2018-05-15T08:25:13-05:00 2017-06-30 540565834 MITCHELL WIGGINS & COMPANY LLP 100 FLANK ROAD PETERSBURG VA 238059152 990 2016-07-01 541679279 THE NORTHERN NECK-MIDDLESEX FREE HEALTH CLINIC INC NORT 8044350575 P O BOX 1694 KILMARNOCK VA 22482 R JEAN NELSON EXECUTIVE DIRECTOR 8044350575 2018-05-14 1 M JAMES HARTSON JR CPA P00590214 8047335566 2016 2022-09-23 18:48:47Z R JEAN NELSON 51 WILLIAM B GRANT COURT KILMARNOCK VA 22482 5005977 0 X WWW.NNFHC.COM X 1993 VA THE CLINIC SERVES LOW-INCOME, UNINSURED RESIDENTS OF THE NORTHERN NECK REGION AND MIDDLESEX COUNTY OF VIRGINIA. THEY EMBRACE HEALTH AND WELLNESS AS THE FOUNDATION FOR QUALITY OF LIFE AND DEDICATE THEMSELVES TO PROVIDING THE HIGHEST LEVEL OF MEDICAL CARE TO ALL THOSE THEY SERVE. 11 11 29 270 0 0 2371292 3995315 143237 147410 226828 55133 3745 3619 2745102 4201477 0 2793086 0 0 731324 832585 0 0 36199 2425757 445463 3157081 4071134 -411979 130343 4831928 5113750 118884 103857 4713044 5009893 X THE CLINIC SERVES LOW-INCOME, UNINSURED RESIDENTS OF THE NORTHERN NECK REGION AND MIDDLESEX COUNTY OF VIRGINIA. THEY EMBRACE HEALTH AND WELLNESS AS THE FOUNDATION FOR QUALITY OF LIFE AND DEDICATE THEMSELVES TO PROVIDING THE HIGHEST LEVEL OF MEDICAL CARE TO ALL THOSE THEY SERVE. 0 0 3008072 2793086 82390 PHARMACY PROVIDES PRESCRIPTIONS TO UNINSURED OR UNDERINSURED INDIVIDUALS IN THE NORTHERN NECK REGION AND MIDDLESEX COUNTY OF VIRGINIA AT LITTLE TO NO COST. 561337 3619 HEALTH CLINIC PROVIDES MEDICAL CARE TO UNINSURED OR UNDERINSURED INDIVIDUALS IN THE NORTHERN NECK REGION AND MIDDLESEX COUNTY OF VIRGINIA 350605 65020 DENTAL CLINIC PROVIDES DENTAL CARE AT REDUCED FEES TO PATIENTS IN THE NORTHERN NECK REGION AND MIDDLESEX COUNTY OF VIRGINIA 3920014 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 2 0 1 29 1 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 1 1 1 0 VA X CORPORATION 8044350575 51 WILLIAM B GRAHAM COURT KILMARNOCK VA 22482 R JEAN NELSON EXECUTIVE DIRECTOR 60.00 X X 103308 0 15274 JO CROCKETT BOARD MEMBER 2.00 X 0 0 0 BILL ARNOLD BOARD MEMBER 2.00 X 0 0 0 BONNIE BRYANT BOARD MEMBER 2.00 X 0 0 0 SCOTT GRAHAM BOARD MEMBER 2.00 X 0 0 0 BARRET KEAN BOARD MEMBER 2.00 X 0 0 0 JOHN MAY BOARD MEMBER 2.00 X 0 0 0 PAGE HENLEY TREASURER 4.00 X X 0 0 0 KATHRYN VOSE VICE PRESIDENT 4.00 X X 0 0 0 JOHN O'SHAUGHNESSY PRESIDENT 6.00 X X 0 0 0 BILL LEE BOARD MEMBER 2.00 X 0 0 0 RICHARD BAYLOR MD BOARD MEMBER 2.00 X 0 0 0 103308 0 15274 1 0 0 0 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 022417844 OUTSIDE MEDICAL SERVICES 112796 1 189905 3805410 2654884 3995315 DENTAL FEES 611300 44726 44726 PHARMACY HDS 446110 41619 41619 PHARMACY SUPPORT 446110 40771 40771 DENTAL DENTURES 621300 20294 20294 147410 53039 53039 806594 804500 2094 2094 2094 MEDICAL RECORDS 621300 3619 3619 3619 4201477 151029 0 55133 2793086 2793086 102886 73594 17419 11873 616445 595451 14961 6033 11159 10055 733 371 47507 42811 3119 1577 54588 50887 2360 1341 89038 89038 27800 27800 22057 22057 11790 8090 3700 2826 141 2685 63058 46721 7716 8621 35328 33606 1445 277 24641 21628 1818 1195 1623 1401 214 8 1390 1390 26013 25704 272 37 30644 28580 1788 276 SUPPLIES 45855 45855 DENTAL EXPENSE 36449 36449 LAB AND TEST FEES 15038 15038 VOLUNTEER SUPPORT 8517 797 7659 61 3396 1082 1485 829 4071134 3920014 114921 36199 46720 24945 68924 443196 113736 65473 1934135 1817432 20217 30374 803427 473930 352510 329497 2292678 2399220 3008 3613 4831928 5113750 85930 80557 32954 23300 118884 103857 X 2634849 2934967 820947 817678 1257248 1257248 4713044 5009893 4831928 5113750 130343 166506 0 X X 0 1 X 1 0 X 