WATERFALL CLINIC INCORPORATED: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- WATERFALL CLINIC INCORPORATED (EIN 93-1250581)
- Tax period
- 2023-07-01 to 2024-06-30
- Filed
- 2024-11-25
- IRS object ID
- 202423309349300927
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-25T16:26:13-06:00 | ReturnTs |
| Tax Period End | 2024-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 931250581 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WATERFALL CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WATE | BusinessNameControlTxt |
| Phone | 5417566232 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1890 WAITE STREET 1 | AddressLine1Txt |
| City | NORTH BEND | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97459 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LANCE NELSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5417566232 | PhoneNum |
| Signature | 2024-11-21 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2024-11-21 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WATERFALL COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LANCE NELSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1890 WAITE STREET 1 | AddressLine1Txt |
| City | NORTH BEND | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97459 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,213,049 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WFALL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | TO PROMOTE ACCESS TO QUALITY INTEGRATED HEALTH SERVICES THAT MEET THE NEEDS OF INDIVIDUALS WITH BARRIERS TO CARE ON THE SOUTHERN OREGON COAST. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 140 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | -$16,640 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,459,229 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,654,745 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,185,206 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,448,932 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$170,008 | PYInvestmentIncomeAmt |
| CY Investment Income | $18,705 | CYInvestmentIncomeAmt |
| PY Other Revenue | $107,447 | PYOtherRevenueAmt |
| CY Other Revenue | -$10,871 | CYOtherRevenueAmt |
| PY Total Revenue | $11,581,874 | PYTotalRevenueAmt |
| CY Total Revenue | $17,111,511 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $18,490 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,213,376 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,414,844 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,814,463 | PYOtherExpensesAmt |
| CY Other Expenses | $3,263,597 | CYOtherExpensesAmt |
| PY Total Expenses | $11,027,839 | PYTotalExpensesAmt |
| CY Total Expenses | $13,696,931 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $554,035 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,414,580 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,896,364 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,059,547 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,885,485 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,634,088 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,010,879 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,425,459 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROMOTE ACCESS TO QUALITY INTEGRATED HEALTH SERVICES THAT MEET THE NEEDS OF INDIVIDUALS WITH BARRIERS TO CARE ON THE SOUTHERN OREGON COAST. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,412,495 | ExpenseAmt |
| Grant | $18,490 | GrantAmt |
| Revenue | $13,448,932 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED INTEGRATED HEALTH CARE SERVICES TO INDIVIDUALS WITH BARRIERS TO CARE ON THE SOUTHERN OREGON COAST. SERVICES INCLUDE MEDICAL, DENTAL, MENTAL HEALTH CARE, PSYCHIATRY AND AUTISM SERVICES. | Desc |
| Total Program Service Expenses | $10,412,495 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 140 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANDREA ZAMORA | PersonNm |
| Phone | 5417566232 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1890 WAITE STREET 1 | AddressLine1Txt |
| City | NORTH BEND | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97459 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| LORRAINE DAVIES MD | |||||||
| PSYCHIATRIST | 40.00 | Yes (X) | $396,573 | $0 | $45,478 | ||
| ROBERT GERBER MD | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $289,875 | $0 | $1,303 | ||
| LANCE NELSON MS LPC | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $222,824 | $0 | $3,969 | Yes (X) | ||
| ANDREA ZAMORA CPA | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $198,733 | $0 | $15,839 | Yes (X) | ||
| ANTONIA PEREZ FNP | |||||||
| PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER | 40.00 | Yes (X) | $168,865 | $0 | $11,974 | ||
| DR PRIYA AGRAWAL | |||||||
| DENTAL PROGRAM MANAGER | 40.00 | Yes (X) | $157,418 | $0 | $8,179 | ||
| MARK PASTERNAK MD | |||||||
| PHYSICIAN | 40.00 | Yes (X) | $144,117 | $0 | $9,310 | ||
