GOOD SAMARITAN CLINIC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN CLINIC (EIN 71-0863639)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2013-11-22
- IRS object ID
- 201313269349300206
- Schema version
- 2012v2.0
- 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) |
|---|---|---|
| Timestamp | 2013-11-22T06:58:11-08:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRZYBYSZ & ASSOCIATES CPAS PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 JENNY LIND SUITE B | AddressLine1 |
| City | FORT SMITH | City |
| State | AR | State |
| ZIP Code | 72901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 710863639 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Clinic | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOOD | NameControl |
| Phone | 4797830233 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 North B Street | AddressLine1 |
| City | Fort Smith | City |
| State | AR | State |
| ZIP Code | 72901 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Darrell Stovall | Name |
| Title | Treasurer | Title |
| Date Signed | 2013-11-22 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Marc Lux CPA | Name |
| PTIN | P00588449 | PTIN |
| Phone | 4796490888 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 531812 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.good-sam-clinic.net | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2001 | YearFormation |
| State Legal Domicile | AR | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UNINUSRED,ELDERLY & HOMELESS | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 18 | NbrIndependentVotingMembers |
| Total Nbr Employees | 13 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 551542 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 482055 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 25750 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 32533 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 8716 | InvestmentIncomePriorYear |
| Investment Income Current Year | 17093 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 5221 | OtherRevenuePriorYear |
| Other Revenue Current Year | 131 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 591229 | TotalRevenuePriorYear |
| Total Revenue Current Year | 531812 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 383387 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 411948 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 19084 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 223046 | OtherExpensePriorYear |
| Other Expenses Current Year | 195381 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 606433 | TotalExpensesPriorYear |
| Total Expenses Current Year | 607329 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -15204 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -75517 | RevenuesLessExpensesCY |
| Total Assets BOY | 1157950 | TotalAssetsBOY |
| Total Assets EOY | 1105514 | TotalAssetsEOY |
| Total Liabilities BOY | 29152 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 36096 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1128798 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1069418 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UNINUSRED,ELDERLY & HOMELESS | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 548681 | Expense |
| Description | THE CLINIC PROVIDES MEDICAL SERVICES AND MEDICATIONS AT REASONABLE COSTS TO THE WORKING POOR, UNINUSRED,ELDERLY & HOMELESS | Description |
| Total Program Service Expense | 548681 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | 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 | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | 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 | false | 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 |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| 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 |
| Transaction Related Entity | false | TransactionRelatedEntity |
| 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 |
| Compliance With Backup Witholding | false | ComplianceWithBackupWitholding |
| Number Of Employees | 13 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 18 | 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 | false | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | 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 | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | AR | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | The Organization | NamePerson |
| Telephone Number | 4797830233 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 615 North B Street | AddressLine1 |
| City | Fort Smith | City |
| State | AR | State |
| ZIP Code | 72901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|---|
| Diane Arnold | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| John VinsonPh D | ||||||||
| Chairman | 2.00 | 0.00 | X | 0 | 0 | 0 | X | |
| Cathy Ulrich | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Darrell Stovall | ||||||||
| Treasurer | 2.00 | 0.00 | X | 0 | 0 | 0 | X | |
| Rosemary Wingfield | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Rex Terry | ||||||||
| Vice Chairman | 1.00 | 0.00 | X | 0 | 0 | 0 | X | |
| Harold MacDowell | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Russ Aikman | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Sister Rebecca Hendricks | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Carolyn Mosley PhD | ||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Michael Schluterman CPA | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| GaeVon Hoover | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Diane Graham | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Leslie Ziegler MD | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Joel James | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Judy Boreham | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Ronnie Rouse | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Norma Basinger MD | ||||||||
| Director | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| Evan Breedlove | ||||||||
| Executive Director | 40.00 | 0.00 | 55000 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 55000 | TotalReportableCompFromOrg |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| All Other Contributions | 482055 | AllOtherContributions |
| Total Contributions | 482055 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient payments | Description |
| Total Revenue Column | 32533 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32533 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 32533 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10238 | TotalRevenueColumn |
| Exclusion | $10,238 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 6855 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 6855 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6855 | TotalRevenueColumn |
| Exclusion | $6,855 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Miscellaneous Income | Description |
| Total Revenue Column | 131 | TotalRevenueColumn |
| Related Or Exempt Function Income | 131 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 131 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 531812 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32664 | RelatedOrExemptFunctionIncome |
| Exclusion | $17,093 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55000 | Total |
| Program Services | 50600 | ProgramServices |
| Management And General | 4400 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 283624 | Total |
| Program Services | 247836 | ProgramServices |
| Management And General | 22690 | ManagementAndGeneral |
| Fundraising | 13098 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46236 | Total |
| Program Services | 42537 | ProgramServices |
| Management And General | 3699 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27088 | Total |
| Program Services | 23762 | ProgramServices |
