MAINLINE HEALTH SYSTEMS INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- MAINLINE HEALTH SYSTEMS INC (EIN 71-0623643)
- Tax period
- 2023-02-01 to 2024-01-31
- Filed
- 2024-12-16
- IRS object ID
- 202443519349300549
- 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 | 2024-12-16T11:40:48+00:00 | ReturnTs |
| Tax Period End | 2024-01-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Forvis Mazars LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 3667 | AddressLine1Txt |
| City | Little Rock | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 722033667 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-02-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 710623643 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAINLINE HEALTH SYSTEMS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MAIN | BusinessNameControlTxt |
| Phone | 8705385414 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 509 | AddressLine1Txt |
| City | DERMOTT | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71638 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY ALLAN NICHOLS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8705385414 | PhoneNum |
| Signature | 2024-12-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Amber Sherrill | PreparerPersonNm |
| PTIN | P00748683 | PTIN |
| Phone | 5013721040 | PhoneNum |
| Preparation | 2023-12-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GARY ALLAN NICHOLS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 509 | AddressLine1Txt |
| City | DERMOTT | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71638 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,645,863 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | https://www.mainlinehealth.net | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | AR | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE QUALITY OF LIFE FOR THE POPULATION WITHIN THE SCOPE OF OPERATION THROUGH THE DELIVERY OF HIGH QUALITY ACCESSIBLE COMPREHENSIVE HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 328 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,308,017 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,543,343 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,998,192 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,930,897 | CYProgramServiceRevenueAmt |
| PY Investment Income | $490 | PYInvestmentIncomeAmt |
| CY Investment Income | -$5,856 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,343 | PYOtherRevenueAmt |
| CY Other Revenue | $111,779 | CYOtherRevenueAmt |
| PY Total Revenue | $35,308,042 | PYTotalRevenueAmt |
| CY Total Revenue | $42,580,163 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $15,372 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $15,000 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,176,402 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $24,937,205 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,816,990 | PYOtherExpensesAmt |
| CY Other Expenses | $17,831,705 | CYOtherExpensesAmt |
| PY Total Expenses | $33,008,764 | PYTotalExpensesAmt |
| CY Total Expenses | $42,783,910 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,299,278 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$203,747 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $33,839,417 | TotalAssetsBOYAmt |
| Total Assets EOY | $33,841,173 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,120,990 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,876,324 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $23,718,427 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,964,849 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IMPROVE THE QUALITY OF LIFE FOR THE POPULATION WITHIN THE SCOPE OF OPERATION THROUGH THE DELIVERY OF HIGH QUALITY ACCESSIBLE COMPREHENSIVE HEALTH CARE. SERVICES INCLUDE MEDICAL, DENTAL, MENTAL HEALTH AND PREVENTIVE HEALTH SERVICES FOR THE ENTIRE FAMILY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $33,392,811 | ExpenseAmt |
| Grant | $15,000 | GrantAmt |
| Revenue | $34,930,897 | RevenueAmt |
| Desc | PROVIDED MEDICAL SERVICES TO 23,917 PATIENTS, DENTAL SERVICES TO 4,599 PATIENTS, AND BEHAVIORAL HEALTH SERVICES TO 1,352 PATIENTS IN SOUTHEAST ARKANSAS; SERVED RESIDENTS OF CHICOT, BRADLEY, ASHLEY, DREW, LINCOLN, GRANT, CLEVELAND & PULASKI COUNTIES. | Desc |
| Total Program Service Expenses | $33,392,811 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| 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 | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | 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 | Yes (true) | 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 | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | 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 | 58 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 328 | 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 |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | false | LocalChaptersInd |
| 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAINLINE HEALTH SYSTEMS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8705385414 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 108 E SPEEDWAY | AddressLine1Txt |
