KOINONIA PRIMARY CARE INC: Form 990, tax year 2025
View the entire original 990 at ProPublica ↗
- Organization
- KOINONIA PRIMARY CARE INC (EIN 45-3448794)
- Tax period
- 2025-01-01 to 2025-12-31
- Filed
- 2026-09-23
- IRS object ID
- 202632669349301603
- Schema version
- 2025v4.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-09-23T15:25:08-04:00 | ReturnTs |
| Tax Period End | 2025-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 141637151 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCOTT STACKROW & COMPANY PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 314 HOOSICK ST | AddressLine1Txt |
| City | TROY | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 121802073 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2025-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453448794 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KOINONIA PRIMARY CARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KOIN | BusinessNameControlTxt |
| Phone | 5186890282 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 553 CLINTON AVE | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12206 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR ROBERT PAEGLOW | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5186890282 | PhoneNum |
| Signature | 2026-09-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID P PIETRAFESA | PreparerPersonNm |
| PTIN | P00639829 | PTIN |
| Phone | 5182749081 | PhoneNum |
| Preparation | 2026-09-21 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2025 | TaxYr |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR ROBERT PAEGLOW | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 553 CLINTON AVE | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,284,114 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | KOINONIAPC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | KOINONIA PRIMARY CARE, INC. (KOINONIA)IS A NYS DIAGNOSTIC AND TREATMENT CENTER WHOSE MISSION IS TO PROVIDE COMPASSIONATE, HIGH QUALITY, PATIENT- CENTERED HEALTHCARE, IN A FAITH-BASED ENVIRONMENT, TO THE UNDERSERVED IN THE CAPITAL REGION OF NEW YORK STATE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 23 | TotalEmployeeCnt |
| Total Volunteers | 70 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $925,366 | PYContributionsGrantsAmt |
| CY Contributions Grants | $292,460 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,169,748 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $967,965 | CYProgramServiceRevenueAmt |
| PY Investment Income | $19,276 | PYInvestmentIncomeAmt |
| CY Investment Income | $19,579 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,800 | PYOtherRevenueAmt |
| CY Other Revenue | $4,110 | CYOtherRevenueAmt |
| PY Total Revenue | $2,120,190 | PYTotalRevenueAmt |
| CY Total Revenue | $1,284,114 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,041,704 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,053,369 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $6,196 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $599,789 | PYOtherExpensesAmt |
| CY Other Expenses | $576,903 | CYOtherExpensesAmt |
| PY Total Expenses | $1,641,493 | PYTotalExpensesAmt |
| CY Total Expenses | $1,630,272 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $478,697 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$346,158 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,705,018 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,365,293 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $68,632 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $75,065 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,636,386 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,290,228 | NetAssetsOrFundBalancesEOYAmt |
| Mission | KOINONIA PRIMARY CARE, INC. (KOINONIA) IS A NYS DIAGNOSTIC AND TREATMENT CENTER THAT PROVIDES QUALITY PATIENT CENTERED HEALTHCARE TO THE UNDERSERVED IN THE CAPITAL REGION OF NEW YORK STATE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,298,066 | ExpenseAmt |
| Desc | KOINONIA PROVIDES HOLISTIC CARE BODY, MIND AND SPIRIT - TO PATIENTS IN NEW YORKS CAPITAL REGION. ANNUALLY, IT SERVES AROUND 2,200 PATIENTS AT MORE THAN 8000 VISITS. ITS PARTICULAR FOCUS IS THE WEST HILL AND ARBOR HILL NEIGHBORHOODS OF ALBANY, WHICH ARE AMONG THE MOST UNDERSERVED AREAS IN THE REGION. TO FURTHER SUPPORT THIS COMMUNITY AND ADDRESS THE SOCIAL DETERMINANTS OF HEALTH NEEDS THAT OCCUR THERE KOINONIA HOLDS OUTREACH ACTIVITIES, INCLUDING HOLDING A SUMMER CAMP, COMMUNITY BARBEQUES AND HOLIDAY PARTIES. KOINONIA ALSO PROVIDES SPACE TO OTHER COMMUNITY-SERVING ORGANIZATIONS, INCLUDING LOCAL CHURCHES, OTHER LOCAL NON-PROFITS AND NARCOTICS ANONYMOUS. | Desc |
| Total Program Service Expenses | $1,298,066 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 23 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CORRIE PAEGLOW | PersonNm |
| Phone | 5186890282 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 553 CLINTON AVE | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12206 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| DR ROBERT PAEGLOW | ||||||
| PRESIDENT | 60.00 | Yes (X) | Yes (X) | $177,302 | $0 | $3,242 |
| CORRIE PAEGLOW | ||||||
| EXECUTIVE DI | 60.00 | Yes (X) | $102,119 | $0 | $9,863 | |
