FREE CLINIC OF ROME INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- FREE CLINIC OF ROME INC (EIN 20-5296305)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-28
- IRS object ID
- 202213019349301676
- 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 | 2022-10-28T13:04:01-07:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 582357052 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RL JENNINGS AND ASSOCIATES PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 506 E 3rd St | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30161 | 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 | 205296305 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Free Clinic of RomeInc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FREE | BusinessNameControlTxt |
| Phone | 7062341331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Professional Court SW | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Renee Blackburn | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Phone | 7062341331 | PhoneNum |
| Signature | 2022-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Renee | PersonFirstNm |
| Person Last | Blackburn | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Richard L Jennings | PreparerPersonNm |
| PTIN | P00118987 | PTIN |
| Phone | 7068021945 | PhoneNum |
| Preparation | 2022-10-28 | 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 |
| Federated Assurance Level | FAL1 | FederatedAssuranceLevelCd |
| 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 | Renee Blackburn | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Professional Court SW | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,245,488 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.freeclinicofrome.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | To serve the Greater Rome area by providing quality healthcare services to people who are uninsured and low income. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 4 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,271,488 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,243,508 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$393 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,980 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $1,271,095 | PYTotalRevenueAmt |
| CY Total Revenue | $1,245,488 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $118,072 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $127,863 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $9,536 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,079,638 | PYOtherExpensesAmt |
| CY Other Expenses | $1,155,167 | CYOtherExpensesAmt |
| PY Total Expenses | $1,197,710 | PYTotalExpensesAmt |
| CY Total Expenses | $1,283,030 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $73,385 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$37,542 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $196,058 | TotalAssetsBOYAmt |
| Total Assets EOY | $156,291 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,367 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,142 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $190,691 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $153,149 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To serve the Greater Rome area by providing quality healthcare services to people who are uninsured and low income. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,234,589 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | To provide free quality healthcare and treatment to individuals. | Desc |
| Total Program Service Expenses | $1,234,589 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| 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 | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | 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 | false | 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 | Yes (true) | 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 | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 4 | 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 |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Renee Blackburn | PersonNm |
| Phone | 7062341331 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 Professional Court SW | AddressLine1Txt |
| City | Rome | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30165 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| Jennifer R Blackburn | |||||||
| Executive Director | 40.00 | Yes (X) | $70,000 | $0 | $0 | ||
| John Pillsbury | |||||||
| President | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Dr PJ Lynn | |||||||
| Vice President | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Jose Ajanel | |||||||
| Secretary | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Toni Rhinehart | |||||||
| Treasurer | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Rick Childs | |||||||
| Atrium Representative | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Scotty Hancock | |||||||
| Advent Representative | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| John Reiners | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Carol Gooch | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Terrence Hight | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Dr Adam Karmali | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Andrew Williams | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Mike Nichols | |||||||
| Board Member | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $70,000 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $31,603 | FundraisingAmt |
| All Other Contributions | $1,211,905 | AllOtherContributionsAmt |
| Noncash Contributions | $1,060,562 | NoncashContributionsAmt |
| Total Contributions | $1,243,508 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,980 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $31,603 | ContriRptFundraisingEventAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,245,488 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,980 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,000 | TotalAmt |
| Program Services | $59,500 | ProgramServicesAmt |
| Management And General | $9,800 | ManagementAndGeneralAmt |
| Fundraising | $700 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,377 | TotalAmt |
| Program Services | $30,070 | ProgramServicesAmt |
| Management And General | $4,953 | ManagementAndGeneralAmt |
| Fundraising | $354 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,486 | TotalAmt |
| Program Services | $19,113 | ProgramServicesAmt |
| Management And General | $3,148 | ManagementAndGeneralAmt |
