UPPER GREAT LAKES FAMILY HEALTH CENTER: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- UPPER GREAT LAKES FAMILY HEALTH CENTER (EIN 26-4299275)
- Tax period
- 2020-11-01 to 2021-10-31
- Filed
- 2022-09-12
- IRS object ID
- 202242559349300204
- Schema version
- 2020v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-09-12T08:25:50-04:00 | ReturnTs |
| Tax Period End | 2021-10-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381977929 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDERSON TACKMAN & COMPANY PLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 W WASHINGTON ST SUITE 109 | AddressLine1Txt |
| City | MARQUETTE | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49855 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264299275 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPPER GREAT LAKES FAMILY HEALTH CEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UPPE | BusinessNameControlTxt |
| Phone | 9064831705 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 135 EAST M-35 | AddressLine1Txt |
| City | GWINN | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49841 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TREVOR HODGES | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9064831705 | PhoneNum |
| Signature | 2022-09-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TREVOR | PersonFirstNm |
| Person Last | HODGES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WILLIAM C SHELTROW CPA | PreparerPersonNm |
| PTIN | P00281691 | PTIN |
| Phone | 9062251166 | PhoneNum |
| Preparation | 2022-09-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DONALD SIMILA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 135 EAST M-35 | AddressLine1Txt |
| City | GWINN | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49841 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $27,617,561 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UGLHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2009 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES FOR ALL PEOPLE IN THE UPPER GREAT LAKES REGION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 233 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $2,470 | TotalGrossUBIAmt |
| PY Contributions Grants | $6,367,850 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,420,273 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,906,120 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,143,822 | CYProgramServiceRevenueAmt |
| PY Investment Income | $221 | PYInvestmentIncomeAmt |
| CY Investment Income | $258 | CYInvestmentIncomeAmt |
| PY Other Revenue | $41,215 | PYOtherRevenueAmt |
| CY Other Revenue | $51,945 | CYOtherRevenueAmt |
| PY Total Revenue | $24,315,406 | PYTotalRevenueAmt |
| CY Total Revenue | $27,616,298 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,857,957 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,521,672 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,013,204 | PYOtherExpensesAmt |
| CY Other Expenses | $8,830,382 | CYOtherExpensesAmt |
| PY Total Expenses | $21,871,161 | PYTotalExpensesAmt |
| CY Total Expenses | $22,352,054 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,444,245 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,264,244 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,807,281 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,648,579 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,951,945 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,528,999 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,855,336 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,119,580 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES FOR ALL PEOPLE IN THE UPPER GREAT LAKES REGION REGARDLESS OF ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $19,485,277 | ExpenseAmt |
| Revenue | $20,143,822 | RevenueAmt |
| Desc | THE ORGANIZATION OPERATES CLINICS IN TWELVE LOCATIONS SERVING HOUGHTON, IRON, MARQUETTE, MENOMINEE AND ONTONAGON COUNTIES. SERVICES (ONSITE AND THROUGH REFERRAL) INCLUDE PRIMARY CARE, ORAL HEALTH CARE AND BEHAVIORAL HEALTH SERVICES, SUBSTANCE ABUSE COUNSELING, ENABLING SERVICES, SPECIALTY CARE/SERVICES, EDUCATION AND COMPREHENSIVE OUTREACH. DURING THE TAX YEAR, THE ORGANIZATION HAD 85,892 PATIENT VISITS. | Desc |
| Total Program Service Expenses | $19,485,277 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (true) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 233 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | Yes (true) | LocalChaptersInd |
| Policies Reference Chapters | Yes (true) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TREVOR HODGES | PersonNm |
