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LIFECARE FAMILY HEALTH AND DENTAL CENTER INC: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
LIFECARE FAMILY HEALTH AND DENTAL CENTER INC (EIN 34-1708901)
Tax period
2023-01-01 to 2023-12-31
Filed
2024-11-11
IRS object ID
202403169349301925
Schema version
2023v5.1
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

FieldValueIRS element (for citing)
Return2024-11-11T10:10:38-06:00ReturnTs
Tax Period End2023-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN340677006PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MALONEY NOVOTNY LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14774 MUNSON STREET NW SUITE 402AddressLine1Txt
CityCANTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP447183634ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2023-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN341708901EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LIFECARE FAMILY HEALTH AND DENTAL CENTERBusinessNameLine1Txt
Business Name Line2INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlLIFEBusinessNameControlTxt
Phone3304542000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12725 LINCOLN STREET EASTAddressLine1Txt
CityCANTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44707ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonERIC NIEMEYERPersonNm
Person TitleCEOPersonTitleTxt
Phone3304542000PhoneNum
Signature2024-10-23SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMATTHEW J BANJOPreparerPersonNm
PTINP01260593PTIN
Phone3309669400PhoneNum
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2024-10-15 13:58:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerERIC NIEMEYERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12725 LINCOLN STREET EASTAddressLine1Txt
CityCANTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44707ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$14,182,686GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.LIFECAREFHDC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1992FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionPROVIDE HIGH-QUALITY, COMPREHENSIVE AND AFFORDABLE PRIMARY CARE HEALTH SERVICESActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee130TotalEmployeeCnt
Total Volunteers12TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$5,807,222PYContributionsGrantsAmt
CY Contributions Grants$4,946,680CYContributionsGrantsAmt
PY Program Service Revenue$6,698,402PYProgramServiceRevenueAmt
CY Program Service Revenue$9,054,842CYProgramServiceRevenueAmt
PY Investment Income$15,743PYInvestmentIncomeAmt
CY Investment Income$45,082CYInvestmentIncomeAmt
PY Other Revenue$86,107PYOtherRevenueAmt
CY Other Revenue$136,082CYOtherRevenueAmt
PY Total Revenue$12,607,474PYTotalRevenueAmt
CY Total Revenue$14,182,686CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,312,039PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,510,670CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,271,162PYOtherExpensesAmt
CY Other Expenses$4,466,313CYOtherExpensesAmt
PY Total Expenses$11,583,201PYTotalExpensesAmt
CY Total Expenses$12,976,983CYTotalExpensesAmt
PY Revenues Less Expenses$1,024,273PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,205,703CYRevenuesLessExpensesAmt
Total Assets BOY$8,408,044TotalAssetsBOYAmt
Total Assets EOY$9,899,853TotalAssetsEOYAmt
Total Liabilities BOY$1,725,072TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,880,948TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,682,972NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,018,905NetAssetsOrFundBalancesEOYAmt
MissionPROVIDE HIGH-QUALITY, COMPREHENSIVE AND AFFORDABLE PRIMARY CARE HEALTH SERVICES THAT IMPROVE OUR PATIENT'S OVERALL HEALTH.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$10,775,247ExpenseAmt
Revenue$9,190,924RevenueAmt
DescAS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC), LIFECARE FAMILY HEALTH AND DENTAL CENTER PROVIDES QUALITY PREVENTATIVE AND RESTORATIVE PRIMARY HEALTH CARE TO PATIENTS WITH PAYMENT OPTIONS BASED ON A PATIENT'S ABILITY TO PAY. LIFECARE CONTINUALLY IMPROVES ITS SERVICES AND FACILITIES TO DEVELOP A GROWING, FINANCIALLY-SOUND, PROGRESSIVE COMMUNITY HEALTH CENTER.Desc
Total Program Service Expenses$10,775,247TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document26IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee130EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldOHStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PATRICIA JOHNSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3304542000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12725 LINCOLN STREET EASTAddressLine1Txt
CityCANTONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44707ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
BARBARA FRUSTACI BSN RN
DIRECTOR1.00Yes (X)$0$0$0
DEAN VARIAN MD
CHAIR1.00Yes (X)$0$0$0Yes (X)
ALLANA HAUT
DIRECTOR1.00Yes (X)$0$0$0
GEORGE CRUES
VICE CHAIR1.00Yes (X)$0$0$0Yes (X)