| City | DERMOTT | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71638 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ALICIA WHITAKER | ||||||||
| BOARD CHAIR | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BECKY PHILLIPS | ||||||||
| TREASURER | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| FRANK HENTRY JR | ||||||||
| SECRETARY | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RON MILLER | ||||||||
| BOARD VICE CHAIR | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRANDI POOLE | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| EUGENE BUTLER | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| IRMA BERNAL | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| KEITH SHEPHERD | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| LESLIE ADAMS | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| MARY HOLLINS-SCOTT RN | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| MICHELLE DUNBAR | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT THOMAS | ||||||||
| BOARD MEMER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| SHANNA KNOWLES | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| AMANDA GILBERT | ||||||||
| CPO | 40.0 | 0.0 | Yes (X) | $127,348 | $0 | $12,889 | ||
| ASHLEY ANTHONY | ||||||||
| COO | 40.0 | 0.0 | Yes (X) | $144,042 | $0 | $7,708 | ||
| BYRON MONTGOMERY | ||||||||
| CIO | 40.0 | 0.0 | Yes (X) | $147,523 | $0 | $13,890 | ||
| GARY ALLAN NICHOLS | ||||||||
| CEO | 40.0 | 0.0 | Yes (X) | $307,840 | $0 | $20,565 | ||
| JENI BARHAM | ||||||||
| CQO & CCO | 40.0 | 0.0 | Yes (X) | $121,894 | $0 | $11,555 | ||
| TAFTA MCCAIN | ||||||||
| CFO - THROUGH 1/21/24 | 40.0 | 0.0 | Yes (X) | $154,169 | $0 | $14,116 | ||
| BLAYNE BEENE DO | ||||||||
| MEDICAL DOCTOR | 40.0 | 0.0 | $253,291 | $0 | $16,617 | Yes (X) | ||
| CONSTANCE CHAPMAN MD | ||||||||
| MEDICAL DOCTOR | 40.0 | 0.0 | $341,430 | $0 | $7,708 | Yes (X) | ||
| KELLY SHRUM MD | ||||||||
| MEDICAL DOCTOR | 40.0 | 0.0 | $321,935 | $0 | $20,742 | Yes (X) | ||
| KERRY PENNINGTON MD | ||||||||
| MEDICAL DOCTOR | 40.0 | 0.0 | $391,926 | $0 | $16,054 | Yes (X) | ||
| PAUL WHIPPLE MD | ||||||||
| MEDICAL DOCTOR | 40.0 | 0.0 | $295,566 | $0 | $18,200 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,606,964 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $160,044 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 39 | 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 |
|---|---|---|---|---|---|---|
| CPI 340B LLC | ||||||
| PO BOX 7 | MAMMOTH SPRING | AR | 72554 | 340B Pharmacy Consultant | $240,428 | |
| FORVIS MAZARS LLP | ||||||
| 111 Center St | Little Rock | AR | 72201 | ACCOUNTING | $206,699 | 1600 |
| REAL RADIOLOGY | ||||||
| 17310 Wright St | Omaha | NE | 68130 | RADIOLOGY SERVICES | $190,316 | |
| PHILLIPS MANAGEMENT | ||||||
| 148 QUAIL RUN | MONTICELLO | AR | 71655 | JANITORIAL SERVICES | $153,514 | |
| CHARLES ALAN MELDERS ELECTRIC LLC | ||||||
| 139 WILSON LANE | MONTICELLO | AR | 71655 | ELECTRICAL SERVICES CONTRACTOR | $141,772 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,752,864 | GovernmentGrantsAmt |
| All Other Contributions | $790,479 | AllOtherContributionsAmt |
| Noncash Contributions | $351,928 | NoncashContributionsAmt |
| Total Contributions | $7,543,343 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621110 | $19,246,253 | $19,246,253 |
| 340B REVENUE | 621110 | $14,675,396 | $14,675,396 |
| SHARED SAVINGS REVENUE | 621110 | $1,009,248 | $1,009,248 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,930,897 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $270 | TotalRevenueColumnAmt |
| Exclusion | $270 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $59,574 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $65,700 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | -$6,126 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,126 | TotalRevenueColumnAmt |
| Exclusion | -$6,126 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INSURANCE PROCEEDS | Desc |
| Business | 900999 | BusinessCd |
| Total Revenue Column | $84,513 | TotalRevenueColumnAmt |
| Exclusion | $84,513 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,266 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $27,266 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $111,779 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,580,163 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,930,897 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $105,923 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,090,180 | TotalAmt |
| Management And General | $1,090,180 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,038,577 | TotalAmt |
| Program Services | $13,905,788 | ProgramServicesAmt |
| Management And General | $5,132,789 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,383 | TotalAmt |
| Program Services | $269,067 | ProgramServicesAmt |
| Management And General | $99,316 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,987,064 | TotalAmt |
| Program Services | $2,181,753 | ProgramServicesAmt |