| DR JOHN BENNETT | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DR JACK BRAATEN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ROBERT BAKER CPA | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DR FREDRICK EAMES | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| HERBERT L SHULTZ JR | ||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SHARON LOBEL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAVID POLLITZER | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DEAN RUECKERT | ||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ANDREW WILSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $279,421 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $13,105 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $292,460 | AllOtherContributionsAmt |
| Total Contributions | $292,460 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL SERVICES | Desc |
| Total Revenue Column | $967,965 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $967,965 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $967,965 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,579 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,579 | RelatedOrExemptFuncIncomeAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,110 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,110 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,110 | TotalRevenueColumnAmt |
| Exclusion | $4,110 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,284,114 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $987,544 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $4,110 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $925,883 | TotalAmt |
| Program Services | $772,186 | ProgramServicesAmt |
| Management And General | $149,067 | ManagementAndGeneralAmt |
| Fundraising | $4,630 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,193 | TotalAmt |
| Program Services | $14,339 | ProgramServicesAmt |
| Management And General | $2,768 | ManagementAndGeneralAmt |
| Fundraising | $86 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,517 | TotalAmt |
| Program Services | $29,621 | ProgramServicesAmt |
| Management And General | $5,718 | ManagementAndGeneralAmt |
| Fundraising | $178 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,776 | TotalAmt |
| Program Services | $62,363 | ProgramServicesAmt |
| Management And General | $12,039 | ManagementAndGeneralAmt |
| Fundraising | $374 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,925 | TotalAmt |
| Management And General | $11,925 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $581 | TotalAmt |
| Fundraising | $581 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,412 | TotalAmt |
| Program Services | $17,024 | ProgramServicesAmt |
| Management And General | $3,286 | ManagementAndGeneralAmt |
| Fundraising | $102 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,309 | TotalAmt |
| Program Services | $1,092 | ProgramServicesAmt |
| Management And General | $211 | ManagementAndGeneralAmt |
| Fundraising | $6 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,819 | TotalAmt |
| Program Services | $11,724 | ProgramServicesAmt |
| Management And General | $26,095 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,882 | TotalAmt |
| Program Services | $12,338 | ProgramServicesAmt |
| Management And General | $19,512 | ManagementAndGeneralAmt |
| Fundraising | $32 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES: MEDICAL SUPPLIE | $126,877 | $126,877 | |
| BUILDING REPAIRS & MAINTE | $70,135 | $18,856 | $51,279 |
| BILLING SERVICE | $60,870 | $60,870 | |
| COMPUTER MAINTENANCE: EMR | $40,750 | $40,750 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,343 | TotalAmt |
| Program Services | $130,026 | ProgramServicesAmt |
| Management And General | $44,110 | ManagementAndGeneralAmt |
| Fundraising | $207 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,630,272 | TotalAmt |
| Program Services | $1,298,066 | ProgramServicesAmt |
| Management And General | $326,010 | ManagementAndGeneralAmt |
| Fundraising | $6,196 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $925,404 | BOYAmt |
| EOY | $427,866 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,000 | BOYAmt |
| EOY | $201,987 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,508 | BOYAmt |
| EOY | $44,734 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,429 | BOYAmt |
| EOY | $44,285 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,036,884 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $390,463 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $540,677 | BOYAmt |
| EOY | $646,421 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,705,018 | BOYAmt |
| EOY | $1,365,293 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,632 | BOYAmt |
| EOY | $75,065 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,632 | BOYAmt |
| EOY | $75,065 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,501,636 | BOYAmt |
| EOY | $1,236,978 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $134,750 | BOYAmt |
| EOY | $53,250 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,636,386 | BOYAmt |
| EOY | $1,290,228 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,705,018 | BOYAmt |
| EOY | $1,365,293 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$346,158 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $456,841 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $265,947 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $235,730 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $925,336 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $292,460 | CurrentTaxYearAmt |
| Total | $2,176,314 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,212,331 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,169,250 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,205,718 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,169,748 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $967,965 | CurrentTaxYearAmt |
