HAMM MEMORIAL PSYCHIATRIC CLINIC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HAMM MEMORIAL PSYCHIATRIC CLINIC (EIN 41-1649502)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-03-23
- IRS object ID
- 202320829349300932
- Schema version
- 2021v4.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-03-23T14:47:34-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411649502 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HAMM MEMORIAL PSYCHIATRIC CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HAMM | BusinessNameControlTxt |
| Phone | 6512240614 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 RIVER PARK PLAZA 710 | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55107 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT EDWARDS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6512240614 | PhoneNum |
| Signature | 2023-01-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ROBERT | PersonFirstNm |
| Person Last | EDWARDS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2023-01-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | ROBERT EDWARDS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 RIVER PARK PLAZA 710 | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,805,537 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HAMMCLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | HAMM CLINIC'S MISSION IS TO PROMOTE MENTAL HEALTH WITH CULTURALLY RESPONSIVE, RELATIONAL CARE FOR ADULTS, ESPECIALLY FOR THOSE FACING FINANCIAL BARRIERS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 36 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,082,222 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,311,471 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,381,063 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,492,304 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,381 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,762 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $3,464,666 | PYTotalRevenueAmt |
| CY Total Revenue | $3,805,537 | 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 | $2,108,718 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,477,809 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $167,485 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $717,743 | PYOtherExpensesAmt |
| CY Other Expenses | $880,220 | CYOtherExpensesAmt |
| PY Total Expenses | $2,826,461 | PYTotalExpensesAmt |
| CY Total Expenses | $3,358,029 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $638,205 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $447,508 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,086,143 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,652,218 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $310,653 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $449,954 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,775,490 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,202,264 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | HAMM CLINIC'S MISSION IS TO PROMOTE MENTAL HEALTH WITH CULTURALLY RESPONSIVE, RELATIONAL CARE FOR ADULTS, ESPECIALLY FOR THOSE FACING FINANCIAL BARRIERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,201,972 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,332,866 | RevenueAmt |
| Desc | CLINICAL SERVICES:HAMM MEMORIAL PSYCHIATRIC CLINIC PROVIDES A VARIETY OF OUTPATIENT MENTAL HEALTH AND RELATED SERVICES TO ADULTS AND OPERATES IN THE TWIN CITIES METROPOLITAN AREA. THE CLINIC OFFERS A FULL SPECTRUM OF OUTPATIENT MENTAL HEALTH SERVICES IN ENGLISH AND SPANISH. THE CLINIC SEEKS TO TREAT SYMPTOMS AND ALSO TO HELP CLIENTS GAIN INSIGHT AND UNDERSTANDING INTO THEIR BEHAVIOR. THE CLINIC TEAM IS COMPRISED OF CLINICAL SOCIAL WORKERS, PSYCHOLOGISTS, AND PSYCHIATRISTS WORKING TOGETHER TO IMPROVE MENTAL HEALTH.IN FY 2022, THE CLINIC HAD A TOTAL OF 14,092 VISITS, SERVING 593 INDIVIDUALS WITH THERAPY NEEDS AND 303 WITH PSYCHIATRIC NEEDS. 137 GROUP THERAPY SESSIONS WERE OFFERED. OVER 50% OF CLIENTS WERE EITHER UNEMPLOYED OR HAD INCOMES LESS THAN $20,000 PER YEAR. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $188,177 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | TRAINING AND PROFESSIONAL DEVELOPMENT:THE CLINIC'S TRAINING PROGRAM PROVIDES SPECIALIZED TRAINING AND EDUCATION FOR GRADUATES AND POST-GRADUATES IN CLINICAL SOCIAL WORK, PSYCHOLOGY, AND PSYCHIATRY. THE CLINIC'S COMPREHENSIVE APPROACH TO TRAINING ENABLES STUDENTS TO PROVIDE DIRECT CLIENT CARE UNDER CLOSE SUPERVISION. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $31,004 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | RESEARCH AND PUBLICATIONS:RESEARCH AND EVALUATION ARE INTEGRAL TO HAMM CLINIC'S DIRECT SERVICE AND TRAINING MISSION. THE INTEGRATION OF CLINICAL PRACTICE, RESEARCH, AND TRAINING PROVIDES THE FOUNDATION FOR DELIVERY OF HIGH QUALITY, EVIDENCE-BASED CARE.EFFECTIVE EVALUATION, COMBINED WITH INTENTIONAL AND COLLABORATIVE CARE, IS THE PATH TO SUCCESSFUL TREATMENT AND INFORMATIVE RESEARCH. THE CLINIC PRACTICES DELIBERATELY AND EVALUATE OUR WORK WITH EACH CLIENT THROUGH USE OF STANDARDIZED MEASURES. CLIENTS ALWAYS WORK WITH US TO DETERMINE WHAT'S EFFECTIVE FOR THEM, AND THEY CAN OPT IN OR OUT OF FORMAL EVALUATION.HAMM CLINIC'S PRIMARY RESEARCH TOOL IS THE OUTCOME QUESTIONNAIRE OQ-45.2. WITH EACH CLIENT'S PERMISSION, THE CLINIC ADMINISTERS THIS DURING THE INITIAL INTAKE APPOINTMENT AND AT REGULAR INTERVALS DURING THERAPY.THE OQ-45.2 IS A RELATIVELY BRIEF, SELF-REPORT SCALE THAT MEASURES CLIENT PROGRESS IN FOUR AREAS OF FUNCTIONING:- GLOBAL ASSESSMENT/QUALITY OF LIFE,- SYMPTOMS OF PSYCHOLOGICAL DISTRESS,- INTERPERSONAL RELATIONSHIPS, AND - SOCIAL ROLE FUNCTIONING (ABILITY TO WORK, GO TO SCHOOL, AND ENJOY LEISURE ACTIVITIES). | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $101,610 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | COMMUNITY OUTREACH THE CLINIC PARTICIPATES IN LOCAL MENTAL HEALTH AWARENESS EVENTS IN THE TWIN CITIES AREA. