UNIVERSAL HERITAGE INSTITUTE INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSAL HERITAGE INSTITUTE INC (EIN 65-0268904)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-16
- IRS object ID
- 202211369349316711
- Schema version
- 2021v4.1
- 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 | 2022-05-16T19:47:38-04:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 204424972 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOFTBOOKS INC - CPA FIRM | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5373 N NOB HILL ROAD | AddressLine1Txt |
| City | LAUDERHILL | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33351 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 650268904 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNIVERSAL HERITAGE INSTITUTE I | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UNIV | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18441 NW 2ND AVENUE | AddressLine1Txt |
| City | MIAMI | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33169 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KHALID MIRZA | PersonNm |
| Person Title | VICE PRESIDENT/ADMINSITRATOR | PersonTitleTxt |
| Phone | 3056207797 | PhoneNum |
| Signature | 2022-03-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KHALID | PersonFirstNm |
| Person Last | MIRZA | PersonLastNm |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ALTAF SATTAR | PreparerPersonNm |
| PTIN | P01379430 | PTIN |
| Phone | 9548746230 | PhoneNum |
| Preparation | 2022-05-05 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | KHALID MIRZA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18441 NW 2ND AVENUE | AddressLine1Txt |
| City | MIAMI | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33169 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $511,291 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE FREE PRIMARY HEALTHCARE CLINIC TO ALL IN NEED | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 10 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $360,237 | PYContributionsGrantsAmt |
| CY Contributions Grants | $439,271 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $124 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $72,020 | CYOtherRevenueAmt |
| PY Total Revenue | $360,361 | PYTotalRevenueAmt |
| CY Total Revenue | $511,291 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $193,879 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $210,750 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $2,648 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,648 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $138,068 | PYOtherExpensesAmt |
| CY Other Expenses | $231,228 | CYOtherExpensesAmt |
| PY Total Expenses | $331,947 | PYTotalExpensesAmt |
| CY Total Expenses | $444,626 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $28,414 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $66,665 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $726,087 | TotalAssetsBOYAmt |
| Total Assets EOY | $756,968 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,805 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | -$1,979 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $692,282 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $758,947 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDE FREE PRIMARY HEALTHCARE CLINIC TO ALL IN NEED | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $433,652 | ExpenseAmt |
| Revenue | $439,271 | RevenueAmt |
| Desc | CLINIC PROVIDE SERVICE UNDER THE STATE OF FLS VOLUNTRY HEALTH CARE | Desc |
| Total Program Service Expenses | $433,652 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| 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 | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | 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 | Yes (true) | 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 | false | 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 | false | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 10 | 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 |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Excs Tax Sect4951 Or4952 Or4953 | false | ExcsTaxSect4951Or4952Or4953Ind |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | 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 |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALTAF SATTAR | PersonNm |
| Phone | 9548746230 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5373 N NOB HILL | AddressLine1Txt |
| City | SUNRISE | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33351 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| MOHAMMAD LATIF | |||||||
| PRESIDENT | 5 | 0 | Yes (X) | $0 | $0 | $0 | |
| MOHSIN JAFFER | |||||||
| DIRECTOR | 5 | 0 | $0 | $0 | $0 | Yes (X) | |
| ZAKIA SUBHANI | |||||||
| DIRECTOR | 5 | 0 | $0 | $0 | $0 | Yes (X) | |
| AZHAR DALAL | |||||||
| TREASURER | 5 | 0 | Yes (X) | $0 | $0 | $0 | |
| ASHRAF AMDANI | |||||||
| DIRECTOR | 5 | 0 | $0 | $0 | $0 | Yes (X) | |
| SHABBIR MOTORW | |||||||
| DIRECTOR | 5 | 0 | $0 | $0 | $0 | Yes (X) | |
| KHALID MIRZA | |||||||
| VP | 5 | 0 | Yes (X) | $0 | $0 | $0 | |
| RIAZ MERCHANT | |||||||
| SECRETARY | 5 | 0 | Yes (X) | $0 | $0 | $0 | |
| BIRJIS ALAM | |||||||
| DIRECTOR | 5 | 0 | $0 | $0 | $0 | Yes (X) | |
| ZAHRA KHAN | |||||||
| DIRECTOR | 5 | 0 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $15,525 | FundraisingAmt |
| Government Grants | $111,520 | GovernmentGrantsAmt |
| All Other Contributions | $312,226 | AllOtherContributionsAmt |
