2022-11-11T09:35:47-06:00 2021-12-31 450473857 Crouch Joslyn Good PLLC 4505 Country Club Rd Ste 100 WinstonSalem NC 27104 990 2021-01-01 562062170 North Carolina Association of Free and Charitable Clinics Inc NORT 3362511111 1399 Ashleybrook Lane Ste 110 Winston Salem NC 27103 April Cook CEO 3362511111 2022-11-05 1 April Cook 999009999 Eugene J Joslyn P00288276 3367688000 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z April Cook 1399 Ashleybrook Lane Ste 110 Winston Salem NC 27103 278241 0 X www.ncafcc.org X 1997 NC To improve access to free health clinics and pharmacies for the under and uninsured people of NC. 11 11 4 0 0 0 15819959 277327 0 0 12232 914 12837 0 15845028 278241 9664398 3977962 0 0 467186 412489 0 0 25730 295344 273035 10426928 4663486 5418100 -4385245 7650388 1942143 1431586 61869 6218802 1880274 To improve access to health clinics and pharmacies for the uninsured and underinsured people of North Carolina. 0 0 756801 650654 To improve access to free health clinics and pharmacies for the unisured and underinsured people of North Carolina. 3416043 3327308 COVID-19 Relief Fund - Provide funds for member clinics to provide necessary and appropriate relief from the effects of COVID-19 N/A 4172844 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 9 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 NC X April Cook 3362511111 1399 Ashleybrook Lane Suite 100 Winston Salem NC 27103 Sissy Lee-Elmore Director 5.00 X 0 0 0 April Cook Director 5.00 X X 0 0 0 John Price Treasurer 5.00 X X 0 0 0 Michael Lischke Director 5.00 X 0 0 0 John Mills Director 5.00 X 0 0 0 Anthony Price Chairman 5.00 X X 0 0 0 Andy Kurtzman Director 5.00 X 0 0 0 Krista Woolly Secretary 5.00 X X 0 0 0 Sherri Fisher Director 5.00 X 0 0 0 Janet Jarrett Director 5.00 X 0 0 0 Randolph S Jordan CEO 40.00 X 112995 0 4116 112995 0 4116 1 0 0 0 0 45555 231772 277327 914 914 278241 0 0 914 3977962 3977962 112995 101696 11299 224586 139301 78210 7075 10000 10000 39257 7445 31812 25651 9946 14277 1428 32207 10080 20799 1328 620 495 125 15009 3150 11148 711 15574 14761 813 2884 2884 45644 45644 5342 443 4772 127 26889 25132 1757 1265 519 746 43055 43055 2191 2191 6340 6129 211 Communications 32797 32797 Non pilot clinic expens 23503 23503 0 Technology 11027 10365 662 Telephone 4803 4484 319 3885 3885 4663486 4172844 464912 25730 4862854 543760 684443 1750000 1000000 269 5607 5686 3837 53452 50590 5053 2862 342083 386077 0 7650388 1942143 1422234 49104 9352 12765 1431586 61869 X 846340 521647 5372462 1358627 6218802 1880274 7650388 1942143 -4385245 46717 0 X X 0 1 X 1 1 1 X 869149 1285148 1646434 15819959 278241 19898931 869149 1285148 1646434 15819959 278241 19898931 5570107 14328824 207 962 13767 12232 914 28082 17500 15825 16205 6000 17000 72530 19999543 87100 0.71650 0.71350 X Schedule A, Part II, Line 10, Explanation of Other Income: Conference income once a year - 2017 Amount: $ 17,500. 2018 Amount: $ 15,825. 2019 Amount: $ 16,205. 2020 Amount: $ 6,000. 2021 Amount: $ 17,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 15574 0 0 15574 0 Part II-B, Line 1: Meetings with and/or calling government officials or legislators. 53452 50590 2862 2862 Foundation for the Carolinas Investment Pool 386077 F 386077 322074 43833 43833 278241 0 278241 4660602 0 4660602 2884 2884 4663486 Part XII, Line 4b - Other Adjustments: Investment fees netted to revenue on books 2,884. 1 ABCCM Medical Ministry 155 Livingston St Asheville NC 28801 560945001 501(c)(3) 362379 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Ada Jenkins Center (fka Free Clinic of Our Towns) PO Box 1842 Davidson NC 28036 561927067 501(c)(3) 19749 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Alliance Medical Ministry 101 Donald Ross Drive Raleigh NC 27610 562168673 501(c)(3) 36178 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Blue Ridge Free Dental Clinic PO Box 451 Cashiers NC 28717 510509517 501(c)(3) 13726 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Broad Street Clinic Foundation 534 N 35th Street Suite K Morehead City NC 28557 561853604 501(c)(3) 62602 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Camino Community Center (Camino Clinic) 133 Stetson Dr Charlotte NC 28262 562116201 501(c)(3) 147367 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Cape Fear Clinic