| Fundraising | $225 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,305 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $5,305 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $30 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,650 | TotalAmt |
| Program Services | $2,650 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,810 | TotalAmt |
| Program Services | $90 | ProgramServicesAmt |
| Management And General | $8,720 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $333 | TotalAmt |
| Program Services | $333 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,813 | TotalAmt |
| Program Services | $21,091 | ProgramServicesAmt |
| Management And General | $3,524 | ManagementAndGeneralAmt |
| Fundraising | $198 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,499 | TotalAmt |
| Program Services | $2,499 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,787 | TotalAmt |
| Program Services | $8,787 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,512 | TotalAmt |
| Program Services | $2,135 | ProgramServicesAmt |
| Management And General | $377 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Dues | $1,439 | $0 | $1,439 | $0 |
| Equipment Rental | $1,759 | $1,759 | $0 | $0 |
| Laboratory Services | $230,000 | $230,000 | $0 | $0 |
| Maintenance | $683 | $580 | $103 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $865,547 | TotalAmt |
| Program Services | $855,982 | ProgramServicesAmt |
| Management And General | $1,506 | ManagementAndGeneralAmt |
| Fundraising | $8,059 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,283,030 | TotalAmt |
| Program Services | $1,234,589 | ProgramServicesAmt |
| Management And General | $38,905 | ManagementAndGeneralAmt |
| Fundraising | $9,536 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,509 | BOYAmt |
| EOY | $102,769 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,020 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,577 | BOYAmt |
| EOY | $1,467 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $59,823 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,791 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,819 | BOYAmt |
| EOY | $39,032 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,133 | BOYAmt |
| EOY | $13,023 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,058 | BOYAmt |
| EOY | $156,291 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,367 | BOYAmt |
| EOY | $3,142 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,367 | BOYAmt |
| EOY | $3,142 | 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 | $190,691 | BOYAmt |
| EOY | $153,149 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $190,691 | BOYAmt |
| EOY | $153,149 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,058 | BOYAmt |
| EOY | $156,291 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$37,542 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support CY170 | 0 | PublicSupportCY170Pct |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $125,784 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $152,999 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $241,328 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $245,424 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $182,946 | CurrentTaxYearAmt |
| Total | $948,481 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $125,784 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $152,999 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $241,328 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $245,424 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $182,946 | CurrentTaxYearAmt |
| Total | $948,481 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $948,481 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $934 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $129 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,059 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,980 | CurrentTaxYearAmt |
| Total | $4,102 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $934 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $129 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,059 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,980 | CurrentTaxYearAmt |
| Total | $4,102 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $952,583 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99570 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99070 | PublicSupportPY509Pct |
| Investment Income CY | 0.00430 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00930 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $17,411 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $3,567 | DepreciationAmt |
| Book Value | $13,844 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $42,412 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $17,224 | DepreciationAmt |
| Book Value | $25,188 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $39,032 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $1,245,488 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $1,245,488 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,245,488 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,283,030 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $1,283,030 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,283,030 | TotalExpensesPerForm990Amt |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 11b | A copy of the 990 is given to all board members for review. |
| Pt VI, Line 12c | All policies are reviewed by board members on scheduled basis. |
| Pt VI, Line 15b | Officer salary is reviewed based on current standards. |
| Pt VI, Line 15a | Salary is reviewed based on current standards. |
| Form 990, Part IX, Line 24e | Medical Services 399280. 399280. 0. 0. |
| Form 990, Part IX, Line 24e | Medical Supplies 423747. 423747. 0. 0. |
| Form 990, Part IX, Line 24e | Misc 390. 390. 0. 0. |
| Form 990, Part IX, Line 24e | Postage 409. 348. 61. 0. |
| Form 990, Part IX, Line 24e | Security 30. 26. 4. 0. |
| Form 990, Part IX, Line 24e | Supplies 18726. 18726. 0. 0. |
| Form 990, Part IX, Line 24e | Telephone 5026. 4272. 704. 50. |
| Form 990, Part IX, Line 24e | Printing and copying 621. 528. 93. 0. |
| Form 990, Part IX, Line 24e | Contract labor 7241. 7241. 0. 0. |
| Form 990, Part IX, Line 24e | Fundraising expense 7815. 0. 0. 7815. |
| Form 990, Part IX, Line 24e | Program services 1230. 1230. 0. 0. |
| Form 990, Part IX, Line 24e | Bank fees 280. 0. 280. 0. |
| Form 990, Part IX, Line 24e | Gifts and awards 364. 0. 364. 0. |
| Form 990, Part IX, Line 24e | Website 388. 194. 0. 194. |