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FAMILY COMMUNITY CLINIC, INC.

Company Details

Name: FAMILY COMMUNITY CLINIC, INC.
Legal type: Kentucky Corporation
Status: Active
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 02 Jun 2010 (15 years ago)
Organization Date: 02 Jun 2010 (15 years ago)
Last Annual Report: 01 Feb 2024 (a year ago)
Organization Number: 0759000
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 40206
City: Louisville
Primary County: Jefferson County
Principal Office: 1420 E. WASHINGTON ST, LOUISVILLE, KY 40206
Place of Formation: KENTUCKY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FAMILY COMMUNITY CLINIC CBS BENEFIT PLAN 2021 272994215 2022-12-29 FAMILY COMMUNITY CLINIC 1
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-07-01
Business code 621491
Sponsor’s telephone number 5023848444
Plan sponsor’s address 1420 E WASHINGTON STREET, LOUISVILLE, KY, 40206

Plan administrator’s name and address

Administrator’s EIN 846429706
Plan administrator’s name SHAWNA BURTON
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of

Role Plan administrator
Date 2022-12-29
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature
FAMILY COMMUNITY CLINIC CBS BENEFIT PLAN 2020 272994215 2021-12-14 FAMILY COMMUNITY CLINIC 1
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2020-07-01
Business code 621491
Sponsor’s telephone number 5023848444
Plan sponsor’s address 1420 E WASHINGTON STREET, LOUISVILLE, KY, 40206

Plan administrator’s name and address

Administrator’s EIN 846429706
Plan administrator’s name SHAWNA BURTON
Plan administrator’s address 464 CHENAULT RD, FRANKFORT, KY, 40601
Administrator’s telephone number 5026954700

Signature of

Role Plan administrator
Date 2021-12-14
Name of individual signing SHAWNA BURTON
Valid signature Filed with authorized/valid electronic signature

Vice President

Name Role
DAVID CASEY Vice President

Director

Name Role
MANUEL GRIMALDI Director
MUHAMMAD BABAR Director
LISA TWOHEY Director
JAMES RANSDELL Director
PHILLP BOND Director
KEVIN SHURN Director
DEEPAK AZAD Director
LAURA CHANDLER Director
NANCY MARTIN Director
SCOTT COLOSI Director

Incorporator

Name Role
TIMOTHY D. LANGE Incorporator

Secretary

Name Role
BEVERLY BECKMAN Secretary

Treasurer

Name Role
BILL FREY Treasurer

President

Name Role
BOB MUELLER President

Registered Agent

Name Role
TIMOTHY D. LANGE Registered Agent

Former Company Names

Name Action
FAMILY COMMUNITY CLINIC, INC. Type Conversion

Filings

Name File Date
Annual Report 2024-02-01
Annual Report 2023-06-05
Annual Report 2022-05-17
Principal Office Address Change 2022-03-07
Annual Report 2021-04-14
Annual Report 2020-06-01
Annual Report 2019-06-21
Annual Report 2018-04-16
Amendment 2017-12-27
Annual Report 2017-06-19

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
27-2994215 Corporation Unconditional Exemption 1420 E WASHINGTON ST, LOUISVILLE, KY, 40206-1829 2010-11
In Care of Name % ELLEN WELLS
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2024-09
Asset 500,000 to 999,999
Income 100,000 to 499,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount 976915
Income Amount 400855
Form 990 Revenue Amount 400855
National Taxonomy of Exempt Entities Health Care: Ambulatory Health Center, Community Clinic
Sort Name -

Publication 78 Data

Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Determination Letter

Final Letter(s) FinalLetter_27-2994215_FAMILYCOMMUNITYCLINICINC_08192010_01.tif
FinalLetter_27-2994215_FAMILYCOMMUNITYCLINICINC_08192010_02.tif

Copies of Returns (990, 990-EZ, 990-PF, 990-T)

Organization Name FAMILY COMMUNITY CLINIC INC
EIN 27-2994215
Tax Period 202209
Filing Type E
Return Type 990
File View File
Organization Name FAMILY COMMUNITY CLINIC INC
EIN 27-2994215
Tax Period 202009
Filing Type E
Return Type 990
File View File
Organization Name FAMILY COMMUNITY CLINIC INC
EIN 27-2994215
Tax Period 201909
Filing Type E
Return Type 990
File View File
Organization Name FAMILY COMMUNITY CLINIC INC
EIN 27-2994215
Tax Period 201809
Filing Type E
Return Type 990
File View File
Organization Name FAMILY COMMUNITY CLINIC INC
EIN 27-2994215
Tax Period 201709
Filing Type E
Return Type 990
File View File
Organization Name FAMILY COMMUNITY CLINIC INC
EIN 27-2994215
Tax Period 201609
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3741878408 2021-02-05 0457 PPS 1420 E Washington St, Louisville, KY, 40206-1829
Loan Status Date 2021-11-18
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 44700
Loan Approval Amount (current) 44700
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27542
Servicing Lender Name Republic Bank & Trust Company
Servicing Lender Address 601 W Market St Republic Corporate Center, LOUISVILLE, KY, 40202
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address Louisville, JEFFERSON, KY, 40206-1829
Project Congressional District KY-03
Number of Employees 6
NAICS code 813410
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 27542
Originating Lender Name Republic Bank & Trust Company
Originating Lender Address LOUISVILLE, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 44989.31
Forgiveness Paid Date 2021-10-04
6340547802 2020-06-01 0457 PPP 1420 E WASHINGTON ST, LOUISVILLE, KY, 40206-1829
Loan Status Date 2021-05-15
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 49700
Loan Approval Amount (current) 49700
Undisbursed Amount 0
Franchise Name -
Lender Location ID 27542
Servicing Lender Name Republic Bank & Trust Company
Servicing Lender Address 601 W Market St Republic Corporate Center, LOUISVILLE, KY, 40202
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address LOUISVILLE, JEFFERSON, KY, 40206-1829
Project Congressional District KY-03
Number of Employees 5
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 27542
Originating Lender Name Republic Bank & Trust Company
Originating Lender Address LOUISVILLE, KY
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 50141.78
Forgiveness Paid Date 2021-04-22

Sources: Kentucky Secretary of State