Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 4,177,573 | 9,068,527 | 4,663,457 | 3,547,094 | 6,124,509 | 27,581,160 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | 4,177,573 | 9,068,527 | 4,663,457 | 3,547,094 | 6,124,509 | 27,581,160 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | 7,892,549 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 19,688,611 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 4,177,573 | 9,068,527 | 4,663,457 | 3,547,094 | 6,124,509 | 27,581,160 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 2,840 | 3,368 | 6,376 | 72,540 | 66,307 | 151,431 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 1,000 | 828 | 1,294 | 3,122 | ||
| 11 | Total support. Add lines 7 through 10 | 27,735,713 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2022 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | MISCELLANEOUS - 2018 AMOUNT: $ 0. 2019 AMOUNT: $ 1,000. 2020 AMOUNT: $ 0. 2021 AMOUNT: $ 828. 2022 AMOUNT: $ 1,294. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 1 | THE MISSION OF AMERICARES FREE CLINICS, INC. IS TO PROVIDE FREE HEALTH CARE TO LOW-INCOME UNINSURED RESIDENTS OF THE GREATER NORWALK, DANBURY, STAMFORD AND BRIDGEPORT CONNECTICUT AREAS IN A SETTING WHERE ALL INDIVIDUALS ARE TREATED WITH DIGNITY AND RESPECT. AMERICARES FREE CLINICS, INC. HELPS THOSE WHO ARE MAKING A SINCERE EFFORT TO HELP THEMSELVES AND THEIR FAMILIES, BUT DO NOT HAVE THE FINANCIAL RESOURCES FOR MEDICAL CARE. |
| FORM 990, PART III, LINE 4A | AMERICARES FREE CLINICS, INC. ACCEPTS NO FEDERAL GOVERNMENT FUNDING. RATHER IT OPERATES WITH PRIVATE AND LOCAL DONATIONS AND VOLUNTEER SERVICES. HEALTH SERVICES VALUED AT MORE THAN $154.8 MILLION HAVE BEEN DELIVERED TO OVER 28,414 PATIENTS THROUGH THE FREE CLINIC NETWORK SINCE THE FIRST CLINIC OPENED IN 1994. CURRENTLY AMERICARES FREE CLINICS, INC. OPERATES CLINICS IN DANBURY, NORWALK, STAMFORD AND BRIDGEPORT, CONNECTICUT. IN OFFERING FREE HEALTH CARE TO THE UNINSURED, AMERICARES FREE CLINICS, INC. DIAGNOSE AND TREAT PATIENTS BEFORE THEIR ILLNESSES REACH THE CRISIS STAGE, THEREBY REDUCING PREVENTABLE HOSPITAL STAYS AND EMERGENCY ROOM VISITS AND, MOST IMPORTANTLY, PRESERVING AND IMPROVING THE HEALTH OF INDIVIDUALS AND COMMUNITIES AS A WHOLE. IN ADDITION TO THE AMOUNTS LISTED ABOVE, AMERICARES FREE CLINICS, INC. USED $11,323,308 IN CONTRIBUTED SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 6 | PER THE ORGANIZATION'S BYLAWS, ITS SOLE CORPORATE MEMBER IS AMERICARES FOUNDATION, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | PER THE ORGANIZATION'S BYLAWS, THE SOLE CORPORATE MEMBER IS RESERVED THE POWER TO ESTABLISH THE STRUCTURE OF THE BOARD OF DIRECTORS IN TERMS OF ITS SIZE AND COMPOSITION. THE SOLE MEMBER SHALL HAVE THE AUTHORITY TO REMOVE A BOARD MEMBER OR BOARD OFFICER WITH OR WITHOUT CAUSE. |
| FORM 990, PART VI, SECTION A, LINE 7B | PER THE ORGANIZATION'S BYLAWS, THE SOLE CORPORATE MEMBER IS RESERVED CERTAIN RIGHTS, INCLUDING THE RIGHT TO REVIEW THE ORGANIZATION'S ANNUAL BUDGET. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS PREPARED BY A NATIONALLY RENOWNED ACCOUNTING FIRM IN CONJUNCTION WITH THE ORGANIZATION'S FINANCIAL DEPARTMENT. THE FORM 990 IS REVIEWED BY MANAGEMENT AND WAS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT IN MARCH OF 2024 AND APPROVED FOR FILING SHORTLY THEREAFTER. |
