2024-04-11T12:33:57-05:00 2023-06-30 521022232 SNYDER COHN PC 11200 ROCKVILLE PIKE SUITE 415 NORTH BETHESDA MD 20852 990 2022-07-01 541671883 ARLINGTON FREE CLINIC INC ARLI 7039791425 2921 11TH STREET SOUTH ARLINGTON VA 222040827 NANCY WHITE PRESIDENT 7039791425 2024-04-10 1 NANCY WHITE XXX-XX-XXXX 0 KEITH JENNINGS P01319883 3016526700 2024-04-10 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z NANCY WHITE 2921 11TH STREET SOUTH ARLINGTON VA 222040827 7808328 0 X WWW.ARLINGTONFREECLINIC.ORG X 1993 VA ARLINGTON FREE CLINIC (AFC) HAS BEEN A VITAL COMMUNITY RESOURCE, PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ARLINGTON COUNTY ADULTS LIVING WITHOUT HEALTH INSURANCE. 21 21 58 373 0 0 7474522 5393656 0 0 112452 212854 -46071 -86375 7540903 5520135 0 0 0 0 3125523 3276101 0 0 516614 2344035 2982950 5469558 6259051 2071345 -738916 12173453 11393804 427347 493329 11746106 10900475 X ARLINGTON FREE CLINIC ADVANCES HEALTH EQUITY BY PROVIDING COMPREHENSIVE. WHOLE-PERSON HEALTHCARE TO OUR NEIGHBORS WHO WOULD OTHERWISE LACK ACCESS. 0 0 4950503 SINCE 1994, ARLINGTON FREE CLINIC (AFC) HAS BEEN A VITAL COMMUNITY RESOURCE, PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ARLINGTON COUNTY ADULTS LIVING WITHOUT HEALTH INSURANCE. WITH THE SUPPORT OF A LOYAL DONOR COMMUNITY, 400 VOLUNTEERS, AND 45 FULL/PART-TIME STAFF, AFC ANNUALLY DELIVERS PATIENT-CENTERED HEALTHCARE TO MORE THAN 1,400 OF OUR COMMUNITY'S MOST VULNERABLE RESIDENTS. AFC PATIENTS EARN BELOW 200% OF THE FEDERAL POVERTY LEVEL AND ARE DISPROPORTIONATELY IMPACTED BY SYSTEMIC INEQUITIES INCLUDING UNEMPLOYMENT, FOOD INSECURITY, INADEQUATE HOUSING, AND POOR HEALTH. AT AFC, WE ADDRESS THIS BY PROVIDING A WIDE RANGE OF HEALTH CARE OPTIONS (MEDICAL, DENTAL, BEHAVIORAL HEALTH, PHARMACY AND SOCIAL SUPPORTS) WHILE CONCURRENTLY WORKING UPSTREAM TO EFFECT LASTING, SYSTEMS-LEVEL CHANGE. THROUGH THESE PAIRED PRIORITIES, AFC SERVES THE COMMUNITY BY HAVING A CLEAR UNDERSTANDING OF THE SYSTEMIC BARRIERS PATIENTS FACE IN ACHIEVING GOOD HEALTH AND WORKING TO AMPLIFY PATIENT VOICES TO DRIVE MEANINGFUL CHANGE TOWARDS A HEALTHIER, MORE EQUITABLE COMMUNITY FOR ALL. 4950503 1 1 0 0 0 1 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 22 0 1 58 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 21 21 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X X DIANA NAMUGENYI 7039791425 2921 11ST STREET SOUTH ARLINGTON VA 22204 DONNA ALPI CHAIR 2.00 X X 0 0 0 JENNIFER SOSIN VICE-CHAIR 2.00 X X 0 0 0 CARLY KELLY JD SECRETARY 2.00 X X 0 0 0 JOHN COURIC TREASURER; CHAIR, FINANCE COMMITEE 2.00 X X 0 0 0 ANA ALVAREZ CHAIR, GOVERNANCE COMMITTEE 