Inc 1605 Doctors Circle Wilmington NC 28401 561984630 501(c)(3) 48948 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs CARE Clinic PO Box 53438 Fayetteville NC 28305 561837010 501(c)(3) 25882 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Care Ring 601 E 5th St Suite 140 Charlotte NC 28202 560621073 501(c)(3) 133514 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Caring Community Clinic (Onslow) 600 Court Street Jacksonville NC 28540 561705813 501(c)(3) 12100 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs CCC - Albemarle Hospital Foundation PO Box 1412 Elizabeth City NC 27906 432031990 501(c)(3) 84538 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Chatham CARES Community Pharmacy 127 East Raleigh Street Siler City NC 27344 412170926 501(c)(3) 32116 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Christ Community Church 4555 Fairview Drive Wilmington NC 28412 030389985 Church 33582 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Care Center for Forsyth County 2135 New Walkertown Road Winston Salem NC 27101 581403699 501(c)(3) 311583 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Care Clinic - Elizabeth City 918 Greenleaf Street Elizabeth City NC 27909 432031990 501(c)(3) 15000 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Care Clinic of Boone 141 Health Center Dr Suite B Boone NC 28607 208607858 501(c)(3) 17531 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Care Clinic of Dare PO Box 1329 Nags Head NC 27959 202230717 501(c)(3) 64882 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Care Clinic of Franklin Inc 1830 Lakeside Drive Franklin NC 28734 611662916 501(c)(3) 53655 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Care Clinic of Highlands-Cashiers Inc 52 Aunt Dora Drive Highlands NC 28741 651251915 501(c)(3) 8496 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Care Clinic of Rowan County 315 Mocksville Avenue Suite G Salisbury NC 28144 561964773 501(c)(3) 26796 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Clinic of High Point PO Box 5607 High Point NC 27262 561795022 501(c)(3) 186761 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Free Clinic 528A Lake Concord Road NE Concord NC 280252926 582131301 501(c)(3) 17871 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Community Health Services of Union County 1338-C East Sunset Drive Monroe NC 28112 460495947 501(c)(3) 30469 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Crisis Control Ministry Pharmacy 200 E 10th Street Winston Salem NC 271011512 237348168 501(c)(3) 70267 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Davidson Medical Ministries Clinic Inc PO Box 584 Lexington NC 272930584 561746266 501(c)(3) 94672 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Free Clinic of Rockingham County PO Box 2668 Reidsville NC 273232668 562003143 501(c)(3) 18539 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Good Samaritan Clinic 305 West Union Street Morganton NC 28655 561939030 501(c)(3) 109103 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Grace Clinic 948 Johnson Ridge Rd Elkin NC 28621 760800084 501(c)(3) 55569 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Greater Hickory CCM Medical Ministries 31 1st Ave SE Hickory NC 28602 560934855 501(c)(3) 14600 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Hands of Hope Medical Clinic 148 Beroth Drive Yadkinville NC 270550062 275569145 501(c)(3) 50064 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs HealthQuest of Union County 415 East Franklin Street Monroe NC 281125600 562117596 501(c)(3) 97801 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs HealthReach Community Clinic 400 E Statesvill Ave Suite 300 Mooresville NC 28115 201020941 501(c)(3) 49877 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Helping Hand Clinic - Sanford 507 N Steele St Sanford NC 27330 561752295 501(c)(3) 52110 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Helping Hands of Caldwell County 810 Harper Ave NW Lenoir NC 28645 562076541 501(c)(3) 49039 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Hope Community Clinic (Smith Family Wellness) PO Box 728 Bayboro NC 28515 562114681 501(c)(3) 202183 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Hunger & Health Coalition Inc 141 Health Center Dive Suite C Boone NC 28607 