RHODE ISLAND FREE CLINIC INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- RHODE ISLAND FREE CLINIC INC (EIN 05-0501276)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-13
- IRS object ID
- 202221339349302937
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-13T10:22:51-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 050392605 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MULLEN SCORPIO & CERILLI | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 67 CEDAR STREET | AddressLine1Txt |
| City | PROVIDENCE | CityNm |
| State Abbreviation | RI | StateAbbreviationCd |
| ZIP | 02903 | 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 | 050501276 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE RHODE ISLAND FREE CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RHOD | BusinessNameControlTxt |
| Phone | 4012746347 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 655 BROAD STREET | AddressLine1Txt |
| City | PROVIDENCE | CityNm |
| State Abbreviation | RI | StateAbbreviationCd |
| ZIP | 02907 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WILLIAM FITZGERALD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 4012746347 | PhoneNum |
| Signature | 2022-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | WILLIAM | PersonFirstNm |
| Person Last | FITZGERALD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANTHONY W SCORPIO | PreparerPersonNm |
| PTIN | P01360145 | PTIN |
| Phone | 4017513860 | PhoneNum |
| Preparation | 2022-05-11 | 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 | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WILLIAM FITZGERALD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 655 BROAD STREET | AddressLine1Txt |
| City | PROVIDENCE | CityNm |
| State Abbreviation | RI | StateAbbreviationCd |
| ZIP | 02907 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,058,658 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | RIFREECLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | RI | LegalDomicileStateCd |
| Activity Or Mission | RHODE ISLAND FREE CLINIC'S MISSION IS TO PROVIDE COMPREHENSIVE MEDICAL CARE AND PREVENTIVE HEALTH SERVICES TO UNINSURED, LOW-INCOME RHODE ISLAND ADULTS, AND TO SERVE AS A TRAINING SITE FOR ASPIRING HEALTHCARE TRAINEES. IN 2021 THE CLINIC MOBILIZED A STATEWIDE CORPS OF MORE THAN 525 VOLUNTEERS AND COMMUNITY PARTNERS, TO SERVE OVER 4,400 ADULTS THROUGH OVER 14,000 VISITS AND ENCOUNTERS, AND TRAINING FOR OVER 195 STUDENT TRAINEES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 21 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 21 | VotingMembersIndependentCnt |
| Total Employee | 34 | TotalEmployeeCnt |
| Total Volunteers | 528 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,754,949 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,919,439 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,434 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,289 | CYInvestmentIncomeAmt |
| PY Other Revenue | $107,253 | PYOtherRevenueAmt |
| CY Other Revenue | $132,930 | CYOtherRevenueAmt |
| PY Total Revenue | $1,875,636 | PYTotalRevenueAmt |
| CY Total Revenue | $2,058,658 | 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 | $933,255 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,168,338 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $95,458 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $502,889 | PYOtherExpensesAmt |
| CY Other Expenses | $538,551 | CYOtherExpensesAmt |
| PY Total Expenses | $1,436,144 | PYTotalExpensesAmt |
| CY Total Expenses | $1,706,889 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $439,492 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $351,769 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,254,684 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,540,511 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $193,182 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $85,390 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,061,502 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,455,121 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | RHODE ISLAND FREE CLINIC'S MISSION IS TO PROVIDE COMPREHENSIVE MEDICAL CARE AND PREVENTIVE HEALTH SERVICES TO UNINSURED, LOW-INCOME RHODE ISLAND ADULTS, AND TO SERVE AS A TRAINING SITE FOR ASPIRING HEALTHCARE TRAINEES. IN 2021 THE CLINIC MOBILIZED A STATEWIDE CORPS OF MORE THAN 525 VOLUNTEERS AND COMMUNITY PARTNERS, TO SERVE OVER 4,400 ADULTS THROUGH OVER 14,000 VISITS AND ENCOUNTERS, AND TRAINING FOR OVER 195 STUDENT TRAINEES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $364,417 | ExpenseAmt |
| Desc | CLINICAL - IN 2021 THE CLINIC PROVIDED A COMPREHENSIVE MEDICAL HOME FOR UNINSURED RHODE ISLAND ADULTS WHO EARNED BELOW 200% OF THE FEDERAL POVERTY LEVEL. CARE INCLUDED INTEGRATED PRIMARY, SPECIALTY, BEHAVIORAL HEALTH, AND DENTAL SERVICES, LABS AND DIAGNOSTIC TESTING, MEDICINE, AND WELLNESS EDUCATION - ALL FREE TO PATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $58,715 | ExpenseAmt |