2.00 X 0 0 0 KATY BANKS CO-CHAIR, DEVELOPMENT COMMITTEE 2.00 X 0 0 0 TRACY DONLEY CO-CHAIR, DEVELOPMENT COMMITTEE 2.00 X 0 0 0 PEPPER BINNER DIRECTOR 1.00 X 0 0 0 MARYANNE BOSTER DIRECTOR 1.00 X 0 0 0 JENNIFER BREAREY DIRECTOR 1.00 X 0 0 0 BRIAN CRIVELLA DIRECTOR 1.00 X 0 0 0 NEELIMA DENDULURI MD DIRECTOR 1.00 X 0 0 0 MELISSA DULSKI DIRECTOR 1.00 X 0 0 0 LAURA FUENTES DIRECTOR 1.00 X 0 0 0 MARY-MARGARET LEWIS MD DIRECTOR 1.00 X 0 0 0 JOSEPH LYNCH JD DIRECTOR 1.00 X 0 0 0 JOHN E PARKER DIRECTOR 1.00 X 0 0 0 MICHAEL SAURI DIRECTOR 1.00 X 0 0 0 KEEGAN STROUP CPA DIRECTOR 1.00 X 0 0 0 TANNIA TALENTO DIRECTOR 1.00 X 0 0 0 MICHAEL WARD DIRECTOR 1.00 X 0 0 0 NANCY WHITE PRESIDENT 40.00 X 202614 0 20955 SUREKHA COHEN DIRECTOR, CLINICAL SERVICE 40.00 X 116714 0 5045 PHUNG HA PHARMACIST, IN-CHARGE 40.00 X 119500 0 3226 CAROLINE JONES DIRECTOR OF OPERATIONS 40.00 X 104164 0 2057 TERENCE MCMANUS NURSE PRACTITIONER 40.00 X 120880 0 3687 ALICIA NIEVES DIRECTOR OF DEVELOPMENT AND COMMUNICATIONS 40.00 X 100289 0 5693 764161 0 40663 6 0 1 0 0 7315 1124331 31000 4231010 1328400 5393656 90887 90887 2235335 2113368 121967 121967 121967 40300 1124331 172380 -132080 -132080 48150 2445 45705 45705 5520135 0 0 126479 202614 60784 60784 81046 2653431 2119536 311781 222114 58758 41281 11526 5951 162372 114074 31852 16446 198926 139756 39022 20148 115701 3196 84655 27850 252651 34518 163405 54728 7491 3187 3160 1144 136714 82798 4140 49776 38631 33527 668 4436 116604 79430 6579 30595 14761 4838 9125 798 174779 127864 46915 13955 13955 PHARMACEUTICALS 1977723 1977723 CLINIC EXPENSES 123587 123587 PERSONAL PROPERTY TAXES 10353 4404 4367 1582 6259051 4950503 791934 516614 941798 688901 1399129 1942898 1120895 541742 1100190 483758 105289 93222 5489436 1778262 3868172 3711174 3469330 3785746 168650 146363 12173453 11393804 228440 249435 0 85221 198907 158673 427347 493329 X 9496742 8936273 2249364 1964202 11746106 10900475 12173453 11393804 -738916 176613 -283328 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 5000 347210 1 1 320021 5000 39518 17329 347210 380761 5000 -46262 16478 320021 308097 6000 82354 15690 380761 323232 6000 -5051 16084 308097 323177 8100 8785 16830 323232 0.00000 1.00000 0.00000 0 0 1370731 1370731 3333093 1177012 2156081 599473 422573 176900 186139 178677 7462 3711174 LEASE LIABILITY 158673 158673 X 10656927 176613 4957734 2445 5136792 5520135 0 5520135 11219230 4957734 2445 4960179 6259051 0 6259051 PART V, LINE 4: A VOLUNTEER PHYSICIAN DONATED ENDOWMENT FUNDS FOR THE PURPOSE OF ASSISTING PATIENT CARE EXPENSES OUTSIDE THE CLINIC, INCLUDING TRANSPORTATION, SURGERY