SUSAN DEW HOFF MEMORIAL CLINIC INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization: SUSAN DEW HOFF MEMORIAL CLINIC INC (EIN 55-0768457)
Tax period: 2022-01-01 to 2022-12-31
Filed: 2023-09-20
IRS object ID: 202332639349300533
Schema version: 2022v5.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2023-09-20T12:14:08-05:00	ReturnTs
Tax Period End	2022-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	390859910	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	BAKER TILLY US LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 908	AddressLine1Txt
City	BRIDGEPORT	CityNm
State Abbreviation	WV	StateAbbreviationCd
ZIP	26330	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2022-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	550768457	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SUSAN DEW HOFF MEMORIAL CLINIC INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	SUSA	BusinessNameControlTxt
Phone	3047453700	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	623 LIBERTY AVENUE	AddressLine1Txt
City	WEST MILFORD	CityNm
State Abbreviation	WV	StateAbbreviationCd
ZIP	26451	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	DR JD HISSEM	PersonNm
Person Title	EXECUTIVE DIRECTOR	PersonTitleTxt
Phone	3047453700	PhoneNum
Signature	2023-08-28	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	DR	PersonFirstNm
Person Last	JD HISSEM	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Field	Value	IRS element (for citing)
IRS Responsible Prty Info Curr	0	IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	WILLIAM H PHILLIPS CPA	PreparerPersonNm
PTIN	P00197505	PTIN
Phone	3046245471	PhoneNum
Preparation	2023-08-28	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2022	TaxYr
Build TS	2023-04-26 12:10:37Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	SUSAN DEW HOFF MEMORIAL CLINIC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	DR JD HISSEM	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	623 LIBERTY AVENUE	AddressLine1Txt
City	WEST MILFORD	CityNm
State Abbreviation	WV	StateAbbreviationCd
ZIP	26451	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$377,259	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	N/A	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Other Organization Dsc	OTHER	OtherOrganizationDsc
Formation	1999	FormationYr
Legal Domicile State	WV	LegalDomicileStateCd
Activity Or Mission	PROVIDE HEALTH AND DENTAL CARE TO THE UNINSURED WORKING POOR.	ActivityOrMissionDesc
Voting Members Governing Body	26	VotingMembersGoverningBodyCnt
Voting Members Independent	26	VotingMembersIndependentCnt
Total Employee	2	TotalEmployeeCnt
Total Volunteers	26	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$486,375	PYContributionsGrantsAmt
CY Contributions Grants	$376,039	CYContributionsGrantsAmt
PY Program Service Revenue	$0	PYProgramServiceRevenueAmt
CY Program Service Revenue	$0	CYProgramServiceRevenueAmt
PY Investment Income	$12,827	PYInvestmentIncomeAmt
CY Investment Income	$1,220	CYInvestmentIncomeAmt
PY Other Revenue	$0	PYOtherRevenueAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$499,202	PYTotalRevenueAmt
CY Total Revenue	$377,259	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	$80,423	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$79,210	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$422,343	PYOtherExpensesAmt
CY Other Expenses	$334,718	CYOtherExpensesAmt
PY Total Expenses	$502,766	PYTotalExpensesAmt
CY Total Expenses	$413,928	CYTotalExpensesAmt
PY Revenues Less Expenses	-$3,564	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$36,669	CYRevenuesLessExpensesAmt
Total Assets BOY	$642,218	TotalAssetsBOYAmt
Total Assets EOY	$604,355	TotalAssetsEOYAmt
Total Liabilities BOY	$5,586	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$4,393	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$636,632	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$599,962	NetAssetsOrFundBalancesEOYAmt
Mission	TO PROVIDE HEALTH ASSESSMENT, PROMOTION AND REFERRAL SERVICES TO THE WORKING POOR WHO LACK MEDICAL AND DENTAL INSURANCE.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$344,484	ExpenseAmt
Revenue	$0	RevenueAmt
Desc	IN 2022, THE CLINIC HELD 73 CLINICS AND SAW 732 PATIENTS. WE PERFORMED 1,127 PROCEDURES, WHICH INCLUDED: 397 X-RAYS, 95 CLEANINGS, 397 FILLINGS, FASHIONED 12 FULL DENTURES AND 8 PARTIALS, 21 REPAIR/RELINES, 161 EXTRACTIONS, 20 ROOT CANALS, 11 CROWNS, 5 REFERRALS TO AN ORAL SURGEON AND 224 REFERRALS TO OUR CONTRACTED OUTSIDE DENTIST. INCLUDED IN THIS WAS SERVICE TO 93 NEW PATIENTS AND 106 VETERAN VISITS, THOSE WHO NO LONGER QUALIFY FOR CARE AT THE LOCAL VA HOSPITAL.	Desc
