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TAYLORS FREE MEDICAL CLINIC INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
TAYLORS FREE MEDICAL CLINIC INC (EIN 20-1715911)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-15
IRS object ID
201302279349302910
Schema version
2012v2.2
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)
Timestamp2013-08-15T02:20:32-00:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Margaret M Gaillard CPA PABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1104 Sugar Creek RoadAddressLine1
CityGreerCity
StateSCState
ZIP Code29650ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN201715911EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Taylors Free Medical Clinic IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% Dennis BallentineInCareOfName
Name ControlTAYLNameControl
Phone8642441134Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1400 W Main StAddressLine1
CityTaylorsCity
StateSCState
ZIP Code29687ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDennis BallentineName
TitleTreasurerTitle
Phone8642441134Phone
Date Signed2013-08-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMargaret GaillardName
Phone8642922277Phone
Date Prepared2013-08-15DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Name Of Principal Officer PersonJames HayesNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1400 W Main StAddressLine1
CityTaylorsCity
StateSCState
ZIP Code29687ZIPCode
FieldValueIRS element (for citing)
Gross Receipts489753GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileSCStateLegalDomicile
Activity Or Mission DescriptionTFMC exists to fill the community need for free medical services, including pharmaceuticals and specialty clinics. Current program initatives are to assure preventaive health services, primary and specialty, to the community and to coordinate outreach services with local hospitals, physicians and social services.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees9TotalNbrEmployees
Total Nbr Volunteers500TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year624599ContributionsGrantsPriorYear
Contributions Grants Current Year489652ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year73InvestmentIncomePriorYear
Investment Income Current Year101InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year624672TotalRevenuePriorYear
Total Revenue Current Year489753TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year320957SalariesEtcPriorYear
Salaries Etc Current Year323651SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year71030TotalFundrsngExpCurrentYear
Other Expense Prior Year236333OtherExpensePriorYear
Other Expenses Current Year220255OtherExpensesCurrentYear
Total Expenses Prior Year557290TotalExpensesPriorYear
Total Expenses Current Year543906TotalExpensesCurrentYear
Revenues Less Expenses Prior Year67382RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-54153RevenuesLessExpensesCY
Total Assets BOY391413TotalAssetsBOY
Total Assets EOY325052TotalAssetsEOY
Total Liabilities BOY205892TotalLiabilitiesBOY
Total Liabilities EOY193684TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY185521NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY131368NetAssetsOrFundBalancesEOY
Mission DescriptionTFMC exists to fill the community need for free medical services, including pharmaceuticals and specialty clinics. Current program initatives are to assure preventaive health services, primary and specialty, to the community and to coordinate outreach services with local hospitals, physicians and social services.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense435333Expense
DescriptionSince opening in July 2005, we have screened and provided medical services to over 3226 patients. In 2012, we dispensed 21,791 prescriptions, provided 4,491 patient visits including 255 counseling visits.Description
Total Program Service Expense435333TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees9NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledSCStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDennis BallentineNamePerson
Telephone Number8642441134TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1400 W Main StreetAddressLine1
CityTaylorsCity
StateSCState
ZIP Code29687ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployee
Russell Ashmore
Vice President008.00XX000
Robin Scott Blackburn
Board Member002.00X000
Dennis Ballentine
Treasurer008.00XX000
Betty Brown
Secretary008.00XX000
J Mike Burns
Board Member002.00X000
Bill Clifton
Board Member002.00X000
Phillip Ellenburg
Board Member002.00X000
James Hayes
President008.00XX000
Dave Herndon
Board Member002.00X000
Ken Howell
Board Member002.00X000
Barbara Massey
Board Member002.00X000
Patricia Osbon
Board Member002.00X000
Queenie Scott
Board Member002.00X000
Kenneth Smith
Board Member002.00X000
Karen Salerno
Executive Director050.00X5497300X
FieldValueIRS element (for citing)
Total Reportable Comp From Org54973TotalReportableCompFromOrg
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
All Other Contributions489652AllOtherContributions
Total Contributions489652TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column101TotalRevenueColumn

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column489753TotalRevenueColumn

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total54973Total
Program Services38482ProgramServices
Management And General10995ManagementAndGeneral
Fundraising5496Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total221793Total
Program Services221793ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total7037Total
Program Services6333ProgramServices
Management And General563ManagementAndGeneral
Fundraising141Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total18577Total
Program Services16882ProgramServices
Management And General1130ManagementAndGeneral
Fundraising565Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total21271Total
Program Services19991ProgramServices
Management And General853ManagementAndGeneral
Fundraising427Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9410Total
Program Services7305ProgramServices
Management And General1882ManagementAndGeneral
Fundraising223Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3978Total
Program Services3182ProgramServices
Management And General796ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total700Total
Program Services490ProgramServices
Management And General140ManagementAndGeneral
Fundraising70Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total11835Total
Program Services9468ProgramServices
Management And General2367ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total10423Total
Program Services8337ProgramServices
Management And General2086ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total6273Total
Program Services5018ProgramServices
Management And General1255ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Postage698948921398699
Professional Consulting248101240512405
Supplies and Program Expenses6855568555
Fundraising expenses6340963409

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13873Total
Program Services12200ProgramServices
Management And General1673ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total543906Total
Program Services435333ProgramServices
Management And General37543ManagementAndGeneral
Fundraising71030Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY94762BOY
EOY38825EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis401305LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec115078LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY296651BOY
EOY286227EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY391413BOY
EOY325052EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY194027BOY
EOY186734EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY11865BOY
EOY6950EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY205892BOY
EOY193684EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY185521BOY
EOY131368EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY185521BOY
EOY131368EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY391413BOY
EOY325052EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-54153ReconcilationRevenueExpenses
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years171938CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years497889CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years411117CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year624599CurrentTaxYearMinus1Year
Current Tax Year489652CurrentTaxYear
Total2195195Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years171938CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years497889CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years411117CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year624599CurrentTaxYearMinus1Year
Current Tax Year489652CurrentTaxYear
Total2195195Total
FieldValueIRS element (for citing)
Public Support Total1702195195PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years155CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years60CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year73CurrentTaxYearMinus1Year
Current Tax Year101CurrentTaxYear
Total389Total
FieldValueIRS element (for citing)
Total Support2195584TotalSupport
Public Support Pertcentage1700.99980PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99980PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FSfalseIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis149631OtherCostOrOtherBasis
Book Value149631BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis165659OtherCostOrOtherBasis
Depreciation30615Depreciation
Book Value135044BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis86015OtherCostOrOtherBasis
Depreciation84463Depreciation
Book Value1552BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings286227TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescription
Financial derivatives and other financial products
Closely-held equity interests

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionFederal income taxesDescription

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

ExplanationExplanation
Form 990 Part VI Section b Line 11b The Executive Director and the Treasurer independently review the 990 before filing. The Treasurer signs the efile authorization form to acknowledge approval.
Form 990 Part VI Section B Line 12c Each member of the Board of Directors is required to sign a Conflict of Interest Policy statement at the time of their appointment to the board. Under the agreement, the members are to immediately report any conflicts of interest that arise during their term of service.