LAKE AREA FREE CLINIC INC: Form 990, tax year 2025
View the entire original 990 at ProPublica ↗
- Organization
- LAKE AREA FREE CLINIC INC (EIN 39-2006388)
- Tax period
- 2025-01-01 to 2025-12-31
- Filed
- 2026-06-29
- IRS object ID
- 202641809349301309
- Schema version
- 2025v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule J
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-06-29T12:53:46-05:00 | ReturnTs |
| Tax Period End | 2025-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390747409 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REILLY PENNER & BENTON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1233 NORTH MAYFAIR RD SUITE 302 | AddressLine1Txt |
| City | MILWAUKEE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 532263255 | 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 | 392006388 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE AREA FREE CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAKE | BusinessNameControlTxt |
| Phone | 2625694990 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 856 ARMOUR ROAD UNIT B | AddressLine1Txt |
| City | OCONOMOWOC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53066 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PEG KOENIGS | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 2625694990 | PhoneNum |
| Signature | 2026-06-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRANDON PANKA | PreparerPersonNm |
| PTIN | P01596345 | PTIN |
| Phone | 4142717800 | PhoneNum |
| Preparation | 2026-06-25 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2025 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PEG KOENIGS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 856 ARMOUR ROAD UNIT B | AddressLine1Txt |
| City | OCONOMOWOC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53066 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,481,436 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | LAKEAREAFREECLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | PROVIDES HIGH-QUALITY MEDICAL AND DENTAL CARE TO LOW-INCOME RESIDENTS OF WAUKESHA COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 41 | TotalEmployeeCnt |
| Total Volunteers | 265 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,302,770 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,715,714 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $550,098 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $512,038 | CYProgramServiceRevenueAmt |
| PY Investment Income | $74,034 | PYInvestmentIncomeAmt |
| CY Investment Income | $84,706 | CYInvestmentIncomeAmt |
| PY Other Revenue | $89,430 | PYOtherRevenueAmt |
| CY Other Revenue | $71,073 | CYOtherRevenueAmt |
| PY Total Revenue | $3,016,332 | PYTotalRevenueAmt |
| CY Total Revenue | $2,383,531 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,695,329 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,942,940 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $114,408 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $631,763 | PYOtherExpensesAmt |
| CY Other Expenses | $782,682 | CYOtherExpensesAmt |
| PY Total Expenses | $2,327,092 | PYTotalExpensesAmt |
| CY Total Expenses | $2,725,622 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $689,240 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$342,091 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,820,656 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,337,198 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $770,222 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $603,512 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,050,434 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,733,686 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE LAKE AREA FREE CLINIC IS THE MEDICAL AND DENTAL HOME TO LOW-INCOME RESIDENTS OF WAUKESHA COUNTY. THE MISSION IS TO PROVIDE HIGH-QUALITY COMPREHENSIVE HEALTH CARE TO THOSE IN NEED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,417,029 | ExpenseAmt |
| Revenue | $512,038 | RevenueAmt |
| Desc | LAKE AREA FREE CLINIC IS THE MEDICAL HOME TO ADULTS AND PROVIDES ACUTE AND CHRONIC CARE SERVICES AND SPECIALITIES INCLUDE: CARDIOLOGY, DERMATOLOGY, INTERNAL MEDICINE, GYNECOLOGY, HEPATOLOGY, HEMATOLOGY, RHEUMATOLOGY, NEPHROLOGY, NEUROLOGY, PHYSICAL THERAPY, MENTAL HEALTH, ORTHOPEDICS, WELLNESS, AND COMPREHENSIVE DIABETES CLINIC. LAFC DETNAL IS THE 7-CHAIR DENTAL HOME FOR THOSE IN NEED OF ACCESS TO BASIC DENTAL, EDUCATIONAL AND REFERRAL SERVICES. LAFC DENTAL SERVES MEDICAID AND UNINSURED ADULTS. | Desc |
| Total Program Service Expenses | $2,417,029 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | Yes (1) | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 41 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEG KOENIGS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2625694990 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 856 ARMOUR ROAD UNIT B | AddressLine1Txt |
| City | OCONOMOWOC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53066 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| BRYAN BREESER | |||||||
| PRESIDENT | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NANINE NELSON | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PEG KOENIGS | |||||||
| TREASURER | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR JAY PLUDEMAN | |||||||
| MEDICAL DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RAMON AGUIRRE | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHY ALLEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BETH BOYER-RYAN | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| NANCY BRADT | |||||||
| SECRETARY | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MITZI CASS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JESUS CASAS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRIDGET ESSMA | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| DR ROBERT PANTHER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR ERIC RUIZ | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOE SORUM | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JACALYN STETINA | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTINA WEIR | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK ZWASKA | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| KAREN BIALAS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY REICH | |||||||