| Phone | 9064831846 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 56901 S 6TH STREET SUITE 1 2 | AddressLine1Txt |
| City | CALUMET | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49913 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CATHRYN BEER | ||||||||
| CHAIR (PRESI | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN VAIRO | ||||||||
| VICE CHAIR | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DIANNA CHRISTENSON | ||||||||
| SECRETARY | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| FR ALLEN MOTT | ||||||||
| TREASURER | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GUY HEMBROFF | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| ELISE BUR | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| NICHOLAS EMMENDORFER | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| CHRISTOPHER ADAMS | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| TANYA JOHNSON | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| KEVIN PIGGOTT | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| JULIE SHAW | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| MICAH STIPECH | ||||||||
| TRUSTEE | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| DONALD SIMILA | ||||||||
| CEO | 40.00 | Yes (X) | $304,493 | $0 | $18,551 | |||
| TREVOR HODGES | ||||||||
| CFO | 40.00 | Yes (X) | $109,632 | $0 | $22,611 | |||
| CATHERINE KROLL | ||||||||
| CMO | 40.00 | $338,245 | $0 | $26,682 | Yes (X) | |||
| BRUCE TRUSOCK | ||||||||
| MEDICAL DIRE | 32.00 | $194,796 | $0 | $17,815 | Yes (X) | |||
| ZACHARIAH DEYOUNG | ||||||||
| PHYSICIAN | 40.00 | $225,800 | $0 | $26,381 | Yes (X) | |||
| JOE-LA DEWITT | ||||||||
| PHYSICIAN | 40.00 | $318,410 | $0 | $28,538 | Yes (X) | |||
| ADAM FRIMODIG | ||||||||
| PHYSICIAN | 40.00 | $206,838 | $0 | $26,075 | Yes (X) | |||
| JESSE HEARD | ||||||||
| PHYSICIAN | 40.00 | $215,669 | $0 | $14,814 | Yes (X) | |||
| SHERYL PARKS | ||||||||
| PHYSICIAN | 40.00 | $360,350 | $0 | $27,784 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,274,233 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $209,251 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| UP HEALTH SYSTEM - PORTAGE | ||||||
| 500 CAMPUS DRIVE | HANCOCK | MI | 49930 | LEASED EMPLOYEE | $3,116,407 | |
| LIFEPOINT CORPORATE SERVICES | ||||||
| PO BOX 645061 | CINCINNATTI | OH | 45264 | RENT | $732,171 | |
| E CLINICAL WORKS LLC | ||||||
| PO BOX 847950 | BOSTON | MA | 02284 | RECORDS MANAGEM | $409,626 | |
| 44 NORTH | ||||||
| 620 S LAKE ST | MARQUETTE | MI | 49855 | MEDICAL/ HEALTH | $146,581 | PO BOX 747 |
| COMP HEALTH | ||||||
| PO BOX 972651 | DALLAS | TX | 75397 | MEDICAL LOCUM | $133,356 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,971,659 | GovernmentGrantsAmt |
| All Other Contributions | $448,614 | AllOtherContributionsAmt |
| Total Contributions | $7,420,273 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PHYSICIAN SERVICES | 621110 | $15,330,226 | $15,330,226 |
| 340B DRUG PRICING PROGRAM | 621110 | $4,161,597 | $4,161,597 |
| INCENTIVE PROGRAM PAYMENTS | 621110 | $382,692 | $382,692 |
| VACCINE PROGRAM | 621110 | $108,139 | $108,139 |
| MI CARE PROGRAM | 621110 | $83,253 | $83,253 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,915 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $77,915 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,143,822 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $258 | TotalRevenueColumnAmt |
| Exclusion | $258 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,447 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,263 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $35,184 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,184 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $2,470 | UnrelatedBusinessRevenueAmt |
| Exclusion | $32,714 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| MEDICAL RECORDS FEES | 561439 | $9,048 | $9,048 | |
| MISCELLANEOUS | 900099 | $7,713 | $7,713 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $16,761 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,616,298 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,152,870 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,470 | UnrelatedBusinessRevenueAmt |
| Exclusion | $40,685 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,005,949 | TotalAmt |
| Program Services | $575,995 | ProgramServicesAmt |
| Management And General | $429,954 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,824,784 | TotalAmt |
| Program Services | $8,521,821 | ProgramServicesAmt |
| Management And General | $1,302,963 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $303,438 | TotalAmt |
