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Nonprofiteer
← CLOVER FORK OUTPATIENT MEDICAL PROJECT INC

Form 990 for tax year 2022

Filed by CLOVER FORK OUTPATIENT MEDICAL PROJECT INC.

Totals

Total revenue
$6,666,863
Total expenses
$4,241,166
Contributions and grants received
$741,806
Grants paid
$0
Program service revenue
$2,251,531
Investment income
$465,506
Other revenue
$3,208,020
Total assets, end of year
$21,602,131
Total liabilities, end of year
$444,161
Net assets or fund balances, end of year
$21,157,970
Program services expenses (Part IX)
$2,831,152
Management and general expenses
$1,410,014
Fundraising expenses
$0
Program service expenses (Part III)
$2,831,152

Program services were 66.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1e · Government grants (contributions)

    $741,806

  • 2a · Program service revenue: OUTPATIENT CLINIC

    total $2,251,531 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $465,506 · unrelated business $0 · excluded $0

  • 10a · Gross sales of inventory

    $4,986,221

  • 10b · Cost of goods sold

    $1,778,201

  • 10c · Net income from sales of inventory

    total $3,208,020 · related or exempt $3,208,020

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $2,583,119 · program services $1,914,830 · management and general $668,289 · fundraising $0

  • 8 · Pension plan contributions

    total $376,911 · program services $291,013 · management and general $85,898 · fundraising $0

  • 10 · Payroll taxes

    total $188,888 · program services $137,395 · management and general $51,493 · fundraising $0

  • 11c · Fees: accounting

    total $15,591 · program services $15,441 · management and general $150 · fundraising $0

  • 11g · Fees: other

    total $102,105 · program services $20,215 · management and general $81,890 · fundraising $0

  • 13 · Office expenses

    total $71,279 · program services $5,648 · management and general $65,631 · fundraising $0

  • 16 · Occupancy

    total $41,574 · program services $41,473 · management and general $101 · fundraising $0

  • 17 · Travel

    total $2,590 · program services $1,931 · management and general $659 · fundraising $0

  • 22 · Depreciation, depletion and amortization

    total $137,914 · program services $0 · management and general $137,914 · fundraising $0

  • 23 · Insurance

    total $58,624 · program services $37,678 · management and general $20,946 · fundraising $0

  • 24a · Other expenses: SCHEDULE

    total $662,571 · program services $365,528 · management and general $297,043 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $8,026,600 · end of year $10,059,506

  • 2 · Savings and temporary cash investments

    beginning of year $2,063,128 · end of year $2,108,570

  • 4 · Accounts receivable

    beginning of year $691,605 · end of year $600,319

  • 8 · Inventories for sale or use

    beginning of year $278,431 · end of year $331,677

  • 10a · Land, buildings and equipment: cost or other basis

    $4,034,949

  • 10b · Land, buildings and equipment: accumulated depreciation

    $2,406,342

  • 10c · Land, buildings and equipment, net

    beginning of year $1,504,325 · end of year $1,628,607

  • 11 · Investments: publicly traded securities

    beginning of year $6,548,560 · end of year $6,873,452

  • 17 · Accounts payable and accrued expenses

    beginning of year $372,522 · end of year $444,161

  • 27 · Net assets without donor restrictions

    beginning of year $15,390,127 · end of year $17,807,970

  • 28 · Net assets with donor restrictions

    beginning of year $3,350,000 · end of year $3,350,000

Mission and programs · 2022

Mission

MEDICAL & DENTAL CLINIC

  • OUTPATIENT MEDICAL & DENTAL CLINIC

    Expenses $2,831,152 · Grants $741,806 · Revenue $5,925,056

As filed on the 2022 return.

Listed in Part VII

  • John Henson

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    2

  • Barry Martin

    DIRECTOR - HEALTHCARE

    Total calculated
    $0
    Hours/week
    1

  • Sonya Lawson

    CHAIRMAN OF THE BOARD

    Total calculated
    $0
    Hours/week
    1

  • Wayne Collett

    DIRECTOR - FINANCE

    Total calculated
    $0
    Hours/week
    1

  • Darlene Lemarr

    DIRECTOR - BUSINESS

    Total calculated
    $0
    Hours/week
    1

  • William Miller

    PHYSICIAN ASST

    Total calculated
    $111,824
    From this org
    $111,824
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

  • Jack Miniard

    ADMINISTRATOR

    Total calculated
    $159,867
    From this org
    $159,867
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $159,867
    Bonus
    $0
    Other
    $0
    Deferred
    $7,993
    Nontaxable benefits
    $0
    Filer's total
    $167,860

  • Sharon Colton

    PHYSICIAN

    Total calculated
    $203,800
    From this org
    $203,800
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $203,800
    Bonus
    $0
    Other
    $0
    Deferred
    $10,190
    Nontaxable benefits
    $0
    Filer's total
    $213,990

  • Michael Napier

    PHYSICIAN ASST

    Total calculated
    $135,132
    From this org
    $135,132
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

  • Tom McCurry

    PHARMACIST

    Total calculated
    $162,735
    From this org
    $162,735
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $162,735
    Bonus
    $0
    Other
    $0
    Deferred
    $8,137
    Nontaxable benefits
    $0
    Filer's total
    $170,872

  • Bobbie Dixon

    DIRECTOR - GOVERNMENT

    Total calculated
    $0
    Hours/week
    1

  • Kimberly Brown

    VICE CHAIR OF THE BOARD

    Total calculated
    $0
    Hours/week
    1

  • Jerry Haynes

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Kristen M Nash

    PHYSICIAN

    Total calculated
    $237,930
    From this org
    $237,930
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $237,930
    Bonus
    $0
    Other
    $0
    Deferred
    $11,897
    Nontaxable benefits
    $0
    Filer's total
    $249,827

  • Eugene Enix

    DIRECTOR - BUSINESS

    Total calculated
    $0
    Hours/week
    1

  • Tammy Chapman

    DIRECTOR - EDUCATION

    Total calculated
    $0
    Hours/week
    1

  • Mia Cornett

    PHYSICIAN ASST

    Total calculated
    $102,130
    From this org
    $102,130
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

  • Eric Roberts

    PHYSICIAN ASSIS

    Total calculated
    $108,278
    From this org
    $108,278
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Provenance

Return type
form_990
Tax year
2022
Filed
28 November 2023
IRS schema version
2022v5.0
Source object
202323329349300322

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