES WITH TRANSITIONAL SHELTER. FREE CLINIC WOMEN'S RESIDENCE PROVIDES A SAFE PLACE TO STAY AS WELL AS SUPPORT SERVICES TO SINGLE, HOMELESS WOMEN AS THEY WORK TOWARD THEIR GOAL OF SELF-SUFFICIENCY. RESIDENTS MAY STAY FROM ONE TO TWELVE MONTHS WHILE WORKING TO SAVE MONEY, SET GOALS AND BUILD LIFE SKILLS. FREE CLINIC WOMEN'S RESIDENCE PROVIDED SHELTER AND SUPPORT TO 64 WOMEN IN FISCAL YEAR 2013. 6212349 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 10 0 1 34 1 0 0 0 0 0 1 1 0 0 0 0 X 20 20 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X THE ORGANIZATION 7278211200 863 THIRD AVENUE NORTH ST PETERSBURG FL 33701 SANDRA AVERITT PHD 1.00 X 0 0 0 MARYLOU BOURDOW 8.00 X X 0 0 0 ELISE MINKOFF 3.00 X X 0 0 0 MARY WYATT ALLEN 2.00 X 0 0 0 TIMOTHY COOP 2.00 X X 0 0 0 LYNDETTE AGUIRRE 4.00 X 0 0 0 DAVE HOSICK 1.00 X 0 0 0 ED AMEEN 1.00 X 0 0 0 WAYNE HOOVER 8.00 X 0 0 0 SARAH M LUCAS 2.00 X 0 0 0 RICHARD MALCHON JR 3.00 X X 0 0 0 MICHAEL BICE 1.00 X 0 0 0 WILLIE B FELTON JR 1.00 X 0 0 0 JUDY HOLLAND 2.00 X 0 0 0 WALTER INMAN 1.00 X 0 0 0 LYNNE MORMINO 5.00 X 0 0 0 CHRIS NELSON JR 1.00 X 0 0 0 JANICE G SHARP 1.00 X 0 0 0 JEAN SPENCER-CARNES 1.00 X 0 0 0 JANET PAROO 1.00 X 0 0 0 BETH HOUGHTON 45.00 X 73530 0 0 73530 0 0 0 0 0 0 0 136887 6245655 4552660 6382542 3677 3677 1500 0 1500 1500 1500 354744 72853 281891 281891 6669610 0 0 287068 200597 200597 75941 59137 5342 11462 1034375 805498 72761 156116 25020 25020 75273 55585 6471 13217 94700 72151 6672 15877 41514 34795 4352 2367 58517 43623 6169 8725 53288 26308 18437 8543 94531 73739 11858 8934 250921 215289 25309 10323 31319 30663 656 13279 9957 1663 1659 83674 75174 4250 4250 99129 87819 5580 5730 DONATED FOOD USED/DISTR 4353420 4353420 PROGRAM SUPPLIES 95043 62981 5671 26391 STAFF TRAINING AND CONT 9310 4787 15 4508 RENTAL EXPENSE 7581 327 1255 5999 5490 499 3286 1705 6702922 6212349 204111 286462 59076 55161 543683 123236 435348 320429 110218 0 82912 53863 50613 67158 2350460 735205 1043701 1615255 50000 251133 2375551 2486235 120170 139807 276980 390256 397150 530063 X 1336116 1239610 424685 498962 217600 217600 1978401 1956172 2375551 2486235 -33312 11083 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 824559 30000 90937 945496 497643 231103 95813 824559 442404 48500 6739 497643 355634 101428 30436 45094 442404 272636 62694 22602 2298 355634 0.82550 0.17450 0.00000 0 0 422987 422987 1493564 529433 964131 433909 205772 228137 1615255 INVESTMENTS - RAYMOND JAMES 33 F HANCOCK BANK C.D. 201100 F SMFF - FOUNDER'S FUND FIDELITY 50000 F 251133 X 7112447 11083 280041 151713 442837 6669610 0 6669610 6983149 280041 186 280227 6702922 0 6702922 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: PROVIDE A LONG-TERM PREDICTABLE STREAM OF FUNDING TO PROGRAMS SUPPORTED BY THE FREE CLINIC. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FREE CLINIC FOLLOWS ACCOUNTING STANDARDS CODIFICATION TOPIC 740, "INCOME TAXES" ("ASC 740"). A COMPONENT OF THIS STANDARD PRESCRIBES A RECOGNITION AND MEASUREMENT THRESHOLD OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. FOR THOSE BENEFITS TO BE RECOGNIZED, A TAX POSITION MUST BE MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES. THE FREE CLINICS POLICY IS TO RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH TAX POSITIONS UNDER THIS STANDARD AS A COMPONENT OF TAX