Total Program Service Expenses	$344,484	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	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	0	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	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	0	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	0	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	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	2	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
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	26	GoverningBodyVotingMembersCnt
Independent Voting Member	26	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	0	WhistleblowerPolicyInd
Document Retention Policy	0	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	0	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	WV	StatesWhereCopyOfReturnIsFldCd
Other Website	Yes (X)	OtherWebsiteInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SUSAN DEW HOFF MEMORIAL CLINIC INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	3047453700	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	623 LIBERTY STREET	AddressLine1Txt
City	WEST MILFORD	CityNm
State Abbreviation	WV	StateAbbreviationCd
ZIP	26451	ZIPCd

Field	Value	IRS element (for citing)
No Listed Persons Compensated	Yes (X)	NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd
GINA SHARPS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
BERNICE JEAN LUCAS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
MARY LOU VARGO
DIRECTOR	1.00	Yes (X)	$0	$0	$0
DR ROBERT WRANKER DDS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
FRANK NUZUM
DIRECTOR	1.00	Yes (X)	$0	$0	$0
DR MARY BETH HINKLE DDS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
DR ANDREW MINIGH DDS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
LADONNE WETZEL
DIRECTOR	1.00	Yes (X)	$0	$0	$0
GARY WETZEL
DIRECTOR	1.00	Yes (X)	$0	$0	$0
SANDRA MANO
DIRECTOR	1.00	Yes (X)	$0	$0	$0
DR MARK SPIKER DDS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
ANDY WHARTON
DIRECTOR	1.00	Yes (X)	$0	$0	$0
CECILIA REID
DIRECTOR	1.00	Yes (X)	$0	$0	$0
BEVERLY TALBERT
DIRECTOR	1.00	Yes (X)	$0	$0	$0
JOELLEN KEMMNER
CHAIR	4.00	Yes (X)	$0	$0	$0	Yes (X)
TODD SOMMERS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
LOU ORTENZIO
DIRECTOR	1.00	Yes (X)	$0	$0	$0
VIRGIL SMITH
DIRECTOR	1.00	Yes (X)	$0	$0	$0
DR LAURA GRAVES DDS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
SUSAN FORD
DRECTOR	1.00	Yes (X)	$0	$0	$0
BONNIE STARKEY
DIRECTOR	1.00	Yes (X)	$0	$0	$0
SISTER MARY REBECCA FIDLER RSM MD
CEO	5.00		$0	$0	$0	Yes (X)
DR JD HISSEM DDS
EXECUTIVE DIRECTOR	10.00		$0	$0	$0	Yes (X)
DR RICHARD MECKSTROTH DDS
VICE-CHAIR	4.00		$0	$0	$0	Yes (X)
TERRY WAXMAN
SECRETARY	4.00		$0	$0	$0	Yes (X)
BARBARA PRINCE
TREASURER	4.00		$0	$0	$0	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$0	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$0	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	0	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	0	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Federated Campaigns	$50,696	FederatedCampaignsAmt
All Other Contributions	$325,343	AllOtherContributionsAmt
Total Contributions	$376,039	TotalContributionsAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,220	TotalRevenueColumnAmt
Exclusion	$1,220	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$377,259	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$1,220	ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$73,520	TotalAmt
Program Services	$26,380	ProgramServicesAmt
Management And General	$47,140	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$5,690	TotalAmt
Program Services	$2,042	ProgramServicesAmt
Management And General	$3,648	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$9,125	TotalAmt
Management And General	$9,125	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,213	TotalAmt
Management And General	$2,213	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$30,413	TotalAmt
Program Services	$26,621	ProgramServicesAmt
Management And General	$3,792	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,402	TotalAmt
Program Services	$1,402	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$10,683	TotalAmt
Program Services	$10,683	ProgramServicesAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
CONTRACT SERVICES	$270,008	$270,008
DENTAL SUPPLIES	$7,348	$7,348
OTHER EXPENSES	$3,526		$3,526

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$413,928	TotalAmt