| Program Services | $254,888 | ProgramServicesAmt |
| Management And General | $48,550 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,635,340 | TotalAmt |
| Program Services | $1,447,200 | ProgramServicesAmt |
| Management And General | $188,140 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $752,161 | TotalAmt |
| Program Services | $631,815 | ProgramServicesAmt |
| Management And General | $120,346 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,529 | TotalAmt |
| Management And General | $13,529 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,436 | TotalAmt |
| Program Services | $6,298 | ProgramServicesAmt |
| Management And General | $31,138 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,014,939 | TotalAmt |
| Program Services | $3,829,509 | ProgramServicesAmt |
| Management And General | $185,430 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,370 | TotalAmt |
| Program Services | $70,317 | ProgramServicesAmt |
| Management And General | $53 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,054 | TotalAmt |
| Program Services | $108,392 | ProgramServicesAmt |
| Management And General | $67,662 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,135,074 | TotalAmt |
| Program Services | $953,462 | ProgramServicesAmt |
| Management And General | $181,612 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $986,958 | TotalAmt |
| Program Services | $982,610 | ProgramServicesAmt |
| Management And General | $4,348 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,328 | TotalAmt |
| Program Services | $73,355 | ProgramServicesAmt |
| Management And General | $13,973 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,714 | TotalAmt |
| Program Services | $16,906 | ProgramServicesAmt |
| Management And General | $19,808 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,415 | TotalAmt |
| Management And General | $1,415 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,378 | TotalAmt |
| Program Services | $262,662 | ProgramServicesAmt |
| Management And General | $37,716 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,137 | TotalAmt |
| Program Services | $153,137 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES/EQUIP | $1,218,002 | $1,034,656 | $183,346 |
| BAD DEBTS/SLIDING FEE | $446,545 | $446,545 | |
| LICENSES/DUES | $86,126 | $51,149 | $34,977 |
| 340B DRUG PROGRAM COSTS | $55,082 | $55,082 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,295 | TotalAmt |
| Program Services | $9,478 | ProgramServicesAmt |
| Management And General | $1,817 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,352,054 | TotalAmt |
| Program Services | $19,485,277 | ProgramServicesAmt |
| Management And General | $2,866,777 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,304,485 | BOYAmt |
| EOY | $10,265,812 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,698,666 | BOYAmt |
| EOY | $334,063 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,826,025 | BOYAmt |
| EOY | $3,332,350 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,609 | BOYAmt |
| EOY | $205,336 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $278,609 | BOYAmt |
| EOY | $302,571 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,539,651 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,551,994 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,225,675 | BOYAmt |
| EOY | $1,987,657 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $327,212 | BOYAmt |
| EOY | $220,790 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,807,281 | BOYAmt |
| EOY | $16,648,579 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,277,966 | BOYAmt |
| EOY | $2,402,613 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,132 | BOYAmt |
| EOY | $126,386 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,047 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,367,800 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,951,945 | BOYAmt |
| EOY | $2,528,999 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,855,336 | BOYAmt |
| EOY | $14,119,580 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,855,336 | BOYAmt |
| EOY | $14,119,580 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,807,281 | BOYAmt |
| EOY | $16,648,579 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,264,244 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $144,900 | OtherCostOrOtherBasisAmt |
| Book Value | $144,900 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,607,269 | OtherCostOrOtherBasisAmt |
| Depreciation | $128,871 | DepreciationAmt |
| Book Value | $1,478,398 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,780,197 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,423,123 | DepreciationAmt |