REBECCA JOHNSON
DIRECTOR1.00Yes (X)$0$0$0
TERRANCE JONES
DIRECTOR1.00Yes (X)$0$0$0
ZACHARY HOSTETLER
SECRETARY1.00Yes (X)$0$0$0Yes (X)
GAIL TARANTINO
DIRECTOR1.00Yes (X)$0$0$0
KELLY HENLEY
TREASURER1.00Yes (X)$0$0$0Yes (X)
REBEKKA RUSSELL
DIRECTOR1.00Yes (X)$0$0$0
LORA HARLEY
DIRECTOR1.00Yes (X)$0$0$0
JOANNA PHILLIPS
DIRECTOR1.00Yes (X)$0$0$0
PATRICIA JOHNSON
CFO40.00$125,111$0$14,307Yes (X)
ERIC NIEMEYER
CEO40.00$187,019$0$34,531Yes (X)
DAVID M COLA
CHIEF MEDICAL DIRECTOR40.00$415,272$0$12,363Yes (X)
THOMAS K MUN
DENTAL DIRECTOR40.00$194,354$0$39,624Yes (X)
BYRON ROSSI
DENTIST40.00$189,538$0$43,260Yes (X)
PHILIP WITHNELL
PHYSICIAN40.00$185,573$0$29,105Yes (X)
WILLIAM FISCHER
DENTIST40.00$193,614$0$10,368Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,490,481TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$183,558TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K7IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

FieldValueIRS element (for citing)
PersonECLINICALWORKS LLCPersonNm

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 847950AddressLine1Txt
CityBOSTONCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02284ZIPCd
FieldValueIRS element (for citing)
ServicesBILLING SERVICESServicesDesc
Compensation$290,745CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$3,566,155GovernmentGrantsAmt
All Other Contributions$1,380,525AllOtherContributionsAmt
Noncash Contributions$1,379,655NoncashContributionsAmt
Total Contributions$4,946,680TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT & THIRD PARTY FEE621400$7,555,934$7,555,934
340B PROGRAM621400$1,266,178$1,266,178
INSURANCE INCENTIVES621400$232,730$232,730
FieldValueIRS element (for citing)
Total Program Service Revenue$9,054,842TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$34,102TotalRevenueColumnAmt
Exclusion$34,102ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$10,980SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$10,980SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,980TotalRevenueColumnAmt
Exclusion$10,980ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS INCOMEDesc
Business900099BusinessCd
Total Revenue Column$136,082TotalRevenueColumnAmt
Related Or Exempt Func Income$136,082RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$136,082OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,182,686TotalRevenueColumnAmt
Related Or Exempt Func Income$9,190,924RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$45,082ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$360,968TotalAmt
Program Services$309,456ProgramServicesAmt
Management And General$51,512ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,563,786TotalAmt
Program Services$5,626,288ProgramServicesAmt
Management And General$937,498ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$92,333TotalAmt
Program Services$77,559ProgramServicesAmt
Management And General$14,774ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$991,876TotalAmt
Program Services$834,754ProgramServicesAmt
Management And General$157,122ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$501,707TotalAmt
Program Services$426,898ProgramServicesAmt
Management And General$74,809ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$31,737TotalAmt
Management And General$31,737ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$20,500TotalAmt
Management And General$20,500ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$13,054TotalAmt
Management And General$13,054ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$221,234TotalAmt
Program Services$56,280ProgramServicesAmt
Management And General$164,954ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$129,297TotalAmt
Program Services$50,057ProgramServicesAmt
Management And General$79,240ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$239,556TotalAmt
Program Services$114,236ProgramServicesAmt
Management And General$125,320ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$559,329TotalAmt
Program Services$275,074ProgramServicesAmt
Management And General$284,255ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$199,105TotalAmt
Program Services$199,105ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$46,423TotalAmt
Program Services$14,913ProgramServicesAmt
Management And General$31,510ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$24,023TotalAmt
Program Services$6,699ProgramServicesAmt
Management And General$17,324ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$41,302TotalAmt
Program Services$39,043ProgramServicesAmt
Management And General$2,259ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$255,399TotalAmt
Program Services$161,581ProgramServicesAmt
Management And General$93,818ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$50,277TotalAmt
Program Services$44,180ProgramServicesAmt
Management And General$6,097ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$1,533,270$1,527,263$6,007
WHOLESALER EXP.-340B PR$428,224$427,224$1,000
