FREE MEDICAL CLINIC OF OAK RIDGE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FREE MEDICAL CLINIC OF OAK RIDGE INC (EIN 90-0715369)
Tax period
2011-04-25 to 2011-12-31
Filed
2012-05-15
IRS object ID
201211369349304371
Schema version
2011v1.2
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)
Timestamp2012-05-15T14:37:01-04:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DALE C ISABELL CPABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1253 SHORT STREETAddressLine1
CityClintonCity
StateTNState
ZIP Code37716ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-04-25TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN900715369EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FREE MEDICAL CLINIC OF OAK RIDGE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFREENameControl

US Address USAddress

FieldValueIRS element (for citing)
Address Line1320 ROBERTSVILLE RDAddressLine1
CityOak RidgeCity
StateTNState
ZIP Code37830ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTERESA BRITTAINName
TitleEXECUTIVE DIRECTitle
Phone8654833904Phone
Date Signed2012-05-15DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDALE C ISABELL CPAName
Phone8654572411Phone
Date Prepared2012-05-15DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Initial ReturnXInitialReturn
Name Of Principal Officer PersonDR TANYA VARGASNameOfPrincipalOfficerPerson
Gross Receipts361140GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2011YearFormation
State Legal DomicileTNStateLegalDomicile
Activity Or Mission DescriptionTO PROMOTE AND DELIVER FREE MEDICAL AND DENTAL CARE TO THE UNINSURED AND UNDERINSURED WHO HAVE LIMITED ACCESS TO BASIC HEALTH CARE SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees2TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Current Year259137ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Current Year311InvestmentIncomeCurrentYear
Other Revenue Current Year101692OtherRevenueCurrentYear
Total Revenue Current Year361140TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Current Year41012SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year5584TotalFundrsngExpCurrentYear
Other Expenses Current Year154273OtherExpensesCurrentYear
Total Expenses Current Year195285TotalExpensesCurrentYear
Revenues Less Expenses CY165855RevenuesLessExpensesCY
Total Assets EOY168757TotalAssetsEOY
Total Liabilities EOY2902TotalLiabilitiesEOY
Net Assets Or Fund Balances EOY165855NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROMOTE AND DELIVER FREE MEDICAL AND DENTAL CARE TO THE UNINSURED AND UNDERINSURED WHO HAVE LIMITED ACCESS TO BASIC HEALTH CARE SERVICESMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense175022Expense
DescriptionWITH A LARGE AMOUNT OF DONATED SERVICES AND SUPPLIES THE ORGANIZATION IS ABLE TO PROMOTE AND DELIVER FREE MEDICAL AND DENTAL CARE TO THOSE INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED THAT DO NOT HAVE ASSESS TO BASIC MEDICAL CARE IT ALSO COORDINA TES WITH OTHER HEALTH CARE PROVIDERS TO PROVIDE MEDICAL CARE TO THE PEOPLE OF THE SURROUNDING REGIONDescription
Total Program Service Expense175022TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonsfalseAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTERESA BRITTAINNamePerson
Telephone Number8654833904TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1320 ROBERTSVILLE RDAddressLine1
CityOak RidgeCity
StateTNState
ZIP Code37830ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerAverage Hours Per WeekAverageHoursPerWeekKey EmployeeKeyEmployee
CHRISTINE LEE
BOARD MEMBERX000
DR JAMES MICHAEL
MEDICAL DIRECTORX000
JIM BARNES
BOARD MEMBERX000
JULIE UTTERBACK
BOARD MEMBERX000
KEN SOMMERFELD
BOARD MEMBERX000
MAUREEN HOYT
BOARD MEMBERX000
MICHAEL MCCUTCHEON
BOARD MEMBERX000
DR TANYA VARGAS
PRESIDENT000X
MARTIN BAUER
TREASURER000X
MAYME CROWELL
VICE PRESIDENT000X
PRISCILLA SPITZER
SECRETARY000X
TERESA BRITTAIN
EXECUTIVE DIRECTOR236000040.00X
FieldValueIRS element (for citing)
Total Reportable Comp From Org23600TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Fundraising Events8785FundraisingEvents
Government Grants54900GovernmentGrants
All Other Contributions195452AllOtherContributions
Total Contributions259137TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column311TotalRevenueColumn
Related Or Exempt Function Income311RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Cntrbtns Rprtd Fundraising Events8785CntrbtnsRprtdFundraisingEvents

