LAFOLLETTE MEDICAL FOUNDATION INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LAFOLLETTE MEDICAL FOUNDATION INC (EIN 20-4901729)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-10-07
- IRS object ID
- 201332809349300953
- 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 | 2013-10-07T08:48:44-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 621142155 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PUGH & COMPANY PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 315 N CEDAR BLUFF RD SUITE 200 | AddressLine1 |
| City | KNOXVILLE | City |
| State | TN | State |
| ZIP Code | 37923 | 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 | 204901729 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAFOLLETTE MEDICAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LAFO | NameControl |
| Phone | 4239126963 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1 |
| City | JACKSBORO | City |
| State | TN | State |
| ZIP Code | 37757 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JUDGE SHAYNE SEXTON | Name |
| Title | PRESIDENT | Title |
| Phone | 4239126963 | Phone |
| Date Signed | 2013-08-29 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RE FOUST | Name |
| PTIN | P00745365 | PTIN |
| Phone | 8657690660 | Phone |
| 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 | JUDGE SHAYNE SEXTON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1 |
| City | JACKSBORO | City |
| State | TN | State |
| ZIP Code | 37757 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2725295 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LAFOLLETTEMEDICALFOUNDATION.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2006 | YearFormation |
| State Legal Domicile | TN | StateLegalDomicile |
| Activity Or Mission Description | THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1498158 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 418638 | InvestmentIncomePriorYear |
| Investment Income Current Year | 393937 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1916796 | TotalRevenuePriorYear |
| Total Revenue Current Year | 393937 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 549175 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 602253 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | 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 | 145134 | OtherExpensePriorYear |
| Other Expenses Current Year | 134606 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 694309 | TotalExpensesPriorYear |
| Total Expenses Current Year | 736859 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1222487 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -342922 | RevenuesLessExpensesCY |
| Total Assets BOY | 10050850 | TotalAssetsBOY |
| Total Assets EOY | 10129485 | TotalAssetsEOY |
| Total Liabilities BOY | 31800 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10019050 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10129485 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 602253 | Expense |
| Grants | 602253 | Grants |
| Description | THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF LAFOLLETTE COMMUNITY, WHICH INCLUDES ALL OF CAMPBELL COUNTY. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | THE FOUNDATION IS ORGANIZED AS A PUBLIC BENEFIT CORPORATION FOR THE CHARITABLE PURPOSE OF MAKING DISTRIBUTIONS TO QUALIFYING 501(C)(3) ORGANIZATIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF THE LAFOLLETTE,TN COMMUNITY. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 602253 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | 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 | 1 | 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 | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | 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 | 1 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | TN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JUNE WILBURN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4239126963 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 128 | AddressLine1 |
| City | JACKSBORO | City |
| State | TN | State |
| ZIP Code | 37757 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|
| BRENDA ROBARDS | |||||
| TREASURER | 1.00 | X | 0 | 0 | 0 |
| MIKE STANFIELD | |||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 |
| LUCY LOBERTINI | |||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 |
| KATHY MYERS | |||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 |
| JUDGE SHAYNE SEXTON | |||||
| PRESIDENT AND CHAIRMAN | 1.00 | X | 0 | 0 | 0 |
| ELIZABETH ASBURY | |||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 |
| DR JAMES FARRIS | |||||
| DIRECTOR | 1.00 | 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 |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 279611 | TotalRevenueColumn |
| Exclusion | $279,611 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2445684 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2331358 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 114326 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 114326 | TotalRevenueColumn |
| Related Or Exempt Function Income | 114326 | RelatedOrExemptFunctionIncome |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 393937 | TotalRevenueColumn |
| Related Or Exempt Function Income | 114326 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $279,611 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 602253 | Total |
| Program Services | 602253 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3938 | Total |
| Management And General | 3938 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11200 | Total |
| Management And General | 11200 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100002 | Total |
| Management And General | 100002 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14940 | Total |
| Management And General | 14940 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2687 | Total |
