CALVARY COMMUNITY CLINIC INC: Form 990EZ, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CALVARY COMMUNITY CLINIC INC (EIN 47-1252154)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2022-11-23
- IRS object ID
- 202213279349200301
- Schema version
- 2021v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-23T01:40:37-07:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 471252154 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALVARY COMMUNITY CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CALV | BusinessNameControlTxt |
| Phone | 8132386000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3401 East Louisiana Avenue | AddressLine1Txt |
| City | Tampa | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33610 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Nathaniel Mattox | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 3526508426 | PhoneNum |
| Signature | 2022-11-21 | SignatureDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 1 | TrustedCustomerCd |
| OOB Security Verification | 11 | OOBSecurityVerificationCd |
| Last Submission Rqr OOB | 1 | LastSubmissionRqrOOBCd |
| Authentication Assurance Level | AAL2 | AuthenticationAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Website Address | calvarycommunityclinic.org | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $111,242 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $110,739 | ContributionsGiftsGrantsEtcAmt |
| Program Service Revenue | $503 | ProgramServiceRevenueAmt |
| Membership Dues | $0 | MembershipDuesAmt |
| Investment Income | $0 | InvestmentIncomeAmt |
| Sale Of Assets Gross | $0 | SaleOfAssetsGrossAmt |
| Cost Or Other Basis Expense Sale | $0 | CostOrOtherBasisExpenseSaleAmt |
| Gain Or Loss From Sale Of Assets | $0 | GainOrLossFromSaleOfAssetsAmt |
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Special Events Direct Expenses | $216 | SpecialEventsDirectExpensesAmt |
| Special Events Net Income Loss | -$216 | SpecialEventsNetIncomeLossAmt |
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
| Gross Profit Loss Sls Of Invntry | $0 | GrossProfitLossSlsOfInvntryAmt |
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
| Total Revenue | $111,026 | TotalRevenueAmt |
| Grants And Similar Amounts Paid | $0 | GrantsAndSimilarAmountsPaidAmt |
| Benefits Paid To Or For Members | $3,292 | BenefitsPaidToOrForMembersAmt |
| Salaries Other Comp Empl Bnft | $51,990 | SalariesOtherCompEmplBnftAmt |
| Fees And Other Pymt To Ind Cntrct | $8,996 | FeesAndOtherPymtToIndCntrctAmt |
| Occupancy Rent Utlts And Maint | $17,554 | OccupancyRentUtltsAndMaintAmt |
| Printing Publications Postage | $380 | PrintingPublicationsPostageAmt |
| Other Expenses Total | $2,509 | OtherExpensesTotalAmt |
| Total Expenses | $84,721 | TotalExpensesAmt |
| Excess Or Deficit For Year | $26,305 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $395,113 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $2,091 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $423,509 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,047 | BOYAmt |
| EOY | $76,931 | EOYAmt |
Land And Buildings LandAndBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $334,470 | BOYAmt |
| EOY | $334,470 | EOYAmt |
Other Assets Total Detail OtherAssetsTotalDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,108 | BOYAmt |
| EOY | $12,108 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $397,625 | BOYAmt |
| EOY | $423,509 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,512 | BOYAmt |
| EOY | $0 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $395,113 | BOYAmt |
| EOY | $423,509 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | n response to the growing uninsured population in the East Tampa community, the free clinic addresses one of the most critical needs of the community which it serves. Within the 33604, 33610 and 33612 zip codes, 40% of the population has no health insurance coverage and 25% live below the poverty level. The Calvary Community Clinic provides quality, compassionate health care for the underprivileged, uninsured, unemployed and underserved segments of our community. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | The Calvary Community Free Clinic is driven by a mission to provide free quality and compassionate primary healthcare to indigent and uninsured residents of Hillsborough County. We are committed to meeting the healthcare needs of anyone who cannot afford medical care regardless of gender, age, religion, ethnicity or national origin. The aim of our clinic is to improve the overall health of our community through volunteerism, community partnerships and outreach programs. Calvary Community Free Clinic is in its sixth year of operation and the need for our services is now greater than ever. The clinic staff consists of a volunteer team of fully qualified and certified professionals including physicians, physician assistants, nurse practitioners and nurses. Our campus is equipped to serve in three major areas- primary care (non-urgent), vision and dental In 2020, the clinic served 400 duplicated and unduplicated patients. This is a significant decrease from prior (pre-pandemic) years. The clinic worked in collaboration with local agencies to provide diagnostic lab work at no cost to 112 new and returning patients. This partnership allowed providers the opportunity to diagnose and treat these patients, all of whom are uninsured. Also in 2020, in collaboration with a local pharmacy, the clinic supplied prescription medication to its patients in need, with a subsidy of 50% of the total cost. Calvary Community Free Clinic continues to be a beacon of hope, help and healing in the community | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $0 | GrantsAndAllocationsAmt |
| Program Service Expenses | $0 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $0 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (15 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| Patrick Vincent | ||||
| Chairman | 2 | $0 | $0 | $0 |
| Albert Coleman | ||||
| Vice Chairman | 2 | $0 | $0 | $0 |
| Antoinette Lloyd | ||||
| Medical Director | 2 | $0 | $0 | $0 |
| Nathaniel Mattox | ||||
| Treasurer | 4 | $0 | $0 | $0 |
| Annette Forde | ||||
| Secretary | 3 | $0 | $0 | $0 |
| Antonia Barber | ||||
| Director | 1 | $0 | $0 | $0 |
| Brenda Greenway | ||||
| Director | 1 | $0 | $0 | $0 |
| Cheryl Kenneth-Jenkins | ||||
| Director | 1 | $0 | $0 | $0 |
| Darlene Chisolm | ||||
| Director | 1 | $0 | $0 | $0 |
| Essie Sims Jr | ||||
| Director | 1 | $0 | $0 | $0 |
| John Richardson | ||||
| Director | 1 | $0 | $0 | $0 |
| Trina Copeland | ||||
| Director | 1 | $0 | $0 | $0 |
| Rosa Cambridge | ||||
| Director | 1 | $0 | $0 | $0 |
| Marcellina Adonis | ||||
| Executive Director | 40 | $41,200 | $0 | $0 |
| Brenda Angall | ||||
| Admin Asst | 20 | $15,600 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Form1120 Pol Filed | 0 | Form1120PolFiledInd |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | FL | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NATHANIEL MATTOX | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3401 East Louisiana Avenue | AddressLine1Txt |
| City | Tampa | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 33610 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8132386000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Community Trust | Yes (X) | CommunityTrustInd |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $77,446 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $95,599 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $121,617 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $110,738 | CurrentTaxYearAmt |
| Total | $405,400 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $77,446 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $95,599 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $121,617 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $110,738 | CurrentTaxYearAmt |
| Total | $405,400 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $405,400 | PublicSupportTotal170Amt |
| Total Support | $405,400 | TotalSupportAmt |
| Public Support CY170 | 1 | PublicSupportCY170Pct |
| Public Support PY170 | 1 | 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 O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990-EZ, Part I, Line 16 | Advertising Bank Charges Office Supplies |
| Form 990-EZ, Part I, Line 20 | Office equipment |
| Form 990-EZ, Part II, Line 24 | Computer equipment Dental equipment |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Had to verify contributor address information | ExplanationTxt |