| Book Value | $357,074 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,285 | OtherCostOrOtherBasisAmt |
| Book Value | $7,285 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,987,657 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $27,115,934 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,263 | OtherRevenueAmt |
| Revenue Not Reported | $1,263 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,114,671 | RevenueSubtotalAmt |
| Other Revenues Not Included | $501,627 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $501,627 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $27,616,298 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $21,851,690 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1,263 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,263 | ExpensesNotReportedAmt |
| Expenses Subtotal | $21,850,427 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $501,627 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $501,627 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $22,352,054 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | AUDITED FS REPORT DEPRECIATION FOR RENTAL PORTION 1,263 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | AUDITED FS REPORT PATIENT FEE REVENUE NET OF SLIDING FEE 92,893 AUDITED FS REPORT PATIENT FEE REVENUE NET OF BAD DEBTS 353,652 AUDITED FS REPORT DRUG PRICING PROGRAM REVENUE NET OF COST 55,082 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | AUDITED FS REPORT DEPRECIATION FOR RENTAL PORTION 1,263 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | AUDITED FS REPORT DRUG PRICING PROGRAM REVENUE NET OF COST 55,082 AUDITED FS REPORT PATIENT FEE REVENUE NET OF SLIDING FEE 92,893 AUDITED FS REPORT PATIENT FEE REVENUE NET OF BAD DEBTS 353,652 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount |
|---|---|---|---|---|---|---|
| DONALD SIMILA | ||||||
| CEO | $276,067 | $28,426 | $9,140 | $11,632 | $323,044 | |
| CATHERINE KROLL | ||||||
| CMO | $177,577 | $49,936 | $10,268 | $22,422 | $364,927 | $110,732 |
| BRUCE TRUSOCK | ||||||
| MEDICAL DIRECTOR | $136,440 | $16,921 | $6,149 | $23,873 | $212,611 | $41,435 |
| ZACHARIAH DEYOUNG | ||||||
| PHYSICIAN | $218,117 | $6,683 | $5,057 | $27,515 | $252,181 | $1,000 |
| JOE-LA DEWITT | ||||||
| PHYSICIAN | $312,116 | $1,294 | $9,645 | $26,849 | $346,948 | $5,000 |
| ADAM FRIMODIG | ||||||
| PHYSICIAN | $179,422 | $24,159 | $6,344 | $24,566 | $232,913 | $3,257 |
| JESSE HEARD | ||||||
| PHYSICIAN | $179,886 | $16,187 | $6,465 | $9,839 | $230,483 | $19,596 |
| SHERYL PARKS | ||||||
| PHYSICIAN | $335,839 | $19,511 | $10,653 | $23,984 | $388,134 | $5,000 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NASTARA HOLDING LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | NASTARA HOLDING | RelationshipDescriptionTxt |
| Transaction | $100,245 | TransactionAmt |
| Transaction | BUILDING RENTAL | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: NASTARA HOLDING LLC (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: NASTARA HOLDINGS LLC IS OWNED BY THE SPOUSE OF A KEY EMPLOYEE (D) DESCRIPTION OF TRANSACTION: BUILDING RENTAL | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER. THEN A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES BEFORE IT IS FILED. IT IS ULTIMATELY SIGNED BY THE CHEIF FINANCIAL OFFICER. |
| FORM 990, PAGE 6, PART VI, LINE 12C | BOARD MEMEBERS ARE REQUIRED TO ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY ACKNOWLEDGMENT AND DISCLOSURE FORM AT THE ANNUAL BOARD MEETING. ANY CONFLICTS ARE NOTED AND MONITORED. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION FOR THE CEO AND OTHER OFFICERS INCLUDES A REVIEW OF CURRENT WAGE AND SALARY SURVEYS CONDUCTED BY THE MICHIGAN PRIMARY CARE ASSOCIATION AND THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. THE PERSONNEL COMMITTEE PRESENTS ITS RECOMMENDATIONS TO THE BOARD FOR APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 15B | COMPENSATION FOR THE CEO AND OTHER OFFICERS INCLUDES A REVIEW OF CURRENT WAGE AND SALARY SURVEYS CONDUCTED BY THE MICHIGAN PRIMARY CARE ASSOCIATION AND THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. THE PERSONNEL COMMITTEE PRESENTS ITS RECOMMENDATIONS TO THE BOARD FOR APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE DECISION OF WHETHER OR NOT TO RELEASE THESE DOCUMENTS IS MADE ON A CASE BY CASE BASIS IF AND WHEN THEY ARE REQUESTED. |
| FORM 990, PART IX, LINE 11G | CONSULTING 0 34,680 0 LEASED STAFF 2,230,061 0 0 PURCHASED SERVICES 765,332 145,778 0 LOCUMS 669,549 0 0 RECRUITMENT 164,567 4,972 0 TOTAL 3,829,509 185,430 0 |