STRATEGY STUDIO / PUBLIC DATA EXPLORER

PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVANCEMENT: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVANCEMENT (EIN 75-2878960)
Tax period
2022-09-01 to 2023-08-31
Filed
2023-11-07
IRS object ID
202303119349302255
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 ReturnHeader

FieldValueIRS element (for citing)
Return2023-11-07T11:33:32-05:00ReturnTs
Tax Period End2023-08-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN751925251PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1LEWIS KAUFMAN REID STUKEY GATTIS & CO PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12308 W 5TH STAddressLine1Txt
CityPLAINVIEWCityNm
State AbbreviationTXStateAbbreviationCd
ZIP79072ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-09-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN752878960EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PLAINVIEW FOUNDATION FOR RURALBusinessNameLine1Txt
Business Name Line2HEALTH ADVANCEMENTBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlPLAIBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1705 - 2NDAddressLine1Txt
CityHARTCityNm
State AbbreviationTXStateAbbreviationCd
ZIP79043ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRETTA KNOXPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone8069382299PhoneNum
Signature2023-11-07SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstRETTAPersonFirstNm
Person LastKNOXPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrfalseIRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTHAD K REIDPreparerPersonNm
PTINP00850719PTIN
Phone8062934287PhoneNum
Preparation2023-11-07PreparationDt
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRETTA KNOXPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 336AddressLine1Txt
CityHARTCityNm
State AbbreviationTXStateAbbreviationCd
ZIP79043ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$596,173GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2000FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionOPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee12TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$420,599PYContributionsGrantsAmt
CY Contributions Grants$438,351CYContributionsGrantsAmt
PY Program Service Revenue$81,935PYProgramServiceRevenueAmt
CY Program Service Revenue$87,287CYProgramServiceRevenueAmt
PY Investment Income$95PYInvestmentIncomeAmt
CY Investment Income$400CYInvestmentIncomeAmt
CY Other Revenue$70,135CYOtherRevenueAmt
PY Total Revenue$502,629PYTotalRevenueAmt
CY Total Revenue$596,173CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$281,124PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$294,946CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$320,858PYOtherExpensesAmt
CY Other Expenses$288,116CYOtherExpensesAmt
PY Total Expenses$601,982PYTotalExpensesAmt
CY Total Expenses$583,062CYTotalExpensesAmt
PY Revenues Less Expenses-$99,353PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$13,111CYRevenuesLessExpensesAmt
Total Assets BOY$272,632TotalAssetsBOYAmt
Total Assets EOY$281,730TotalAssetsEOYAmt
Total Liabilities BOY$4,368TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$268,264NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$281,730NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionOPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$463,187ExpenseAmt
Revenue$87,287RevenueAmt
DescOPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS.Desc
Total Program Service Expenses$463,187TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document4IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee12EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcfalseRegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonLKRSG CO PCPersonNm
Phone8062934287PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12308 W 5TH STREETAddressLine1Txt
CityPLAINVIEWCityNm
State AbbreviationTXStateAbbreviationCd
ZIP79072ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
MARTY GERBER
DIRECTOR/PRE1.00Yes (X)Yes (X)$0$0$0
RETTA KNOX
EXECUTIVE DI40.00Yes (X)$52,632$0$0
STANLEY DYER
DIRECTOR1.00Yes (X)$0$0$0
JACKIE JENKINS
DIRECTOR1.00Yes (X)$0$0$0
LUPE MORALES
DIRECTOR1.00Yes (X)$0$0$0
DIANNE WASHINGTON
DIRECTOR1.00Yes (X)$0$0$0
TEREESA MONTEMAYOR
DIRECTOR1.00Yes (X)$0$0$0
DERRICK RAMSEY
DIRECTOR1.00Yes (X)$0$0$0
ADRIAN ROSAS
DIRECTOR1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$52,632TotalReportableCompFromOrgAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Government Grants$391,851GovernmentGrantsAmt
All Other Contributions$46,500AllOtherContributionsAmt
Noncash Contributions$48,000NoncashContributionsAmt
Total Contributions$438,351TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CO-PAYMENTS$42,769$42,769
PRIVATE INSURANCE$26,975$26,975
MEDICARE$8,913$8,913
MEDICAID$8,222$8,222
OTHER INCOME$408$408
FieldValueIRS element (for citing)
Total Program Service Revenue$87,287TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$400TotalRevenueColumnAmt
Related Or Exempt Func Income$400RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescEMPLOYEE RETENTION CREDITDesc
Total Revenue Column$70,135TotalRevenueColumnAmt
Exclusion$70,135ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$70,135OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$596,173TotalRevenueColumnAmt
Related Or Exempt Func Income$87,687RelatedOrExemptFuncIncomeAmt
Exclusion$70,135ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$272,023TotalAmt
Program Services$192,888ProgramServicesAmt
Management And General$79,135ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$22,923TotalAmt
Program Services$16,275ProgramServicesAmt
Management And General$6,648ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$19,427TotalAmt
Program Services$1,943ProgramServicesAmt
Management And General$17,484ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$111,081TotalAmt
Program Services$111,081ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$8,700TotalAmt
Program Services$2,175ProgramServicesAmt
Management And General$6,525ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$52,037TotalAmt
Program Services$46,228ProgramServicesAmt
Management And General$5,809ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,776TotalAmt
Program Services$1,528ProgramServicesAmt
Management And General$248ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$10,188TotalAmt
Program Services$10,188ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$5,214TotalAmt
Program Services$4,693ProgramServicesAmt
Management And General$521ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES$27,300$27,300
PHAMACEUTICALS$13,128$13,128
EMR$12,517$12,517
DENTAL SUPPLIES$9,612$9,612

