STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

POTOMAC HEALTHCARE FOUNDATION: Form 990PF, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
POTOMAC HEALTHCARE FOUNDATION (EIN 52-1116578)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-05-12
IRS object ID
201511329349101591
Schema version
2013v4.0
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

FieldValueIRS element (for citing)
Return2015-05-12T13:36:37-05:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN521158459PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HERTZBACH & COMPANY PABusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1800 RED BROOK BLVD SUITE 300AddressLine1
CityOWINGS MILLSCity
StateMDState
ZIP Code21117ZIPCode
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN521116578EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1POTOMAC HEALTHCARE FOUNDATIONINCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlPOTOBusinessNameControlTxt
Phone3014472360PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13800 FREDERICK AVENUEAddressLine1
CityBALTIMORECity
StateMDState
ZIP Code21229ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARC FISHMANMDPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone3014472360PhoneNum
Signature2015-05-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLEONARD SACKSPreparerPersonNm
PTINP00929712PTIN
Phone4103633200PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$4,306,952FMVAssetsEOYAmt
Method Of Accounting OtherYes (X)MethodOfAccountingOtherInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$4,194,887ContriRcvdRevAndExpnssAmt
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Cap Gain Net Incm Net Invst Incm$0CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$9,960OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$0OtherIncomeNetInvstIncmAmt
Other Income Adj Net Incm$9,960OtherIncomeAdjNetIncmAmt
Total Rev And Expnss$4,204,847TotalRevAndExpnssAmt
Total Net Invst Incm$0TotalNetInvstIncmAmt
Total Adj Net Incm$9,960TotalAdjNetIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$191,000CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Adj Net Incm$452CompOfcrDirTrstAdjNetIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$190,548CompOfcrDirTrstDsbrsChrtblAmt
Oth Empl Slrs Wgs Rev And Expnss$1,835,157OthEmplSlrsWgsRevAndExpnssAmt
Oth Empl Slrs Wgs Net Invst Incm$0OthEmplSlrsWgsNetInvstIncmAmt
Oth Empl Slrs Wgs Adj Net Incm$4,347OthEmplSlrsWgsAdjNetIncmAmt
Oth Empl Slrs Wgs Dsbrs Chrtbl$1,830,810OthEmplSlrsWgsDsbrsChrtblAmt
Pension Empl Bnft Rev And Expnss$175,401PensionEmplBnftRevAndExpnssAmt
Pension Empl Bnft Net Invst Incm$0PensionEmplBnftNetInvstIncmAmt
Pension Empl Bnft Adj Net Incm$415PensionEmplBnftAdjNetIncmAmt
Pension Empl Bnft Dsbrs Chrtbl$174,986PensionEmplBnftDsbrsChrtblAmt
Legal Fees Rev And Expnss$4,568LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$0LegalFeesNetInvstIncmAmt
Legal Fees Adj Net Incm$11LegalFeesAdjNetIncmAmt
Legal Fees Dsbrs Chrtbl$4,557LegalFeesDsbrsChrtblAmt
Accounting Fees Rev And Expnss$23,000AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$0AccountingFeesNetInvstIncmAmt
Accounting Fees Adj Net Incm$54AccountingFeesAdjNetIncmAmt
Accounting Fees Chrtbl Prps$22,946AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$26,018OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$0OtherProfFeesNetInvstIncmAmt
Other Prof Fees Adj Net Incm$62OtherProfFeesAdjNetIncmAmt
Other Prof Fees Dsbrs Chrtbl$25,956OtherProfFeesDsbrsChrtblAmt
Interest Rev And Expnss$1,355InterestRevAndExpnssAmt
Interest Net Invst Incm$0InterestNetInvstIncmAmt
Interest Adj Net Incm$3InterestAdjNetIncmAmt
Interest Dsbrs Chrtbl$1,352InterestDsbrsChrtblAmt
Taxes Rev And Expnss$148,361TaxesRevAndExpnssAmt
Taxes Net Invst Incm$0TaxesNetInvstIncmAmt
Taxes Adj Net Incm$351TaxesAdjNetIncmAmt
Taxes Dsbrs Chrtbl$148,010TaxesDsbrsChrtblAmt
Deprec And Dpltn Rev And Expnss$55,444DeprecAndDpltnRevAndExpnssAmt
Deprec And Dpltn Net Invst Incm$0DeprecAndDpltnNetInvstIncmAmt
Deprec And Dpltn Adj Net Incm$55,444DeprecAndDpltnAdjNetIncmAmt
Occupancy Rev And Expnss$873,057OccupancyRevAndExpnssAmt
Occupancy Net Invst Incm$0OccupancyNetInvstIncmAmt
Occupancy Adj Net Incm$2,068OccupancyAdjNetIncmAmt
Occupancy Dsbrs Chrtbl$870,989OccupancyDsbrsChrtblAmt
Other Expenses Rev And Expnss$581,019OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$0OtherExpensesNetInvstIncmAmt
Other Expenses Adj Net Incm$1,375OtherExpensesAdjNetIncmAmt
Other Expenses Dsbrs Chrtbl$579,129OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$3,914,380TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$0TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Adj Net Incm$64,582TotOprExpensesAdjNetIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$3,849,283TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$0ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$0ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$3,914,380TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$0TotalExpensesNetInvstIncmAmt
