COMMUNITY CARE CENTER FOR FORSYTH COUNTY: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY CARE CENTER FOR FORSYTH COUNTY (EIN 58-1403699)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-08-12
IRS object ID
201132289349301178
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)
Timestamp2011-08-12T10:29:44-04:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DANIEL PROFESSIONAL GROUP INCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14400 SILAS CREEK PARKWAY SUITE 200AddressLine1
CityWINSTONSALEMCity
StateNCState
ZIP Code27104ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN581403699EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY CARE CENTER FOR FORSTYH COUNTY INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone3367601235Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12135 NEW WALKERTOWN ROADAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27101ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJAMES T ROBINSONName
TitleEXECUTIVE DIRECTORTitle
Date Signed2011-08-11DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameJOSEPH P SILLSName
Phone3367683290Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts3367297GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.cccforsyth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1980YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE FREE ON-SITE MEDICAL AND DENTAL CARE TO LOW-INCOME FAMILIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees36TotalNbrEmployees
Total Nbr Volunteers350TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year2423346ContributionsGrantsPriorYear
Contributions Grants Current Year3326800ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year8798InvestmentIncomePriorYear
Investment Income Current Year4893InvestmentIncomeCurrentYear
Other Revenue Prior Year31535OtherRevenuePriorYear
Other Revenue Current Year35604OtherRevenueCurrentYear
Total Revenue Prior Year2463679TotalRevenuePriorYear
Total Revenue Current Year3367297TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year884836SalariesEtcPriorYear
Salaries Etc Current Year959795SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY18932TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year18932TotalFundrsngExpCurrentYear
Other Expense Prior Year1680021OtherExpensePriorYear
Other Expenses Current Year2409349OtherExpensesCurrentYear
Total Expenses Prior Year2564857TotalExpensesPriorYear
Total Expenses Current Year3388076TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-101178RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-20779RevenuesLessExpensesCY
Total Assets BOY1239691TotalAssetsBOY
Total Assets EOY1232539TotalAssetsEOY
Total Liabilities BOY43233TotalLiabilitiesBOY
Total Liabilities EOY53399TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1196458NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1179140NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE FREE ON-SITE MEDICAL AND DENTAL CARE TO LOW-INCOME FAMILIES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense3209566Expense
DescriptionCOMMUNITY CARE CENTER OF FORSYTH COUNTY, INC. IS A FREE MEDICAL CLINIC FOR FAMILIES WHO EARN LESS THAN 200% OF THE FEDERAL POVERTY LEVEL AND ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAMS AND HAVE NO MEDICAL INSURANCE. THE CENTER PROVIDES FREE ON-SITE MEDICAL AND DENTAL CARE TO LOW-INCOME FAMILIES, AS THE SOLE PROGRAM.Description
Total Program Service Expense3209566TotalProgramServiceExpense
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 FundraisingtrueProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
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 RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees36NumberOfEmployees
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
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
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 PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementfalseRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
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 PersonJAMES T ROBINSONNamePerson
Telephone Number3367601235TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12135 NEW WALKERTOWN ROADAddressLine1
CityWINSTON SALEMCity
StateNCState
ZIP Code27101ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficer
DR WILLIAM M SATTERWHITE JR
VICE PRESIDENTXX
JAMES T ROBINSON
SECRETARY/EXECUTIVE DIRECTORXX
DR CARL S PHIPPS
DIRECTORX
FANNY STRONACH
CHAIRX
MARY ANNE SQUIRE
DIRECTORX
BO KENAN
DIRECTORX
RAMON VELEZ MD
DIRECTORX
DUDLEY C CHANDLER DDS
DIRECTORX
MICHAEL CLEMENTS
DIRECTORX
DR ERNESTO DE LA TORRE
VICE PRESIDENTXX
ANN FLYNT
BOARD CHAIRXX
MURRAY C GREASON
DIRECTORX
KATHY KENNEDY
DIRECTORX
WARD B MILLER
DIRECTORX
DR ROBERT V FORD
DIRECTORX
DAVID L MOUNT
DIRECTORX
DAVID BURKE
TREASURERXX
ANTHONY H BRETT
DIRECTORX
SHERRI Y MURRRELL
DIRECTORX
SYLVIA I OBERLE
DIRECTORX
DR R TED TOBORG
DIRECTORX
FieldValueIRS element (for citing)
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonROBINSON ASSOCIATION MGMT SVCS INamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12135 NEW WALKERTOWN ROADAddressLine1
CityWINSTONSALEMCity
StateNCState
ZIP Code27101ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesMANAGEMENT COMPANYDescriptionOfServices
Compensation137667Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns238000FederatedCampaigns
Fundraising Events72855FundraisingEvents
Government Grants470327GovernmentGrants
All Other Contributions2545618AllOtherContributions
Noncash Contributions1767113NoncashContributions
Total Contributions3326800TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4893TotalRevenueColumn
Exclusion$4,893ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real15600Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real15600Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column15600TotalRevenueColumn
Related Or Exempt Function Income15600RelatedOrExemptFunctionIncome