| Management And General | 2687 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1839 | Total |
| Management And General | 1839 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 736859 | Total |
| Program Services | 602253 | ProgramServices |
| Management And General | 134606 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 649003 | BOY |
| EOY | 478280 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9401847 | BOY |
| EOY | 9651205 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10050850 | BOY |
| EOY | 10129485 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11050 | BOY |
| EOY | 0 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20750 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31800 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10019050 | BOY |
| EOY | 10129485 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10019050 | BOY |
| EOY | 10129485 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10050850 | BOY |
| EOY | 10129485 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -342922 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 453035 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 322 | 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 | 0 | 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 Minus1 Year | 1498158 | CurrentTaxYearMinus1Year |
| Total | 1498158 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 1498158 | CurrentTaxYearMinus1Year |
| Total | 1498158 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 1498158 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 328328 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 231982 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 251778 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 260522 | CurrentTaxYearMinus1Year |
| Current Tax Year | 393937 | CurrentTaxYear |
| Total | 1466547 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 2964705 | TotalSupport |
| Public Support Pertcentage170 | 0.50530 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.43720 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 846972 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 453035 | OtherRevenues |
| Revenue Not Rptd F990 | 453035 | RevenueNotRptdF990 |
| Revenue Subtotal | 393937 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 393937 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 736537 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 736537 | ExpensesSubtotal |
| Other Expenses Not Included | 322 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 322 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 736859 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | UNREALIZED GAINS ON INVESTMENTS 453,035. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RECOVERIES OF PRIOR YEAR GRANTS 322. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Method Of ValuationMethodOfValuation | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|
| THE SHEPHERD'S HOME INC | ||||||||
| P O BOX 707 | JACKSBORO | TN | 37757 | 270988603 | 501(C)(3) | 70727 | CASH GRANT | HEALTH CARE |
| FOOD LIFE SERVICES OF CAMPBELL COUNTY | ||||||||
| 206 S INDIANA AVE | LAFOLLETTE | TN | 37766 | 621812105 | 501(C)(3) | 60000 | CASH GRANT | HEALTH CARE |
| CAMPBELL COUNTY SENIOR CITIZENS | ||||||||
| 102 8TH STREET | LAFOLLETTE | TN | 37766 | 620988347 | 501(C)(3) | 59520 | CASH GRANT | HEALTH CARE |
| CAMPBELL COUNTY CHILDREN'S CENTER | ||||||||
| 2315 JACKSBORO PIKE | JACKSBORO | TN | 37766 | 780251005 | 501(C)(3) | 99594 | CASH GRANT | HEALTH CARE |
| EAST TENNESSEE HUMAN RESOURCE AGENCY INC | ||||||||
| 9111 CROSS PARK DRIVE D-100 | KNOXVILLE | TN | 37923 | 621493851 | 501(C)(3) | 22000 | CASH GRANT | HEALTH CARE |
| CHET - COMMUNITY HEALTH OF EAST TN | ||||||||
| P O BOX 209 507 MAIN ST | JACKSBORO | TN | 37757 | 581470587 | 501(C)(3) | 125912 | CASH GRANT | HEALTH CARE |
| TN BAPTIST ADULT HOMES | ||||||||
| PO BOX 728 | BRENTWOOD | TN | 37024 | 620934533 | 501(C)(3) | 20000 | CASH GRANT | HEALTH CARE |
| CASA OF CAMPBELL COUNTY | ||||||||
| PO BOX 1054 | JACKSBORO | TN | 37757 | 205755609 | 501(C)(3) | 21000 | CASH GRANT | HEALTH CARE |
| LAFOLLETTE UNITED METHODIST CHURCH | ||||||||
| 808 E CENTRAL AVENUE | LAFOLLETTE | TN | 37766 | 626043365 | 501(C)(3) | 16500 | CASH GRANT | HEALTH CARE |
| JELLICO COMMUNITY HOSPITAL | ||||||||
| 188 HOSPITAL LANE | JELLICO | TN | 37762 | 620924706 | 501(C)(3) | 7000 | CASH GRANT | HEALTH CARE |
| WYNN HABERSHAM COMMUNITY HEALTH CLINIC | ||||||||
| 1037 STINKING CREEK ROAD | LA FOLLETTE | TN | 37766 | 311548496 | 501(C)(3) | 100000 | CASH GRANT | HEALTH CARE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 11 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990; SCHEDULE I; PART I; LINE 2 | Identifier |
| Explanation | THE ORGANIZATION SELECTS ORGANIZATIONS THAT ENGAGE IN ACTIVITIES AND MAKE DISTRIBUTIONS THAT PROVIDE FOR THE HEALTHCARE OF THE RESIDENTS OF THE LAFOLLETTE. THE PROPERTY, AFFAIRS AND BUSINESS OF THE FOUNDATION ARE TO BE MANAGED BY A BOARD OF DIRECTORS, WHOSE OPERATIONS IN GOVERNING THE FOUNDATION ARE DEFINED BY TENNESSEE STATUTE AND THE FOUNDATIONS BYLAWS. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY CALLS FOR ANNUAL STATEMENTS TO BE SIGNED EACH YEAR. ARTICLE VII CALLS FOR PERIODIC REVIEWS OF COMPENSATION ISSUES AND RELATED PARTY AFFILIATIONS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS PRESENTED TO EACH BOARD MEMBER PRIOR TO THE MEETING FOR MEMBERS TO VIEW PRIOR TO THE FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY CALLS FOR ANNUAL STATEMENTS SHALL BE SIGNED EACH YEAR. ARTICLE VII CALLS FOR PERIODIC REVIEWS OF COMPENSATION ISSUES AND RELATED PARTY AFFILIATIONS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST | |
| FORM 990, PART XI, LINE 9: | RECOVERIES OF PRIOR YEARS GRANTS 322. | CHANGES IN NET ASSETS OR FUND BALANCES: |
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