COMMUNITY CARE CENTER FOR FORSYTH COUNTY: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY CARE CENTER FOR FORSYTH COUNTY (EIN 58-1403699)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201323189349304852
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T14:06:36-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561215661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE DANIEL PROFESSIONAL GRP INC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4400 SILAS CREEK PKY SUITE 200 | AddressLine1 |
| City | WINSTONSALEM | City |
| State | NC | State |
| ZIP Code | 27104 | 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 | 581403699 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY CARE CENTER FOR FORSTYH COUNTY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 3367601235 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 NEW WALKERTOWN ROAD | AddressLine1 |
| City | WINSTON SALEM | City |
| State | NC | State |
| ZIP Code | 27101 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES T ROBINSON | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 3367601235 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOSEPH P SILLS | Name |
| PTIN | P00194921 | PTIN |
| Phone | 3367683290 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES T ROBINSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 NEW WALKERTOWN ROAD | AddressLine1 |
| City | WINSTONSALEM | City |
| State | NC | State |
| ZIP Code | 27101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2877425 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CCCFORSYTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1980 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE FREE ON-SITE MEDICAL AND DENTAL CARE TO LOW-INCOME FAMILIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 23 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 23 | NbrIndependentVotingMembers |
| Total Nbr Employees | 33 | TotalNbrEmployees |
| Total Nbr Volunteers | 222 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2210073 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2843824 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1395 | InvestmentIncomePriorYear |
| Investment Income Current Year | 895 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 57361 | OtherRevenuePriorYear |
| Other Revenue Current Year | 32706 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2268829 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2877425 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 943599 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 961610 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1419603 | OtherExpensePriorYear |
| Other Expenses Current Year | 2247461 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2363202 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3209071 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -94373 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -331646 | RevenuesLessExpensesCY |
| Total Assets BOY | 1141075 | TotalAssetsBOY |
| Total Assets EOY | 815904 | TotalAssetsEOY |
| Total Liabilities BOY | 54981 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 52276 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1086094 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 763628 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE FREE ON-SITE MEDICAL AND DENTAL CARE TO LOW-INCOME FAMILIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 3056943 | Expense |
| Description | COMMUNITY CARE CENTER OF FORSYTH COUNTY, INC. IS A FREEMEDICAL CLINIC FOR FAMILIES WHO EARN LESS THAN 200% OF THEFEDERAL POVERTY LEVEL AND ARE NOT ELIGIBLE FOR GOVERNMENTPROGRAMS AND HAVE NO MEDICAL INSURANCE. THE CENTER PROVIDESFREE ON-SITE MEDICAL AND DENTAL CARE TO LOW-INCOME FAMILIES,AS THE SOLE PROGRAM. | Description |
| Total Program Service Expense | 3056943 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 33 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 23 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 23 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 0 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Own Website | X | OwnWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES T ROBINSON | NamePerson |
| Telephone Number | 3367601235 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 NEW WALKERTOWN ROAD | AddressLine1 |
| City | WINSTON SALEM | City |
| State | NC | State |
| ZIP Code | 27101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| DR WILLIAM M SATTERWHITE JR | ||||||
| VICE PRESIDENT | 0.00 | X | X | 0 | 0 | 0 |
| JAMES T ROBINSON | ||||||
| SECRETARY/EXECUTIVE DIRECT | 0.00 | X | X | 0 | 0 | 0 |
| DR CARL S PHIPPS | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| HAMPDEN D KENAN | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| DUDLEY C CHANDLER DDS | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| MICHAEL CLEMENTS | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| DR ERNESTO DE LA TORRE | ||||||
| VICE PRESIDENT | 0.00 | X | X | 0 | 0 | 0 |
| ANN FLYNT | ||||||
| BOARD CHAIR | 0.00 | X | X | 0 | 0 | 0 |
| KATHY KENNEDY | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| WARD B MILLER | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| DR ROBERT V FORD | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| DAVID L MOUNT | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| ANTHONY H BRETT | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| SYLVIA I OBERLE | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| DR R TED TOBORG | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| KIM JONES | ||||||
| TREASURER | 0.00 | X | X | 0 | 0 | 0 |
| DONNA KINLEY REYNOLDS | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| MICHELLE MARTINEZ | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| FELIPE VILLALON | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| ANNE SLOWEY | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| CAROLYN BREESE | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| HAROLD POLLARD MD | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| JULIA H FLOYD | ||||||