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Total Revenue Column20004TotalRevenueColumn
Related Or Exempt Function Income20004RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue20004TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3367297TotalRevenueColumn
Related Or Exempt Function Income35604RelatedOrExemptFunctionIncome
Exclusion$4,893ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total815805Total
Program Services815805ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total78439Total
Program Services78439ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total65551Total
Program Services65551ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total137667Total
Management And General137667ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total68783Total
Program Services46872ProgramServices
Management And General21911ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total18932Total
Fundraising18932Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total25667Total
Program Services25667ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total1143Total
Program Services1143ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total33985Total
Program Services33985ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total3069Total
Program Services3069ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total52683Total
Program Services52683ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total31310Total
Program Services31310ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
SECURITY1394413944
REPAIRS & MAINTENANCE4442044420
UTILITIES5330253302
FEES, MEDICINES, SUPPLIES129845129845
PRINTING & COPYING2161721617

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1791914Total
Program Services1791914ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3388076Total
Program Services3209566ProgramServices
Management And General159578ManagementAndGeneral
Fundraising18932Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY287454BOY
EOY258965EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY171864BOY
EOY184530EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY375820BOY
EOY425571EOY
FieldValueIRS element (for citing)
Accounts ReceivableAccountsReceivable

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY19766BOY
EOY19766EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY25345BOY
EOY27834EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis627537LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec422671LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY255813BOY
EOY204866EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY103629BOY
EOY111007EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1239691BOY
EOY1232539EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY43233BOY
EOY53399EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY43233BOY
EOY53399EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY669283BOY
EOY620611EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY407175BOY
EOY558529EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY120000BOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1196458BOY
EOY1179140EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1239691BOY
EOY1232539EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-20779ReconcilationRevenueExpenses
Reconcilation Other Changes3461ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years883108CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years955142CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1374943CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2423346CurrentTaxYearMinus1Year
Current Tax Year3326800CurrentTaxYear
Total8963339Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years883108CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years955142CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1374943CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2423346CurrentTaxYearMinus1Year
Current Tax Year3326800CurrentTaxYear
Total8963339Total
FieldValueIRS element (for citing)
Public Support Total1708963339PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6068CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12725CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12032CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8798CurrentTaxYearMinus1Year
Current Tax Year4893CurrentTaxYear
Total44516Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9851CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years17636CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13380CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year31535CurrentTaxYearMinus1Year
Current Tax Year35603CurrentTaxYear
Total108005Total
FieldValueIRS element (for citing)
Total Support9115860TotalSupport
Public Support Pertcentage1700.98327PublicSupportPertcentage170
Public Support Pertcent Prior Year0.98113PublicSupportPertcentPriorYear
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)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance103629BeginningOfYearBalance
Investment Earnings Or Losses12303InvestmentEarningsOrLosses
Grants Or Scholarships4168GrantsOrScholarships
Administrative Expenses757AdministrativeExpenses
End Of Year Balance111007EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance80625BeginningOfYearBalance
Contributions10000Contributions
Investment Earnings Or Losses16989InvestmentEarningsOrLosses
Grants Or Scholarships3454GrantsOrScholarships
Administrative Expenses531AdministrativeExpenses
End Of Year Balance103629EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance69210BeginningOfYearBalance
Contributions35000Contributions
Investment Earnings Or Losses-23097InvestmentEarningsOrLosses
Administrative Expenses488AdministrativeExpenses
End Of Year Balance80625EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated OrgstrueEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
LandLand
BuildingsBuildings

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis40776OtherCostOrOtherBasis
Depreciation5877Depreciation
Book Value34899BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis579866OtherCostOrOtherBasis
Depreciation414355Depreciation
Book Value165511BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis6895OtherCostOrOtherBasis
Depreciation2439Depreciation
Book Value4456BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings204866TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionENDOWMENT FUNDDescription
Book Value111007BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets111007TotalBookValueOtherAssets
Total Revenue3367297TotalRevenue
Total Expenses3388076TotalExpenses
Excess Or Deficit For Year-20779ExcessOrDeficitForYear
Net Unrealized GL On Investments10484NetUnrealizedGLOnInvestments
Total Adjustments10484TotalAdjustments
Excess Or Deficit Per FS-10295ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt8205313TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments10484NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities4827532DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F9904838016RevenueNotRptdF990
Revenue Subtotal3367297RevenueSubtotal
Total Revenue Per Form9903367297TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8215608TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities4827532DonatedServicesUseOfFacilities
Expenses Not Rptd F9904827532ExpensesNotRptdF990
Expenses Subtotal3388076ExpensesSubtotal
Total Expenses Per Form9903388076TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierENDOWMENT FUND PURPOSEIdentifier
Return ReferencePART V LINE 4ReturnReference
ExplanationTHE PURPOSE OF THE ENDOWMENT FUND IS TO PROVIDE A PERMANENT FUND WHICH MAY BE USED BY THE ORGANIZATION TO SUPPORT THE PROVISION OF HEALTHCARE SERVICES TO THE MEDICALLY UNINSURED AND UNDERSERVED WHO MEET THE ELIGIBILITY REQUIREMENT GUIDELINES OF THE ORGANIZATION.Explanation