| EXECUTIVE DIRECTOR THROUGH JUNE 2025 | 40.00 | Yes (X) | $59,711 | $0 | $8,914 | ||
| AUDRA O'CONNELL | |||||||
| EXECUTIVE DIRECTOR AS OF FEBRUARY 2025 | 40.00 | Yes (X) | $100,096 | $0 | $7,617 | ||
| ALICIA BUSH | |||||||
| EMPLOYEE | 40.00 | $153,810 | $0 | $8,814 | Yes (X) | ||
| PABLO FERNANDEZ | |||||||
| EMPLOYEE THROUGH MAY 2025 | 40.00 | $102,140 | $0 | $5,064 | Yes (X) | ||
| MEGAN WALSH | |||||||
| EMPLOYEE | 40.00 | $103,494 | $0 | $9,105 | Yes (X) | ||
| CHRISTINA COPOULOS-SWANSON | |||||||
| EMPLOYEE | 40.00 | $118,699 | $0 | $9,061 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $637,950 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $48,575 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $198,834 | FundraisingAmt |
| Government Grants | $206,291 | GovernmentGrantsAmt |
| All Other Contributions | $1,310,589 | AllOtherContributionsAmt |
| Noncash Contributions | $278,103 | NoncashContributionsAmt |
| Total Contributions | $1,715,714 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DENTAL SERVICES | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $512,038 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $512,038 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $512,038 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,616 | TotalRevenueColumnAmt |
| Exclusion | $65,616 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,020,197 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,001,107 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $19,090 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,090 | TotalRevenueColumnAmt |
| Exclusion | $19,090 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $138,010 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $198,834 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $88,232 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $49,778 | TotalRevenueColumnAmt |
| Exclusion | $49,778 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $26,325 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $8,566 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,759 | TotalRevenueColumnAmt |
| Exclusion | $17,759 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $3,536 | TotalRevenueColumnAmt |
| Exclusion | $3,536 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,536 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,383,531 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $512,038 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $155,779 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,956 | TotalAmt |
| Program Services | $89,478 | ProgramServicesAmt |
| Management And General | $89,478 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,479,564 | TotalAmt |
| Program Services | $1,407,211 | ProgramServicesAmt |
| Fundraising | $72,353 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,314 | TotalAmt |
| Program Services | $28,774 | ProgramServicesAmt |
| Management And General | $5,540 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,727 | TotalAmt |
| Program Services | $93,819 | ProgramServicesAmt |
| Management And General | $18,908 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,379 | TotalAmt |
| Program Services | $125,924 | ProgramServicesAmt |
| Management And General | $5,499 | ManagementAndGeneralAmt |
| Fundraising | $5,956 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,100 | TotalAmt |
| Program Services | $10,575 | ProgramServicesAmt |
| Management And General | $3,525 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,805 | TotalAmt |
| Management And General | $8,805 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,331 | TotalAmt |
| Program Services | $79,748 | ProgramServicesAmt |
| Management And General | $26,583 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,873 | TotalAmt |
| Fundraising | $30,873 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,671 | TotalAmt |
| Program Services | $12,068 | ProgramServicesAmt |
| Management And General | $10,904 | ManagementAndGeneralAmt |
| Fundraising | $3,699 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,558 | TotalAmt |
| Program Services | $27,419 | ProgramServicesAmt |
| Management And General | $9,139 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,286 | TotalAmt |
| Program Services | $100,157 | ProgramServicesAmt |
| Management And General | $11,129 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,045 | TotalAmt |
| Program Services | $39,045 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,476 | TotalAmt |
| Program Services | $9,476 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,072 | TotalAmt |
| Program Services | $70,072 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,703 | TotalAmt |
| Program Services | $14,028 | ProgramServicesAmt |
| Management And General | $4,675 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $270,351 | $270,351 |
| DUES AND SUBSCRIPTIONS | $16,701 | $16,701 |
| REPAIRS AND MAINTENANCE | $12,594 | $12,594 |
| MISCELLANEOUS | $9,589 | $9,589 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,527 | TotalAmt |
| Fundraising | $1,527 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,725,622 | TotalAmt |
| Program Services | $2,417,029 | ProgramServicesAmt |
| Management And General | $194,185 | ManagementAndGeneralAmt |
| Fundraising | $114,408 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $546,794 | BOYAmt |
| EOY | $1,261 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $841,499 | BOYAmt |
| EOY | $1,000,437 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,403 | BOYAmt |
| EOY | $301,936 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,795 | BOYAmt |
| EOY | $12,081 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,188 | BOYAmt |
| EOY | $87,015 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,334 | BOYAmt |
| EOY | $27,005 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $776,274 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $534,374 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $285,913 | BOYAmt |
| EOY | $241,900 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,052,635 | BOYAmt |
| EOY | $1,125,097 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,533 | BOYAmt |