| CRAIG WRIGHT | |||||||
| CHIEF MEDICAL OFFICER | 40.00 | $138,532 | $0 | $8,312 | Yes (X) | ||
| NICOLE NORRIS MA THW | |||||||
| CHIEF QUALITY OFFICER | 40.00 | $129,254 | $0 | $9,139 | Yes (X) | ||
| KAREN SHEELAR MS LPC NCC | |||||||
| CHIEF BEHAVIORAL HEALTH OFFICER | 40.00 | $131,699 | $0 | $4,921 | Yes (X) | ||
| JUSTIN CASEY | |||||||
| CHIEF OPERATING OFFICER | 40.00 | $126,321 | $0 | $5,670 | Yes (X) | ||
| SANDRA QUALMAN | |||||||
| PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MARCE KNIGHT | |||||||
| VICE PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| ELIZABETH BRIGHAM | |||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| TONY CRANE | |||||||
| TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MCLCAIN ALTMAN | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| RUTH BELL | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ANNA HUIT | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ARNOLD ROBLAN | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| LESLIE RYAN | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| STEVE SANDEN | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,104,211 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $124,094 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| OCHIN | |||||
| 1881 SW NAITO PARKWAY | PORTLAND | OR | 97201 | ELECTRONIC MEDICAL RECORDS SERVICES | $246,243 |
| CURATIVE TALENT | |||||
| 370 W LAS COLINAS BLVD SUITE 104 | IRVING | TX | 75039 | STAFFING SERVICES | $109,800 |
| CENTERLOGIC | |||||
| 7414 NE HAZEL DELL AVENUE 150 | VANCOUVER | WA | 98665 | IT CONTRACT SERVICES | $101,631 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,514,740 | GovernmentGrantsAmt |
| All Other Contributions | $140,005 | AllOtherContributionsAmt |
| Total Contributions | $3,654,745 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 624100 | $7,533,950 | $7,533,950 |
| CAPITATION | 624100 | $5,062,577 | $5,062,577 |
| OTHER PROGRAM REVENUES | 624100 | $449,758 | $449,758 |
| PHARMACY | 456110 | $402,647 | $402,647 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,448,932 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,705 | TotalRevenueColumnAmt |
| Exclusion | $18,705 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $90,582 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $101,538 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$10,956 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$10,956 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$16,640 | UnrelatedBusinessRevenueAmt |
| Exclusion | $5,684 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $85 | TotalRevenueColumnAmt |
| Exclusion | $85 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $85 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,111,511 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,448,932 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$16,640 | UnrelatedBusinessRevenueAmt |
| Exclusion | $24,474 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,000 | TotalAmt |
| Program Services | $10,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,490 | TotalAmt |
| Program Services | $8,490 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $988,516 | TotalAmt |
| Management And General | $988,516 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,206,886 | TotalAmt |
| Program Services | $6,115,686 | ProgramServicesAmt |
| Management And General | $1,091,200 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,762 | TotalAmt |
| Program Services | $249,174 | ProgramServicesAmt |
| Management And General | $62,588 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,017,863 | TotalAmt |
| Program Services | $778,580 | ProgramServicesAmt |
| Management And General | $239,283 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $889,817 | TotalAmt |
| Program Services | $667,363 | ProgramServicesAmt |
| Management And General | $222,454 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,695 | TotalAmt |
| Management And General | $69,695 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,138,886 | TotalAmt |
| Program Services | $897,871 | ProgramServicesAmt |
| Management And General | $241,015 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,424 | TotalAmt |
| Program Services | $64,424 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,100 | TotalAmt |
| Program Services | $75,825 | ProgramServicesAmt |
| Management And General | $25,275 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383,013 | TotalAmt |
| Program Services | $341,955 | ProgramServicesAmt |
| Management And General | $41,058 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,886 | TotalAmt |
| Program Services | $38,999 | ProgramServicesAmt |
| Management And General | $5,887 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,039 | TotalAmt |
| Program Services | $158,039 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $291,633 | TotalAmt |
