Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME | DESCRIPTION: INTEREST. AMOUNT: 171. |
| FORM 990-EZ, PART I, LINE 8 - OTHER REVENUE | DESCRIPTION: MISC. INCOME . AMOUNT: 65. DESCRIPTION: MIDWEST WIC CONFERENCE . AMOUNT: 12,920. DESCRIPTION: FELLOW PROGRAM . AMOUNT: 11,391. TOTAL TO FORM 990-EZ, LINE 8: 24,376. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: . GRANTEE NAME: SARAH SMITH, R.N.. PROPERTY DESCRIPTION: CASH . DATE OF GIFT: 02/01/18. AMOUNT GIVEN: 2,500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: . GRANTEE NAME: KATHRINE LINDLEY, M.D.. PROPERTY DESCRIPTION: CASH . DATE OF GIFT: 02/01/18. AMOUNT GIVEN: 5,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: . GRANTEE NAME: KATIE JASCHKE, R.N.. PROPERTY DESCRIPTION: CASH . DATE OF GIFT: 02/01/18. AMOUNT GIVEN: 2,500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: . GRANTEE NAME: KELVIN WOO, M.D.. PROPERTY DESCRIPTION: CASH . DATE OF GIFT: 02/01/18. AMOUNT GIVEN: 5,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: . GRANTEE NAME: ANDREW HALL, M.D.. PROPERTY DESCRIPTION: CASH . DATE OF GIFT: 02/01/18. AMOUNT GIVEN: 5,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: . GRANTEE NAME: WILSON KING, M.D.. PROPERTY DESCRIPTION: CASH . DATE OF GIFT: 02/01/18. AMOUNT GIVEN: 5,000. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 25,000. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: MANAGEMENT SERVICES. AMOUNT: 34,320. DESCRIPTION: INSURANCE. AMOUNT: 1,072. DESCRIPTION: CHAPTER MEETINGS & SEMINARS. AMOUNT: 10,505. DESCRIPTION: ACC MEETINGS - ANNUAL MEETING. AMOUNT: 28,529. DESCRIPTION: ACC MEETINGS - LEGISLATIVE CONFERENCE. AMOUNT: 8,049. DESCRIPTION: OFFICE EXPENSE. AMOUNT: 2,144. DESCRIPTION: BOARD OF DIRECTOR EXPENSE. AMOUNT: 20. DESCRIPTION: ACC MEETINGS - LEADERSHIP SUMMIT . AMOUNT: 8. DESCRIPTION: MIDWEST WIC CONFERENCE . AMOUNT: 17,814. DESCRIPTION: PARTNERSHIP PROGRAM . AMOUNT: 9,000. TOTAL TO FORM 990-EZ, LINE 16: 111,461. |
| FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETS | DESCRIPTION: PRIOR PERIOD ADJUSTMENT FOR CHANGE OF CASH TO ACCRUAL IN PRIOR YEAR. . AMOUNT: -42,271. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: PREPAID EXPENSES. BEG. OF YEAR AMOUNT: 4,043. END OF YEAR AMOUNT: 2,860. DESCRIPTION: ACCOUNTS RECEIVABLE . BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 17,391. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: ACCOUNTS PAYABLE . BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 336. DESCRIPTION: CREDIT CARD . BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 13. |
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