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAL RECORD FEES62140026752675
DONATED SERVICES6214009901799017
FieldValueIRS element (for citing)
Total Other Revenue101692TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column361140TotalRevenueColumn
Related Or Exempt Function Income102003RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total38098Total
Program Services29336ProgramServices
Management And General8000ManagementAndGeneral
Fundraising762Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2914Total
Program Services2244ProgramServices
Management And General612ManagementAndGeneral
Fundraising58Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total3000Total
Management And General3000ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2712Total
Program Services2712ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total1746Total
Program Services1746ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6852Total
Program Services5520ProgramServices
Management And General1257ManagementAndGeneral
Fundraising75Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total115Total
Program Services115ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total17060Total
Program Services17060ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total429Total
Program Services322ProgramServices
Management And General107ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1371Total
Program Services1083ProgramServices
Management And General288ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionSUMMARYDescription
Total120988Total
Program Services114884ProgramServices
Management And General1415ManagementAndGeneral
Fundraising4689Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total195285Total
Program Services175022ProgramServices
Management And General14679ManagementAndGeneral
Fundraising5584Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY153471EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis15715LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec429LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
EOY15286EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY168757EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
EOY2902EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY2902EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
EOY165855EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY165855EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY168757EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses165855ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year250351CurrentTaxYear
Total250351Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year250351CurrentTaxYear
Total250351Total
FieldValueIRS element (for citing)
Public Support Total170250351PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year311CurrentTaxYear
Total311Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year101692CurrentTaxYear
Total101692Total
FieldValueIRS element (for citing)
Total Support352354TotalSupport
Public Support Pertcentage1700.71050PublicSupportPertcentage170
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis12138OtherCostOrOtherBasis
Depreciation173Depreciation
Book Value11965BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3577OtherCostOrOtherBasis
Depreciation256Depreciation
Book Value3321BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings15286TotalOfBookValueLandBuildings
Total Revenue361140TotalRevenue
Total Expenses195285TotalExpenses
Excess Or Deficit For Year165855ExcessOrDeficitForYear
Excess Or Deficit Per FS165855ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt361140TotRevenueEtcAuditedFinclStmt
Revenue Subtotal361140RevenueSubtotal
Total Revenue Per Form990361140TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt195285TotExpensesEtcAuditedFinclStmt
Expenses Subtotal195285ExpensesSubtotal
Total Expenses Per Form990195285TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanation
01. Form 990 governing body review (Part VI, line 11)NO REVIEW WAS CONDUCTED OR WILL BE CONDUCTED
02. Conflict of interest policy compliance (Part VI, line 12c)THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE BOARD ON ALL DECISIONS ALL BOARD MEMBERS ARE INDEPENDENT FROM MANAGEMENT AND ALL CONTRACTORS
03. CEO, executive director, top management comp (Part VI, line 15a)BOARD OF DIRECTORS REVIEWS AND SETS SALARIES FOR ALL EMPLOYEES BASED ON PERFORMANCE REVIEWS
04. Other officer or key employee compensation (Part VI, line 15bBOARD OF DIRECTORS REVIEWS AND SETS SALARIES FOR ALL EMPLOYEES BASES ON PERFORMANCE REVIEWS
05. Governing documents, etc, available to public (Part VI, line 19)OTHER DOCUMENTS ARE AVAILABLE UPON REQUEST

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.