2025-05-15T13:17:34-05:00 2024-06-30 540618213 HANTZMON WIEBEL LLP PO BOX 1408 CHARLOTTESVILLE VA 22902 990 2023-07-01 541610405 CHARLOTTESVILLE FREE CLINIC CHAR 4342965525 901 PRESTON AVE 301 CHARLOTTESVILLE VA 22903 WILLA BARNHARDT CEO OF DEVELOPMENT AND FINANCE 4342958967 2025-05-15 1 0 CLARISSA B HOFFMAN P01390684 4342962156 2023 2025-03-06 01:10:19Z WILLA BARNHARDT 901 PRESTON AVE 301 CHARLOTTESVILLE VA 22903 4339543 0 X WWW.CVILLEFREECLINIC.ORG X 1991 VA THE CHARLOTTESVILLE FREE CLINIC'S MISSION IS TO:1. PROVIDE A COMMUNITY HEALTH SUPPORT SYSTEM THAT PROVIDES HIGH-QUALITY MEDICAL, MENTAL HEALTH, VISION, AND DENTAL SERVICES TO LOW-INCOME, UNINSURED, AND UNDERINSURED INDIVIDUALS WHO HAVE NO OTHER OPTION FOR CARE, AT NO COST TO PATIENTS.2. PROVIDE PRACTICAL EXPERIENCE FOR CURRENT AND FUTURE HEALTH CARE PROFESSIONALS.3. HASTEN, THROUGH EDUCATION AND ADVOCACY, THE CREATION OF A COMPREHENSIVE POLICY FOR ACCESS TO HEALTH CARE. 13 13 30 642 0 0 4111995 4044601 0 0 65445 177610 93087 -55879 4270527 4166332 0 0 0 0 1489320 1677420 0 0 157018 1957015 2205348 3446335 3882768 824192 283564 4907070 5191161 7937 8464 4899133 5182697 X THE CHARLOTTESVILLE FREE CLINIC'S MISSION IS TO PROVIDE A VOLUNTEER-DRIVEN, COMMUNITY HEALTH SUPPORT SYSTEM THAT PROVIDES HIGH-QUALITY MEDICAL, MENTAL HEALTH, VISION, AND DENTAL SERVICES TO LOW-INCOME, UNINSURED AND UNDERINSURED INDIVIDUALS WHO HAVE NO OTHER OPTIONS FOR CARE, AT NO COST TO PATIENTS. 0 0 3541062 THE CHARLOTTESVILLE FREE CLINIC (CLINIC) PROVIDES MEDICAL CARE, DENTAL CARE AND PHARMACEUTICALS TO QUALIFYING INDIVIDUALS WHO DO NOT QUALIFY FOR MEDICARE AND/OR MEDICAID, AND ARE UNINSURED OR UNDERINSURED. THE CLINIC RECEIVED SUPPORT IN THE FORM OF DONATED SERVICES AND FACILITIES. THE DONATED SERVICES, VALUED AT $477,137 WERE PROVIDED BY HEALTH CARE PROFESSIONALS, PHARMACISTS, LAB TECHNICIANS AND OTHER PROFESSIONALS. THE DONATED FACILITY WAS VALUED AT $41,000 AND DONATED PHARMACEUTICALS WERE VALUED AT $1,478,143. THE CLINIC ENCOURAGES PATIENTS TO SEEK TREATMENT EARLY BEFORE SMALL PROBLEMS BECOME LARGE PROBLEMS. THE SERVICES ARE PROVIDED BY APPROXIMATELY 642 VOLUNTEERS FROM THROUGHOUT THE COMMUNITY INCLUDING MEDICAL STAFF AND OTHER HEALTH PROFESSIONALS FROM LOCAL HOSPITALS AND OTHER COMMUNITY HEALTH FACILITIES. ON-SITE SERVICES INCLUDE MEDICAL AND NURSING ASSISTANCE FOR PRIMARY CARE, MENTAL HEALTH ISSUES, BASIC LAB TESTING, INDIVIDUAL AND GROUP HEALTH EDUCATION PROGRAMS, DENTAL SERVICES, AND A FULLY LICENSED PHARMACY. REFERRAL SERVICES INCLUDE COMPREHENSIVE LAB TESTING, RADIOLOGY SERVICES AND OTHER MEDICAL SPECIALTY SERVICES. ALL SERVICES, SUPPLIES AND MEDICATION ARE PROVIDED FREE OF CHARGE. 