PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVANCEMENT: Form 990, tax year 2015
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- Organization
- PLAINVIEW FOUNDATION FOR RURAL HEALTH ADVANCEMENT (EIN 75-2878960)
- Tax period
- 2015-09-01 to 2016-08-31
- Filed
- 2016-12-12
- IRS object ID
- 201633479349300963
- Schema version
- 2015v2.1
- 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 | 2016-12-12T11:02:31-06:00 | ReturnTs |
| Tax Period End | 2016-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 751925251 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LEWIS KAUFMAN REID STUKEY GATTIS & CO PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2308 W 5TH | AddressLine1Txt |
| City | PLAINVIEW | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 79072 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752878960 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLAINVIEW FOUNDATION FOR RURAL | BusinessNameLine1Txt |
| Business Name Line2 | HEALTH ADVANCEMENT | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PLAI | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 705 - 2ND | AddressLine1Txt |
| City | HART | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 79043 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RETTA KNOX | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Signature | 2016-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | THAD K REID | PreparerPersonNm |
| PTIN | P00850719 | PTIN |
| Phone | 8062934287 | PhoneNum |
| Preparation | 2016-11-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RETTA KNOX | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 336 | AddressLine1Txt |
| City | HART | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 79043 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $663,027 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | OPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 10 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $479,921 | PYContributionsGrantsAmt |
| CY Contributions Grants | $585,437 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $78,268 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $77,590 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $558,189 | PYTotalRevenueAmt |
| CY Total Revenue | $663,027 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $175,677 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $178,941 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $383,455 | PYOtherExpensesAmt |
| CY Other Expenses | $412,538 | CYOtherExpensesAmt |
| PY Total Expenses | $559,132 | PYTotalExpensesAmt |
| CY Total Expenses | $591,479 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$943 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $71,548 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $135,421 | TotalAssetsBOYAmt |
| Total Assets EOY | $211,973 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,788 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $20,792 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $119,633 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $191,181 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $538,499 | ExpenseAmt |
| Revenue | $77,590 | RevenueAmt |
| Desc | OPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS. | Desc |
| Total Program Service Expenses | $538,499 | 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 |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| 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 | false | 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 With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| 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 | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 10 | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | false | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LKRSG CO PC | PersonNm |
| Phone | 8062934287 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2308 W 5TH STREET | AddressLine1Txt |
| City | PLAINVIEW | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 79072 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| TERESA MONTEMAYOR | ||||||
| SECRETARY/TR | 12.00 | Yes (X) | Yes (X) | $6,375 | $0 | $0 |
| MARTY GERBER | ||||||
| DIRECTOR/PRE | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SIDNEY ONTAI | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ALLEN KING | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| TRAVIS HANSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JACE JONES | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| STANLEY DYER | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| NITA SANDERS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| RETTA KNOX | ||||||
| EXECUTIVE DI | 40.00 | Yes (X) | $51,600 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $57,975 | TotalReportableCompFromOrgAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $585,437 | GovernmentGrantsAmt |
| Noncash Contributions | $129,578 | NoncashContributionsAmt |
| Total Contributions | $585,437 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| CO-PAYMENTS | $37,723 | $37,723 |
| MEDICAID | $34,944 | $34,944 |
| PRIVATE INSURANCE | $4,203 | $4,203 |
| MEDICARE | $720 | $720 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $77,590 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $663,027 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $77,590 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,026 | TotalAmt |
| Program Services | $140,226 | ProgramServicesAmt |
| Management And General | $25,800 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,915 | TotalAmt |
| Program Services | $10,908 | ProgramServicesAmt |
| Management And General | $2,007 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,212 | TotalAmt |
| Program Services | $762 | ProgramServicesAmt |
| Management And General | $8,450 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,222 | TotalAmt |
| Program Services | $172,222 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169 | TotalAmt |
| Program Services | $169 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,904 | TotalAmt |
| Program Services | $9,814 | ProgramServicesAmt |
| Management And General | $1,090 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,578 | TotalAmt |
| Program Services | $116,620 | ProgramServicesAmt |
| Management And General | $12,958 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,955 | TotalAmt |
| Program Services | $2,955 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,484 | TotalAmt |
| Program Services | $1,484 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,243 | TotalAmt |
| Program Services | $3,932 | ProgramServicesAmt |
| Management And General | $1,311 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PHAMACEUTICALS | $20,382 | $20,382 |
| DENTAL SUPPLIES | $13,387 | $13,387 |
| MEDICAL SUPPLIES | $10,749 | $10,749 |
| TECHNICAL SUPPORT | $9,660 | $9,660 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,593 | TotalAmt |
| Program Services | $25,229 | ProgramServicesAmt |
| Management And General | $1,364 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $591,479 | TotalAmt |
| Program Services | $538,499 | ProgramServicesAmt |
| Management And General | $52,980 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,788 | BOYAmt |
| EOY | $166,079 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,856 | BOYAmt |
| EOY | $40,552 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,433 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,091 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $777 | BOYAmt |
| EOY | $5,342 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,421 | BOYAmt |
| EOY | $211,973 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,788 | BOYAmt |
| EOY | $20,792 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,788 | BOYAmt |
| EOY | $20,792 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,633 | BOYAmt |
| EOY | $191,181 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,633 | BOYAmt |
| EOY | $191,181 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,421 | BOYAmt |
| EOY | $211,973 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $71,548 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | false | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | $686,738 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $615,362 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $169,578 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $479,921 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $585,436 | CurrentTaxYearAmt |
| Total | $2,537,035 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $686,738 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $615,362 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $169,578 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $479,921 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $585,436 | CurrentTaxYearAmt |
| Total | $2,537,035 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $2,537,035 | PublicSupportTotal170Amt |
| Total Support | $2,537,035 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $276,108 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | 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
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,433 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,091 | DepreciationAmt |
| Book Value | $5,342 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,342 | TotalBookValueLandBuildingsAmt |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 3 | ContributionCnt |
| Noncash Contributions Rpt F990 | $129,578 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV RENTAL | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | OPERATION OF TELEMEDICINE AND SCHOOL BASED CLINICS IN RURAL COUNTIES WITHOUT A PRIMARY CARE CLINIC, PROVIDING GENERAL MEDICAL CARE, URGENT CARE, PRENATAL CARE AND WELL CHILD CARE IN UNDER-SERVED, LOW- SOCIO-ECONOMIC AREAS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE EXECUTIVE DIRECTOR AND BOARD OF DIRECTORS REVIEWS TAX RETURN AND ATTACHMENTS BEFORE FILING. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS REVIEW AND APPROVE THE SALARY OF THE EXECUTIVE DIRECTOR AND IS DOCUMENTED IN THE BOARD'S MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | MADE AVAILABLE UPON REQUEST |
| FORM 990, PART IX, LINE 11G | CONTRACTED MEDICAL SERVICES 172,222 0 0 |