| Desc | VOLUNTEER - IN 2021 THE CLINIC MOBILIZED A CORPS OF OVER 525 VOLUNTEERS AND COMMUNITY PARTNERS TO DELIVER COMPREHENSIVE HEALTH CARE AND COVID-19 RESPONSE SERVICES TO UNINSURED, LOW-INCOME RHODE ISLAND ADULTS. VOLUNTEERS INCLUDED DOCTORS, DENTISTS, NURSE PRACTITIONERS, PHYSICIAN ASSISTANTS, NURSES, BEHAVIORAL HEALTH CLINICIANS, PHYSICAL THERAPISTS, DIABETES EDUCATORS, LANGUAGE INTERPRETERS, MEDICAL ASSISTANTS, AND MORE. CARE WAS PROVIDED AT THE CLINIC'S STATE-OF-THE-ART FACILITY AT 655 BROAD STREET, PROVIDENCE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $739,926 | ExpenseAmt |
| Desc | THE CLINIC WAS ON THE FRONT LINE OF COVID-RESPONSE FOR UNDERSERVED ADULTS IN RHODE ISLAND. SERVICES INCLUDED OVER 5,800 TESTS AND VACCINATIONS, AND FOLLOW UP CARE FOR THOSE WHO TESTED POSITIVE. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $357,623 | ExpenseAmt |
| Desc | TRAINING - THE CLINIC IS THE NORTHERN RHODE ISLAND AREA HEALTH EDUCATION CENTER (AHEC). THROUGH IT THE CLINIC COLLABORATED WITH 17 ACADEMIC AND TRAINING PARTNERS TO PROVIDE OVER 195 HEALTHCARE TRAINEES WITH FACULTY-SUPERVISED TRAINING. TRAINING INCLUDED SKILLS AND SITE-BASED EXPERIENCE IN OVER 12 DISCIPLINES. DENTAL - DENTAL CARE IS INTEGRATED INTO PATIENTS' COMPREHENSIVE MEDICAL HOME AT THE CLINIC. PATIENTS RECEIVED PREVENTIVE, RESTORATIVE, ENDODONTIC, PERIODONTAL, AND SURGICAL TREATMENTS, THROUGH OVER 990 VISITS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $357,623 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $1,520,681 | 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 | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | 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 | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 34 | 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 | 21 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 21 | 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 | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| 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 | MARIE GHAZAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4012746347 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 655 BROAD STREET | AddressLine1Txt |
| City | PROVIDENCE | CityNm |
| State Abbreviation | RI | StateAbbreviationCd |
| ZIP | 02907 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| MARK GIM | ||||||
| PRESIDENT EMERITUS | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JEFFREY CHASE LUBITZ ESQ | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| WILLIAM FITZGERALD | ||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CAROLINE TROISE MD | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CARRIE BRIDGES FELIZ MPH | ||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ANDREW DAVIS ESQ | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JERRY FINGERUT MD | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LOREE DUBOIS | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| WHITNEY CLARKE | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| HERBERT RAKATANSKY MD FACG | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MICHELLE LEDERBERG ESQ | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PHILIP R RIZZUTO MD | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JEHANNE BJORNBYE ESQ | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| GEORGE GREER | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| JOSEPH PERRONI | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ROSS HILLIARD MD | ||||||
| VOLUNTEER MEDICAL DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DIANA DUCHARME ESQ | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TRAVIS ESCOBAR | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RILWAN FEYISITAN JR | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARIE GHAZAL | ||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | Yes (X) | $221,172 | $0 | $26,763 |
| BRENDAN KANE | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARINA RODRIGUEZ MD | ||||||
| BOARD MEMBER/PART-TIME PRIMARY CARE PROVIDER | 1.00 | Yes (X) | $43,600 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $264,772 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $26,763 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | 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 |
| Government Grants | $125,530 | GovernmentGrantsAmt |
| All Other Contributions | $1,793,909 | AllOtherContributionsAmt |
| Total Contributions | $1,919,439 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $819 | TotalRevenueColumnAmt |
| Exclusion | $819 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,470 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,470 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,470 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,470 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $115,068 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $115,068 | TotalRevenueColumnAmt |
| Exclusion | $115,068 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $17,862 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,862 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $17,862 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,058,658 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,332 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $115,887 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,934 | TotalAmt |
| Program Services | $223,141 | ProgramServicesAmt |
| Management And General | $24,793 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $776,386 | TotalAmt |