| Management And General | $805,311 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,453,001 | TotalAmt |
| Program Services | $1,061,273 | ProgramServicesAmt |
| Management And General | $391,728 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,177 | TotalAmt |
| Program Services | $11,816 | ProgramServicesAmt |
| Management And General | $4,361 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $191,353 | TotalAmt |
| Program Services | $139,764 | ProgramServicesAmt |
| Management And General | $51,589 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,615,385 | TotalAmt |
| Program Services | $1,910,279 | ProgramServicesAmt |
| Management And General | $705,106 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,463 | TotalAmt |
| Program Services | $54,388 | ProgramServicesAmt |
| Management And General | $20,075 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $628,800 | TotalAmt |
| Program Services | $459,276 | ProgramServicesAmt |
| Management And General | $169,524 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $795,861 | TotalAmt |
| Program Services | $581,297 | ProgramServicesAmt |
| Management And General | $214,564 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $278,089 | TotalAmt |
| Program Services | $203,116 | ProgramServicesAmt |
| Management And General | $74,973 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $330,797 | TotalAmt |
| Program Services | $241,614 | ProgramServicesAmt |
| Management And General | $89,183 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $653,182 | TotalAmt |
| Program Services | $477,085 | ProgramServicesAmt |
| Management And General | $176,097 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,055 | TotalAmt |
| Program Services | $140,277 | ProgramServicesAmt |
| Management And General | $51,778 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| 340B EXPENSES | $7,724,126 | $7,724,126 | |
| MEDICAL SUPPLIES | $3,164,779 | $3,164,779 | |
| REPAIRS & MAINTENANCE | $288,006 | $210,360 | $77,646 |
| EQUIPMENT EXPENSE | $142,151 | $103,827 | $38,324 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $736,481 | TotalAmt |
| Program Services | $537,926 | ProgramServicesAmt |
| Management And General | $198,555 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,783,910 | TotalAmt |
| Program Services | $33,392,811 | ProgramServicesAmt |
| Management And General | $9,391,099 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,982,571 | BOYAmt |
| EOY | $2,157,857 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,894,438 | BOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,354,833 | BOYAmt |
| EOY | $7,528,076 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $700,595 | BOYAmt |
| EOY | $559,272 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $313,390 | BOYAmt |
| EOY | $434,401 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,504,450 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,865,270 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,388,032 | BOYAmt |
| EOY | $12,639,180 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,005,993 | BOYAmt |
| EOY | $5,291,805 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,004,219 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $570,109 | BOYAmt |
| EOY | $506,764 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,629,456 | BOYAmt |
| EOY | $3,719,599 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,839,417 | BOYAmt |
| EOY | $33,841,173 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,477,434 | BOYAmt |
| EOY | $2,129,789 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,417,474 | BOYAmt |
| EOY | $7,641,010 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $226,082 | BOYAmt |
| EOY | $105,525 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,120,990 | BOYAmt |
| EOY | $9,876,324 | 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 | $23,718,427 | BOYAmt |
| EOY | $23,964,849 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,718,427 | BOYAmt |
| EOY | $23,964,849 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,839,417 | BOYAmt |
| EOY | $33,841,173 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$203,747 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $395,593 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $54,576 | DonatedServicesAndUseFcltsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,276,625 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,053,958 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,629,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,308,017 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,543,343 | CurrentTaxYearAmt |
| Total | $37,811,443 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,276,625 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,053,958 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,629,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,308,017 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,543,343 | CurrentTaxYearAmt |
| Total | $37,811,443 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,068,498 | SubstantialContributorsTotAmt |
