COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY (EIN 57-1074191)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-08-15
IRS object ID: 201302279349302915
Schema version: 2012v2.1
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
Form 990
Schedule A
Schedule D
Schedule G
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-08-15T13:00:34-05:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CANTEY TILLER PIERCE & GREEN LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 862	AddressLine1
City	CAMDEN	City
State	SC	State
ZIP Code	29021	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	571074191	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY MEDICAL CLINIC OF KERSHAW	BusinessNameLine1
Business Name Line2	COUNTY C/O SUSAN WITKOWSKI	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	COMM	NameControl
Phone	8037130806	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	110 EAST DEKALB STREET	AddressLine1
Address Line2	ROOM/SUITE 1-B	AddressLine2
City	CAMDEN	City
State	SC	State
ZIP Code	29020	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	SUSAN WITKOWSKI	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	8037130806	Phone
Date Signed	2013-08-07	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	HENRY D GREEN III	Name
Phone	8034321436	Phone
Date Prepared	2013-08-15	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	SUSAN WITKOWSKI	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	110 EAST DEKALB STREET	AddressLine1
City	CAMDEN	City
State	SC	State
ZIP Code	29020	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	462793	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.CMCOFKC.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1998	YearFormation
State Legal Domicile	SC	StateLegalDomicile
Activity Or Mission Description	THE ORGANIZATION IS ENGAGED IN THE OPERATION OF A MEDICAL CLINIC FOR RESIDENTS OF CAMDEN AND KERSHAW COUNTY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	16	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	16	NbrIndependentVotingMembers
Total Nbr Employees	7	TotalNbrEmployees
Total Nbr Volunteers	200	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	322897	ContributionsGrantsPriorYear
Contributions Grants Current Year	414757	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	414	InvestmentIncomePriorYear
Investment Income Current Year	195	InvestmentIncomeCurrentYear
Other Revenue Prior Year	26329	OtherRevenuePriorYear
Other Revenue Current Year	41865	OtherRevenueCurrentYear
Total Revenue Prior Year	349640	TotalRevenuePriorYear
Total Revenue Current Year	456817	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	234426	SalariesEtcPriorYear
Salaries Etc Current Year	290175	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	99236	OtherExpensePriorYear
Other Expenses Current Year	124378	OtherExpensesCurrentYear
Total Expenses Prior Year	333662	TotalExpensesPriorYear
Total Expenses Current Year	414553	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	15978	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	42264	RevenuesLessExpensesCY
Total Assets BOY	343022	TotalAssetsBOY
Total Assets EOY	385830	TotalAssetsEOY
Total Liabilities BOY	20504	TotalLiabilitiesBOY
Total Liabilities EOY	21048	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	322518	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	364782	NetAssetsOrFundBalancesEOY
Mission Description	THE ORGANIZATION IS ENGAGED IN THE OPERATION OF A MEDICAL CLINIC FOR RESIDENTS OF CAMDEN AND KERSHAW COUNTY.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	411928	Expense
Description	TO PROVIDE OUT-PATIENT HEALTH CARE SERVICES TO PERSONS IN KERSHAW COUNTY WHO CANNOT PAY FOR SUCH SERVICES OUT OF POCKET AND WHO DO NOT HAVE HEALTH INSURANCE	Description
Total Program Service Expense	411928	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	true	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	7	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	16	NbrVotingGoverningBodyMembers
Number Independent Voting Members	16	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	false	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	SUSAN WITKOWSKI	NamePerson
Telephone Number	8037130806	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	110 E DEKALB ST	AddressLine1
City	CAMDEN	City
State	SC	State
ZIP Code	29020	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitle	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Average Hours Per WeekAverageHoursPerWeek	OfficerOfficer
ALICE BROOKS MD
CHAIRMAN	X	0	0	0
WILLIAM SUMMERS
BOARD MEMBER	X	0	0	0
KENNETH CARSON
BOARD MEMBER	X	0	0	0
DONNIE WEEKS
V CHAIR	X	0	0	0
GEORGE GIBSON
BOARD MEMBER	X	0	0	0
JIM BURNS
BOARD MEMBER	X	0	0	0
JOHN DUBOSE
BOARD MEMBER	X	0	0	0
META MARKLEY
BOARD MEMBER	X	0	0	0
TINA LOCKHART
SECRETARY	X	0	0	0
HARRIET HERIOT
BOARD MEMBER	X	0	0	0
ROY FAKOURY
BOARD MEMBER	X	0	0	0
JOANN CUSHMAN
BOARD MEMBER	X	0	0	0
HANK GREEN
TREASURER	X	0	0	0
LAURIE SLADE FUNDERBURK
BOARD MEMBER	X	0	0	0
NED TOWELL
BOARD MEMBER	X	0	0	0
MARY CLARK
BOARD MEMBER	X	0	0	0
SUSAN WITKOWSKI
EXEC. DIRECT		72873	0	0	40.00	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	72873	TotalReportableCompFromOrg
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
All Other Contributions	414757	AllOtherContributions
Total Contributions	414757	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	195	TotalRevenueColumn
Related Or Exempt Function Income	195	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	47841	GrossIncomeFundraisingEvents
Fundraising Direct Expenses	5976	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	41865	TotalRevenueColumn

