OPEN ARMS FREE CLINIC INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
OPEN ARMS FREE CLINIC INC (EIN 45-4475625)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-05-14
IRS object ID
201331349349302513
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

FieldValueIRS element (for citing)
Timestamp2013-05-14T11:04:28-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN391971296EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CHAMBERLAIN & HENNINGFIELD CPASBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1119AddressLine1
CityLAKE GENEVACity
StateWIState
ZIP Code53147ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN454475625EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1OPEN ARMS FREE CLINIC INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlOPENNameControl
Phone2622756154Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 560AddressLine1
CityFONTANACity
StateWIState
ZIP Code53125ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDANIEL SANDERSName
TitlePRESIDENTTitle
Phone2622756154Phone
Date Signed2013-05-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDAVID J HENNINGFIELD CPAName
PTINP00188242PTIN
Phone2622491100Phone
Date Prepared2013-05-10DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDANIEL SANDERSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1797 EAST GENEVA STREETAddressLine1
CityELKHORNCity
StateWIState
ZIP Code53121ZIPCode
FieldValueIRS element (for citing)
Gross Receipts229919GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.OPENARMSFREECLINIC.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2012YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionSTRIVE TO BETTER UNDERSTAND AND SERVE THE HEALTH AND WELLNESS NEEDS OF THE UNINSURED, LOW INCOME AND UNDER-SERVED RESIDENTS OF WALWORTH COUNTY WITH COMPASSION AND UNDERSTANDING.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year228908ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year25InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year292OtherRevenueCurrentYear
Total Revenue Prior Year0TotalRevenuePriorYear
Total Revenue Current Year229225TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year0OtherExpensePriorYear
Other Expenses Current Year80084OtherExpensesCurrentYear
Total Expenses Prior Year0TotalExpensesPriorYear
Total Expenses Current Year80084TotalExpensesCurrentYear
Revenues Less Expenses Prior Year0RevenuesLessExpensesPriorYear
Revenues Less Expenses CY149141RevenuesLessExpensesCY
Total Assets BOY0TotalAssetsBOY
Total Assets EOY149141TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY0NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY149141NetAssetsOrFundBalancesEOY
Mission DescriptionSTRIVE TO BETTER UNDERSTAND AND SERVE THE HEALTH AND WELLNESS NEEDS OF THE UNINSURED, LOW INCOME AND UNDER-SERVED RESIDENTS OF WALWORTH COUNTY WITH COMPASSION AND UNDERSTANDING.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10226Expense
DescriptionCLINIC SERVICESDescription
Total Program Service Expense10226TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHRISTINA DEANBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2622756154TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1797 EAST GENEVA STREETAddressLine1
CityELKHORNCity
StateWIState
ZIP Code53121ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
COLLEEN ANDERSON
ASSISTAND MED DIRECTOR0.00X000
REBECCA BRUSA
SECRETARY0.00X000
WILLIAM CLARK
DIRECTOR0.00X000
CHRISTINA DEAN
TREASURER0.00X000
BOB DILLMAN
DIRECTOR0.00X000
NICHOLAS EGERT
DIRECTOR0.00X000
ROBERT FASANO
MEDICAL DIRECTOR0.00X000
JUDY JOHNSON
BOARD MEMBER0.00X000
PATRICK KENNY
BOARD MEMBER0.00X000
PAM KNORR
BOARD MEMBER0.00X000
LISA KROLOW
CATHOLIC CHARITIES0.00X000
JAMES MEHLTRETTER
VICE PRESIDENT0.00X000
ORIOL REGALES
BOARD MEMBER0.00X000
DANIEL SANDERS
PRESIDENT0.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions228908AllOtherContributions
Noncash Contributions114773NoncashContributions
Total Contributions228908TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column25TotalRevenueColumn
Related Or Exempt Function Income25RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Gross Income Fundraising Events986GrossIncomeFundraisingEvents
Fundraising Direct Expenses694FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column292TotalRevenueColumn
Exclusion$292ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column229225TotalRevenueColumn
Related Or Exempt Function Income25RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$292ExclusionAmount

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total234Total
Management And General234ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3539Total
Management And General3539ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4750Total
Management And General4750ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total53340Total
Management And General53340ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1900Total
Management And General1900ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PHARMACY52045204
OFFICE EXPENSE384124271414
TELEPHONE27272727
BACKGROUND CHECKS17101710

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2839Total
Program Services885ProgramServices
Management And General1954ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total80084Total
Program Services10226ProgramServices
Management And General69858ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY99481EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis103000LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec53340LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY0BOY
EOY49660EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY149141EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY149141EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY149141EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY149141EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses149141ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis103000OtherCostOrOtherBasis
Depreciation53340Depreciation
Book Value49660BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings49660TotalOfBookValueLandBuildings

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9901200NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable (3 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XFURNITURE AND EQIUPMENT105273COMPARABLE SALES
XPROFESSIONAL2134COST
XOFFICE SUPPLIES6166COST
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS REVIEWED, SIGNED, AND FILED BY THE PRESIDENT WHO THEN PRESENTS A COPY TO EACH MEMBER OF THE BOARD OF DIRECTORS. SHOULD ANY MATERIAL REASON BE FOUND, AMENDMENTS TO THE RETURN WOULD BE MADE UNDER BOARD DIRECTION AND APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.

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