FREE CLINIC OF POWHATAN: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
FREE CLINIC OF POWHATAN (EIN 26-1275136)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201123189349302107
Schema version
2010v3.4
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)
Timestamp2011-11-14T08:39:42-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1RICHARD W MCMINN III CPABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13229 ANDERSON HWY STE 100AddressLine1
CityPOWHATANCity
StateVAState
ZIP Code231397340ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN261275136EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FREE CLINIC OF POWHATAN INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFREENameControl
Phone8043796484Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12364 HUGUENOT TRAILAddressLine1
CityPOWHATANCity
StateVAState
ZIP Code23139ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCONNIE MOSLOWName
TitleEXECUTIVE DIRECTORTitle
Phone8043796484Phone
Date Signed2011-11-09DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRICHARD W MCMINNIII CPAName
Phone8045986662Phone
Date Prepared2011-11-11DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCONNIE MOSLOWNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12364 HUGUENOT TRAILAddressLine1
CityPOWHATANCity
StateVAState
ZIP Code23139ZIPCode
FieldValueIRS element (for citing)
Gross Receipts282249GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.FREECLINICOFPOWHATAN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2007YearFormation
Activity Or Mission DescriptionTO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUESActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers25TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year67412ContributionsGrantsPriorYear
Contributions Grants Current Year282249ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year67412TotalRevenuePriorYear
Total Revenue Current Year282249TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year39598OtherExpensePriorYear
Other Expenses Current Year92293OtherExpensesCurrentYear
Total Expenses Prior Year39598TotalExpensesPriorYear
Total Expenses Current Year92293TotalExpensesCurrentYear
Revenues Less Expenses Prior Year27814RevenuesLessExpensesPriorYear
Revenues Less Expenses CY189956RevenuesLessExpensesCY
Total Assets BOY70374TotalAssetsBOY
Total Assets EOY261522TotalAssetsEOY
Total Liabilities EOY1192TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY70374NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY260330NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE MEDICAL AND DENTAL SERVICES TO THOSE NOT ABLE TO PURCHASE THESE SERVICES THROUGH OTHER AVENUESMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense36933Expense
DescriptionORGANIZATION FACILITATES THE AVAILABILITY OF MEDICAL AND DENTAL SERVICES TO THE RESIDENTS OF POWHATAN, VIRGINIA THAT DO NOT HAVE THE RESOURCES TO GET THE SERVICES ELSEWHERE.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense9005Expense
FieldValueIRS element (for citing)
Total Of Other Program Service Exp9005TotalOfOtherProgramServiceExp
Total Program Service Expense45938TotalProgramServiceExpense
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 EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
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 With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
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 Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
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 PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCONNIE MOSLOWNamePerson
Telephone Number8043796484TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12364 HUGUENOT TRAILAddressLine1
CityPOWHATANCity
StateVAState
ZIP Code23139ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
CONNIE MOSLOW
PRESIDENT10.00XX000
JOHN CARMACK MD
VICE-PRES20.00XX000
CARSON TUCKER
SECRETARY5.00XX000
LARRY LYONS
TREASURER1.00XX000
TINA BUSTOS
DIRECTOR1.00X000
SISTER MAUREEN CARROLL
DIRECTOR1.00X000
CAROLYN BISHOP
DIRECTOR1.00X000
ROBERT COSBY
DIRECTOR1.00X000
INDIA COX
DIRECTOR1.00X000
RON SPEARS
DIRECTOR1.00X000
JOHN RICK
DIRECTOR1.00X000
KIM WRIGHT
DIRECTOR1.00X000
ANN HOGG
DIRECTOR1.00X000
LINDA JONES
DIRECTOR1.00X000
RICHARD MCMINN III
DIRECTOR1.00X000
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Government Grants2270GovernmentGrants
All Other Contributions279979AllOtherContributions
Total Contributions282249TotalContributions

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column282249TotalRevenueColumn

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total49342Total
Program Services8947ProgramServices
Management And General40395ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total547Total
Management And General547ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2774Total
Management And General2774ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total170Total
Management And General170ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total6901Total
Program Services6901ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total58Total
Program Services58ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PRESCRIPTIONS ASSISTANCE2258922589
DENTAL SUPPLIES60856085
MEDICAL SUPPLIES13581358
DUES/MEMBERSHIPS11331133
TELEPHONE719719

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total617Total
Management And General617ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total92293Total
Program Services45938ProgramServices
Management And General46355ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY70374BOY
EOY260434EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1146LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec58LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
EOY1088EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY70374BOY
EOY261522EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY1192EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY1192EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY30321BOY
EOY117067EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY40053BOY
EOY143263EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY70374BOY
EOY260330EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY70374BOY
EOY261522EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses189956ReconcilationRevenueExpenses
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or ReviewtrueAccountantCompileOrReview
FS AuditedfalseFSAudited
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years55704CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year67412CurrentTaxYearMinus1Year
Current Tax Year282249CurrentTaxYear
Total405365Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years55704CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year67412CurrentTaxYearMinus1Year
Current Tax Year282249CurrentTaxYear
Total405365Total
FieldValueIRS element (for citing)
Public Support Total170405365PublicSupportTotal170
Total Support405365TotalSupport
Public Support Pertcentage1701.00000PublicSupportPertcentage170
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
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1146OtherCostOrOtherBasis
Depreciation58Depreciation
Book Value1088BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1088TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionOTHER LIABILITIESDescription
Amount$1,192Amount
FieldValueIRS element (for citing)
Total Of Amounts1192TotalOfAmounts

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7ATHE EXECUTIVE BOARD NOMINATES DIRECTORS EVERY TWO YEARS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BOFFICERS REVIEW ON ANNUAL BASIS
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CTHE OFFICER'S REVIEW FOR POTENTIAL CONFLICTS CONTINUOUSLY
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ACOMPENSATION REVIEWED ON AN ANNUAL BASIS
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BCOMPENSATION REVIEWED ON AN ANNUAL BASIS
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19AVAILABLE UPON REQUEST

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