CLARKSVILLE MONTGOMERY COUNTYCOMMUNITY HEALTH FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CLARKSVILLE MONTGOMERY COUNTYCOMMUNITY HEALTH FOUNDATION INC (EIN 20-4862825)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-15
IRS object ID
201232899349300008
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)
Timestamp2012-10-15T08:07:25-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1THURMAN CAMPBELL GROUP PLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1324 FRANKLIN STAddressLine1
CityCLARKSVILLECity
StateTNState
ZIP Code37040ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN204862825EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CLARKSVILLE-MONTGOMERY COUNTYBusinessNameLine1
Business Name Line2COMMUNITY HEALTH FOUNDATION INCBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlCLARNameControl
Phone9315021131Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 31003AddressLine1
CityCLARKSVILLECity
StateTNState
ZIP Code37040ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMIKE O'MALLEYName
TitleCHAIRMAN OF THE BOARDTitle
Phone9315021131Phone
Date Signed2012-08-09DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJEFFERY PROCTORName
Phone9315527474Phone
Date Prepared2012-10-04DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts1358778GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteCOMMUNITYHEALTHFOUNDATION.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2007YearFormation
State Legal DomicileTNStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION IS OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE RESIDENTS OF CLARKSVILLE,TN; MONTGOMERY COUNTY, TN; AND THE COUNTIES OF NORTHERN MIDDLE TN.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1662636ContributionsGrantsPriorYear
Contributions Grants Current Year337364ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year173564InvestmentIncomePriorYear
Investment Income Current Year308987InvestmentIncomeCurrentYear
Other Revenue Prior Year580503OtherRevenuePriorYear
Other Revenue Current Year631143OtherRevenueCurrentYear
Total Revenue Prior Year2416703TotalRevenuePriorYear
Total Revenue Current Year1277494TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year437939GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY487774GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4629SalariesEtcPriorYear
Salaries Etc Current Year7321SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year63642OtherExpensePriorYear
Other Expenses Current Year89082OtherExpensesCurrentYear
Total Expenses Prior Year506210TotalExpensesPriorYear
Total Expenses Current Year584177TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1910493RevenuesLessExpensesPriorYear
Revenues Less Expenses CY693317RevenuesLessExpensesCY
Total Assets BOY12359717TotalAssetsBOY
Total Assets EOY12529419TotalAssetsEOY
Total Liabilities BOY1717TotalLiabilitiesBOY
Total Liabilities EOY4903TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY12358000NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12524516NetAssetsOrFundBalancesEOY
Mission DescriptionTHE ORGANIZATION IS OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE RESIDENTS OF CLARKSVILLE,TN; MONTGOMERY COUNTY, TN; AND THE COUNTIES OF NORTHERN MIDDLE TN.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense487774Expense
Grants487774Grants
DescriptionHEALTH INITIATIVES, EDUCATION, AND PROJECTS SUPPORTING THE COMMUNITY.Description
Total Program Service Expense487774TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
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 OrganizationstrueGrantsToOrganizations
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 RequiredfalseScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
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 EnforcementfalseRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PAULA JOHNSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9315021131TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1651 DUNLOP LANEAddressLine1
CityCLARKSVILLECity
StateTNState
ZIP Code37040ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
ANNE BLACK
BOARD MEMBERX000
KAY DREW
SECRETARYX000X
JENNIFER ELLIS
VICE PRESIDEX000X
LM ELLIS
BOARD MEMBERX000
MARCOS A ARANCIBIA
BOARD MEMBERX000
BEN KIMBROUGH
CHAIRMANX000X
ANDRE S FRESCO
BOARD MEMBERX000
MIKE O'MALLEY
BOARD MEMBERX000
PRISCILLA G STORY
BOARD MEMBERX000
KIM MCMILLAN
BOARD MEMBERX000
JACK B TURNER
BOARD MEMBERX000
HAROLD VANN
BOARD MEMBERX000
CAROLYN BOWERS
BOARD MEMBERX000
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Related Organizations337364RelatedOrganizations
Total Contributions337364TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column308987TotalRevenueColumn
Exclusion$308,987ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real779848Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real151705Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real628143Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column628143TotalRevenueColumn
Exclusion$628,143ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Total Revenue Column3000TotalRevenueColumn
Exclusion$3,000ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3000TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1277494TotalRevenueColumn
Exclusion$940,130ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total487774Total
Program Services487774ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7321Total
Management And General7321ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1080Total
Management And General1080ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total19800Total
Management And General19800ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total64876Total
Management And General64876ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total333Total
Management And General333ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2993Total
Management And General2993ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total584177Total
Program Services487774ProgramServices
Management And General96403ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY62969BOY
EOY22803EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY443314BOY
EOY835108EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1662636BOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY8295BOY
EOY10490EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3692654LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec725912LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3025609BOY
EOY2966742EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3664310BOY
EOY5453211EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3492584BOY
EOY3241065EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12359717BOY
EOY12529419EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1717BOY
EOY4903EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1717BOY
EOY4903EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8676691BOY
EOY9097913EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3230178BOY
EOY2993675EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY451131BOY
EOY432928EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12358000BOY
EOY12524516EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12359717BOY
EOY12529419EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses693317ReconcilationRevenueExpenses
Reconcilation Other Changes-526801ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Community Trust170b1 AviXCommunityTrust170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years310CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3001897CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1662636CurrentTaxYearMinus1Year
Current Tax Year337364CurrentTaxYear
Total5002227Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years310CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3001897CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1662636CurrentTaxYearMinus1Year
Current Tax Year337364CurrentTaxYear
Total5002227Total
FieldValueIRS element (for citing)
Public Support Total1705002227PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years253573CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years-1266213CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years673495CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year948640CurrentTaxYearMinus1Year
Current Tax Year1088835CurrentTaxYear
Total1698330Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years538782CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years693956CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years728896CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1000CurrentTaxYearMinus1Year
Current Tax Year2000CurrentTaxYear
Total1964634Total
FieldValueIRS element (for citing)
Total Support8665191TotalSupport
Public Support Pertcentage1700.57730PublicSupportPertcentage170
Public Support Pertcent Prior Year0.64460PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