1742549 2758119 2378427 2465728 3995315 13340138 1742549 2758119 2378427 2465728 3995315 13340138 5410642 7929496 110959 129716 104623 60741 53039 459078 13799216 1019576 0.57460 0.53160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2296686 198647 91500 2403833 2294385 2301 2296686 2315702 1000 -22317 2294385 2082093 383609 150000 2315702 2125794 102519 230000 1998313 0.17220 0.30470 0.52310 0 0 96550 96550 260049 92068 167981 446828 381862 64966 329497 X 4883301 166506 537375 703881 4179420 22057 22057 4201477 4586452 537375 537375 4049077 22057 22057 4071134 PART V, LINE 4: INCOME WILL BE USED TO SUPPORT THE ORGANIZATION'S ACTIVITIES. PART X, LINE 2: THE CLINIC FOLLOWS GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REGARDING "ACCOUNTING FOR UNCERTAIN TAX POSITIONS". THIS STANDARD PROVIDES DETAILED GUIDANCE FOR FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, AND DISCLOSURE OF UNCERTAIN TAX POSITIONS RECOGNIZED IN THE CLINIC'S FINANCIAL STATEMENTS. IT REQUIRES AN ENTITY TO RECOGNIZE THE FINANCIAL STATEMENT IMPACT OF A TAX POSITION WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL NOT BE SUSTAINED UPON EXAMINATION. THE CLINIC HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AT JUNE 30, 2017. THE TAX YEARS OF 2014 TO 2016 REMAIN SUBJECT TO EXAMINATION BY THE TAXING AUTHORITIES. THE CLINIC INCLUDES PENALTIES AND INTEREST ASSESSED BY INCOME TAXING AUTHORITIES IN OPERATING EXPENSES. THE CLINIC DID NOT HAVE PENALTIES AND INTEREST EXPENSES FOR THE YEAR ENDED JUNE 30, 2017. 1 PRESCRIPTION MEDICATIONS PROVIDED TO UNINSURED OR UNDERINSURED INDIVIDUALS IN THE NORTHERN NECK REGION AND MIDDLESEX COUNTY OF VIRGINIA 958 2793086 FAIR MARKET VALUE PRESCRIPTION MEDICATIONS PART I, LINE 2: PATIENT ELIGIBILITY IS DOCUMENTED PRIOR TO DISPENSING ANY MEDICATIONS. NNFHCP SCREENS PATIENTS USING ELIGIBILITY FORMS THAT HAVE BEEN APPROVED BY MANAGEMENT. THE FORMS DECLARATION OF INCOME/ NO INCOME AND NO LONGER WORKING ARE NEVER USED BY THEMSELVES TO DETERMINE ELIGIBILITY. THERE WILL ALWAYS BE OTHER DOCUMENTATION ALONG WITH THESE FORMS (FOR EXAMPLE: FOOD STAMP LETTER, SOCIAL SECURITY LETTER, LETTER OF SUPPORT). EACH PATIENT MUST BE SCREENED FOR ELIGIBILITY DETERMINATION EVERY 12 MONTHS, AT A MINIMUM, HAVE COMBINED HOUSEHOLD INCOME AT OR BELOW 200% OF FEDERAL POVERTY LEVEL, AND BE WITHOUT ANY PRESCRIPTION DRUG COVERAGE. VIRGINIA RESIDENCY IS REQUIRED FOR EACH PATIENT. AT A MINIMUM, ELIGIBILITY SCREENERS MUST REVIEW A PATIENT SIGNED ELIGIBILITY FORM, WHICH IDENTIFIES THE PATIENT'S VIRGINIA ADDRESS. LASTLY, PATIENTS MUST ATTEST TO THE FACT THEY HAVE NO INSURANCE ON A SIGNED ELIGIBILITY FORM. X 2 75379 QUOTED MARKET VALUE X 137 2579505 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED BY THE EXCUTIVE DIRECTOR AND MADE AVAILABLE TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C WHEN EMPLOYEES AND BOARD MEMBERS BECOME PART OF THE ORGANIZATION THEY ARE REQUIRED TO SIGN THE ORGANIZATIONS CONFLICT OF INTEREST POLICY. EACH YEAR EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY TO CERTIFY THAT NO CONFLICTS OF INTEREST HAVE ARISEN DUE TO NEW MEMBERS OR EMPLOYEES WHO HAVE JOINED THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 BOARD REVIEWS AND SETS COMPENSATION FOR EXECUTIVE DIRECTOR ANNUALLY BASED ON THE RECOMMENDATION OF THE EMPLOYEE COMPENSATION COMMITTEE FORM 990, PART VI, SECTION C, LINE 19 TAX RETURNS, BUDGETS AND OTHER GOVERNING DOCUMENTS ARE AVAILABLE FOR REVIEW BY DONORS AND THE GENERAL PUBLIC AT THE CLINIC DURING SCHEDULED OFFICE HOURS FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.