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$17,136TotalAmt
Program Services$13,631ProgramServicesAmt
Management And General$3,505ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$583,062TotalAmt
Program Services$463,187ProgramServicesAmt
Management And General$119,875ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$230,551BOYAmt
EOY$228,609EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,586BOYAmt
EOY$25,485EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$463BOYAmt
EOY$7,792EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$79,193LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$59,349LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$30,032BOYAmt
EOY$19,844EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$272,632BOYAmt
EOY$281,730EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,368BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,368BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$268,264BOYAmt
EOY$281,730EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$268,264BOYAmt
EOY$281,730EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$272,632BOYAmt
EOY$281,730EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$13,111ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$355OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedfalseFSAuditedInd
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$569,181CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$450,325CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$733,935CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$420,599CurrentTaxYearMinus1YearAmt
Current Tax Year$438,351CurrentTaxYearAmt
Total$2,612,391TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$569,181CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$450,325CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$733,935CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$420,599CurrentTaxYearMinus1YearAmt
Current Tax Year$438,351CurrentTaxYearAmt
Total$2,612,391TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$2,612,391PublicSupportTotal170Amt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Current Tax Year$69,135CurrentTaxYearAmt
Total$69,135TotalAmt
FieldValueIRS element (for citing)
Total Support$2,681,526TotalSupportAmt
Gross Receipts Rltd Activities$449,412GrossReceiptsRltdActivitiesAmt
Public Support CY1700.97420PublicSupportCY170Pct
Public Support PY1701.00000PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$79,193OtherCostOrOtherBasisAmt
Depreciation$59,349DepreciationAmt
Book Value$19,844BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$19,844TotalBookValueLandBuildingsAmt

Schedule M IRS990ScheduleM

Real Estate Commercial RealEstateCommercialGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution2ContributionCnt
Noncash Contributions Rpt F990$48,000NoncashContributionsRptF990Amt
Method Of Determining RevenuesFMV RENTALMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGiftsInd
Third Parties UsedfalseThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSIONOPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS.
FORM 990, PAGE 6, PART VI, LINE 11BTHE EXECUTIVE DIRECTOR AND BOARD OF DIRECTORS REVIEWS TAX RETURN AND ATTACHMENTS BEFORE FILING.
FORM 990, PAGE 6, PART VI, LINE 15ATHE BOARD OF DIRECTORS REVIEW AND APPROVE THE SALARY OF THE EXECUTIVE DIRECTOR AND IS DOCUMENTED IN THE BOARD'S MINUTES.
FORM 990, PAGE 6, PART VI, LINE 19MADE AVAILABLE UPON REQUEST
FORM 990, PART IX, LINE 11GCONTRACTED MEDICAL SERVICES 111,081 0 0
FORM 990, PART XI, LINE 9PRIOR YEAR ADJUSTMENT 355