EXPENSE, AND NONE WERE RECOGNIZED SINCE THERE WAS NO MATERIAL IMPACT OF THE APPLICATION OF THIS STANDARD FOR THE YEARS ENDED SEPTEMBER 30, 2013 AND 2012. THE FREE CLINICS INFORMATION RETURNS ARE OPEN TO IRS EXAMINATION FOR THE 2009 TAX YEAR ENDED SEPTEMBER 30, 2010, AND ALL SUBSEQUENT YEARS. PART XI, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF SISTER MARGARET FREEMAN FOUNDATION ACTIVITY ON FS 60,775. ELIMINATION OF SISTER MARGARET FREEMAN FOUNDATION UNREALIZED GAIN/LOSS 90,938. PART XII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF SISTER MARGARET FREEMAN FOUNDATION ACTIVITY ON FS 186. SOUP'S ON FUNDRAISER 80798 80798 9226 BATTLE OF THE MINDS FUNDRAISER 273946 273946 63627 354744 354744 72853 72853 281891 1 SPECIFIC ASSISTANCE TO INDIVIDUALS IN NEED OF FOOD, MEDICAL CARE, SHELTER, LIMITED FINANCIAL ASSISTANCE, AND REFERRAL INFORMATION, THROUGH PROGRAMS SUCH AS BEACON HOUSE, WE HELP SERVICES, AND WOMEN'S RESIDENCE 15500 200597 BOOK PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE VARIOUS PROGRAMS, SUCH AS BEACON HOUSE, WE HELP SERVICES, FAMILY RESIDENCE, HEALTH CENTER AND WOMEN'S RESIDENCE PROVIDE ASSISTANCE TO INDIVIDUALS IN THE FOLLOWING WAYS: - DIRECT MEDICINE - THE CLINIC PURCHASES AND DISTRIBUTES MEDICINE DIRECTLY TO PATIENTS. - UTILITIES - THE CLINIC PAYS UTILITY BILLS ON BEHALF OF INDIVIDUALS. - DIRECT ASSISTANCE - THE CLINIC PROVIDES FOOD (MOSTLY DONATED) ON BEHALF OF INDIVIDUALS. - TRANSPORTATION - THE CLINIC PURCHASES BUS PASSES ON BEHALF OF INDIVIDUALS. - ID SERVICES - THE CLINIC HELPS INDIVIDUALS WITH OBTAINING DRIVER LICENSES AND BIRTH CERTIFICATES. - DIABETIC SUPPLIES - THE CLINIC PROVIDES DIABETIC TESTING SUPPLIES. ALL APPLICANTS ARE INTERVIEWED AND SCREENED TO DETERMINE THEIR SPECIFIC NEEDS. ALL ASSISTANCE IS PAID FOR DIRECTLY BY THE CLINIC, AND NO MONEY GOES DIRECTLY TO INDIVIDUALS. X 1 228288 FAIR MARKET VALUE X 4324372 ESTIMATED $1.73/LB 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: PART I, COLUMN (B): LINE 15 ASAP FAMILY SERVICES CLOSED ITS DOORS AND DONATED 5 CONTIGUOUS PARCELS OF REAL ESTATE TO ST. PETERSBURG FREE CLINIC. LINE 19 CONTRIBUTORS DONATED APPROXIMATELY 2,500,000 POUNDS OF FOOD DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR REVIEWS THE FORM 990, AND PRESENTS THE EXACT IRS FILING COPY OF THE FORM 990 FOR EACH VOTING BOARD MEMBER'S REVIEW, BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE EXECUTIVE DIRECTOR MONITORS FOR ANY CONFLICT OF INTEREST AMONG EMPLOYEES, AND INVOLVES THE CHAIRPERSON OR BOARD AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD'S EXECUTIVE COMMITTEE DETERMINES THE EXECUTIVE DIRECTOR'S SALARY BASED ON THEIR KNOWLEDGE OF SALARIES AT COMPARABLE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 FORM 990 AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE ON THE ORGANIZATION'S WEBSITE. SISTER MARGARET FREEMAN FOUNDATION 863 3RD AVENUE NORTH ST PETERSBURG FL 33701 311470427 PROVIDE FUNDS FOR THE ST. PETERSBURG FREE CLINIC FL 501(C)(3) 11A - TYPE 1 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 SCHEDULE R, PART V, LINE 1B EACH YEAR, ST. PETERSBURG FREE CLINIC CONTRIBUTES $50,000 TO THE FOUNDERS FUND, IF BEQUESTS OF THAT AMOUNT ARE RECEIVED SISTER MARGARET FREEMAN FOUNDATION DISTRIBUTES 5% ANNUALLY OF THE VALUE OF THE FOUNDERS FUND TO ST PETERSBURG FREE CLINIC