| Program Services | $730,557 | ProgramServicesAmt |
| Management And General | $7,244 | ManagementAndGeneralAmt |
| Fundraising | $38,585 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,172 | TotalAmt |
| Program Services | $41,144 | ProgramServicesAmt |
| Management And General | $1,816 | ManagementAndGeneralAmt |
| Fundraising | $4,212 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,846 | TotalAmt |
| Program Services | $90,140 | ProgramServicesAmt |
| Management And General | $2,871 | ManagementAndGeneralAmt |
| Fundraising | $3,835 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,545 | TotalAmt |
| Program Services | $49,105 | ProgramServicesAmt |
| Management And General | $12,246 | ManagementAndGeneralAmt |
| Fundraising | $3,194 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,721 | TotalAmt |
| Management And General | $9,960 | ManagementAndGeneralAmt |
| Fundraising | $2,761 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,245 | TotalAmt |
| Program Services | $120,105 | ProgramServicesAmt |
| Management And General | $2,841 | ManagementAndGeneralAmt |
| Fundraising | $8,299 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $515 | TotalAmt |
| Program Services | $408 | ProgramServicesAmt |
| Management And General | $107 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,655 | TotalAmt |
| Program Services | $108,230 | ProgramServicesAmt |
| Management And General | $4,165 | ManagementAndGeneralAmt |
| Fundraising | $12,260 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,528 | TotalAmt |
| Program Services | $11,860 | ProgramServicesAmt |
| Management And General | $901 | ManagementAndGeneralAmt |
| Fundraising | $767 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| COVID-19 EXPENSES | $58,981 | $59,979 | -$998 | |
| MISCELLANEOUS EXPENSE | $28,753 | $14,292 | $7,458 | $7,003 |
| DENTAL SUPPLIES | $17,727 | $17,727 | ||
| COMPUTER HARDWARE AND S | $14,342 | $9,270 | $4,553 | $519 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,539 | TotalAmt |
| Program Services | $44,723 | ProgramServicesAmt |
| Management And General | $12,793 | ManagementAndGeneralAmt |
| Fundraising | $14,023 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,706,889 | TotalAmt |
| Program Services | $1,520,681 | ProgramServicesAmt |
| Management And General | $90,750 | ManagementAndGeneralAmt |
| Fundraising | $95,458 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $998,194 | BOYAmt |
| EOY | $862,902 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $197,316 | BOYAmt |
| EOY | $520,791 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,753 | BOYAmt |
| EOY | $69,429 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,603,588 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,139,455 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,486 | BOYAmt |
| EOY | $464,133 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $361,629 | BOYAmt |
| EOY | $366,101 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $214,306 | BOYAmt |
| EOY | $257,155 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,254,684 | BOYAmt |
| EOY | $2,540,511 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,652 | BOYAmt |
| EOY | $85,390 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,530 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,182 | BOYAmt |
| EOY | $85,390 | 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 | $1,644,041 | BOYAmt |
| EOY | $1,995,543 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $417,461 | BOYAmt |
| EOY | $459,578 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,061,502 | BOYAmt |
| EOY | $2,455,121 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,254,684 | BOYAmt |
| EOY | $2,540,511 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $351,769 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $41,850 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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 | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 | $1,187,300 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,206,846 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,217,098 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,833,733 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,907,977 | CurrentTaxYearAmt |
| Total | $7,352,954 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,187,300 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,206,846 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,217,098 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,833,733 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,907,977 | CurrentTaxYearAmt |
| Total | $7,352,954 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $7,352,954 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $33,956 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,734 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $47,320 | CurrentTaxYearAmt |
| Total | $109,010 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $39,873 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $50,309 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $28,424 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $28,469 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,680 | CurrentTaxYearAmt |