| Total | $5,725,012 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,669,172 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,435,197 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,441,448 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,095,084 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,260,425 | CurrentTaxYearAmt |
| Total | $7,901,326 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $160,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $90,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $85,797 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $733,757 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $88,000 | CurrentTaxYearAmt |
| Total | $1,157,554 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $160,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $90,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $85,797 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $733,757 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $88,000 | CurrentTaxYearAmt |
| Total | $1,157,554 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $6,743,772 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $19,276 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,110 | CurrentTaxYearAmt |
| Total | $23,386 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $19,276 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,110 | CurrentTaxYearAmt |
| Total | $23,386 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $11,104 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,800 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,110 | CurrentTaxYearAmt |
| Total | $21,014 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,669,172 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,435,197 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,452,552 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,120,160 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,268,645 | CurrentTaxYearAmt |
| Total | $7,945,726 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.84870 | PublicSupportCY509Pct |
| Public Support PY509 | 0.84540 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART III, LINE 12 | FormAndLineReferenceDesc |
| Explanation | RENTAL INCOME 21,014 | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,700 | OtherCostOrOtherBasisAmt |
| Book Value | $31,700 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $821,791 | OtherCostOrOtherBasisAmt |
| Depreciation | $239,730 | DepreciationAmt |
| Book Value | $582,061 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $183,393 | OtherCostOrOtherBasisAmt |
| Depreciation | $150,733 | DepreciationAmt |
| Book Value | $32,660 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $646,421 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $1,377,023 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $92,909 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $92,909 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,284,114 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,284,114 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,723,181 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $92,909 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $92,909 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,630,272 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,630,272 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR ROBERT PAEGLOW | PersonNm |
| Title | PRESIDENT | TitleTxt |
| Base Compensation Filing Org | $177,302 | BaseCompensationFilingOrgAmt |
| Deferred Compensation Flng Org | $3,242 | DeferredCompensationFlngOrgAmt |
| Total Compensation Filing Org | $180,544 | TotalCompensationFilingOrgAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 2 | DR ROBERT PAEGLOW CORRIE PAEGLOW PRESIDENT EXECUTIVE DI FATHER/DAUGHTER |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FINANCE COMMITTEE REVIEWS THE 990 AND PRESENTS IT TO THE BOARD BEFORE FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ANNUALLY, BOARD MEMBERS ARE PROVIDED WITH THE CONFLICT OF INTEREST POLICY AND CONFIRM THAT NO CONFLICTS EXIST OR PROVIDE DETAILS IF A CONFLICT OR PO TENTIAL CONFLICT EXISTS |
| FORM 990, PAGE 6, PART VI, LINE 15A | ALL COMPENSATION AND REVIEW PROCEDURES ARE ESTABLISHED BY THE FINANCE COMM ITTEE BASED ON THE REVIEW OF SIMILAR NON-PROFIT'S COMPENSATION STRUCTURE CURRENT MARKET RATE AND STANDARD HUMAN RESOURCE GUIDELINES. COMPENSATION IS REVIEWED DURING THE ANNUAL BUDGETING PROCESS AND SUBMITTED TO THE BOARD FOR FINAL APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 15B | ALL COMPENSATION AND REVIEW PROCEDURES ARE ESTABLISHED BY THE FINANCE COMM ITTEE BASED ON THE REVIEW OF SIMILAR NON-PROFIT'S COMPENSATION STRUCTURE CURRENT MARKET RATE AND STANDARD HUMAN RESOURCE GUIDELINES. COMPENSATION IS REVIEWED DURING THE ANNUAL BUDGETING PROCESS AND SUBMITTED TO THE BOARD FOR FINAL APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 19 | PROVIDED UPON REQUEST |
| FORM 990, PART IX, LINE 24E | INSURANCE EXPENSE, ORGANI 39,252 0 0 UTILITIES: NATIONAL GRID 8,431 21,428 0 COMMUNITY OUTREACH 23,129 0 0 UTILITIES: TELEPHONE 13,745 2,653 83 INTERPRETING SERVICES 14,469 0 0 COMPUTER MAINTENANCE: IT 11,943 0 0 COMPUTER MAINTENANCE: HAR 7,660 3,784 118 HUMAN RESOURCES 0 5,988 0 STAFF APPRECIATION 0 5,875 0 UTILITIES: ALARM SYSTEM 4,182 0 0 PAYROLL EXPENSES: PAYROLL 0 3,497 0 CONTINUING EDUCATION 1,850 0 0 DUES AND LICENSES 1,818 0 0 PAITIENT AID/INCENTIVE 1,391 0 0 UTILITIES: OTHER 1,196 0 0 POSTAGE AND DELIVERY 960 185 6 MERCHANT SERVICES PROCESS 0 700 0 TOTAL 130,026 44,110 207 |
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