COSTS, PROSTHETICS, ETC. ALSO, AN ANONYMOUS DONOR PROVIDED ENDOWMENT FUNDS THAT WILL SUSTAIN THE CLINIC'S DIABETES EDUCATION PROGRAMS AND ACTIVITIES. PART X, LINE 2: THE ORGANIZATION ACCOUNTS FOR THE EFFECT OF ANY UNCERTAIN TAX POSITIONS BASED ON A "MORE LIKELY THAN NOT" THRESHOLD TO THE RECOGNITION OF THE TAX POSITIONS BEING SUSTAINED BASED ON THE TECHNICAL MERITS OF THE POSITION UNDER SCRUTINY BY THE APPLICABLE TAXING AUTHORITY. IF A TAX POSITION OR POSITIONS ARE DEEMED TO RESULT IN UNCERTAINTIES OF THOSE POSITIONS, THE UNRECOGNIZED TAX EFFECT IS ESTIMATED BASED ON A "CUMULATIVE PROBABILITY ASSESSMENT" THAT AGGREGATES THE ESTIMATED TAX LIABILITY FOR UNCERTAIN TAX POSITIONS. INTEREST AND PENALTIES, IF ANY, ARE ACCRUED AS A COMPONENT OF GENERAL AND ADMINISTRATIVE EXPENSES WHEN ASSESSED. THE ORGANIZATION HAS IDENTIFIED ITS TAX STATUS AS A TAX EXEMPT ENTITY UNDER SECTION 501(C)(6) AND ITS DETERMINATION THAT IT HAS NO UNRELATED BUSINESS INCOME AS TAX POSITIONS; HOWEVER, THE ORGANIZATION HAS DETERMINED THAT SUCH TAX POSITIONS DO NOT RESULT IN AN UNCERTAINTY REQUIRING RECOGNITION. INCOME TAX YEARS ENDED PRIOR TO JUNE 30, 2020 ARE NO LONGER SUBJECT TO AUDIT BY TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS FUNDRAISING EXPENSES INCLUDED IN INCOME PART XII, LINE 2D - OTHER ADJUSTMENTS FUNDRAISING EXPENSES INCLUDED IN INCOME ANNUAL GALA 1164631 1124331 40300 172380 1164631 1124331 40300 172380 172380 -132080 48150 2445 1 0.90000 48150 2445 2445 45705 VA 0 THE NATURE AND SIZE OF THE ORGANIZATION'S RAFFLE ACTIVITY DOES NOT MEET THE LICENSING REQUIREMENTS IN THE COMMONWEALTH OF VIRGINIA. 0 1 0 0.01000 0.99000 ALICIA NIEVES 2921 11TH STREET SOUTH ARLINGTON VA 22204 0 ALICIA NIEVES 100289 SEE BELOW X 0 SCHEDULE G, PART III, LINE 16, DESCRIPTION OF SERVICES PROVIDED RESPONSIBLE FOR THE OVERALL SUCCESS OF THE RAFFLE INCLUDING COORDINATING VOLUNTEERS WHO PROVIDE PRIZES AND MARKET AND TRACK TICKET SALES. HER POSITION AT THE CLINIC IS DIRECTOR OF DEVELOPMENT AND COMMUNICATIONS. X X X 0 0 0 0 0 0 0 0 0 NANCY WHITE PRESIDENT 182614 0 20000 0 0 0 11400 0 9555 0 223569 0 0 0 X 11 132016 AVERAGE SALE PRICE X 3 1285915 FAIR MARKET VALUE X AUCTION ITEMS 202 115353 FAIR MARKET VALUE X COMPUTER SOFTWARE 2 32135 FAIR MARKET VALUE X COMPUTER HARDWARE 1 10350 FAIR MARKET VALUE 0 0 0 PART I, COLUMN (B): THE NONCASH CONTRIBUTIONS REPORTED ON SCHEDULE M, PART I REPORTS THE NUMBER OF DONORS. FORM 990, PART VI, SECTION B, LINE 11B DRAFT FORM 990 IS PREPARED BY AN ACCOUNTING FIRM AND IS REVIEWED BY THE TREASURER AND PRESIDENT. THE DRAFT RETURN IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO SIGN CONFLICT OF INTEREST