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $101,610 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $2,522,763 | 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 | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | 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 | 0 | 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 | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 36 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | MN | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6123764500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | 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 | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|
| HENRY STOKMAN | |||||||
| BOARD PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAMON ANDERSON | |||||||
| BOARD TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RAEONE MAGNUSON | |||||||
| BOARD SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JULIE BLUHM | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KEN EBEL | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| EDWARD H HAMM JR | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KELLEY O'NEILL | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RAYMOND BOYLE | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA EWING | |||||||
| INTERIM EXECUTIVE DIRECTOR (BEG 2022) | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| ANGELA LEWIS-DMELLO | |||||||
| EXECUTIVE DIRECTOR (THRU MAY '22) | 40.00 | Yes (X) | $155,656 | $0 | $18,301 | ||
| BUD INGRAM-LILE | |||||||
| DIRECTOR OF PSYCHIATRY | 40.00 | $283,213 | $0 | $29,310 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $438,869 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $47,611 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | 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 |
| All Other Contributions | $2,311,471 | AllOtherContributionsAmt |
| Noncash Contributions | $98,579 | NoncashContributionsAmt |
| Total Contributions | $2,311,471 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT FEES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $1,332,866 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,332,866 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $159,438 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $159,438 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,492,304 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,762 | TotalRevenueColumnAmt |
| Exclusion | $1,762 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,805,537 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,492,304 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,762 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $557,022 | TotalAmt |
| Program Services | $313,559 | ProgramServicesAmt |
| Management And General | $243,463 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,526,998 | TotalAmt |
| Program Services | $1,476,207 | ProgramServicesAmt |
| Management And General | $12,438 | ManagementAndGeneralAmt |
| Fundraising | $38,353 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,889 | TotalAmt |
| Program Services | $24,945 | ProgramServicesAmt |
| Fundraising | $944 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,699 | TotalAmt |
| Program Services | $211,972 | ProgramServicesAmt |
| Management And General | $16,527 | ManagementAndGeneralAmt |
| Fundraising | $5,200 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,201 | TotalAmt |
| Program Services | $116,755 | ProgramServicesAmt |
| Management And General | $14,762 | ManagementAndGeneralAmt |
| Fundraising | $2,684 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,706 | TotalAmt |
| Management And General | $22,706 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,099 | TotalAmt |
| Management And General | $57,099 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,732 | TotalAmt |
| Management And General | $20,732 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $287,874 | TotalAmt |
| Program Services | $67,472 | ProgramServicesAmt |
| Management And General | $131,096 | ManagementAndGeneralAmt |
| Fundraising | $89,306 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,886 | TotalAmt |
| Program Services | $4,960 | ProgramServicesAmt |
| Management And General | $8,836 | ManagementAndGeneralAmt |
| Fundraising | $2,090 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,536 | TotalAmt |
| Program Services | $16,973 | ProgramServicesAmt |
| Management And General | $5,209 | ManagementAndGeneralAmt |