| Program Services | $218,725 | ProgramServicesAmt |
| Management And General | $72,908 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,848 | TotalAmt |
| Program Services | $80,136 | ProgramServicesAmt |
| Management And General | $26,712 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $438,243 | $342,697 | $95,546 |
| OTHER EMPLOYEE EXPENSES | $157,613 | $118,907 | $38,706 |
| PROGRAM DEVELOPMENT | $114,789 | $99,523 | $15,266 |
| DUES & SUBSCRIPTIONS | $80,091 | $60,069 | $20,022 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,337 | TotalAmt |
| Program Services | $86,032 | ProgramServicesAmt |
| Management And General | $28,305 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,696,931 | TotalAmt |
| Program Services | $10,412,495 | ProgramServicesAmt |
| Management And General | $3,284,436 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $816,209 | BOYAmt |
| EOY | $2,356,935 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $788,050 | BOYAmt |
| EOY | $1,488,485 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,389,211 | BOYAmt |
| EOY | $2,454,582 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,301 | BOYAmt |
| EOY | $98,669 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,320,387 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,714,269 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,015,337 | BOYAmt |
| EOY | $9,606,118 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,814,256 | BOYAmt |
| EOY | $1,054,758 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,896,364 | BOYAmt |
| EOY | $17,059,547 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $454,601 | BOYAmt |
| EOY | $718,916 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $59,771 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $13,654 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $564,290 | BOYAmt |
| EOY | $5,761,344 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,866,594 | BOYAmt |
| EOY | $1,080,403 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,885,485 | BOYAmt |
| EOY | $7,634,088 | 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 | $6,010,879 | BOYAmt |
| EOY | $9,392,959 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $32,500 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,010,879 | BOYAmt |
| EOY | $9,425,459 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,896,364 | BOYAmt |
| EOY | $17,059,547 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,414,580 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $622,538 | OtherCostOrOtherBasisAmt |
| Book Value | $622,538 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,474,382 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,141,367 | DepreciationAmt |
| Book Value | $8,333,015 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $538,652 | OtherCostOrOtherBasisAmt |
| Depreciation | $52,603 | DepreciationAmt |
| Book Value | $486,049 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $684,815 | OtherCostOrOtherBasisAmt |
| Depreciation | $520,299 | DepreciationAmt |
| Book Value | $164,516 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,606,118 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| SECURITY DEPOSITS | $12,575 |
| RIGHT-OF-USE LEASE ASSETS | $1,042,183 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,054,758 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RIGHT-OF-USE LEASE LIABILITIES | Desc |
| Amt | $1,080,403 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,080,403 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $17,180,549 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $101,538 | OtherRevenueAmt |
| Revenue Not Reported | $101,538 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,079,011 | RevenueSubtotalAmt |
| Other Revenues Not Included | $32,500 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $32,500 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,111,511 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,798,469 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $101,538 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $101,538 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,696,931 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,696,931 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | THE ORGANIZATION HOLDS SECURITY DEPOSITS FOR RENTAL TENANTS. THE FUNDS ARE RETURNED TO THE TENANT WHEN THE RENTAL RELATIONSHIP ENDS, LESS THE COST OF ANY REPAIRS. |
| PART X, LINE 2: | THE CENTER IS INCORPORATED AS A NONPROFIT ENTITY AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAX UNDER THE PROVISIONS OF THE INTERNAL REVENUE CODE SECTION 501(C)(3). MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CENTER AND HAS CONCLUDED THAT, AS OF JUNE 30, 2024 AND 2023, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2021 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. THE CENTER WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE STATEMENT OF FINANCIAL POSITION. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 101,538. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTIONS WITH DONOR RESTRICTIONS 32,500. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 101,538. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COOS BAY COAST LEAGUE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 56 | AddressLine1Txt |