Program Services	$344,484	ProgramServicesAmt
Management And General	$69,444	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$259,991	BOYAmt
EOY	$223,035	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$368,588	BOYAmt
EOY	$368,901	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$6,843	BOYAmt
EOY	$7,025	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$57,079	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$51,685	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$6,796	BOYAmt
EOY	$5,394	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$642,218	BOYAmt
EOY	$604,355	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$5,586	BOYAmt
EOY	$4,393	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$5,586	BOYAmt
EOY	$4,393	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	$636,632	BOYAmt
EOY	$599,962	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$636,632	BOYAmt
EOY	$599,962	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$642,218	BOYAmt
EOY	$604,355	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$36,669	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$1	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	0	FSAuditedInd
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	$331,104	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$375,267	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$322,963	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$486,375	CurrentTaxYearMinus1YearAmt
Current Tax Year	$376,040	CurrentTaxYearAmt
Total	$1,891,749	TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$331,104	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$375,267	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$322,963	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$486,375	CurrentTaxYearMinus1YearAmt
Current Tax Year	$376,040	CurrentTaxYearAmt
Total	$1,891,749	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total170	$1,891,749	PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$6,379	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$7,182	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$10,146	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$12,827	CurrentTaxYearMinus1YearAmt
Current Tax Year	$1,220	CurrentTaxYearAmt
Total	$37,754	TotalAmt

Field	Value	IRS element (for citing)
Total Support	$1,929,503	TotalSupportAmt
Public Support CY170	0.98040	PublicSupportCY170Pct
Public Support PY170	0.97160	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

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,647	OtherCostOrOtherBasisAmt
Depreciation	$4,578	DepreciationAmt
Book Value	$2,069	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$50,432	OtherCostOrOtherBasisAmt
Depreciation	$47,107	DepreciationAmt
Book Value	$3,325	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$5,394	TotalBookValueLandBuildingsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$377,259	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$377,259	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$377,259	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$413,928	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$413,928	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$413,928	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART X, LINE 2:	FormAndLineReferenceDesc
Explanation	INCOME TAXES: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND IS RECOGNIZED AS TAX EXEMPT UNDER 501(A) OF THE CODE. IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ENTITY THAT IS NOT A PRIVATE FOUNDATION UNDER 509(A)(1). THE ORGANIZATION HAD NO UNRELATED BUSINESS INCOME DURING THE YEARS ENDED DECEMBER 31, 2021 AND 2020. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY OR ASSET IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICES (IRS). THE ORGANIZATION HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE FINANCIAL STATEMENTS. GENERALLY, TAX RETURNS FOR YEARS ENDED DECEMBER 31, 2018, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11B	THE BOARD MEMBERS ARE PROVIDED A COPY OF THE 990 AND IT IS REVIEWED AT BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12C	THE CLINIC ENFORCES AN ANNUAL DISCLOSURE REQUIREMENT WITH ITS CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION C, LINE 19	THE CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	ROUNDING -1.
FORM 990, PART XI, LINE 2C	THE ORGANIZATION HAS A COMMITEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS. THE SELECTION PROCESS FOR CHOOSING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PREVIOUS YEAR.