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FREE CLINIC OF ROME INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
FREE CLINIC OF ROME INC (EIN 20-5296305)
Tax period
2013-01-01 to 2013-12-31
Filed
2014-11-06
IRS object ID
201423109349301387
Schema version
2013v3.1
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

FieldValueIRS element (for citing)
Return2014-11-06T14:33:36-05:00ReturnTs
Tax Period End2013-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN582648047PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DEM Enterprises IncBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11101 East 2nd AvenueAddressLine1
CityROMECity
StateGAState
ZIP Code30161ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN205296305EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Free Clinic of Rome Georgia IBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlFREEBusinessNameControlTxt
Phone7062341331PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101-B John Maddox DriveAddressLine1
CityROMECity
StateGAState
ZIP Code30165ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBarbara EarlePersonNm
Person TitleExecutive DirectorPersonTitleTxt
Signature2014-11-04SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonEvie McNiecePreparerPersonNm
PTINP00021755PTIN
Phone7062376070PhoneNum
Preparation2014-11-04PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerBarbara EarlePrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101-B John Maddox DriveAddressLine1
CityROMECity
StateGAState
ZIP Code30165ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$193,021GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2006FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionTo serve the Rome community by providing quality healthcare services to people who have no access to basic healthcareActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee1TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$817,389PYContributionsGrantsAmt
CY Contributions Grants$192,525CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$70PYInvestmentIncomeAmt
CY Investment Income$496CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$817,459PYTotalRevenueAmt
CY Total Revenue$193,021CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$82,001PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$81,724CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$2,850CYTotalFundraisingExpenseAmt
PY Other Expenses$751,114PYOtherExpensesAmt
CY Other Expenses$131,737CYOtherExpensesAmt
PY Total Expenses$833,115PYTotalExpensesAmt
CY Total Expenses$213,461CYTotalExpensesAmt
PY Revenues Less Expenses-$15,656PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$20,440CYRevenuesLessExpensesAmt
Total Assets BOY$45,928TotalAssetsBOYAmt
Total Assets EOY$19,658TotalAssetsEOYAmt
Total Liabilities BOY$5,830TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$40,098NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$19,658NetAssetsOrFundBalancesEOYAmt
MissionTo serve the Rome community by providing quality healthcare services to people who have no access to basic healthcareMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$157,882ExpenseAmt
DescTo provide free, quality healthcare and treatment to individualsDesc
Total Program Service Expenses$157,882TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstYes (true)ReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld CompliancefalseBackupWthldComplianceInd
Employee1EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Excess Business HoldingsfalseExcessBusinessHoldingsInd
Taxable DistributionsfalseTaxableDistributionsInd
Distribution To DonorfalseDistributionToDonorInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcfalseRegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonBarbara EarlePersonNm
Phone7062341331PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101-B John MaddAddressLine1
CityROMECity
StateGAState
ZIP Code30165ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp

FieldValueIRS element (for citing)
PersonBarbara EarlePersonNm
TitleExec DirectorTitleTxt
Average Hours Per Week40AverageHoursPerWeekRt
Individual Trustee Or DirectorYes (X)IndividualTrusteeOrDirectorInd
OfficerYes (X)OfficerInd
Key EmployeeYes (X)KeyEmployeeInd
Highest Compensated EmployeeYes (X)HighestCompensatedEmployeeInd
Reportable Comp From Org$0ReportableCompFromOrgAmt
Reportable Comp From Rltd Org$57,000ReportableCompFromRltdOrgAmt
Other Compensation$0OtherCompensationAmt
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$57,000TotReportableCompRltdOrgAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
All Other Contributions$192,525AllOtherContributionsAmt
Total Contributions$192,525TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$496TotalRevenueColumnAmt
Related Or Exempt Func Income$496RelatedOrExemptFuncIncomeAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$193,021TotalRevenueColumnAmt
Related Or Exempt Func Income$496RelatedOrExemptFuncIncomeAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$57,000TotalAmt
Program Services$45,600ProgramServicesAmt
Management And General$8,550ManagementAndGeneralAmt
Fundraising$2,850FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$20,869TotalAmt
Program Services$20,869ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,855TotalAmt
Program Services$3,855ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$630TotalAmt
Management And General$630ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,501TotalAmt
Management And General$3,501ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$20,550TotalAmt
Management And General$20,550ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$255TotalAmt
Management And General$255ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,672TotalAmt
Program Services$1,672ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

TotalTotalAmt
$597
$3,057
$1,883
$76,592

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$23,000TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$213,461TotalAmt
Program Services$157,882ProgramServicesAmt
Management And General$52,729ManagementAndGeneralAmt
Fundraising$2,850FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$44,437BOYAmt
EOY$18,720EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$189BOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$938BOYAmt
EOY$938EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$7,087LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,087LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$364BOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$45,928BOYAmt
EOY$19,658EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$5,830BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,830BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$40,098BOYAmt
EOY$19,658EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$40,098BOYAmt
EOY$19,658EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$45,928BOYAmt
EOY$19,658EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$20,440ReconcilationRevenueExpnssAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$110,454CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$175,533CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$465,563CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$816,639CurrentTaxYearMinus1YearAmt
Current Tax Year$192,525CurrentTaxYearAmt
Total$1,760,714TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$110,454CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$175,533CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$465,563CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$816,639CurrentTaxYearMinus1YearAmt
Current Tax Year$192,525CurrentTaxYearAmt
Total$1,760,714TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$1,760,714PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$915CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$453CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$296CurrentTaxYearMinus2YearsAmt
Current Tax Year$496CurrentTaxYearAmt
Total$2,160TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$915CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$453CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$296CurrentTaxYearMinus2YearsAmt
Current Tax Year$496CurrentTaxYearAmt
Total$2,160TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$111,369CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$175,986CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$465,859CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$816,639CurrentTaxYearMinus1YearAmt
Current Tax Year$193,021CurrentTaxYearAmt
Total$1,762,874TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99880PublicSupportCY509Pct
Public Support PY5090.99830PublicSupportPY509Pct
Investment Income CY0.00120InvestmentIncomeCYPct
Investment Income PY0.00170InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Org Leg CtrlfalseDisclosedOrgLegCtrlInd
Disclosed For Charitable PrpsfalseDisclosedForCharitablePrpsInd
Written Policy MonitoringfalseWrittenPolicyMonitoringInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart VI Line 11a&b Reviewed return for accuracy and approvedFormAndLineReferenceDesc
ExplanationPart VI Line 19 All documents are available upon request Part VI Line 15a The board sets all starting salaries and approves all raisesExplanationTxt