3541062 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 9 0 1 30 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X WILLA BARNHARDT 4342965525 901 PRESTON AVE 301 CHARLOTTESVILLE VA 22903 JONATHAN B LEIST DENTIST 40.00 X 178316 0 9982 SUSAN SHERMAN FORMER EXECUTIVE DIRECTOR 40.00 X 150761 0 11000 PATRICIA POLGAR-BAILEY FAMILY NURSE PRACTITIONER 40.00 X 130841 0 15179 MEGHAN HINGER CEO OF CLINIC OPERATIONS 40.00 X 106904 0 3008 WILLA BARNHARDT CEO OF DEVELOPMENT AND FINANCE 40.00 X 80573 0 11030 WILL KNIGHT CHAIR 1.00 X X 0 0 0 JACK KAYTON VICE CHAIR 1.00 X X 0 0 0 MICHAEL BROOKS TREASURER 1.00 X X 0 0 0 SANDHYA CHHABRA SECRETARY 1.00 X X 0 0 0 KARA COMER DIRECTOR 1.00 X 0 0 0 TRACY DOWNS DIRECTOR 1.00 X 0 0 0 TED HORN DIRECTOR 1.00 X 0 0 0 MAX LUNA DIRECTOR 1.00 X 0 0 0 DAVID SCHMITT DIRECTOR 1.00 X 0 0 0 AMIT SHAHANE DIRECTOR 1.00 X 0 0 0 KIMBERLY SKELLY DIRECTOR 1.00 X 0 0 0 NATE TRICKER DIRECTOR 1.00 X 0 0 0 GREGG WINSTON DIRECTOR 1.00 X 0 0 0 647395 0 50199 4 0 1 0 0 315323 236103 3493175 1551822 4044601 177101 177101 43418 42909 509 509 509 60101 315323 130302 -70201 -70201 CONTRACT SERVICES & RE 621400 14322 14322 14322 4166332 14322 0 107409 267197 99599 78257 89341 1114912 1102835 4670 7407 30718 26725 1843 2150 160079 139268 9605 11206 104514 90927 6271 7316 42600 5520 37080 120351 101755 15750 2846 1753 1577 88 88 25205 766 4123 20316 32405 22306 10099 170326 167716 1305 1305 11001 10895 106 81606 69365 11425 816 15408 12326 1541 1541 SUPPLIES 1625344 1625292 52 MEMBERSHIP 28399 28399 REPAIRS & MAINTENANCE 20845 7804 12624 417 VOLUNTEER PROGRAM 19168 19168 10937 8819 2118 3882768 3541062 184688 157018 4355600 2355647 1117928 557125 257183 560803 2112565 294287 162146 4907070 5191161 7937 8464 7937 8464 X 4344198 5040501 554935 142196 4899133 5182697 4907070 5191161 283564 0 X X 0 1 X 1 0 X 3910174 3331397 3490853 4111995 4044601 18889020 3910174 3331397 3490853 4111995 4044601 18889020 740340 18148680 24419 12193 3851 67755 177101 285319 3036 393400 41989 198419 74423 711267 19885606 50535 0.91270 0.93550 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SPECIAL EVENT PROCEEDS - 2019 AMOUNT: $ 3,036. 2021 AMOUNT: $ 21,200. 2022 AMOUNT: $ 112,639. 2023 AMOUNT: $ 60,101. PPP LOAN INCOME - 2020 AMOUNT: $ 393,400. SERVICE CONTRACT REIMBURSEMENTS - 2021 AMOUNT: $ 20,789. 2022 AMOUNT: $ 85,780. 2023 AMOUNT: $ 14,322. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 568729 195165 373564 529199 341960 187239 20000 20000 0 560803 CERTIFICATES OF DEPOSIT (CD) 2112565 C 2112565 X 4684469 518137 518137 4166332 0 4166332 4400905 518137 518137 3882768 0 3882768 PART X, LINE 2: THE CLINIC HAS REVIEWED AND EVALUATED THE RELEVANT TECHNICAL MERITS OF EACH OF ITS TAX POSITIONS IN ACCORDANCE WITH GUIDANCE ESTABLISHED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT WOULD HAVE A MATERIAL IMPACT ON THE FINANCIAL STATEMENTS OF THE CLINIC. CONCERTS 333911 276310 57601 81256 12410 22883 OTHER 41513 39013 2500 4574 7894 1285 375424 315323 60101 85830 20304 24168 130302 -70201 SCHEDULE G PART II: FUNDRAISING EVENTS SPECIAL EVENTS ARE REPORTED AS REVENUE IN THE YEAR CASH IS RECEIVED. THE RELATED EXPENSES ARE RECOGNIZED WHEN CASH IS PAID. X X X 0 0 0 0 0 0 0 0 0 JONATHAN B LEIST DENTIST 170066 0 8000 0 250 0 5172 0 4810 0 188298 0 0 0 SUSAN SHERMAN FORMER EXECUTIVE DIRECTOR 126425 0 24336 0 0 0 3813 0 7187 0 161761 0 0 0 X 5 41619 FMV DATE OF TRANSFER X 1 1478143 RETAIL VALUE X DENTAL EQUIPMENT 7 32060 FMV DATE OF GIFT 0 0 1 PART I, COLUMN (B): THE CLINIC IS REPORTING THE TOTAL NUMBER OF CONTRIBUTIONS, WITH EACH CONTRIBUTION POTENTIALLY COMPRISING MULTIPLE ITEMS. PART I, LINE 32B: STOCK CONTRIBUTIONS ARE PROCESSED BY WELLS FARGO ADVISORS. THE BROKER CONFIRMS WITH THE CEO THE GIFT, NUMBER OF SHARES, AND DONOR NAME, AND OBTAINS APPROVAL TO SELL SHARES. FUNDS ARE TRANSFERRED TO THE BANK ACCOUNT AND FOLLOWS STANDARD GIFT PROCESSING. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CEO OF DEVELOPMENT AND FINANCE AND TREASURER AND IS DISTRIBUTED TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS MADE AWARE OF, AND SIGNS, THE WRITTEN CONFLICT OF INTEREST POLICY. POTENTIAL CONFLICTS OF INTERESTS ARE REQUIRED TO BE DISCLOSED AT THE EARLIEST PRACTICAL TIME. NO BOARD MEMBER SHALL VOTE ON ANY MATTER IN WHICH SUCH BOARD MEMBER HAS A CONFLICT OF INTEREST. ANY BOARD MEMBER, WHO IS UNCERTAIN WHETHER A CONFLICT OF INTERESTS EXISTS, MAY REQUEST THE BOARD TO MAKE A DETERMINATION REGARDING THE EXISTENCE OF A CONFLICT OF INTEREST, AND THE BOARD SHALL RESOLVE THE QUESTION BY A MAJORITY VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REFERENCES SALARY SURVEYS PUBLISHED BY THE VIRGINIA ASSOCIATION OF FREE CLINICS AND CHARLOTTESVILLE'S CENTER FOR NONPROFIT EXCELLENCE IN DETERMINING SALARIES OF ALL STAFF, INCLUDING THE EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION C, LINE 18 COPIES OF THE 990 ARE KEPT IN THE CEO OF DEVELOPMENT AND FINANCE'S OFFICE AND AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, RELATED POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE, UPON REQUEST, AT THE ORGANIZATION'S OFFICE. FORM 990, PART XI, QUESTION 2C- ORGANIZATION'S REVIEW OF AUDITED FINANCIALS THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.