FREE CLINIC OF ROME INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: FREE CLINIC OF ROME INC (EIN 20-5296305)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-10-31
IRS object ID: 201333049349300003
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-10-31T06:08:04-07:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RL JENNINGS & ASSOCIATES PC CPAS	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	506 E 3RD ST	AddressLine1
City	ROME	City
State	GA	State
ZIP Code	30161	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	205296305	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	FREE CLINIC OF ROME GEORGIA INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	FREE	NameControl
Phone	7062341331	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	315 WEST 10TH STREET	AddressLine1
City	ROME	City
State	GA	State
ZIP Code	30165	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	BARBARA EARLE	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	7062341331	Phone
Date Signed	2013-10-24	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	RICHARD L JENNINGS	Name
Phone	7068021945	Phone
Date Prepared	2013-10-31	DatePrepared

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

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

Field	Value	IRS element (for citing)
Business Name Line1	BARBARA EARLE	BusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	315 WEST 10TH STREET	AddressLine1
City	ROME	City
State	GA	State
ZIP Code	30165	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	817459	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2006	YearFormation
State Legal Domicile	GA	StateLegalDomicile
Activity Or Mission Description	To serve the Rome community by providing quality healthcare services to people who have no access to basic healthcare.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	12	NbrIndependentVotingMembers
Total Nbr Employees	1	TotalNbrEmployees
Total Nbr Volunteers	80	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	465563	ContributionsGrantsPriorYear
Contributions Grants Current Year	817389	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	296	InvestmentIncomePriorYear
Investment Income Current Year	70	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	465859	TotalRevenuePriorYear
Total Revenue Current Year	817459	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	64690	SalariesEtcPriorYear
Salaries Etc Current Year	82001	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	5135	TotalFundrsngExpCurrentYear
Other Expense Prior Year	403162	OtherExpensePriorYear
Other Expenses Current Year	751114	OtherExpensesCurrentYear
Total Expenses Prior Year	467852	TotalExpensesPriorYear
Total Expenses Current Year	833115	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-1993	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-15656	RevenuesLessExpensesCY
Total Assets BOY	57352	TotalAssetsBOY
Total Assets EOY	45928	TotalAssetsEOY
Total Liabilities BOY	11639	TotalLiabilitiesBOY
Total Liabilities EOY	5830	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	45713	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	40098	NetAssetsOrFundBalancesEOY
Mission Description	To serve the Rome community by	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	772079	Expense
Description	TO PROVIDE FREE, QUALITY HEALTHCARE AND TREATMENT TO INDIVIDUALS WHO HAD NO INSURANCE AND NO ACCESS TO QUALITY HEALTH CARE. CARE IS OFFERED TO THOSE WITH NO MEDICARE, MEDICADE, PEACHCARE OR OTHER INSURANCE PLAN.	Description
Total Program Service Expense	772079	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	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	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
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
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	1	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	12	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	false	RegularMonitoringEnforcement
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	GA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	BARBARA EARLE	NamePerson
Telephone Number	7062341331	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	315 WEST 10TH STREET	AddressLine1
City	ROME	City
State	GA	State
ZIP Code	30165	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA

Field	Value	IRS element (for citing)
Name Person	BARBARA EARLE	NamePerson
Title	Executive Director	Title
Average Hours Per Week	40.00	AverageHoursPerWeek
Individual Trustee Or Director	X	IndividualTrusteeOrDirector
Officer	X	Officer
Key Employee	X	KeyEmployee
Highest Compensated Employee	X	HighestCompensatedEmployee
Reportable Comp From Organization	0	ReportableCompFromOrganization
Reportable Comp From Related Orgs	57000	ReportableCompFromRelatedOrgs
Other Compensation	0	OtherCompensation

Field	Value	IRS element (for citing)
Total Reportable Comp Frm Rltd Orgs	57000	TotalReportableCompFrmRltdOrgs
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Fundraising Events	750	FundraisingEvents
All Other Contributions	816639	AllOtherContributions
Total Contributions	817389	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	70	TotalRevenueColumn

Field	Value	IRS element (for citing)
Cntrbtns Rprtd Fundraising Events	750	CntrbtnsRprtdFundraisingEvents