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	456817	TotalRevenueColumn
Related Or Exempt Function Income	195	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	X	InfoInScheduleOPartIX

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	263913	Total
Program Services	263913	ProgramServices

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	4750	Total
Program Services	4750	ProgramServices

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	21512	Total
Program Services	21512	ProgramServices

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	2625	Total
Management And General	2625	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	20124	Total
Program Services	20124	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
INSURANCE- GROUP	18067	18067
INSURANCE- MALPRACTICE	14153	14153
SUPPLIES	10323	10323
MEDICATION	9174	9174

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	49912	Total
Program Services	49912	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	414553	Total
Program Services	411928	ProgramServices
Management And General	2625	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	256441	BOY
EOY	331659	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	36249	BOY
EOY	6057	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	400	BOY
EOY	400	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	173578	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	125864	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	49932	BOY
EOY	47714	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	343022	BOY
EOY	385830	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	20504	BOY
EOY	21048	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	20504	BOY
EOY	21048	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	322518	BOY
EOY	364782	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	322518	BOY
EOY	364782	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	343022	BOY
EOY	385830	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	42264	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	305216	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	324229	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	336572	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	322897	CurrentTaxYearMinus1Year
Current Tax Year	414757	CurrentTaxYear
Total	1703671	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	305216	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	324229	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	336572	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	322897	CurrentTaxYearMinus1Year
Current Tax Year	414757	CurrentTaxYear
Total	1703671	Total

Field	Value	IRS element (for citing)
Public Support Total170	1703671	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2133	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	314	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	313	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	414	CurrentTaxYearMinus1Year
Current Tax Year	195	CurrentTaxYear
Total	3369	Total

Field	Value	IRS element (for citing)
Total Support	1707040	TotalSupport
Gross Receipts From Admissions Etc	48036	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	0.99800	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.99660	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	173578	OtherCostOrOtherBasis
Depreciation	125864	Depreciation
Book Value	47714	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	47714	TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt	3243317	TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities	2786500	DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990	2786500	RevenueNotRptdF990
Revenue Subtotal	456817	RevenueSubtotal
Total Revenue Per Form990	456817	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	3201053	TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities	2786500	DonatedServicesUseOfFacilities
Expenses Not Rptd F990	2786500	ExpensesNotRptdF990
Expenses Subtotal	414553	ExpensesSubtotal
Total Expenses Per Form990	414553	TotalExpensesPerForm990

Schedule G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	SPECIAL EVENTS	NameOfEvent1
Gross Receipts Event1	47841	GrossReceiptsEvent1
Gross Revenue Event1	47841	GrossRevenueEvent1
Other Direct Expenses Event1	5976	OtherDirectExpensesEvent1
Gross Receipts Total	47841	GrossReceiptsTotal
Gross Revenue Total Events	47841	GrossRevenueTotalEvents
Other Direct Expenses Total Events	5976	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	5976	DirectExpenseSummaryEvents
Net Income Summary	41865	NetIncomeSummary

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	THIS IS REVIEWED ANNUALLY WITH THE BOARD OF DIRECTORS.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	THIS IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THESE DOCUMENTS ARE AVAILABLE UPON REQUEST.
OTHER EXPENSES	FORM 990, PART IX, LINE 24E	HOUSEKEEPING 8,800 0 0 REPAIRS/MAINTAINANCE 8,111 0 0 UTILITIES 7,296 0 0 MISCELLANEOUS 6,520 0 0 COMPUTER SUPPORT 4,382 0 0 TELEPHONE 4,375 0 0 INSURANCE- GENERAL 2,972 0 0 POSTAGE 2,277 0 0 MEDICAL SUPPLIES 2,228 0 0 ADVERTISING 1,689 0 0 TRAVEL 1,262 0 0

COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY: Form 990, tax year 2012

Return header ReturnHeader

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Preparer Firm US Address PreparerFirmUSAddress

Filer Filer

Name Name

US Address USAddress

Officer Officer

Preparer Preparer

Form 990 IRS990

Address Principal Officer US AddressPrincipalOfficerUS

The Books Are In Care Of TheBooksAreInCareOf

Address US AddressUS

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

Investment Income InvestmentIncome

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Total Revenue TotalRevenue

Other Salaries And Wages OtherSalariesAndWages

Pension Plan Contributions PensionPlanContributions

Payroll Taxes PayrollTaxes

Fees For Services Accounting FeesForServicesAccounting

Depreciation Depletion DepreciationDepletion

Other Expenses OtherExpenses (4 entries)

All Other Expenses AllOtherExpenses

Total Functional Expenses TotalFunctionalExpenses

Cash Non Interest Bearing CashNonInterestBearing

Pledges And Grants Receivable PledgesAndGrantsReceivable

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Total Assets TotalAssets

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Total Liabilities TotalLiabilities

Unrestricted Net Assets UnrestrictedNetAssets

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FS Audited Basis FSAuditedBasis

Schedule A IRS990ScheduleA

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Total170 Total170

Gross Investment Income170 GrossInvestmentIncome170

Schedule D IRS990ScheduleD

Equipment Equipment

Schedule G IRS990ScheduleG

Events Information EventsInformation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Comments