| EOY | $24,538 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $585,562 | BOYAmt |
| EOY | $515,928 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,820,656 | BOYAmt |
| EOY | $3,337,198 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $171,573 | BOYAmt |
| EOY | $74,935 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $598,649 | BOYAmt |
| EOY | $528,577 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $770,222 | BOYAmt |
| EOY | $603,512 | 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 | $2,641,400 | BOYAmt |
| EOY | $2,466,037 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $409,034 | BOYAmt |
| EOY | $267,649 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,050,434 | BOYAmt |
| EOY | $2,733,686 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,820,656 | BOYAmt |
| EOY | $3,337,198 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$342,091 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $25,343 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,214,766 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,685,543 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,505,374 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,302,770 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,715,714 | CurrentTaxYearAmt |
| Total | $8,424,167 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,214,766 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,685,543 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,505,374 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,302,770 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,715,714 | CurrentTaxYearAmt |
| Total | $8,424,167 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,419,076 | SubstantialContributorsTotAmt |
| Public Support Total170 | $7,005,091 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,160 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,925 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,690 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $74,034 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $84,706 | CurrentTaxYearAmt |
| Total | $193,515 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,562 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $28,905 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,461 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,536 | CurrentTaxYearAmt |
| Total | $47,964 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $8,665,646 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $3,242,333 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.80840 | PublicSupportCY170Pct |
| Public Support PY170 | 0.85740 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $18,533 | BeginningYearBalanceAmt |
| Contributions | $4,000 | ContributionsAmt |
| Investment Earnings Or Losses | $2,249 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $244 | AdministrativeExpensesAmt |
| End Year Balance | $24,538 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $11,807 | BeginningYearBalanceAmt |
| Contributions | $5,500 | ContributionsAmt |
| Investment Earnings Or Losses | $1,395 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $169 | AdministrativeExpensesAmt |
| End Year Balance | $18,533 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $11,000 | ContributionsAmt |
| Investment Earnings Or Losses | $890 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $83 | AdministrativeExpensesAmt |
| End Year Balance | $11,807 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $480,161 | OtherCostOrOtherBasisAmt |
| Depreciation | $357,626 | DepreciationAmt |
| Book Value | $122,535 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $296,113 | OtherCostOrOtherBasisAmt |
| Depreciation | $176,748 | DepreciationAmt |
| Book Value | $119,365 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $241,900 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE RIGHT-OF-USE ASSET | Desc |
| Book Value | $515,928 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $515,928 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE LIABILITY | Desc |
| Amt | $528,577 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $528,577 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,635,156 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $25,343 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $211,170 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $30,966 | OtherRevenueAmt |
| Revenue Not Reported | $267,479 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,367,677 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $8,805 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $7,049 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $15,854 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,383,531 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,951,904 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $211,170 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $30,966 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $242,136 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,709,768 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $8,805 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $7,049 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $15,854 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,725,622 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ORGANIZATION ENTERED INTO AN AGREEMENT WITH THE WAUKESHA COUNTY COMMUNITY FOUNDATION, INC. (THE "FOUNDATION") TO FORM AN ENDOWMENT FUND TO BE KNOWN AS THE LAKE AREA FREE CLINIC ENDOWMENT FUND ("FUND"). THIS FUND CAME INTO EXISTENCE WHEN THE ORGANIZATION DELIVERED TO THE FOUNDATION AN INITIAL CHARITABLE INVESTMENT OF $10,000. THE TERMS OF THE AGREEMENT STATE THAT THE FUND MUST MAINTAIN A $10,000 BALANCE AT ALL TIMES. THE ASSETS OF THE FUND ARE ASSETS OF THE FOUNDATION AND NOT A SEPARATE TRUST. FUNDS ARE AVAILABLE FOR DISTRIBUTION TO THE ORGANIZATION IN ACCORDANCE WITH THE FOUNDATION'S DISTRIBUTION POLICIES IN ORDER THAT THE PRINCIPAL IS MAINTAINED AND PRESERVED. THE USE OF DISTRIBUTIONS IS AT THE DISCRETION OF THE ORGANIZATION AND IS THEREFORE UNRESTRICTED. THE PRINCIPAL MAY ONLY BE DISTRIBUTED FOR UNUSUAL CIRCUMSTANCES AND AT THE DISCRETION OF THE FOUNDATION'S BOARD OF DIRECTORS. |