STATEMENTS ANNUALLY. THIS PROCESS IS DISCUSSED IN DETAIL WITH THE BOARD MEMBERS AT THE FIRST MEETING OF EACH CALENDAR YEAR. THE POLICY IS REVIEWED WITH ALL NEW INCOMING BOARD MEMBERS DURING THE NEW BOARD MEMBER ORIENTATION SESSION EACH DECEMBER. THE BOARD IS REMINDED OF THE CONFLICT OF INTEREST POLICY AT REGULAR INTERVALS (APPROXIMATELY THREE TIMES A YEAR). BOARD CHAIR AND CHAIR OF THE GOVERNANCE COMMITTEE MONITORS THIS PROCESS. GENERAL ANNOUNCEMENTS AND EDUCATION ARE PROVIDED TO THE BOARD AS A WHOLE. ISSUES AFFECTING ONLY ONE BOARD MEMBER ARE DISCUSSED PRIVATELY BY PHONE. WHEN A CONFLICT IS REPORTED BY A BOARD MEMBER, THEY ARE ADVISED THAT THEY MUST RECUSE THEMSELVES FROM DISCUSSION AND VOTE ON RELATED TOPICS. IF A CONFLICT IS SUSPECTED BUT NOT REPORTED, IT WOULD BE THE BOARD CHAIR'S RESPONSIBILITY FOR HAVING A DISCUSSION AND SEEKING CLARIFICATION AND COMPLIANCE WITH POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS SHALL BE RESPONSIBLE FOR ESTABLISHING AND APPROVING THE EXECUTIVE DIRECTOR'S ANNUAL PERFORMANCE PLAN, MONITORING PERFORMANCE AGAINST THAT PLAN DURING THE FISCAL YEAR, CONDUCTING THE FINAL PERFORMANCE REVIEW AND DECIDING THE PERFORMANCE RATING FOR THE YEAR, AND REVIEWING AND SETTING THE COMPENSATION PACKAGE FOR OTHER EXECUTIVE DIRECTORS IN THE FIELD WILL BE USED FOR THE COMPARISON AS WELL AS THE LOCAL COST OF LIVING INCREASE, THE EXECUTIVE DIRECTOR'S LENGTH OF SERVICE, AND ANY PARTICULAR REQUIREMENTS OR NEEDS OF THE EXECUTIVE DIRECTOR'S IN ARRIVING AT A TOTAL COMPENSATION PACKAGE. THE MINUTES OF THE MEETING OR AN EMAIL FROM THE BOARD CHAIR WILL NOTIFY THE DIRECTOR OF FINANCE AND HR TO MAKE ADJUSTMENTS TO THE EXECUTIVE DIRECTOR'S COMPENSATION. THE MOST RECENT YEAR EXECUTIVE COMPENSATION WAS REVIEWED WAS 2022. THE EXECUTIVE DIRECTOR DETERMINES THE RAISES OF THE DIRECT REPORTS. ALL INCREASES ARE DOCUMENTED BY A WRITTEN LETTER TO THE EMPLOYEE AND SAVED IN THE EMPLOYEE'S HR FILE. THE MOST RECENT YEAR OTHER OFFICERS' COMPENSATION WAS REVIEWED WAS 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR, VICE CHAIR, TREASURER, SECRETARY, AND OTHER DIRECTORS AS DETERMINED BY THE BOARD. THE EXECUTIVE COMMITTEE MAY ACT FOR THE BOARD BETWEEN MEETINGS OF THE BOARD, WITHIN THE POLICIES ESTABLISHED BY ESTABLISHED BY THE BOARD AND WITH SUCH ADDITIONAL AUTHORITY AS MAY BE DELEGATED BY THE BOARD, EXCEPT IN THOSE MATTERS RESERVED IN THESE BYLAWS FOR DETERMINATION BY THE BOARD. ARTICLE 8.2.1. ANNUALLY, THE EXECUTIVE COMMITTEE SHALL REVIEW INDEPENDENTLY THE PERFORMANCE OF THE EXECUTIVE DIRECTOR AND VOTE TO APPROVE CHANGES TO THE EXECUTIVE DIRECTOR'S COMPENSATION AND BENEFITS PACKAGE.