PATIENT SUPPORT$294,188$294,188
REPAIRS AND MAINTENANCE$163,600$130,927$32,673

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$215,795TotalAmt
Program Services$159,522ProgramServicesAmt
Management And General$56,273ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,976,983TotalAmt
Program Services$10,775,247ProgramServicesAmt
Management And General$2,201,736ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$55,339BOYAmt
EOY$17,574EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,344,049BOYAmt
EOY$3,988,847EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,694,941BOYAmt
EOY$1,278,689EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$337,427BOYAmt
EOY$437,666EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$175,208BOYAmt
EOY$170,100EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,682,110LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,242,995LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,461,089BOYAmt
EOY$2,439,115EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,085,087BOYAmt
EOY$1,188,751EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$252,404BOYAmt
EOY$282,854EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$2,500BOYAmt
EOY$96,257EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,408,044BOYAmt
EOY$9,899,853EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$664,652BOYAmt
EOY$696,909EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$984,856BOYAmt
EOY$925,056EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$75,564BOYAmt
EOY$258,983EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,725,072BOYAmt
EOY$1,880,948EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,682,972BOYAmt
EOY$8,018,905EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,682,972BOYAmt
EOY$8,018,905EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,408,044BOYAmt
EOY$9,899,853EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,205,703ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$130,230NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$252,404BeginningYearBalanceAmt
Investment Earnings Or Losses$32,474InvestmentEarningsOrLossesAmt
Administrative Expenses$2,024AdministrativeExpensesAmt
End Year Balance$282,854EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$277,772BeginningYearBalanceAmt
Investment Earnings Or Losses-$23,475InvestmentEarningsOrLossesAmt
Administrative Expenses$1,893AdministrativeExpensesAmt
End Year Balance$252,404EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$236,448BeginningYearBalanceAmt
Investment Earnings Or Losses$43,319InvestmentEarningsOrLossesAmt
Administrative Expenses$1,995AdministrativeExpensesAmt
End Year Balance$277,772EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$324,409BeginningYearBalanceAmt
Investment Earnings Or Losses$12,820InvestmentEarningsOrLossesAmt
Grants Or Scholarships$99,115GrantsOrScholarshipsAmt
Administrative Expenses$1,666AdministrativeExpensesAmt
End Year Balance$236,448EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$485,988BeginningYearBalanceAmt
Investment Earnings Or Losses$78,821InvestmentEarningsOrLossesAmt
Grants Or Scholarships$237,000GrantsOrScholarshipsAmt
Administrative Expenses$3,400AdministrativeExpensesAmt
End Year Balance$324,409EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$77,201OtherCostOrOtherBasisAmt
Book Value$77,201BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,694,047OtherCostOrOtherBasisAmt
Depreciation$963,384DepreciationAmt
Book Value$1,730,663BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,054OtherCostOrOtherBasisAmt
Depreciation$11,336DepreciationAmt
Book Value$3,718BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,659,436OtherCostOrOtherBasisAmt
Depreciation$1,210,169DepreciationAmt
Book Value$449,267BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$236,372OtherCostOrOtherBasisAmt
Depreciation$58,106DepreciationAmt
Book Value$178,266BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,439,115TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescLEASE LIABILITIESDesc
Amt$258,983Amt
FieldValueIRS element (for citing)
Total Liability$258,983TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$14,299,862TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$130,230NetUnrealizedGainsInvstAmt
Revenue Not Reported$130,230RevenueNotReportedAmt
Revenue Subtotal$14,169,632RevenueSubtotalAmt
Investment Expenses Not Incld$13,054InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$13,054RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$14,182,686TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$12,963,929TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$12,963,929ExpensesSubtotalAmt
Investment Expenses Not Incld2$13,054InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$13,054ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$12,976,983TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:THE INTENDED USE OF THE ENDOWMENT IS TO BE USED FOR THE OPERATIONS OF THE ORGANIZATION.