| Total Contributions | $439,271 | TotalContributionsAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PPP LOAN FORGIVNESS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $72,020 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $72,020 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $72,020 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $511,291 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $72,020 | RelatedOrExemptFuncIncomeAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,723 | TotalAmt |
| Management And General | $195,723 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,027 | TotalAmt |
| Management And General | $15,027 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,510 | TotalAmt |
| Management And General | $7,510 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,648 | TotalAmt |
| Fundraising | $2,648 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,390 | TotalAmt |
| Management And General | $3,390 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106 | TotalAmt |
| Management And General | $106 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,057 | TotalAmt |
| Management And General | $64,057 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,348 | TotalAmt |
| Management And General | $4,348 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| BANK & PLATFORM FEE | $53 | $53 |
| UTILITIES | $1,563 | $1,563 |
| CLEANING SERVCIES | $6,645 | $6,645 |
| SCH O FOR OTHER EXPENSES | $143,556 | $143,556 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $444,626 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $441,978 | ManagementAndGeneralAmt |
| Fundraising | $2,648 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,877 | BOYAmt |
| EOY | $409,365 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $353,187 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,363 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $259,430 | BOYAmt |
| EOY | $337,824 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,780 | BOYAmt |
| EOY | $9,779 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $726,087 | BOYAmt |
| EOY | $756,968 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$705 | BOYAmt |
| EOY | $603 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,510 | BOYAmt |
| EOY | -$2,582 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,805 | BOYAmt |
| EOY | -$1,979 | 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 | $679,876 | BOYAmt |
| EOY | $746,541 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,406 | BOYAmt |
| EOY | $12,406 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $692,282 | BOYAmt |
| EOY | $758,947 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $726,087 | BOYAmt |
| EOY | $756,968 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $66,665 | ReconcilationRevenueExpnssAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $490,490 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $452,616 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $568,851 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $360,237 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $439,271 | CurrentTaxYearAmt |
| Total | $2,311,465 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $490,490 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $452,616 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $568,851 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $360,237 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $439,271 | CurrentTaxYearAmt |
| Total | $2,311,465 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $2,311,465 | PublicSupportTotal170Amt |
| Total Support | $2,311,465 | TotalSupportAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Incl Escrow Custodial Acct Liab | false | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $238,149 | InvestmentCostOrOtherBasisAmt |
| Book Value | $238,149 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $75,945 | InvestmentCostOrOtherBasisAmt |
| Book Value | $75,945 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $19,950 | InvestmentCostOrOtherBasisAmt |
| Book Value | $19,950 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $19,143 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $15,363 | DepreciationAmt |
| Book Value | $3,780 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $337,824 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PAYROLL LIABLITIES | Desc |
| Amt | -$2,582 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | -$2,582 | TotalLiabilityAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GIVING DAY | Event1Nm |
| Gross Receipts Event1 | $15,525 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $15,525 | GrossRevenueEvent1Amt |
| Gross Receipts Total | $15,525 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $15,525 | GrossRevenueTotalEventsAmt |
| Net Income Summary | $15,525 | NetIncomeSummaryAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 990- PART XI | CLINIC PROVIDES SERVCIES UNDER THE STATE OF FLS VOLUNTRY HEALTH CARE PROVIDER PROGRAM TO UNINSURED, INDIGENT PEOPLE |
| 990 - PART VI | FINANCIAL COMMITTEE REVIEWS THE 990 TAX RETURN |
| 990 - PART VII | ALL DIRECTORS AND OFFICERS ARE VOLUNTEERS |
| 990 - PART XII | 2021 FINANCIALS WERE AUDITED |
| 990 - PART IX | CLINIC SUPPLIES - 14,739.00 CONTRACTORS - 12,849.00 TELEPHONE - 3,565.00 |
| 990 - PART IX | DUE AND SUBCRIPTIONS - 4,963.00 LAB SERVICES - 66,809.00 OFFICE SUPPLIES - 10,057.00 |
| 990 - PART IX | TOOLS - 1,297.00 LEGAL & PROFESSIONAL FEE - 26,276.00 POSTAGE - 152.00 LICENSE & FEES - 849.00 |
| 990 - PART IX | OFFICE MOVING - 2,000.00 |