| Fundraising | $354 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,308 | TotalAmt |
| Program Services | $18,204 | ProgramServicesAmt |
| Management And General | $32,433 | ManagementAndGeneralAmt |
| Fundraising | $7,671 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,363 | TotalAmt |
| Program Services | $157,182 | ProgramServicesAmt |
| Management And General | $18,594 | ManagementAndGeneralAmt |
| Fundraising | $3,587 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,836 | TotalAmt |
| Program Services | $8,690 | ProgramServicesAmt |
| Management And General | $15,484 | ManagementAndGeneralAmt |
| Fundraising | $3,662 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415 | TotalAmt |
| Management And General | $415 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,006 | TotalAmt |
| Program Services | $9,503 | ProgramServicesAmt |
| Management And General | $9,503 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,442 | TotalAmt |
| Program Services | $57,349 | ProgramServicesAmt |
| Management And General | $6,784 | ManagementAndGeneralAmt |
| Fundraising | $1,309 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| EQUIPMENT MAINTENANCE | $36,028 | $11,248 | $20,040 | $4,740 |
| PROGRAM EXPENSE | $26,292 | $8,208 | $14,625 | $3,459 |
| DUES & SUBSCRIPTIONS | $11,848 | $3,699 | $6,590 | $1,559 |
| BAD DEBT EXPENSE | $9,741 | $9,741 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,108 | TotalAmt |
| Program Services | $6,096 | ProgramServicesAmt |
| Management And General | $10,445 | ManagementAndGeneralAmt |
| Fundraising | $2,567 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,358,029 | TotalAmt |
| Program Services | $2,522,763 | ProgramServicesAmt |
| Management And General | $667,781 | ManagementAndGeneralAmt |
| Fundraising | $167,485 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,794,365 | BOYAmt |
| EOY | $1,011,058 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $496,698 | BOYAmt |
| EOY | $899,635 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,600 | BOYAmt |
| EOY | $101,548 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,399 | BOYAmt |
| EOY | $183,455 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,015 | BOYAmt |
| EOY | $43,814 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,404,908 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $519,362 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,387 | BOYAmt |
| EOY | $885,546 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $551,679 | BOYAmt |
| EOY | $527,162 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,086,143 | BOYAmt |
| EOY | $3,652,218 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $301,971 | BOYAmt |
| EOY | $444,469 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,682 | BOYAmt |
| EOY | $5,485 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $310,653 | BOYAmt |
| EOY | $449,954 | 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 | $2,132,978 | BOYAmt |
| EOY | $2,511,368 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $642,512 | BOYAmt |
| EOY | $690,896 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,775,490 | BOYAmt |
| EOY | $3,202,264 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,086,143 | BOYAmt |
| EOY | $3,652,218 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $447,508 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$20,734 | OtherChangesInNetAssetsAmt |
| 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 | $3,221,278 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,612,728 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,629,378 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,082,222 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,311,471 | CurrentTaxYearAmt |
| Total | $10,857,077 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,221,278 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,612,728 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,629,378 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,082,222 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,311,471 | CurrentTaxYearAmt |
| Total | $10,857,077 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $2,525,671 | SubstantialContributorsTotAmt |
| Public Support Total170 | $8,331,406 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,694 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,682 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,089 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,381 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,762 | CurrentTaxYearAmt |
| Total | $43,608 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $10,900,685 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $6,034,180 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.76430 | PublicSupportCY170Pct |
| Public Support PY170 | 0.59200 | 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 | $551,679 | BeginningYearBalanceAmt |
| Contributions | $16,200 | ContributionsAmt |
| Investment Earnings Or Losses | -$20,734 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $19,983 | GrantsOrScholarshipsAmt |
| End Year Balance | $527,162 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $424,949 | BeginningYearBalanceAmt |