| DIRECTOR | 0.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBINSON ASSOCIATION MGMT SVCS INC | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 NEW WALKERTOWN ROAD | AddressLine1 |
| City | WINSTONSALEM | City |
| State | NC | State |
| ZIP Code | 27101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | MANAGEMENT COMPANY | DescriptionOfServices |
| Compensation | 130000 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Federated Campaigns | 272392 | FederatedCampaigns |
| Government Grants | 55207 | GovernmentGrants |
| All Other Contributions | 2516225 | AllOtherContributions |
| Noncash Contributions | 1737683 | NoncashContributions |
| Total Contributions | 2843824 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 895 | TotalRevenueColumn |
| Exclusion | $895 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 17000 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 17000 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17000 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17000 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISC. REVENUE-RELATED- | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 15706 | TotalRevenueColumn |
| Related Or Exempt Function Income | 15706 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 15706 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2877425 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32706 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $895 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 801728 | Total |
| Program Services | 801728 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91193 | Total |
| Program Services | 91193 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68689 | Total |
| Program Services | 68689 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 130000 | Total |
| Management And General | 130000 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17100 | Total |
| Management And General | 17100 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36005 | Total |
| Program Services | 30977 | ProgramServices |
| Management And General | 5028 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1421 | Total |
| Program Services | 1421 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58211 | Total |
| Program Services | 58211 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33195 | Total |
| Program Services | 33195 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1203 | Total |
| Program Services | 1203 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35956 | Total |
| Program Services | 35956 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15004 | Total |
| Program Services | 15004 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MEDICINES AND MEDICAL S | 1788524 | 1788524 |
| MISCELLANEOUS | 56870 | 56870 |
| REPAIRS | 50037 | 50037 |
| OUTSIDE CONTRACTED SERV | 23935 | 23935 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3209071 | Total |
| Program Services | 3056943 | ProgramServices |
| Management And General | 152128 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 353616 | BOY |
| EOY | 263599 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127480 | BOY |
| EOY | 104849 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 354704 | BOY |
| EOY | 172324 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 1953 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19766 | BOY |
| EOY | 19766 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14130 | BOY |
| EOY | 9080 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 633665 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 505409 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 164212 | BOY |
| EOY | 128256 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107167 | BOY |
| EOY | 116077 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1141075 | BOY |
| EOY | 815904 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54981 | BOY |
| EOY | 52276 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54981 | BOY |
| EOY | 52276 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 578390 | BOY |
| EOY | 480969 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 507704 | BOY |
| EOY | 282659 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1086094 | BOY |
| EOY | 763628 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1141075 | BOY |
| EOY | 815904 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -331646 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 9180 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | 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 | 1374943 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2423346 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3326800 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2210073 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2843824 | CurrentTaxYear |
| Total | 12178986 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1374943 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2423346 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3326800 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2210073 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2843824 | CurrentTaxYear |
| Total | 12178986 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 12178986 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 12032 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8798 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4893 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1395 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9180 | CurrentTaxYear |
| Total | 36298 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 13380 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 31535 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 35603 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 57361 | CurrentTaxYearMinus1Year |
