SUSAN DEW HOFF MEMORIAL CLINIC INC: Form 990, tax year 2013
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- Organization
- SUSAN DEW HOFF MEMORIAL CLINIC INC (EIN 55-0768457)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-05-14
- IRS object ID
- 201441349349303064
- Schema version
- 2013v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-05-14T12:24:04-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550486667 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARNETT FOSTER TOOTHMAN PLLC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 908 | AddressLine1 |
| City | BRIDGEPORT | City |
| State | WV | State |
| ZIP Code | 26330 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550768457 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN DEW HOFF MEMORIAL CLINIC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SUSA | BusinessNameControlTxt |
| Phone | 3047453700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 925 LIBERTY AVENUE | AddressLine1 |
| City | WEST MILFORD | City |
| State | WV | State |
| ZIP Code | 26451 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SISTER MARY REBECCA FIDLER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3047453700 | PhoneNum |
| Signature | 2014-05-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | STACIE MILLER | PreparerPersonNm |
| PTIN | P00247848 | PTIN |
| Phone | 3046245471 | PhoneNum |
| Preparation | 2014-05-05 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN DEW HOFF MEMORIAL CLINIC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SISTER MARY REBECCA FIDLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 925 LIBERTY AVENUE | AddressLine1 |
| City | WEST MILFORD | City |
| State | WV | State |
| ZIP Code | 26451 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $134,561 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Other Organization Dsc | OTHER | OtherOrganizationDsc |
| Formation | 1999 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HEALTH AND DENTAL CARE TO THE UNINSURED WORKING POOR. | ActivityOrMissionDesc |
| Voting Members Governing Body | 21 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 21 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 64 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $164,705 | PYContributionsGrantsAmt |
| CY Contributions Grants | $126,524 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,564 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,037 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $173,269 | PYTotalRevenueAmt |
| CY Total Revenue | $134,561 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,431 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,127 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $170,643 | PYOtherExpensesAmt |
| CY Other Expenses | $171,768 | CYOtherExpensesAmt |
| PY Total Expenses | $172,074 | PYTotalExpensesAmt |
| CY Total Expenses | $172,895 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,195 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$38,334 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $631,458 | TotalAssetsBOYAmt |
| Total Assets EOY | $581,773 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,681 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,330 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $613,777 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $575,443 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE HEALTH ASSESSMENT, PROMOTION AND REFERRAL SERVICES TO THE WORKING POOR WHO LACK MEDICAL AND DENTAL INSURANCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $158,815 | ExpenseAmt |
| Grant | $1,127 | GrantAmt |
| Desc | THE CLINIC PROVIDED IN-CLINIC PROCEDURES WHICH INCLUDED 1,707 DENTAL VISITS RESULTING IN 1,798 RESTORATIVE OR PREVENTATIVE PROCEDURES AND 26 REFERRALS TO OTHER DENTISTS FOR PROCEDURES THE CLINIC COULD NOT ADEQUATELY PERFORM. THESE IN-CLINIC PROCEDURES INCLUDED 169 X-RAYS, 131 CLEANINGS, 556 FILLINGS, 77 PARTIALS AND/OR DENTURES, 4 ROOT CANALS AND 819 EXTRACTIONS. | Desc |
| Total Program Service Expenses | $158,815 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | 0 | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 21 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 21 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WV | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN DEW HOFF MEMORIAL CLINIC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3047453700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 925 LIBERTY STREET | AddressLine1 |
| City | WEST MILFORD | City |
| State | WV | State |
| ZIP Code | 26451 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| JAMES YOHE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| NANCY GALL | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| GINA SHARPS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BERNICE JEAN LUCAS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DINO COLOMBO DDS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| THOMAS CONDRON DDS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SANDY GANS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PAUL GANS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ROBERT HAROLD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| REV LEO LYDON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARY LOU VARGO | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN S WILSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DR ROBERT WRANKER DDS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| FRANK NUZUM ACCOUNTANT | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SISTER BEATRICE BURKLE | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PASTOR CHRIS MULLETT | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| HERBERT UNDERWOOD | ||||||
| CHAIRMAN | 1.00 | $0 | $0 | $0 | Yes (X) | |
| MAGGIE FISHER | ||||||
| VICE CHAIRMAN | 1.00 | $0 | $0 | $0 | Yes (X) | |
| VICTOR FOLIO | ||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | |
| ANGIE CAVANAUGH | ||||||
| TREASURER | 6.00 | $0 | $0 | $0 | Yes (X) | |
| SISTER MARY REBECCA FIDLER | ||||||
| CEO | 70.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $30,777 | GovernmentGrantsAmt |
| All Other Contributions | $95,747 | AllOtherContributionsAmt |
| Total Contributions | $126,524 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,037 | TotalRevenueColumnAmt |