| PART X, LINE 2: | THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED EXEMPT-FUNCTION INCOME UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS BEEN CLASSIFIED AS AN ORGANIZATION OTHER THAN A PRIVATE FOUNDATION. THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS SUPPORT AND REVENUES TO BE UNRELATED BUSINESS INCOME AND ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATION HAS IMPLEMENTED ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IN ACCORDANCE WITH U.S. GAAP. THIS STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN AND ALSO PROVIDES GUIDANCE ON VARIOUS RELATED MATTERS SUCH AS DERECOGNIZING, INTEREST, PENALTIES AND DISCLOSURES REQUIRED. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE. IN MANAGEMENT'S OPINION, THE ORGANIZATION HAS NOT TAKEN ANY UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, HAS NOT REPORTED A CORRESPONDING LIABILITY IN THE ORGANIZATION'S FINANCIAL STATEMENTS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | DIRECT FUNDRAISING EVENT EXPENSES 30,966. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | IN-KIND SUPPLIES 7,049. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT FUNDRAISING EVENT EXPENSES 30,966. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | IN-KIND SUPPLIES 7,049. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $255,474 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $194,389 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $61,085 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,509 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $43,185 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $1,579 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $18,992 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $2,100 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $12,991 | OtherDirectExpensesEvent1Amt |
| Event2 | CRIBBAGE TOURNAMENT | Event2Nm |
| Gross Receipts Event2 | $52,558 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $52,558 | GrossRevenueEvent2Amt |
| Other Events Total | 3 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $28,812 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $4,445 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $24,367 | GrossRevenueOtherEventsAmt |
| Cash Prizes Other Events | $590 | CashPrizesOtherEventsAmt |
| Non Cash Prizes Other Events | $151 | NonCashPrizesOtherEventsAmt |
| Rent Fclty Costs Other Events | $450 | RentFcltyCostsOtherEventsAmt |
| Food And Beverage Other Events | $941 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $5,744 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $336,844 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $198,834 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $138,010 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $2,099 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $43,336 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $2,029 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $19,933 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $2,100 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $18,735 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $88,232 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $49,778 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $26,325 | GrossRevenueOtherGamingAmt |
| Non Cash Prizes Other Gaming | $8,452 | NonCashPrizesOtherGamingAmt |
| Oth Direct Expnss Other Gaming | $114 | OthDirectExpnssOtherGamingAmt |
| Volunteer Labor Other Gaming | Yes (1) | VolunteerLaborOtherGamingInd |
| Volunteer Labor Other Gaming | 1.00000 | VolunteerLaborOtherGamingPct |
| Gross Revenue Total Gaming | $26,325 | GrossRevenueTotalGamingAmt |
| Non Cash Prizes Total Gaming | $8,452 | NonCashPrizesTotalGamingAmt |
| Oth Direct Expnss Total Gaming | $114 | OthDirectExpnssTotalGamingAmt |
| Direct Expense Summary Gaming | $8,566 | DirectExpenseSummaryGamingAmt |
| Net Gaming Income Summary | $17,759 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed | 0 | LicensedInd |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | 0 | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Cntrct With3rd Prty For Game Rev | 0 | CntrctWith3rdPrtyForGameRevInd |
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALICIA BUSH | PersonNm |
| Title | EMPLOYEE | TitleTxt |
| Base Compensation Filing Org | $153,810 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $4,614 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $4,200 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $162,624 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANNA PLUDEMAN | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY RELATIONSHIP WITH BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $102,832 | TransactionAmt |
| Transaction | COMPENSATION FOR EMPLOYMENT, MEDICAL CLINIC MANAGER | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L PART IV | FormAndLineReferenceDesc |
| Explanation | DR. JAY PLUDEMAN IS A BOARD MEMBER BY VIRTUE OF HIS VOLUNTEER ROLE AS MEDICAL DIRECTOR | ExplanationTxt |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $21,109 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 232 | ContributionCnt |
| Noncash Contributions Rpt F990 | $207,819 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COSTS OF SIMILAR GOODS | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | AUCTION PRIZES | 137 | $41,385 | FAIR MARKET VALUE |
| Yes (X) | GAME TICKETS | 4 | $4,016 | FAIR MARKET VALUE |
| Yes (X) | MISCELLANEOUS SUPPLIES | 12 | $3,033 | FAIR MARKET VALUE |
| Yes (X) | TRIVIA PRIZES | 7 | $741 | FAIR MARKET VALUE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT OF THE FORM 990 IS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE. A COMPLETE COPY OF THE FORM 990 FILING IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BOARD BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICTS ARE ADDRESSED AT EVERY BOARD MEETING. EACH BOARD MEMBER IS EXPECTED TO ANNUALLY SIGN THE CONFLICT OF INTEREST FORM DISCLOSING KNOWN CONFLICTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | EVERY EMPLOYEE RECEIVES A REVIEW. THE EXECUTIVE DIRECTOR MAKES THE SALARY RECOMMENDATIONS WITH INPUT FROM THE MANAGEMENT TEAM. THE EXECUTIVE DIRECTORS PERFORMANCE AND SALARY IS REVIEWED BY THE PRESIDENT OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | BYLAWS AND ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS |