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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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 | ||||||
| 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) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 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.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) |
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| 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) |
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| 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): |
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| 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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART VI, SECTION B, LINE 11B | WILMINGTON COMMUNITY CLINIC'S CHIEF EXECUTIVE OFFICER AND CFO REVIEW THE FORM 990 FOR ACCURACY. SUBSEQUENTLY FORM 990, COMPLETE WITH ALL SCHEDULES, IS THEN PROVIDED TO THE FULL BOARD BEFORE FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE PURPOSE OF THE ORGANIZATION'S CONFLICT OF INTEREST (COI) POLICY IS TO PREVENT THE INSTITUTIONAL OR PERSONAL INTERESTS OF WILMINGTON COMMUNITY CLINIC BOARD MEMBERS, EMPLOYEES, AGENTS, CONSULTANTS AND THOSE WHO FURNISH GOODS OR SERVICES TO THE ORGANIZATION ("INTERESTED PERSONS") FROM INTERFERING WITH THE PERFORMANCE OF THEIR DUTIES TO WILMINGTON COMMUNITY CLINIC, AND TO ENSURE THAT THERE IS NO PERSONAL, PROFESSIONAL, OR POLITICAL GAIN AT THE EXPENSE OF WILMINGTON COMMUNITY CLINIC. A CONFLICT OF INTEREST MAY EXIST WHEN THE INTERESTS OR POTENTIAL INTERESTS OF ANY INTERESTED PERSON OR THAT PERSON'S CLOSE RELATIVE, OR ANY INDIVIDUAL, GROUP, OR ORGANIZATION TO WHICH THE INTERESTED PERSON ASSOCIATED WITH WILMINGTON COMMUNITY CLINIC HAS ALLEGIANCE, MAY BE SEEN AS COMPETING WITH THE INTERESTS OF WILMINGTON COMMUNITY CLINIC, OR MAY IMPAIR SUCH INTERESTED PERSON'S INDEPENDENCE OR LOYALTY TO WILMINGTON COMMUNITY CLINIC. A CONFLICT OF INTEREST IS DEFINED AS AN INTEREST THAT MIGHT AFFECT, OR MIGHT REASONABLY APPEAR TO AFFECT, THE JUDGMENT OR CONDUCT OF ANY INTERESTED PERSON IN A MANNER THAT IS ADVERSE TO THE INTERESTS OF WILMINGTON COMMUNITY CLINIC. WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS ARE PROHIBITED FROM PARTICIPATING IN THE SELECTION, AWARD, OR ADMINISTRATION OF CONTRACTS, INCLUDING BUT NOT LIMITED TO, THOSE SUPPORTED BY FEDERAL FUNDS, IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE WILMINGTON COMMUNITY CLINIC INTERESTED PERSON OR THAT PERSON'S CLOSE RELATIVE, OR ANY INDIVIDUAL, GROUP, OR ORGANIZATION TO WHICH THE PERSON ASSOCIATED WITH WILMINGTON COMMUNITY CLINIC HAS ALLEGIANCE, HAS A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR AN AWARD. THE PROHIBITION DOES NOT APPLY TO SITUATIONS IN WHICH THE FINANCIAL INTEREST IS NOT SUBSTANTIAL (FOR EXAMPLE, AN OWNERSHIP INTEREST OF LESS THAN 5 PERCENT OF OUTSTANDING SECURITIES OF PUBLIC CORPORATIONS). WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS ARE PROHIBITED FROM SOLICITING OR ACCEPTING FOR THEIR OWN PERSONAL BENEFIT GRATUITIES, FAVORS, OR ANYTHING OF MONETARY VALUE FROM CONTRACTORS, OR PARTIES TO SUB-AGREEMENTS. THE PROHIBITION DOES NOT APPLY TO SITUATIONS IN WHICH THE GIFT IS AN UNSOLICITED ITEM OF NOMINAL VALUE (NOT > THAN $50). WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS SHALL NOT USE INFORMATION RECEIVED FROM PARTICIPATION IN WILMINGTON COMMUNITY CLINIC AFFAIRS, WHETHER EXPRESSLY DENOMINATED AS CONFIDENTIAL OR NOT, FOR PERSONAL GAIN OR TO THE DETRIMENT OF WILMINGTON COMMUNITY CLINIC. WHENEVER THE CHIEF EXECUTIVE OFFICER OR ANY BOARD MEMBER HAS A CONFLICT OF INTEREST OR A PERCEIVED CONFLICT OF INTEREST WITH WILMINGTON COMMUNITY CLINIC, HE OR SHE SHALL NOTIFY THE FULL BOARD OF SUCH CONFLICT IN WRITING USING THE ANNUAL COI DISCLOSURE FORM. WHEN ANY CONFLICT OF INTEREST IS RELEVANT TO A MATTER THAT COMES UNDER CONSIDERATION OR REQUIRES ACTION BY THE BOARD, OR A BOARD COMMITTEE, THE INTERESTED PERSON SHALL CALL IT TO THE ATTENTION OF THE BOARD CHAIR AND SHALL NOT BE PRESENT DURING BOARD OR COMMITTEE DISCUSSION OR DECISION ON THE MATTER. HOWEVER, THAT PERSON SHALL PROVIDE THE BOARD OR APPLICABLE COMMITTEE WITH ANY AND ALL RELEVANT INFORMATION ON THE PARTICULAR MATTER. THE MINUTES OF THE MEETING OF THE BOARD OR ITS COMMITTEE SHALL REFLECT THAT THE CONFLICT OF INTEREST WAS DISCLOSED, THAT THE INTERESTED PERSON WAS NOT PRESENT DURING DISCUSSION OR DECISION ON THE MATTER, AND DID NOT VOTE. WHENEVER ANY INTERESTED PERSON, WHO IS NOT ALSO A BOARD MEMBER OR THE CHIEF EXECUTIVE OFFICER (FOR EXAMPLE, EMPLOYEES, CONTRACTORS AND CONSULTANTS), HAS A CONFLICT OF INTEREST OR A PERCEIVED CONFLICT OF INTEREST WITH WILMINGTON COMMUNITY CLINIC, HE OR SHE SHALL NOTIFY THE CHIEF EXECUTIVE OFFICER OF SUCH CONFLICT IN WRITING. INTERESTED PERSONS, EXCLUDING BOARD MEMBERS, WHO VIOLATE THE CONFLICT OF INTEREST POLICY INCLUDING THE STANDARDS OF CONDUCT MAY, DEPENDING ON THE SEVERITY OF THE VIOLATION, BE SUBJECT TO ORAL ADMONISHMENT, WRITTEN REPRIMAND, REASSIGNMENT, DEMOTION, SUSPENSION OR SEPARATION. INTERESTED PERSONS, WHO ARE ALSO BOARD MEMBERS, WHO VIOLATE THE CONFLICT OF INTEREST POLICY INCLUDING THE STANDARDS OF CONDUCT MAY, DEPENDING ON THE SEVERITY OF THE VIOLATION, BE SUBJECT TO ORAL ADMONISHMENT OR REMOVAL FROM THEIR POSITION. AS ADMINISTERED BY THE CHIEF EXECUTIVE OFFICER, EACH BOARD MEMBER WILL BE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE AN ANNUAL COI DISCLOSURE FORM TO DISCLOSE ANY KNOWN CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST UPON HIS OR HER ELECTION OR RE-ELECTION TO THE BOARD AND ANNUALLY THEREAFTER. THE BOARD AS APPROPRIATE SHALL REVIEW ALL BOARD MEMBER CERTIFICATIONS. AS ADMINISTERED BY THE EMPLOYEE IN CHARGE OF HUMAN RESOURCES, ALL INTERESTED PERSONS THAT ARE NOT BOARD MEMBERS WILL BE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND USE A COI DISCLOSURE FORM TO DISCLOSE ANY KNOWN CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST UPON HIS OR HER EMPLOYMENT OR ENGAGEMENT WITH WILMINGTON COMMUNITY CLINIC. |
| FORM 990, PART VI, SECTION B, LINE 15A | WILMINGTON COMMUNITY CLINIC'S BOARD OF DIRECTORS HAS A PROCESS FOR REVIEWING AND APPROVING THE COMPENSATION OF CEO ON A ANNUAL BASIS TO DETERMINE IT IS FAIR AND REASONABLE WITH THE GOAL OF RETAINING EMPLOYEES AT COMPENSATION LEVELS WITHIN APPROPRIATE MARKET RANGE. THE PROCESS FOR DETERMINING THE COMPENSATION PAID TO THE CEO, BY THE BOARD OF DIRECTORS, WITH ALL PERSONS WITH A CONFLICT OF INTEREST ABSTAINING FROM THE BOARD'S DELIBERATION AND DISCUSSION. THE BOARD REVIEWS COMPARABLE COMPENSATION DATA FOR COMPARABLE SERVICES, COMPARABLE ENTERPRISES (BY BUDGET, REVENUES, NUMBER OF EMPLOYEES, PERSONS SERVED, AND MISSION), COMPARABLE CIRCUMSTANCES (GEOGRAPHIC LOCATION AND ECONOMIC CONDITIONS/COST OF LIVING), AND OTHER FACTORS SUCH AS WHETHER THE PERSON MANAGES MULTIPLE FUNCTIONS OR DEPARTMENTS, THE EMPLOYEE'S DUTIES AND PAST PERFORMANCE HISTORY, AND THE EMPLOYEE'S BACKGROUND, SKILLS, EDUCATION, AND EXPERIENCE. THE DOCUMENTATION OF THE BOARD INCLUDES THE TERMS OF THE TRANSACTION AND THE DATE OF APPROVAL, THE MEMBERS WHO WERE PRESENT DURING THE DEBATE AND VOTE ON THE TRANSACTION, A DESCRIPTION OF THE COMPARABLE DATA AND HOW IT WAS OBTAINED, AND DOCUMENTATION OF THE BASIS FOR THE DETERMINATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. HOWEVER CURRENT TAX LAW DOES NOT REQUIRE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIALS BE PROVIDED TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 229,312. MANAGEMENT AND GENERAL EXPENSES 60,428. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 289,740. PAYROLL SERVICES: PROGRAM SERVICE EXPENSES 15,094. MANAGEMENT AND GENERAL EXPENSES 3,977. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,071. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 391,762. MANAGEMENT AND GENERAL EXPENSES 103,237. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 494,999. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 763,884. MANAGEMENT AND GENERAL EXPENSES 201,299. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 965,183. |
| FORM 990, PART IX, LINE 24E | PHARMACEUTICALS: PROGRAM SERVICE EXPENSES 67,459. MANAGEMENT AND GENERAL EXPENSES 17,802. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 85,261. PATIENT SERVICES: PROGRAM SERVICE EXPENSES 54,709. MANAGEMENT AND GENERAL EXPENSES 14,437. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 69,146. MEDICAL FURNITURE & EQUIPMENT: PROGRAM SERVICE EXPENSES 38,655. MANAGEMENT AND GENERAL EXPENSES 10,200. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,855. MEMBERSHIP DUES: PROGRAM SERVICE EXPENSES 36,443. MANAGEMENT AND GENERAL EXPENSES 9,617. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,060. STORAGE: PROGRAM SERVICE EXPENSES 32,722. MANAGEMENT AND GENERAL EXPENSES 8,635. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,357. TAXES & LICENSES: PROGRAM SERVICE EXPENSES 19,441. MANAGEMENT AND GENERAL EXPENSES 5,128. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,569. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 17,386. MANAGEMENT AND GENERAL EXPENSES 4,587. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,973. LAUNDRY: PROGRAM SERVICE EXPENSES 11,776. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,776. EDUCATIONAL MATERIALS: PROGRAM SERVICE EXPENSES 2,023. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,023. OUTREACH SERVICES: PROGRAM SERVICE EXPENSES 136. MANAGEMENT AND GENERAL EXPENSES 36. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 172. |
| FORM 990, PART XI, LINE 9: | REVERSAL OF ACCRUED LIABILITIES 262,500. |
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| Software Version: |