FREE CLINIC OF ROME INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- FREE CLINIC OF ROME INC (EIN 20-5296305)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-15
- IRS object ID
- 202433209349310618
- Schema version
- 2023v5.1
- 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 | 2024-11-15T09:40:55-08:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 582357052 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RL JENNINGS AND ASSOCIATES PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 E 3rd St | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30161 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205296305 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Free Clinic of RomeInc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 7062341331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Professional Court SW | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Renee Blackburn | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Phone | 7062341331 | PhoneNum |
| Signature | 2024-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Richard L Jennings | PreparerPersonNm |
| PTIN | P00118987 | PTIN |
| Phone | 7068021945 | PhoneNum |
| Preparation | 2024-11-15 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Renee Blackburn | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Professional Court SW | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,209,147 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.freeclinicofrome.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | To serve the Greater Rome area by providing quality healthcare services to people who are uninsured and low income. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 4 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,918,464 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,199,272 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$465 | PYInvestmentIncomeAmt |
| CY Investment Income | $175 | CYInvestmentIncomeAmt |
| CY Other Revenue | $8,259 | CYOtherRevenueAmt |
| PY Total Revenue | $2,917,999 | PYTotalRevenueAmt |
| CY Total Revenue | $3,207,706 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $126,151 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $160,849 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $19,601 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,787,991 | PYOtherExpensesAmt |
| CY Other Expenses | $3,023,691 | CYOtherExpensesAmt |
| PY Total Expenses | $2,914,142 | PYTotalExpensesAmt |
| CY Total Expenses | $3,184,540 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,857 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $23,166 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $202,367 | TotalAssetsBOYAmt |
| Total Assets EOY | $202,292 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $45,361 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $22,120 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $157,006 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $180,172 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To serve the Greater Rome area by providing quality healthcare services to people who are uninsured and low income. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $3,121,023 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | To provide free quality healthcare and treatment to individuals. | Desc |
| Total Program Service Expenses | $3,121,023 | 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 | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | 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 | false | 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 | Yes (true) | 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 4 | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | 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 | false | 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 | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Renee Blackburn | PersonNm |
| Phone | 7062341331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Professional Court SW | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| Jennifer R Blackburn | |||||||
| Executive Director | 40.00 | Yes (X) | $78,554 | $0 | $0 | ||
| John Pillsbury | |||||||
| President | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Dr PJ Lynn | |||||||
| Medical Director | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Regina Stottlemyer | |||||||
| Secretary | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Toni Rhinehart | |||||||
| Treasurer | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Eric Waters | |||||||
| Vice President | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Rick Childs | |||||||
| Atrium Representative | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Scotty Hancock | |||||||
| Advent Representative | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Carol Gooch | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Jacob Harper | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Scott Preston | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Melissa Eldridge | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Seth McWhorter | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $78,554 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $30,668 | FundraisingAmt |
| All Other Contributions | $3,168,604 | AllOtherContributionsAmt |
| Noncash Contributions | $2,899,185 | NoncashContributionsAmt |
| Total Contributions | $3,199,272 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $175 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,700 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,441 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,259 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,259 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,259 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $30,668 | ContriRptFundraisingEventAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,207,706 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,434 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,554 | TotalAmt |
| Program Services | $66,771 | ProgramServicesAmt |
| Management And General | $10,997 | ManagementAndGeneralAmt |
| Fundraising | $786 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,910 | TotalAmt |
| Program Services | $44,973 | ProgramServicesAmt |
| Management And General | $7,408 | ManagementAndGeneralAmt |
| Fundraising | $529 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,385 | TotalAmt |
| Program Services | $24,977 | ProgramServicesAmt |
| Management And General | $4,114 | ManagementAndGeneralAmt |
| Fundraising | $294 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,525 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $5,525 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $30 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $958 | TotalAmt |
| Program Services | $958 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,641 | TotalAmt |