| City | COOS BAY | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97420 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 264374145 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $10,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | GENERAL OPERATING SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| TRANSPORTATION ASSISTANCE | 455 | $5,660 |
| CLOTHING ASSISTANCE | 91 | $1,132 |
| HOUSING ASSISTANCE | 137 | $1,698 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | PRIOR TO GIVING TO ANOTHER ORGANIZATION, WATERFALL CLINIC CONFIRMS THEIR CHARITABLE OR GOVERNMENTAL STATUS. GRANTS ARE INTENDED AS GENERAL OPERATING SUPPORT, SO NO FURTHER FOLLOW-UP IS CONDUCTED. CASH IS NOT GIVEN DIRECTLY TO INDIVIDUALS. ANY PAYMENTS ARE MADE DIRECTLY TO THIRD PARTIES ON THE INDIVIDUAL'S BEHALF. INDIVIDUALS ARE GIVEN GAS CARDS THAT HAVE TO BE USED AT THE GASH STATION. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LORRAINE DAVIES MD | ||||||||||||||
| PSYCHIATRIST | $353,302 | $0 | $10,088 | $0 | $33,183 | $0 | $21,700 | $0 | $23,778 | $0 | $442,051 | $0 | $0 | $0 |
| ROBERT GERBER MD | ||||||||||||||
| PHYSICIAN | $272,715 | $0 | $13,560 | $0 | $3,600 | $0 | $0 | $0 | $1,303 | $0 | $291,178 | $0 | $0 | $0 |
| LANCE NELSON MS LPC | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $214,924 | $0 | $7,900 | $0 | $0 | $0 | $1,270 | $0 | $2,699 | $0 | $226,793 | $0 | $0 | $0 |
| ANDREA ZAMORA CPA | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $193,588 | $0 | $5,145 | $0 | $0 | $0 | $1,696 | $0 | $14,143 | $0 | $214,572 | $0 | $0 | $0 |
| ANTONIA PEREZ FNP | ||||||||||||||
| PSYCHIATRIC MENTAL HEALTH NURSE PRAC | $156,307 | $0 | $12,558 | $0 | $0 | $0 | $9,117 | $0 | $2,857 | $0 | $180,839 | $0 | $0 | $0 |
| DR PRIYA AGRAWAL | ||||||||||||||
| DENTAL PROGRAM MANAGER | $125,212 | $0 | $10,000 | $0 | $22,206 | $0 | $7,633 | $0 | $546 | $0 | $165,597 | $0 | $0 | $0 |
| MARK PASTERNAK MD | ||||||||||||||
| PHYSICIAN | $141,364 | $0 | $2,753 | $0 | $0 | $0 | $8,647 | $0 | $663 | $0 | $153,427 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD. TO THE EXTENT PERMITTED BY LAW AND BY THE RESOLUTION OF THE BOARD, THE EXECUTIVE COMMITTEE MAY EXERCISE ALL OF THE AUTHORITY OF THE BOARD EXCEPT (A) THE AMENDMENT OR REPEAL OF ANY BOARD RESOLUTION, (B) ENCUMBERING FINANCIAL OBLIGATIONS ON BEHALF OF THE BOARD OR THE ORGANIZATOIN, (C) THE APPOINTMENT OF ANY COMMITTEES OR MEMBERS OF ANY COMMITTEES, AND (D) APPROVAL OR REMOVAL OF BOARD MEMBERS. THROUGH MAY 2024, THE EXECUTIVE COMMITTEE HAD THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS WHEN THE FULL BOARD WAS NOT AVAILABLE AND IMMEDIATE ACTION WAS NECESSARY. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS WERE AMENDED IN MAY 2024 TO CLARIFY THAT THE CEO IS A NON-VOTING EX-OFFICIO MEMBER OF THE BOARD OF DIRECTORS AND TO REMOVE THE EXECUTIVE COMMITTEE'S AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS WHEN THE FULL BOARD IS NOT AVAILABLE AND IMMEDIATE ACTION IS NECESSARY. |
| FORM 990, PART VI, SECTION B, LINE 11B | PRIOR TO FILING, THE FORM 990 WAS REVIEWED BY THE CFO AND THE CEO, THEN IT WAS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW, AFTER WHICH IT RECOMMENDED THAT THE BOARD APPROVE TO FILE. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO THE BOARD MEMBERS, OFFICERS AND EXECUTIVE MANAGEMENT EMPLOYEES. EACH COVERED INDIVIDUAL IS REQUIRED TO COMPLETE A DISCLOSURE STATEMENT ON AN ANNUAL BASIS. EMPLOYEES DISCLOSE CONFLICTS OF INTEREST TO THE CEO. BOARD MEMBERS DISCLOSE CONFLICTS OF INTEREST TO THE BOARD PRESIDENT. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE BOARD OF DIRECTORS MAKES THE DETERMINATION. THE BOARD OF DIRECTORS DETERMINES WHETHER THE TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR AND REASONABLE TO THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 15A | A BOARD SUB-COMMITTEE PERFORMS A REVIEW OF THE CEO AND MAKES A RECOMMENDATION TO THE BOARD REGARDING COMPENSATION UTILIZING SALARY SURVEY DATA PROVIDED BY NORTHWEST REGIONAL PRIMARY CARE ASSOCIATION AND THE OREGON PRIMARY CARE ASSOCIATION. THE CEO PERFORMS REVIEWS OF OTHER OFFICERS AND KEY EMPLOYEES AND UTILIZES THE SALARY SURVEY DATA PROVIDED BY NORTHWEST REGIONAL PRIMARY CARE ASSOCIATION AND THE OREGON PRIMARY CARE ASSOCIATION TO DETERMINE COMPENSATION. THIS PROCESS IS COMPLETED ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | ANY MEMBER OF THE PUBLIC MAY REVIEW THE GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS IN THE BUSINESS OFFICE DURING NORMAL BUSINESS HOURS. |