PART X, LINE 2:THE PREPARATION OF FINANCIAL STATEMENTS IN CONFORMITY WITH GAAP REQUIRES THE CENTER TO REPORT INFORMATION REGARDING ITS EXPOSURE TO VARIOUS TAX POSITIONS TAKEN BY THE CENTER. THE CENTER HAS DETERMINED WHETHER ANY TAX POSITIONS HAVE MET THE RECOGNITION THRESHOLD AND HAS MEASURED THE CENTER'S EXPOSURE TO THOSE TAX POSITIONS. MANAGEMENT BELIEVES THAT THE CENTER HAS ADEQUATELY ADDRESSED ALL RELEVANT TAX POSITIONS AND THAT THERE ARE NO UNRECORDED TAX LIABILITIES. FEDERAL AND STATE TAX AUTHORITIES GENERALLY HAVE THE RIGHT TO EXAMINE AND AUDIT THE PREVIOUS THREE YEARS OF TAX RETURNS FILED.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredYes (1)SubstantiationRequiredInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DAVID M COLA
CHIEF MEDICAL DIRECTOR$295,885$0$119,387$0$0$0$12,363$0$0$0$427,635$0$0$0
THOMAS K MUN
DENTAL DIRECTOR$191,888$0$2,466$0$0$0$5,969$0$33,655$0$233,978$0$0$0
BYRON ROSSI
DENTIST$189,538$0$0$0$0$0$8,729$0$34,531$0$232,798$0$0$0
ERIC NIEMEYER
CEO$171,869$0$15,150$0$0$0$0$0$34,531$0$221,550$0$0$0
PHILIP WITHNELL
PHYSICIAN$185,573$0$0$0$0$0$2,180$0$26,925$0$214,678$0$0$0
WILLIAM FISCHER
DENTIST$191,078$0$2,536$0$0$0$0$0$10,368$0$203,982$0$0$0

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Noncash Contributions Rpt F990$1,379,655NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BFORM 990 REVIEW - FORM 990 IS REVIEWED BY THE CFO AND A COPY OF THE 990 IS SHARED WITH THE FINANCE COMMITTEE AND BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12CMONITORING AND ENFORCEMENT OF CONFLICT POLICY - BOARD MEMBERS ANNUALLY REVIEW THEIR STATUS FOR POTENTIAL CONFLICTS OF INTEREST AND DECLARE IN WRITING ANY THAT MAY EXIST. BOARD MEMBERS ABSTAIN FROM VOTING ON ISSUES THAT MAY REPRESENT A CONFLICT OF INTEREST FOR THEM.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION REVIEW AND APPROVAL - COMPENSATION OF THE CEO AND CFO IS COMPARED TO THE COMPENSATION SHOWN ON FORM 990 FOR SIMILAR ORGANIZATIONS. COMPENSATION FOR KEY EMPLOYEES IS DETERMINED BY A COMPARISON TO INDUSTRY AVERAGES FOR THAT POSITION.
FORM 990, PART VI, SECTION C, LINE 19AVAILABILITY OF DOCUMENTS - GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE AT THE CENTER'S OFFICE AND ARE PRESENTED TO THE PUBLIC UPON REQUEST.
COMPLETION OF SCHEDULE HALTHOUGH THIS ORGANIZATION UTILIZES THE PROVISION OF SECTION 170(B)(1)(A)(III) FOR ITS PUBLIC CHARITY STATUS, IT IS NOT LICENSED IN THE STATE OF OHIO AS A "HOSPITAL". THEREFORE, WE HAVE NOT COMPLETED SCHEDULE H IN ACCORDANCE WITH THE INSTRUCTIONS FOR THAT SCHEDULE.