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	817459	TotalRevenueColumn
Related Or Exempt Function Income	70	RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	45000	Total
Program Services	36000	ProgramServices
Management And General	6750	ManagementAndGeneral
Fundraising	2250	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	25751	Total
Program Services	15686	ProgramServices
Management And General	9150	ManagementAndGeneral
Fundraising	915	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	11250	Total
Program Services	9000	ProgramServices
Management And General	1688	ManagementAndGeneral
Fundraising	562	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	6394	Total
Program Services	0	ProgramServices
Management And General	6394	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	60549	Total
Program Services	43595	ProgramServices
Management And General	15743	ManagementAndGeneral
Fundraising	1211	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	94	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	94	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	3332	Total
Program Services	2399	ProgramServices
Management And General	866	ManagementAndGeneral
Fundraising	67	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	740	Total
Program Services	651	ProgramServices
Management And General	89	ManagementAndGeneral
Fundraising	0	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	42314	Total
Program Services	33851	ProgramServices
Management And General	8463	ManagementAndGeneral
Fundraising	0	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	2530	Total
Program Services	430	ProgramServices
Management And General	2100	ManagementAndGeneral
Fundraising	0	Fundraising

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1417	Total
Program Services	0	ProgramServices
Management And General	1417	ManagementAndGeneral
Fundraising	0	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	1672	Total
Program Services	1338	ProgramServices
Management And General	334	ManagementAndGeneral
Fundraising	0	Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Dues and subscriptions	300	0	300
Labratory services	180000	180000	0
Medical services	158000	158000	0
Medical supplies	4191	4191	0

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	289581	Total
Program Services	286938	ProgramServices
Management And General	2607	ManagementAndGeneral
Fundraising	36	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	833115	Total
Program Services	772079	ProgramServices
Management And General	55901	ManagementAndGeneral
Fundraising	5135	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	54014	BOY
EOY	44437	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	618	BOY
EOY	189	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	938	BOY
EOY	938	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	7087	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	6723	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	1782	BOY
EOY	364	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	57352	BOY
EOY	45928	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	11639	BOY
EOY	5830	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	11639	BOY
EOY	5830	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	45713	BOY
EOY	40098	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	45713	BOY
EOY	40098	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	57352	BOY
EOY	45928	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-15656	ReconcilationRevenueExpenses
Reconcilation Prior Adjustment	10041	ReconcilationPriorAdjustment
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2
Public Support Total170	0	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Public Support Pertcentage170	0	PublicSupportPertcentage170

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	92139	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	110454	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	175533	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	465563	CurrentTaxYearMinus1Year
Current Tax Year	816639	CurrentTaxYear
Total	1660328	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	92139	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	110454	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	175533	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	465563	CurrentTaxYearMinus1Year
Current Tax Year	816639	CurrentTaxYear
Total	1660328	Total

Field	Value	IRS element (for citing)
Public Support Total509	1660328	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1198	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	915	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	453	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	296	CurrentTaxYearMinus1Year
Total	2862	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1198	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	915	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	453	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	296	CurrentTaxYearMinus1Year
Total	2862	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Total	1663190	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99830	PublicSupportPercentage509
Prior Year Support Percentage	0.99680	PriorYearSupportPercentage
Investment Income Percentage	0.00170	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00320	PriorYrInvestIncomePercentage
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

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	7087	OtherCostOrOtherBasis
Depreciation	6723	Depreciation
Book Value	364	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	364	TotalOfBookValueLandBuildings

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	ExplanationExplanation
Pt VI, Line 1a	Reviewed return for accuracy and approved.
Pt VI, Line 19	All documents are available upon request
Pt VI, Line 15a	THe board sets all starting salaries and approved all raises.
Pt VI, Line 11b	All documents are available on request
Form 990, Part IX, Line 24f	MEDICATION EXPENSES 691. 691. 0. 0. LOSS ON INVESTMENT 445. 0. 445. 0. MAINTENANCE EXPENSE 4110. 3288. 822. 0. SECURITY EXPENSE 4368. 3494. 874. 0. DIABETIC CLASSES 444. 444. 0. 0. TELEPHONE EXPENSE 1794. 1292. 466. 36. VOLUNTEER RECOGNITION 149. 149. 0. 0. EQUIPMENT RENTAL 2580. 2580. 0. 0. PATIENT ASSISTANCE 275000. 275000. 0. 0. 0.