| Current Tax Year | 32706 | CurrentTaxYear |
| Total | 170585 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 12385869 | TotalSupport |
| Public Support Pertcentage170 | 0.98330 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.98190 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 107167 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 9209 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4636 | GrantsOrScholarships |
| Administrative Expenses | 823 | AdministrativeExpenses |
| End Of Year Balance | 110917 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 111007 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1404 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4416 | GrantsOrScholarships |
| Administrative Expenses | 828 | AdministrativeExpenses |
| End Of Year Balance | 107167 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 103629 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 12303 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 4168 | GrantsOrScholarships |
| Administrative Expenses | 757 | AdministrativeExpenses |
| End Of Year Balance | 111007 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 80625 | BeginningOfYearBalance |
| Contributions | 10000 | Contributions |
| Investment Earnings Or Losses | 16990 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 3454 | GrantsOrScholarships |
| Administrative Expenses | 531 | AdministrativeExpenses |
| End Of Year Balance | 103630 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 69210 | BeginningOfYearBalance |
| Contributions | 35000 | Contributions |
| Investment Earnings Or Losses | -19845 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 3252 | GrantsOrScholarships |
| Administrative Expenses | 488 | AdministrativeExpenses |
| End Of Year Balance | 80625 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 40776 | OtherCostOrOtherBasis |
| Depreciation | 8037 | Depreciation |
| Book Value | 32739 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 585994 | OtherCostOrOtherBasis |
| Depreciation | 493738 | Depreciation |
| Book Value | 92256 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6895 | OtherCostOrOtherBasis |
| Depreciation | 3634 | Depreciation |
| Book Value | 3261 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 128256 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER ASSETS(DETAIL)-990 | 5160 |
| FUNDS HELD IN TRUST- ENDOWMENT | 110917 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 116077 | TotalBookValueOtherAssets |
| Tot Revenue Etc Audited Fincl Stmt | 7908946 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 9180 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 5022341 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 5031521 | RevenueNotRptdF990 |
| Revenue Subtotal | 2877425 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2877425 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 8231412 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 5022341 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 5022341 | ExpensesNotRptdF990 |
| Expenses Subtotal | 3209071 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 3209071 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | Identifier |
| Return Reference | PART V, LINE 4: | ReturnReference |
| Explanation | THE PURPOSE OF THE ENDOWMENT FUND IS TO PROVIDE A PERMANENT FUND WHICH MAY BE USED BY THE ORGANIZATION TO SUPPORT THE PROVISION OF HEALTHCARE SERVICES TO THE MEDICALLY UNINSURED AND UNDERSERVED WHO MEET THE ELIGIBILITY REQUIREMENT GUIDELINES OF THE ORGANIZATION. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBINSON ASSOCIATION MGMT SVC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | OWNED BY EXECUTIVE DIRECTOR | Relationship |
| Amount Of Transaction | 130000 | AmountOfTransaction |
| Description Of Transaction | MANAGEMENT FEES | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSupplies
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 3 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 1711570 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | DONOR PROVIDED | MethodOfDeterminingRevenues |
Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|
| X | FOOD FOR VOLUNTEERS | 18400 | COST |
| X | DONATED MISCELLANEOUS SUPPLIES | 7713 | COST |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 1 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION RECEIVES MANAGEMENT SERVICES UNDER A BOARD APPROVED CONTRACT FROM ROBINSON ASSOCIATION MANAGEMENT SERVICES, INC., AN ENTITY OWNED BY JAMES T. ROBINSON THE EXECUTIVE DIRECTOR. MANAGEMENT FEES FOR 2012 TOTALED $130,000. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE 990 IS PROVIDED TO THE EXECUTIVE DIRECTOR AND TREASURER FOR THEIR REVIEW PRIOR TO THE RETURN BEING FILED. THE 990 IS SUBSEQUENTLY REVIEWED BY THE FINANCE COMMITTEE. |
| FORM 990, PART VI, SECTION B, LINE 15 | SALARIES AND MANAGEMENT CONTRACTS ARE REVIEWED AND RECOMMENDATIONS MADE BY THE PERSONNEL COMMITTEE WHICH IS MADE UP OF INDEPENDENT PERSONS. THOSE RECOMMENDATIONS THEN GO TO THE FINANCE COMMITTEE FOR REVIEW AND FINALLY TO THE BOARD FOR APPROVAL. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAIALBLE TO ANYONE THAT REQUEST A COPY OF THE INFORMATION. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORSYTH-STOKES-DAVIE COUNTY MEDICAL SOCI | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2135 NEW WALKERTOWN ROAD | AddressLine1 |
| City | WINSTONSALEM | City |
| State | NC | State |
| ZIP Code | 27101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 566047612 | EIN |
| Primary Activities | MEDICAL | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Exempt Code Section | 501(C)(6) | ExemptCodeSection |
| Public Charity Status | N/A | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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