Total Expenses Adj Net Incm$64,582TotalExpensesAdjNetIncmAmt
Total Expenses Dsbrs Chrtbl$3,849,283TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$290,467ExcessRevenueOverExpensesAmt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$0AdjustedNetIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash BOY$1,000,159CashBOYAmt
Cash EOY$793,107CashEOYAmt
Cash EOYFMV$793,107CashEOYFMVAmt
Acct Rcvbl$597,389AcctRcvblAmt
Acct Rcvbl BOY$389,318AcctRcvblBOYAmt
Acct Rcvbl EOY$597,389AcctRcvblEOYAmt
Acct Rcvbl EOYFMV$597,389AcctRcvblEOYFMVAmt
Grants Receivable BOY$134,635GrantsReceivableBOYAmt
Grants Receivable EOY$107,850GrantsReceivableEOYAmt
Grants Receivable EOYFMV$107,850GrantsReceivableEOYFMVAmt
Land Bldg Equip Cost Or Other Bss$2,172,297LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$215,482LandBldgEquipAccumDeprecAmt
Land BOY$2,012,259LandBOYAmt
Land EOY$1,956,815LandEOYAmt
Land EOYFMV$1,956,815LandEOYFMVAmt
Other Assets BOY$459,030OtherAssetsBOYAmt
Other Assets EOY$851,791OtherAssetsEOYAmt
Other Assets EOYFMV$851,791OtherAssetsEOYFMVAmt
Total Assets BOY$3,995,401TotalAssetsBOYAmt
Total Assets EOY$4,306,952TotalAssetsEOYAmt
Total Assets EOYFMV$4,306,952TotalAssetsEOYFMVAmt
Accounts Payable BOY$198,695AccountsPayableBOYAmt
Accounts Payable EOY$219,779AccountsPayableEOYAmt
Total Liabilities BOY$198,695TotalLiabilitiesBOYAmt
Total Liabilities EOY$219,779TotalLiabilitiesEOYAmt
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind
Unrestricted BOY$2,343,373UnrestrictedBOYAmt
Unrestricted EOY$2,687,173UnrestrictedEOYAmt
Temporarily Restricted BOY$1,453,333TemporarilyRestrictedBOYAmt
Temporarily Restricted EOY$1,400,000TemporarilyRestrictedEOYAmt
Tot Net Ast Or Fund Balances BOY$3,796,706TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$4,087,173TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$3,995,401TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$4,306,952TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$3,796,706TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$290,467ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$4,087,173SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$4,087,173TotNetAstOrFundBalancesEOYAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 Tax0LiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$3,752,947AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$3,562,193NetVlNoncharitableAssetsYr1Amt
Distribution Yr11.053550DistributionYr1Rt
Adjusted Qlfy Distri Yr2$2,334,053AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$3,430,572NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.680368DistributionYr2Rt
Adjusted Qlfy Distri Yr3$1,902,769AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$2,725,601NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.698110DistributionYr3Rt
Adjusted Qlfy Distri Yr4$1,950,501AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$2,287,299NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.852753DistributionYr4Rt
Adjusted Qlfy Distri Yr5$2,104,776AdjustedQlfyDistriYr5Amt
Net Vl Noncharitable Assets Yr5$310,899NetVlNoncharitableAssetsYr5Amt
Distribution Yr56.769967DistributionYr5Rt
Total Distribution10.054748TotalDistributionRt
Average Distribution2.010950AverageDistributionRt
Net Vl Noncharitable Assets$4,468,795NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$8,986,523AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$0NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$8,986,523AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$3,849,283QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$0InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$0SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$0TaxBasedOnInvestmentIncomeAmt
Total Payments And Credits$0TotalPaymentsAndCreditsAmt
Tax Due$0TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr Satisfied0Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateMDOrgReportOrRegisterStateCd
Org Report Or Register StateDCOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial Contributors0NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt
Individual With BooksGARY GAGNONIndividualWithBooksNm
Phone3014472360PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 136AddressLine1
CityEMMITSBURGCity
StateMDState
ZIP Code21727ZIPCode
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (6 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
MARC J FISHMAN
3800 FREDERICK AVEBALTIMOREMD21229CHAIRMAN/PRESIDENT/TRUSTEE1.00$0$0$0
WILLIAM J ROBY
3800 FREDERICK AVEBALTIMOREMD21229EXECUTIVE VICE PRESIDENT40.00$191,000$0$0
REBECCA FISHMAN
3800 FREDERICK AVEBALTIMOREMD21229VICE PRESIDENT/TRUSTEE1.00$0$0$0
BARBARA GROVES
3800 FREDERICK AVEBALTIMOREMD21229SECRETARY/TRUSTEE1.00$0$0$0
SUSAN LIEDLICH
3800 FREDERICK AVEBALTIMOREMD21229TREASURER1.00$0$0$0
LAWRENCE FREEDMAN
3800 FREDERICK AVEBALTIMOREMD21229TRUSTEE1.00$0$0$0