561322973 501(c)(3) 73572 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs John P Murray Community Care Clinic Inc 303 Yadkin St Suite C Albemarle NC 28001 562098720 501(c)(3) 16719 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Lake Norman Community Health Clinic PO Box 2398 Huntersville NC 28070 043723062 501(c)(3) 52245 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Mariam Clinic 4441-106 Six Forks 388 Cary NC 27609 203011248 501(c)(3) 48779 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Matthews Free Medical Clinic 196 S Trade St Matthews NC 281055772 510468874 501(c)(3) 18087 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs MERCI Clinic 1315 Tatum Drive New Bern NC 28560 562034052 501(c)(3) 15874 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Moore Free and Charitable Clinic 211 Trimble Plant Rd Suite C Southern Pines NC 28387 010781234 501(c)(3) 105510 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Mustard Seed Community Health 238 South English Street Greensboro NC 27401 464980081 501(c)(3) 41431 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs NC MedAssist 4428 Taggart Creek Road Suite 101 Charlotte NC 28208 562018957 501(c)(3) 15000 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs New Hope Clinic 201 W Boiling Spring Rd Southport NC 28461 311614379 501(c)(3) 15523 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Onslow Community Outreach Inc 600 Court Street Jacksonville NC 28540 561705813 501(c)(3) 432067 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Open Door Clinic of Alamance County 319E N Graham Hopedale Rd Burlington NC 27217 561794210 501(c)(3) 26750 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Samaritan Health Center PO Box 51339 Durham NC 27717 263770762 501(c)(3) 71400 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Senior PharmAssist 406 Rigsbee Avenue Suite 201 Durham NC 277012186 562084639 501(c)(3) 19540 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Shelter Health Services 534 Spratt Street Charlotte NC 28206 203041985 501(c)(3) 42044 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Shepherds Care Medical Clinic 304 Pony Road Zebulon NC 27597 262757593 501(c)(3) 14722 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs St Joseph Primary Care 4400 Falls of Neuse Road Suite 101 Raleigh NC 27609 465192720 501(c)(3) 14144 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Surry Medical Ministries Foundation Inc 813 Rockford Street Mt Airy NC 27030 561829347 501(c)(3) 49992 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs The Free Clinics 841 Case Street Hendersonville NC 28792 562212024 501(c)(3) 64671 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs The Shalom Project 639 S Green St Winston Salem NC 27101 202136431 501(c)(3) 33156 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Urban Ministries Open Door Clinic 1390 Capital Blvd Raleigh NC 27611 581422700 501(c)(3) 29962 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs Wake Forest Baptist Health Mobile Clinic Medical Center Blvd Winston Salem NC 27517 510190238 501(c)(3) 33607 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs WATCH Healthcare (Wayne Memorial) PO Box 8001 Goldsboro NC 27534 561484844 501(c)(3) 112707 0 Increase avail of healthcare to uninsured of NC or CRF for COVID-19 related costs 58 Part I, Line 2 Monitoring Subgrantees must provide documentation of amounts requested for reimbursement and the Association's Grants Manager reviews documentation and calculation of requested reimbursements. Form 990, Part VI, Section B, line 11b Organization's process is to review encrypted electronic copies (pdf) of form 990 which are made available to the governing board for review and comment prior to submission of the form 990 to the IRS. Form 990, Part VI, Section B, line 12c Annual inquiry requiring signature of each officer and director. Form 990, Part VI, Section B, line 15 The Chief Executive Officers compensation is considered annually by the designated members of the governing board. The compensation of all key employees is considered annually by the designated members of the governing board. Form 990, Part VI, Section C, line 19 Documents are available to the public upon request. Form 990, Part XII, Line 2c: Process unchanged from prior year.