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

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3492585BeginningOfYearBalance
Investment Earnings Or Losses-113744InvestmentEarningsOrLosses
Other Expenditures115422OtherExpenditures
Administrative Expenses22353AdministrativeExpenses
End Of Year Balance3241066EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3143325BeginningOfYearBalance
Investment Earnings Or Losses476046InvestmentEarningsOrLosses
Other Expenditures110108OtherExpenditures
Administrative Expenses16678AdministrativeExpenses
End Of Year Balance3492585EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2591410BeginningOfYearBalance
Investment Earnings Or Losses684199InvestmentEarningsOrLosses
Other Expenditures115747OtherExpenditures
Administrative Expenses16537AdministrativeExpenses
End Of Year Balance3143325EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.13350PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.86650TermEndowmentEOYBalance
Endowments Held By Unrelated OrgstrueEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2265537OtherCostOrOtherBasis
Book Value2265537BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis34073OtherCostOrOtherBasis
Depreciation19876Depreciation
Book Value14197BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1393044OtherCostOrOtherBasis
Depreciation706036Depreciation
Book Value687008BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2966742TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
INTEREST IN TRUSTS HELD BY OTHERS2808138
BENEFICIAL INTEREST IN PERPETUAL TRU432927
FieldValueIRS element (for citing)
Total Book Value Other Assets3241065TotalBookValueOtherAssets
Total Revenue1277494TotalRevenue
Total Expenses584177TotalExpenses
Excess Or Deficit For Year693317ExcessOrDeficitForYear
Net Unrealized GL On Investments-526801NetUnrealizedGLOnInvestments
Total Adjustments-526801TotalAdjustments
Excess Or Deficit Per FS166516ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt750693TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-526801NetUnrealizedGainsInvestments
Revenue Not Rptd F990-526801RevenueNotRptdF990
Revenue Subtotal1277494RevenueSubtotal
Total Revenue Per Form9901277494TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt584177TotExpensesEtcAuditedFinclStmt
Expenses Subtotal584177ExpensesSubtotal
Total Expenses Per Form990584177TotalExpensesPerForm990

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrantBusiness Name Line2RecipientNameBusiness/BusinessNameLine2
AUSTIN PEAY FOUNDATION
PO BOX 4417CLARKSVILLETN37044210000NURSING EDUCATION
CLARKSVILLE-MONTGOMERY COUNTY
621 GRACEY AVECLARKSVILLETN3704051234SALARY/BENEFITSSCHOOL SYSTEM
EMERGENCY MEDICAL SERVICES
1608 HAYNES STCLARKSVILLETN37043176540EKG'S FOR AMBULANCES
MISSION CLARKSVILLE
1230 ROSSVIEW ROADCLARKSVILLETN3704350000FOOD INITIATIVE

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE 990 WAS REVIEWED BY THE CHAIRMAN OF THE BOARD
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19NO DOCUMENTS AVAILABLE TO THE PUBLIC

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