| Management And General | 2167 | ManagementAndGeneral |
| Fundraising | 1159 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11624 | Total |
| Program Services | 11624 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1141 | Total |
| Program Services | 479 | ProgramServices |
| Management And General | 91 | ManagementAndGeneral |
| Fundraising | 571 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23247 | Total |
| Program Services | 21387 | ProgramServices |
| Management And General | 1860 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72 | Total |
| Program Services | 66 | ProgramServices |
| Management And General | 6 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15692 | Total |
| Program Services | 14437 | ProgramServices |
| Management And General | 1255 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22288 | Total |
| Program Services | 21599 | ProgramServices |
| Management And General | 689 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Pharmaceutical supplies | 6894 | 6894 | ||
| Office supplies | 11826 | 7923 | 946 | 2957 |
| Medical supplies | 42116 | 42116 | ||
| Laboratory test supplies | 42350 | 42350 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18131 | Total |
| Program Services | 15071 | ProgramServices |
| Management And General | 1761 | ManagementAndGeneral |
| Fundraising | 1299 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 607329 | Total |
| Program Services | 548681 | ProgramServices |
| Management And General | 39564 | ManagementAndGeneral |
| Fundraising | 19084 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 184124 | BOY |
| EOY | 163167 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 552617 | BOY |
| EOY | 485472 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 572 | BOY |
| EOY | 445 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 292713 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 146429 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 142827 | BOY |
| EOY | 146284 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 277810 | BOY |
| EOY | 310146 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1157950 | BOY |
| EOY | 1105514 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29152 | BOY |
| EOY | 36096 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29152 | BOY |
| EOY | 36096 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 955687 | BOY |
| EOY | 810261 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 390 | BOY |
| EOY | 85436 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 172721 | BOY |
| EOY | 173721 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1128798 | BOY |
| EOY | 1069418 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1157950 | BOY |
| EOY | 1105514 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -75517 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 16137 | ReconciliationUnrealizedInvest |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | true | AccountantCompileOrReview |
Accountant Compile Or Review Basis AccountantCompileOrReviewBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 408241 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 364413 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 348795 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 556763 | CurrentTaxYearMinus1Year |
| Current Tax Year | 482186 | CurrentTaxYear |
| Total | 2160398 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 39115 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 35712 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 29831 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 25750 | CurrentTaxYearMinus1Year |
| Current Tax Year | 32533 | CurrentTaxYear |
| Total | 162941 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 447356 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 400125 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 378626 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 582513 | CurrentTaxYearMinus1Year |
| Current Tax Year | 514719 | CurrentTaxYear |
| Total | 2323339 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 2323339 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | -9260 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 18169 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 15352 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10174 | CurrentTaxYearMinus1Year |
| Current Tax Year | 10238 | CurrentTaxYear |
| Total | 44673 | Total |
Post1975 UBTI Post1975UBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | -9260 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 18169 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 15352 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 10174 | CurrentTaxYearMinus1Year |
| Current Tax Year | 10238 | CurrentTaxYear |
| Total | 44673 | Total |
Net Income From Other UBI NetIncomeFromOtherUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 438096 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 418294 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 393978 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 592687 | CurrentTaxYearMinus1Year |
| Current Tax Year | 524957 | CurrentTaxYear |
| Total | 2368012 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.98110 | PublicSupportPercentage509 |
| Investment Income Percentage | 0.01890 | InvestmentIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 186812 | OtherCostOrOtherBasis |
| Depreciation | 61345 | Depreciation |
| Book Value | 125467 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 105901 | OtherCostOrOtherBasis |
| Depreciation | 85084 | Depreciation |
| Book Value | 20817 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 146284 | TotalOfBookValueLandBuildings |
| Total Of Book Value Securities | 310146 | TotalOfBookValueSecurities |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 547949 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 16137 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 16137 | RevenueNotRptdF990 |
| Revenue Subtotal | 531812 | RevenueSubtotal |
| Total Revenue Per Form990 | 531812 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 607329 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 607329 | ExpensesSubtotal |
| Total Expenses Per Form990 | 607329 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X | Part X : FIN48 Footnote | Generally accepted accounting principles require tax effects from an uncertain tax position to be recognized in the financial statements only if the position is more likely than not to be sustained if the position were to be challenged by a taxing authority. The assessment of the tax position is based solely on the technical merits of the position, without regard to the likelihood that the tax position may be challenged. If an uncertain tax position meets the more-likely-than-not threshold, the largest amount of tax benefit that is greater than 50% likely to be recognized upon ultimate settlement with the taxing authority is recorded. The Clinic's primary tax positions relate to its status as a not-for-profit entity exempt from income taxes and classification of activities related to its exempt purpose. Management has evaluated the tax positions reflected in the Clinic's tax filings and does not believe that any material uncertain tax positions exist. |
| Part V, Line 4 | Part V, Line 4: Intended uses of the endowment fund. | Provide additional support to the organization |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The Clinic has the financials and the Form 990 available for inspection at their physical location. |
| Form 990, Part VI, Line 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Potential board members are questioned of any potential conflicts of interest. |
| Form 990, Part VI, Line 11b | Form 990, Part VI, Line 11b: Form 990 Review Process | The Board of Directors reviews the Form 990 prior to filing. |
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