Compensation Highest Paid Empl CompensationHighestPaidEmplGrp (4 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee BenefitsEmployeeBenefitsAmtExpense AccountExpenseAccountAmt
CHRISTOPHER HOLT
3800 FREDERICK AVEBALTIMOREMD21229PSYCHIATRIST40.00$100,570$0$0
PHYLLIS STAHLEY
3800 FREDERICK AVEBALTIMOREMD21229ADMIS/TRAN COORDINAT40.00$76,968$0$0
ADEGBOYEGA OYEMADE
3800 FREDERICK AVEBALTIMOREMD21229PSYCHIATRIST40.00$75,938$0$0
GARY GAGNON
3800 FREDERICK AVEBALTIMOREMD21229COMPTROLLER40.00$69,212$0$0
FieldValueIRS element (for citing)
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (4 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeService TypeServiceTypeTxtCompensationCompensationAmt
KELLY & ASSOCIATES INSURANCE
301 INTERNATIONAL CIRCLEHUNT VALLEYMD21030INSURANCE$212,420
SYSCO
PO BOX 3641HARRISBURGPA171053641FOOD$206,907
REINHART FOOD SERVICE
226 EAST VIEW DRIVEMT PLEASANTPA15666FOOD$129,588
DR CHRISTINE THOMAS
PO BOX 190EMMITSBURGMD21727MEDICAL EVALUATION$78,328
FieldValueIRS element (for citing)
Contractor Paid Over50k0ContractorPaidOver50kCnt