| Contributions | $17,330 | ContributionsAmt |
| Investment Earnings Or Losses | $127,959 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $18,559 | GrantsOrScholarshipsAmt |
| End Year Balance | $551,679 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $454,010 | BeginningYearBalanceAmt |
| Contributions | $250 | ContributionsAmt |
| Investment Earnings Or Losses | -$11,189 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $17,223 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $899 | AdministrativeExpensesAmt |
| End Year Balance | $424,949 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $451,870 | BeginningYearBalanceAmt |
| Contributions | $2,700 | ContributionsAmt |
| Investment Earnings Or Losses | $21,074 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $17,768 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $2,866 | AdministrativeExpensesAmt |
| End Year Balance | $455,010 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $431,160 | BeginningYearBalanceAmt |
| Contributions | $7,350 | ContributionsAmt |
| Investment Earnings Or Losses | $34,252 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $17,227 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $3,665 | AdministrativeExpensesAmt |
| End Year Balance | $451,870 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| 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 | $779,600 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,340 | DepreciationAmt |
| Book Value | $755,260 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $625,308 | OtherCostOrOtherBasisAmt |
| Depreciation | $495,022 | DepreciationAmt |
| Book Value | $130,286 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $885,546 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTEREST IN ENDOWMENT FUNDS | Desc |
| Book Value | $527,162 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $527,162 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASE OBLIGATIONS | Desc |
| Amt | $5,485 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,485 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $3,970,808 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $195,746 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$30,475 | OtherRevenueAmt |
| Revenue Not Reported | $165,271 | RevenueNotReportedAmt |
| Revenue Subtotal | $3,805,537 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $3,805,537 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,544,034 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $195,746 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $195,746 | ExpensesNotReportedAmt |
| Expenses Subtotal | $3,348,288 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $9,741 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $9,741 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $3,358,029 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN ENDOWMENT FUNDS -20,734. BAD DEBT EXPENSE -9,741. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 9,741. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BUD INGRAM-LILE | ||||||||||||||
| DIRECTOR OF PSYCHIATRY | $283,213 | $0 | $0 | $0 | $0 | $0 | $15,070 | $0 | $14,240 | $0 | $312,523 | $0 | $0 | $0 |
| ANGELA LEWIS-DMELLO | ||||||||||||||
| EXECUTIVE DIRECTOR (THRU MAY '22) | $155,656 | $0 | $0 | $0 | $0 | $0 | $6,226 | $0 | $12,075 | $0 | $173,957 | $0 | $0 | $0 |
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 | $98,579 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | DAILY AVG - FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BOARD MEMBERS EDWARD H. HAMM, EDWARD H. HAMM JR., AND KELLEY O'NEILL HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE EXECUTIVE DIRECTOR WILL PROVIDE A COPY TO THE FINANCE COMMITTEE TO REVIEW THE AUDIT RESULTS AND FINANCIAL REPORTS. THE FORM 990 WILL BE EMAILED TO ALL FINANCE COMMITTEE MEMBERS FOR THEIR REVIEW AND EDIT COMMENTS. A COPY OF THE 990 WILL BE PROVIDED TO THE WHOLE BOARD BEFORE IT IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS FILL OUT AN ANNUAL DISCLOSURE FORM. IN THE CASE OF A CONFLICT, OR THE APPEARANCE THEREOF, BOARD MEMBERS ARE EXPECTED TO DISCLOSE THE CONFLICT PRIOR TO THE CLINIC'S MAKING ANY RELATED DECISIONS. IF A CONFLICT AND MAY, AT THE REQUEST OF THE BOARD OR COMMITTEE, REMAIN IN THE ROOM TO ANSWER QUESTIONS OF A FACTUAL NATURE THAT MAY ASSIST THE BOARD OR COMMITTEE IN ITS DELIBERATION AND DETERMINATION OF WHETHER OR NOT AN ACTUAL CONFLICT OF INTEREST EXISTS. BOARD MEMBERS HAVING A CONFLICT OF INTEREST ON A GIVEN ISSUE DO NOT VOTE ON THE ISSUE. PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING THE COMPENSATION OF THE EXECUTIVE DIRECTOR INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION. THE EXECUTIVE COMMITTEE ALSO REVIEWS THE COMPENSATION AND BONUS PLAN. THE PROCESS WAS LAST UNDERTAKEN OF THE EXECUTIVE DIRECTOR, IN MAY OF 2020. THE PROCESS FOR DETERMINING OTHER OFFICERS' COMPENSATION INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, CONTEMPORANEOUS SUBSTANTIATION, AND A REVIEW BY THE FINANCE COMMITTEE. THE PROCESS WAS LAST UNDERTAKEN IN FEBRUARY OF 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CLINIC'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN ENDOWMENT FUND -20,734. |