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref FundraisingtrueAgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation (2 entries)

Name Of IndividualNameOfIndividualAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeActivityActivityFundraiser Control Of FundsFundraiserControlOfFundsGross ReceiptsGrossReceiptsAmount Retained By ContractorAmountRetainedByContractor
CATERED AFFAIRS475 DEACON BOULEVARDWINSTON SALEMNC27105FOODfalse728555819
TRACEY MAXWELL4260 SADDLEWOOD FOREST DRIVEWINSTON SALEMNC27106VIDEOfalse8000
FieldValueIRS element (for citing)
Total Gross Receipts72855TotalGrossReceipts
Total Retained By Contractors13819TotalRetainedByContractors

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1BREAKFASTNameOfEvent1
Gross Receipts Event172855GrossReceiptsEvent1
Gross Revenue Event172855GrossRevenueEvent1
Rent Facility Costs Event1900RentFacilityCostsEvent1
Food And Beverage Event15819FoodAndBeverageEvent1
Other Direct Expenses Event112213OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total72855GrossReceiptsTotal
Gross Revenue Total Events72855GrossRevenueTotalEvents
Rent Facility Costs Total Events900RentFacilityCostsTotalEvents
Food And Beverage Total Events5819FoodAndBeverageTotalEvents
Other Direct Expenses Total Events12213OtherDirectExpensesTotalEvents
Direct Expense Summary Events18932DirectExpenseSummaryEvents
Net Income Summary53923NetIncomeSummary

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonROBINSON ASSOCIATION MGMT SVC INCNamePerson
FieldValueIRS element (for citing)
RelationshipOWNED BY EXECUTIVE DIR.Relationship
Amount Of Transaction137667AmountOfTransaction
Description Of TransactionMANAGEMENT FEESDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F9901746643NoncashContribsRptdF990
Method Of Determining RevenuesDONOR PROVIDEDMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts

Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XFOOD FOR VOLUNTEERS018400COST
XDONATED MISCELLANEOUS SUPPLIES02070COST
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DELEGATION OF MANAGEMENT DUTIESForm 990 Part VI Line 3THE ORGANIZATION RECEIVES MANAGEMENT SERVICES UNDER A BOARD APPROVED CONTRACT FROM ROBINSON ASSOCIATION MANAGEMENT SERVICES, INC., AN ENTITY OWNED BY JAMES T. ROBINSON THE EXECUTIVE DIRECTOR. MANAGEMENT FEES FOR 2010 TOTALED $137,667.
990 REVIEW990 PART VI LINE 11A COPY OF THE 990 IS PROVIDED TO THE EXECUTIVE DIRECTOR AND TREASURER FOR THEIR REVIEW PRIOR TO THE RETURN BEING FILED. THE 990 IS SUBSEQUENTLY REVIEWED BY THE FINANCE COMMITTEE.
COMPENSATION POLICIES990 PART VI LINE 15A & 15BSALARIES AND MANAGEMENT CONTRACTS ARE REVIEWED AND RECOMMENDED BY THE PERSONNEL COMMITTEE WHICH IS MADE UP OF INDEPENDENT PERSONS. IT THEN GOES TO THE FINANCE COMMITTEE AND FINALLY THE BOARD FOR APPROVAL.
PUBLIC INSPECTION990 PART VI LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAIALBLE TO ANYONE THAT REQUESTS A COPY OF THE INFORMATION.
CHANGES IN NET ASSETS OR FUND BALANCEPART XI, LINE 5UNREALIZED GAIN ON INVESTMENTS 10,484 PRIOR PERIOD ADJUSTMENT FOR ADDITIONAL EXPENSE ACCRUALS (7,023) NET CHANGE IN FUND BALANCE 3,461

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1FORSYTH-STOKES-DAVIE COUNTY MEDICAL SOCIBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12135 NEW WALKERTOWN ROADAddressLine1
CityWINSTONSALEMCity
StateNCState
ZIP Code27101ZIPCode
FieldValueIRS element (for citing)
EIN566047612EIN
Primary ActivitiesMedicalPrimaryActivities
Legal Domicile StateNCLegalDomicileState
Exempt Code Section501(c)(6)ExemptCodeSection
Public Charity StatusN/APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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