| Exclusion | $8,037 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $134,561 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $8,037 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,127 | TotalAmt |
| Program Services | $1,127 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,183 | TotalAmt |
| Management And General | $10,183 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100 | TotalAmt |
| Program Services | $100 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,099 | TotalAmt |
| Management And General | $3,099 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $801 | TotalAmt |
| Program Services | $801 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62 | TotalAmt |
| Program Services | $62 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,165 | TotalAmt |
| Program Services | $8,165 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,315 | TotalAmt |
| Program Services | $11,315 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| DENTAL LAB WORK | $61,969 | $61,969 |
| CONTRACTED DENTAL SERVI | $41,176 | $41,176 |
| OTHER CONTRACTED SERVIC | $23,667 | $23,667 |
| SUPPLIES | $4,879 | $4,879 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,352 | TotalAmt |
| Program Services | $5,554 | ProgramServicesAmt |
| Management And General | $798 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,895 | TotalAmt |
| Program Services | $158,815 | ProgramServicesAmt |
| Management And General | $14,080 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,436 | BOYAmt |
| EOY | $98,528 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $388,938 | BOYAmt |
| EOY | $370,683 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,288 | BOYAmt |
| EOY | $1,100 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,498 | BOYAmt |
| EOY | $10,738 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,161 | BOYAmt |
| EOY | $6,752 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $170,634 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $76,662 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,137 | BOYAmt |
| EOY | $93,972 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $631,458 | BOYAmt |
| EOY | $581,773 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,681 | BOYAmt |
| EOY | $6,330 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,681 | BOYAmt |
| EOY | $6,330 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $613,777 | BOYAmt |
| EOY | $575,443 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $613,777 | BOYAmt |
| EOY | $575,443 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $631,458 | BOYAmt |
| EOY | $581,773 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$38,334 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 | $122,409 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $232,851 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $178,695 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $164,705 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $263,647 | CurrentTaxYearAmt |
| Total | $962,307 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $122,409 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $232,851 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $178,695 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $164,705 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $263,647 | CurrentTaxYearAmt |
| Total | $962,307 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $962,307 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,200 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,017 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,421 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,564 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,037 | CurrentTaxYearAmt |
| Total | $37,239 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,193 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,972 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,843 | CurrentTaxYearMinus2YearsAmt |
| Total | $20,008 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $1,019,554 | TotalSupportAmt |
| Public Support CY170 | 0.94390 | PublicSupportCY170Pct |
| Public Support PY170 | 0.91870 | 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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,323 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,550 | DepreciationAmt |
| Book Value | $27,773 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $135,311 | OtherCostOrOtherBasisAmt |
| Depreciation | $69,112 | DepreciationAmt |
| Book Value | $66,199 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $93,972 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $271,684 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $137,123 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $137,123 | RevenueNotReportedAmt |
| Revenue Subtotal | $134,561 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $134,561 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $310,018 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $137,123 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $137,123 | ExpensesNotReportedAmt |
| Expenses Subtotal | $172,895 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $172,895 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ACCOUNTING STANDARDS CODIFICATION TOPIC 740-10 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN WHERE THERE IS UNCERTAINTY ABOUT WHETHER A TAX POSITION WILL ULTIMATELY BE SUSTAINED UPON EXAMINATION. THE CLINIC DOES NOT BELIEVE ITS FINANCIAL STATEMENTS INCLUDE (OR REFLECT) ANY UNCERTAIN TAX POSITIONS. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARKSBURG MISSION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | COMMON OFFICER | RelationshipDescriptionTxt |
| Transaction | $10,000 | TransactionAmt |
| Transaction | THE ORGANIZATION WAS A LOAN GUARANTOR FOR ANOTHER ORGANIZATION IN WHICH THEY SHARE A COMMON OFFICER. THE LOAN WAS DEFAULTED DURING THE YEAR AND REPAID BY THE ORGANIZATION TO THE CLARKSBURG MISSION. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD MEMBERS ARE PROVIDED A COPY OF THE 990 AND IT IS REVIEWED AT BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CLINIC ENFORCES AN ANNUAL DISCLOSURE REQUIREMENT WITH ITS CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 2C | THE ORGANIZATION HAS A COMMITEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS. THE SELECTION PROCESS FOR CHOOSING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PREVIOUS YEAR. |