| Total | $165,755 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $7,627,719 | TotalSupportAmt |
| Public Support CY170 | 0.96400 | PublicSupportCY170Pct |
| Public Support PY170 | 0.96560 | 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 | $214,306 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $42,849 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $257,155 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $192,845 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $21,461 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $214,306 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $164,408 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $28,437 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $192,845 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $172,685 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $8,277 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $164,408 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $155,412 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $17,685 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $172,685 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $1,139,852 | OtherCostOrOtherBasisAmt |
| Depreciation | $810,291 | DepreciationAmt |
| Book Value | $329,561 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $457,808 | OtherCostOrOtherBasisAmt |
| Depreciation | $323,236 | DepreciationAmt |
| Book Value | $134,572 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,928 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,928 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $464,133 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENTS HELD BY OTHERS | Desc |
| Book Value | $257,155 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $257,155 | TotalBookValueSecuritiesAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,164,291 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $41,850 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $2,063,784 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $2,105,634 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,058,657 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,058,657 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,770,673 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $2,063,784 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $2,063,784 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,706,889 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,706,889 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION EVALUATES THEIR UNCERTAIN TAX POSITION USING GUIDANCE FOR CONTINGENCIES AS CONTAINED IN US GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE ORGANIZATION WAS NOT AWARE OF ANY UNCERTAIN TAX POSITIONS. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | FOUNDERS EVENT | Event1Nm |
| Gross Receipts Event1 | $115,068 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $115,068 | GrossRevenueEvent1Amt |
| Gross Receipts Total | $115,068 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $115,068 | GrossRevenueTotalEventsAmt |
| Net Income Summary | $115,068 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARIE GHAZAL | PersonNm |
| Title | EXECUTIVE DIRECTOR | TitleTxt |
| Base Compensation Filing Org | $191,172 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $30,000 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $5,705 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $21,058 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $247,935 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRENDAN KANE | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | PRINCIPAL AT THE PEREGRINE GROUP | RelationshipDescriptionTxt |
| Transaction | THE BOARD MEMEBER IS PRINCIPAL AT THE PEREGRINE GROUP, THE PROPERTY MANAGEMENT COMPANY THAT MANAGES THE HINDLE BUILDING, IN WHICH RHODE ISLAND FREE CLINIC REALTY IS CONDO OWNER OF. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | CLINICAL, PRIMARY CARE AND PHARMACY SERVICES | Desc |
| Contribution | 0 | ContributionCnt |
| Noncash Contributions Rpt F990 | $2,063,784 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FINANCE COMMITTEE REVIEWS THE FORM 990 AND RECOMMENDS TO THE BOARD FOR APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES THAT ALL BOARD OF DIRECTOR MEMBERS AND STAFF MUST REVIEW AND SIGN THE POLICY. A SIGNED COPY OF THE CONFLICT OF INTEREST POLICY IS KEPT ON FILE AND REVIEWED EACH YEAR. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE CHIEF EXECUTIVE OFFICER'S COMPENSATION WAS DETERMINED BY REVIEW OF COMPARABILITY DATA AND WAS APPROVED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND ON GUIDESTAR'S WEBSITE. |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RHODE ISLAND FREE CLINIC REALTY CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 655 BROAD STREET | AddressLine1Txt |
| City | PROVIDENCE | CityNm |
| State Abbreviation | RI | StateAbbreviationCd |
| ZIP | 02907 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 872273706 | EIN |
| Primary Activities | TO HOLD TITLE OF PROPERTY FOR THE RHODE ISLAND FREE CLINIC. | PrimaryActivitiesTxt |
| Legal Domicile State | RI | LegalDomicileStateCd |
| Exempt Code Section | 501(C) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12B, II | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |