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 |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 9,217,265 | 8,734,168 | 9,340,417 | 10,117,109 | 10,032,036 | 47,440,995 |
| 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 | 9,217,265 | 8,734,168 | 9,340,417 | 10,117,109 | 10,032,036 | 47,440,995 |
| 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. | 47,440,995 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 9,217,265 | 8,734,168 | 9,340,417 | 10,117,109 | 10,032,036 | 47,440,995 |
| 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.).. | 1,308 | 409 | 2,709 | 4,204 | 625 | 9,255 |
| 11 | Total support. Add lines 7 through 10 | 47,450,250 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| PART II, LINE 10 | 8,630 |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART III | (CONTINUTED FROM 990 PAGE 2 PART III LINE 4A) OUR SERVICES INCLUDE MEDICAL, DENTAL, BEHAVIORAL HEALTH, VISION, DIABETIC EDUCATION, SPIRITUAL CARE, AND ACCESS TO FREE OR LOW-COST MEDICATIONS. WE ARE THE ONLY FREE AND CHARITABLE CLINIC SERVING THE VIRGINIA PENINSULA. TO EXPAND ACCESS, WE OFFER FREE VIRTUAL URGENT CARE TO ALL VIRGINIA RESIDENTS, REGARDLESS OF INSURANCE. THIS SERVICE HELPS THOSE FACING BARRIERS LIKE COST, TRANSPORTATION, CHILDCARE, OR WORK CONSTRAINTS-OFFERING A VITAL ALTERNATIVE TO COSTLY EMERGENCY CARE. OVER THE PAST FIVE YEARS, LACKEY CLINIC HAS RESEARCHED, TRIALED, AND VALIDATED OUR HYBRID CARE MODEL DEMONSTRATING ITS EFFECTIVENESS AS AN INEXPENSIVE, SCALABLE, AND REPLICABLE SOLUTION FOR EXPANDING CARE AND IMPROVING HEALTH OUTCOMES. THIS INNOVATIVE MODEL MEETS PATIENTS WHERE THEY ARE-PHYSICALLY, EMOTIONALLY, AND TECHNOLOGICALLY-WHILE ADDRESSING KEY SOCIAL DETERMINANTS OF HEALTH (SDOH). KEY COMPONENTS OF THE MODEL "IN-PERSON CARE: PATIENTS BEGIN WITH AN IN-PERSON VISIT FOR COMPREHENSIVE ASSESSMENT, DIAGNOSTICS, AND MEDICATION INITIATION IF NEEDED. THIS IS ALSO THE TIME WHEN WE BEGIN TO DEVELOP A RELATIONSHIP AND TRUST WITH THE PATIENT, SO THEY ARE MORE LIKELY TO FOLLOW THEIR CARE PLAN. "TELEHEALTH (DOXIMITY): THIS IS USED BETWEEN IN-PERSON APPOINTMENTS TO MONITOR CHRONIC CONDITIONS SUCH AS DIABETES, HYPERTENSION, AND BEHAVIORAL HEALTH NEEDS. THESE SECURE, HIPAA-COMPLIANT VIDEO VISITS ALLOW FOR TIMELY FOLLOW-UP AND MEDICATION MANAGEMENT, REDUCING BARRIERS SUCH AS TRANSPORTATION AND TIME OFF WORK. "DIGITAL CARE (FLORENCE): PATIENTS WITH CHRONIC CONDITIONS, WANTING LIFESTYLE MANAGEMENT OR NEEDING ORAL HEALTH EDUCATION ARE ENROLLED IN FLORENCE (GENERATED HEALTH), OUR DIGITAL CARE PLATFORM, WHICH PROVIDES ROUTINE OUTREACH VIA TEXT TO COLLECT HEALTH METRICS AND DELIVER PERSONALIZED HEALTH TIPS. "FLO" ACTS LIKE A VIRTUAL NURSE TO ENGAGE PATIENTS AND EMPOWER THEM TO HELP MANAGE THEIR OWN HEALTH. "ASYNCHRONOUS VIRTUAL CARE (FABRIC): OUR PROGRAM, LACKEY VIRTUAL CARE (THROUGH FABRIC) IS AVAILABLE TO BOTH EXISTING AND NEW PATIENTS ACROSS VIRGINIA. THIS PLATFORM ENABLES SYMPTOM-BASED TRIAGE AND TREATMENT WITHOUT REQUIRING REAL-TIME INTERACTION-SIGNIFICANTLY REDUCING SCHEDULING BARRIERS AND EXPANDING ACCESS TO CARE FOR INDIVIDUALS FACING TRANSPORTATION, WORK, OR CAREGIVING CONSTRAINTS. "BEHAVIORAL HEALTH (VIRGINIA TELEMENTAL HEALTH INITIATIVE): THIS PROVIDES PATIENTS WITH TELEHEALTH ACCESS TO LICENSED MENTAL HEALTH PROFESSIONALS TO ADDRESS DEPRESSION, ANXIETY, TRAUMA, AND OTHER BEHAVIORAL HEALTH NEEDS. COMPELLING RESULTS IN FY'25 WE PROVIDED CARE THROUGH 5,055 IN-PERSON MEDICAL VISITS, 1,685 TELEHEALTH VISITS, AND 1,682 VIRTUAL CARE VISITS. THE ESTIMATED COST PER VISIT FOR EACH OF THESE TYPES OF VISITS WAS 169.63, 21.20, AND 12.92, RESPECTIVELY. OUR VIRTUAL VISITS INCREASED OUR TOTAL VISITS BY 25% AT A FRACTION OF THE COST (ONLY 3%), AND WE WERE ABLE REACH PEOPLE IN 79 COUNTIES AND INDEPENDENT CITIES ACROSS THE COMMONWEALTH. NEW TRADITIONAL PATIENTS TOTALED 1,507 WHILE NEW VIRTUAL CARE PATIENTS WERE 770, A 51% INCREASE. WITH MANY CLINICS LOSING FUNDING AND STRUGGLING TO KEEP THEIR DOORS OPEN, SOME ARE CONTEMPLATING REDUCING THE DAYS THEY ARE OPEN FOR PATIENT VISITS. LACKEY VIRTUAL CARE CAN HELP THESE CLINICS MAINTAIN THE CARE THEY PROVIDE TO THEIR PATIENTS ON DAYS AND HOURS THEY ARE NOT OPEN. OUR DIGITAL CARE PROGRAM HAD 686 PATIENTS ENROLLED IN FY'25. WE UTILIZED FIVE PROTOCOLS TO ENGAGE PATIENTS, RECEIVING 4,810 READINGS FROM PATIENTS. MORE IMPORTANTLY, WE IMPROVED HEALTH OUTCOMES FOR PATIENTS PARTICIPATING. FOR EXAMPLE, 99 PATIENTS ENROLLED IN THE HYPERTENSION PROTOCOL, AND THE NUMBER OF PATIENTS WITH STAGE 2 HYPERTENSION DECREASED BY 41%, AND THE NUMBER OF PATIENTS IMPROVING TO AN ELEVATED OR NORMAL BP STATE INCREASED BY 127%. OUR TOTAL STAFF HOURS SAVED BY THESE AUTOMATED TEXTS WAS ESTIMATED TO BE 2,005 HOURS. THE COST OF FLORENCE PLATFORM IS 10,000/YEAR, 16% OF THE COST IF WE WERE UTILIZING A REAL PERSON. CONVERTING OUR BEHAVIOR HEALTH PROGRAM FROM IN-PERSON COUNSELING TO THE FREE VIRGINIA TELEMENTAL HEALTH INITIATIVE (VTMHI) REDUCED OUR COST/VISIT FROM 99.43 TO 0 WHILE DOUBLING OUR CAPACITY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS DISTRIBUTED ELECTRONICALLY TO THE MEMBERS OF THE GOVERNING BOARD IN ADVANCE TO BEING FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE CONFLICT OF INTEREST POLICY IS SIGNED BY BOARD MEMBERS DURING ORIENTATION, AND THEN ON AN ANNUAL BASIS. KEY EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO BECOME FAMILIAR WITH THE POLICY AND DISCLOSE ANY CONFLICTS OF INTEREST. |
| FORM 990, PAGE 6, PART VI, LINE 15A | TO DETERMINE CEO AND TOP MANAGEMENT'S SALARIES, THE BOARD (EXECUTIVE COMMITTEE) REVIEWS THE SALARY COMPENSATION STUDIES PERFORMED BY THE VIRGINIA ASSOCIATION OF FREE AND CHARITABLE CLINICS (VAFCC) AND DETERMINES THE ANNUAL SALARY OR INCREASE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | EXECUTIVE DIRECTOR AND MEDICAL DIRECTOR GIVE RECOMMENDATIONS TO THE BOARD AND THEY MAKE FINAL DECISIONS ON SALARY OR INCREASES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE CLINIC'S GOVERNING DOCUMENTS ARE AVAILABLE IN THE ADMINISTRATIVE OFFICE FOR THE PUBLIC'S INSPECTION DURING NORMAL BUSINESS HOURS. |
| Software ID: | |
| Software Version: |