| FORM 990, PART VI, SECTION B, LINE 12C | A DIRECTOR OR OFFICER SHALL DISCLOSE TO THE BOARD OF DIRECTORS ANY POTENTIAL CONFLICTS OF INTEREST IN CONNECTION WITH PROPOSED ACTIONS OF THE CORPORATION. WHEN ANY SUCH CONFLICT OF INTEREST IS RELEVANT TO A MATTER REQUIRING ACTION BY THE BOARD OF DIRECTORS, OR A COMMITTEE THEREOF, SUCH INTERESTED DIRECTOR OR OFFICER SHALL NOT VOTE ON THE MATTER. MOREOVER, THE INTERESTED DIRECTOR OR OFFICER SHALL RETIRE FROM THE ROOM IN WHICH THE BOARD OF DIRECTORS (OR THE COMMITTEE) IS MEETING AND SHALL NOT PARTICIPATE IN THE FINAL DELIBERATION OR DECISION REGARDING THE MATTER UNDER CONSIDERATION. HOWEVER, THE INTERESTED DIRECTOR OR OFFICER SHALL PROVIDE THE BOARD OF DIRECTORS OR COMMITTEE WITH ANY AND ALL MATERIAL INFORMATION. THE MINUTES OF THE MEETING OF THE BOARD OF DIRECTORS OR COMMITTEE SHALL REFLECT THAT A CONFLICT OF INTEREST WAS DISCLOSED AND THAT THE INTERESTED DIRECTOR OR OFFICER WAS NOT PRESENT DURING THE FINAL DISCUSSION OR VOTE AND DID NOT VOTE. WHEN THERE IS A DOUBT AS TO WHETHER A CONFLICT OF INTEREST EXISTS, THE MATTER SHALL BE RESOLVED BY A VOTE OF THE BOARD OF DIRECTORS, OR THE COMMITTEE, EXCLUDING THE INTERESTED DIRECTOR OR OFFICER CONCERNING WHOSE SITUATION THE DOUBT HAS ARISEN. THIS POLICY SHALL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF DIRECTORS, OFFICERS AND STAFF MEMBERS; AND ANY NEW DIRECTORS, OFFICERS OR STAFF MEMBERS SHALL BE ADVISED OF THE POLICY AND FURNISHED A DISCLOSURE STATEMENT UPON UNDERTAKING THE DUTIES OF SUCH OFFICE. |
| FORM 990, PART VI, SECTION B, LINE 15 | PROCESS FOR DETERMINING COMPENSATION THE AMERICARES FOUNDATION, INC'S CHIEF EXECUTIVE, ALONG WITH THE SVP OF PROGRAMS AND CHIEF PEOPLE OFFICER, DETERMINES THE COMPENSATION OF THE EXECUTIVE DIRECTOR OF THE AMERICARES FREE CLINICS, INC. ANNUALLY, AN ACROSS-THE-BOARD INCREASE IS PROVIDED. UTILIZATION OF PERFORMANCE EVALUATION, AVAILABLE MARKET DATA, SALARY SURVEY RESULTS, AND OTHER AVAILABLE TOOLS ARE USED TO SUBSTANTIATE ANY COMPENSATION DECISIONS BEYOND THE ORGANIZATION'S ANNUAL STANDARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE TAXPAYER MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC BY RETAINING A COPY AT ITS PLACE OF BUSINESS AND BY POSTING IT ON THE AMERICARES FOUNDATION, INC. WEBSITE, WWW.AMERICARES.ORG, AND THE AMERICARES FREE CLINIC, INC. WEBSITE AMERICARESFREECLINIC.ORG. THE FORM 990 IS LIKEWISE PUBLISHED ON THE INTERNET AT WWW.GUIDESTAR.ORG. THE ORGANIZATION'S FINANCIAL ACTIVITIES ARE PRESENTED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ITS PARENT ORGANIZATION, AMERICARES FOUNDATION, INC. AND ARE SUMMARIZED IN THE ANNUAL REPORT, WHICH IS AVAILABLE ON THE AMERICARES FOUNDATION, INC. WEBSITE. GOVERNING DOCUMENTS ARE NOT ORDINARILY MADE AVAILABLE TO THE PUBLIC. BUT IF REQUESTED, WILL BE PROVIDED AT MANAGEMENT'S DISCRETION. |
| Software ID: | |
| Software Version: |