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

FieldValueIRS element (for citing)
Description1THE FOUNDATION PROVIDES RESIDENTIAL TREATMENT AND SERVICES FOR ALCOHOL AND/OR DRUG DEPENDENT PREGNANT AND POSTPARTUM WOMEN ALONG WITH THEIR CHILDREN.Description1Txt
Expenses1$3,914,383Expenses1Amt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$0AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$1,022,998AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$3,513,850FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$4,536,848TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$4,536,848AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$68,053CashDeemedCharitableAmt
Net Vl Noncharitable Assets$4,468,795NetVlNoncharitableAssetsAmt
Minimum Investment Return$223,440MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$223,440MinimumInvestmentReturnAmt
Total Tax$0TotalTaxAmt
Distributable Before Adj$223,440DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$223,440DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$223,440DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$3,849,283ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$3,849,283QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$0PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$3,849,283AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$223,440DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Excess Distribution Cyov Yr5$2,073,616ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4$1,820,591ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3$1,652,124ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$2,026,244ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$3,403,308ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$10,975,883TotalExcessDistributionCyovAmt
Qualifying Distributions$3,849,283QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$223,440AppliedToCurrentYearAmt
Remaining Distri From Corpus$3,625,843RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$14,601,726TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$2,073,616ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$12,528,110ExcessDistriCyovToNextYrAmt
Excess From Year4$1,820,591ExcessFromYear4Amt
Excess From Year3$1,652,124ExcessFromYear3Amt
Excess From Year2$2,026,244ExcessFromYear2Amt
Excess From Year1$3,403,308ExcessFromYear1Amt
Excess From Current Year$3,625,843ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd
Total Grant Or Contri Pd Dur Yr$0TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Program Service Rev Part VII ProgramServiceRevPartVIIGrp

FieldValueIRS element (for citing)
DescPATIENT REVENUEDesc
Business623990BusinessCd
Related Or Exempt Function Incm$9,960RelatedOrExemptFunctionIncmAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$0ExclusionAmt
Related Or Exempt Function Incm$9,960RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$9,960TotalIncomeProducingActyAmt

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp

Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp

FieldValueIRS element (for citing)
Line Number1ALineNumberTxt
Relationship StatementPATIENT INCOMERelationshipStatementTxt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$23,000Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$54AdjustedNetIncomeAmt
Disbursements Charitable Prps$22,946DisbursementsCharitablePrpsAmt

Depreciation Schedule DepreciationSchedule

Depreciation Property DepreciationPropertyGrp (2 entries)

PropertyPropertyDescAcquiredAcquiredDtCost Or Other BasisCostOrOtherBasisAmtPrior Year DepreciationPriorYearDepreciationAmtComputation MethodComputationMethodTxtLifeLifeRtCurrent Year ExpenseCurrentYearExpenseAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmt
BUILDINGS2010-10-01$2,162,297$150,038SL39.000000000000$55,444$0$55,444
LIBRARY1998-12-31$10,000$10,000SL5.000000000000$0$0$0

Land Etc Schedule2 LandEtcSchedule2

Land Etc LandEtcGrp (2 entries)

Category Or ItemCategoryOrItemTxtCost Or Other BasisCostOrOtherBasisAmtAccumulated DepreciationAccumulatedDepreciationAmtBook ValueBookValueAmt
BUILDINGS$2,162,297$205,482$1,956,815
LIBRARY$10,000$10,000$0

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryLEGAL FEESCategoryTxt
Legal Fees$4,568LegalFeesAmt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$11AdjustedNetIncomeAmt
Disbursements Charitable Prps$4,557DisbursementsCharitablePrpsAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp

FieldValueIRS element (for citing)
DescDUE FROM RELATED PARTIESDesc
BOY Book Value$459,030BOYBookValueAmt
EOY Book Value$851,791EOYBookValueAmt
EOYFMV$851,791EOYFMVAmt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (9 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
ADVERTISING$516$0$1$0
BANK CHARGES$175$0$0$175
CONSULTING FEES$32,120$0$76$32,044
DRUGS AND MEDICINE$26,211$0$62$26,149
INSURANCE$9,603$0$23$9,580
MINOR EQUIPMENT$2,578$0$6$2,572
PURCHASED SERVICES$61,252$0$145$61,107
SUPPLIES$406,251$0$962$405,289
TRANSPORTATION$42,313$0$100$42,213

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail

FieldValueIRS element (for citing)
DescPATIENT REVENUEDesc
Revenue And Expenses Per Books$9,960RevenueAndExpensesPerBooksAmt
Adjusted Net Income$9,960AdjustedNetIncomeAmt

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryPROFESSIONAL FEESCategoryTxt
Amt$26,018Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$62AdjustedNetIncomeAmt
Disbursements Charitable Prps$25,956DisbursementsCharitablePrpsAmt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail

FieldValueIRS element (for citing)
CategoryPAYROLL TAXESCategoryTxt
Amt$148,361Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$351AdjustedNetIncomeAmt
Disbursements Charitable Prps$148,010DisbursementsCharitablePrpsAmt