| Program Services | $779 | ProgramServicesAmt |
| Management And General | $2,862 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,014 | TotalAmt |
| Program Services | $36,562 | ProgramServicesAmt |
| Management And General | $6,022 | ManagementAndGeneralAmt |
| Fundraising | $430 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,118 | TotalAmt |
| Program Services | $4,118 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,833 | TotalAmt |
| Program Services | $7,833 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,881 | TotalAmt |
| Program Services | $3,299 | ProgramServicesAmt |
| Management And General | $582 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Dues | $3,500 | $0 | $3,500 | $0 |
| Equipment Rental | $1,985 | $1,985 | $0 | $0 |
| Laboratory Services | $1,611,947 | $1,611,947 | $0 | $0 |
| Maintenance | $1,249 | $1,060 | $176 | $13 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,336,010 | TotalAmt |
| Program Services | $1,315,761 | ProgramServicesAmt |
| Management And General | $2,700 | ManagementAndGeneralAmt |
| Fundraising | $17,549 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,184,540 | TotalAmt |
| Program Services | $3,121,023 | ProgramServicesAmt |
| Management And General | $43,916 | ManagementAndGeneralAmt |
| Fundraising | $19,601 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,107 | BOYAmt |
| EOY | $155,436 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,806 | BOYAmt |
| EOY | $2,418 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $56,323 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $35,950 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,206 | BOYAmt |
| EOY | $20,373 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,528 | BOYAmt |
| EOY | $12,425 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,720 | BOYAmt |
| EOY | $11,640 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $202,367 | BOYAmt |
| EOY | $202,292 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,641 | BOYAmt |
| EOY | $10,480 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,720 | BOYAmt |
| EOY | $11,640 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,361 | BOYAmt |
| EOY | $22,120 | 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 | $157,006 | BOYAmt |
| EOY | $172,672 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $7,500 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,006 | BOYAmt |
| EOY | $180,172 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $202,367 | BOYAmt |
| EOY | $202,292 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $23,166 | 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 |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support CY170 | 0 | PublicSupportCY170Pct |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $241,328 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $245,424 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $182,946 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $256,029 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $300,087 | CurrentTaxYearAmt |
| Total | $1,225,814 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $241,328 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $245,424 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $182,946 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $256,029 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $300,087 | CurrentTaxYearAmt |
| Total | $1,225,814 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $1,225,814 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,059 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,980 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $175 | CurrentTaxYearAmt |
| Total | $3,214 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,059 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,980 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $175 | CurrentTaxYearAmt |
| Total | $3,214 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,229,028 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99740 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99710 | PublicSupportPY509Pct |
| Investment Income CY | 0.00260 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00290 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $17,411 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $7,183 | DepreciationAmt |
| Book Value | $10,228 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $35,465 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $25,928 | DepreciationAmt |
| Book Value | $9,537 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $3,447 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $2,839 | DepreciationAmt |
| Book Value | $608 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,373 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Right of Use Asset | Desc |
| Book Value | $11,640 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $11,640 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Right of Use liability | Desc |
| Amt | $11,640 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $11,640 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $3,207,706 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $3,207,706 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $3,207,706 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,184,540 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $3,184,540 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $3,184,540 | TotalExpensesPerForm990Amt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | Medical services | 2500 | $1,251,652 | fair market value |
| Yes (X) | Lab services | 1000 | $1,611,947 | fair market value |
| Yes (X) | Supplies | 100 | $35,586 | fair market value |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 11b | A copy of the 990 is given to all board members for review. |
| Pt VI, Line 12c | All policies are reviewed by board members on scheduled basis. |
| Pt VI, Line 15b | Officer salary is reviewed based on current standards. |
| Pt VI, Line 15a | Salary is reviewed based on current standards. |
| Form 990, Part IX, Line 24e | Medical Services 443759. 443759. 0. 0. |
| Form 990, Part IX, Line 24e | Medical Supplies 807893. 807893. 0. 0. |
| Form 990, Part IX, Line 24e | Misc 1062. 997. 65. 0. |
| Form 990, Part IX, Line 24e | Postage 201. 171. 30. 0. |
| Form 990, Part IX, Line 24e | Supplies 39157. 39157. 0. 0. |
| Form 990, Part IX, Line 24e | Telephone 6092. 5178. 914. 0. |
| Form 990, Part IX, Line 24e | Contract labor 11975. 11975. 0. 0. |
| Form 990, Part IX, Line 24e | Fundraising expense 17442. 0. 0. 17442. |
| Form 990, Part IX, Line 24e | Gifts and awards 437. 0. 437. 0. |
| Form 990, Part IX, Line 24e | Website 214. 107. 0. 107. |
| Form 990, Part IX, Line 24e | (Gain) loss on investments 103. 0. 103. 0. |
| Form 990, Part IX, Line 24e | Software expense 7675. 6524. 1151. 0. |