| Public Support Total170 | $36,742,945 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,222 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,080 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $534 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $259 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $270 | CurrentTaxYearAmt |
| Total | $3,365 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,750,712 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $210,504 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,343 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $111,779 | CurrentTaxYearAmt |
| Total | $3,074,338 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $40,889,146 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $108,315,246 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.8986 | PublicSupportCY170Pct |
| Public Support PY170 | 0.8576 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part II, Line 10 Other Income | FormAndLineReferenceDesc |
| Explanation | DESCRIPTION - OTHER INCOME, COLUMN A - 12619.0, COLUMN B - 210504.0, COLUMN C - 0.0, COLUMN D - 1343.0, COLUMN E - 27266.0, COLUMN F - 251732.0; DESCRIPTION - 340B REVENUE, COLUMN A - 2738093.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 0.0, COLUMN F - 2738093.0; DESCRIPTION - INSURANCE PROCEEDS, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 84513.0, COLUMN F - 84513.0; | ExplanationTxt |
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 | $914,746 | OtherCostOrOtherBasisAmt |
| Book Value | $914,746 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,649,811 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,284,090 | DepreciationAmt |
| Book Value | $10,365,721 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,491,889 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,581,180 | DepreciationAmt |
| Book Value | $910,709 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $448,004 | OtherCostOrOtherBasisAmt |
| Book Value | $448,004 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,639,180 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| FQHC COST REPORT RECEIVABLE | $3,610,090 |
| ROU ASSET | $109,509 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,719,599 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LEASE LIABILITY | Desc |
| Amt | $105,525 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $105,525 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $43,036,458 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $395,593 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $54,576 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $6,126 | OtherRevenueAmt |
| Revenue Not Reported | $456,295 | RevenueNotReportedAmt |
| Revenue Subtotal | $42,580,163 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $42,580,163 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $42,790,036 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $6,126 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $6,126 | ExpensesNotReportedAmt |
| Expenses Subtotal | $42,783,910 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $42,783,910 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part X, Line 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 | LOSS ON DISPOSAL - 6126 |
| Schedule D, Part XII, Line 2(d) Other expenses in audited financial statements not in form 990 | LOSS ON DISPOSAL - 6126 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHICOT MEMORIAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2729 HWY 65 82 SOUTH | AddressLine1Txt |
| City | LAKE VILLAGE | CityNm |
| State Abbreviation | AR | StateAbbreviationCd |
| ZIP | 71653 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 383807713 | RecipientEIN |
| IRC Section | 501 (C) (3) | IRCSectionDesc |
| Cash Grant | $15,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
| Purpose Of Grant | Wellness Center | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | WE MAKE CONTRIBUTIONS TO LOCAL SCHOOLS AND OTHER LOCAL ORGANIZATIONS. THESE ARE APPROVED BY THE MARKETING MANAGER BASED ON HER BUDGET. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TAFTA MCCAIN | ||||||||||||||
| CFO - THROUGH 1/21/24 | $135,716 | $0 | $13,001 | $0 | $5,452 | $0 | $6,408 | $0 | $7,708 | $0 | $168,285 | $0 | $0 | $0 |
| BYRON MONTGOMERY | ||||||||||||||
| CIO | $131,756 | $0 | $15,767 | $0 | $0 | $0 | $6,182 | $0 | $7,708 | $0 | $161,413 | $0 | $0 | $0 |
| ASHLEY ANTHONY | ||||||||||||||
| COO | $124,497 | $0 | $14,160 | $0 | $5,385 | $0 | $0 | $0 | $7,708 | $0 | $151,750 | $0 | $0 | $0 |
| GARY ALLAN NICHOLS | ||||||||||||||
| CEO | $206,916 | $0 | $97,320 | $0 | $3,604 | $0 | $12,857 | $0 | $7,708 | $0 | $328,405 | $0 | $0 | $0 |
| KERRY PENNINGTON MD | ||||||||||||||
| MEDICAL DOCTOR | $298,319 | $0 | $82,089 | $0 | $11,518 | $0 | $8,346 | $0 | $7,708 | $0 | $407,980 | $0 | $0 | $0 |
| PAUL WHIPPLE MD | ||||||||||||||
| MEDICAL DOCTOR | $256,778 | $0 | $31,433 | $0 | $7,355 | $0 | $10,492 | $0 | $7,708 | $0 | $313,766 | $0 | $0 | $0 |
| BLAYNE BEENE DO | ||||||||||||||
| MEDICAL DOCTOR | $248,741 | $0 | $4,550 | $0 | $0 | $0 | $8,909 | $0 | $7,708 | $0 | $269,908 | $0 | $0 | $0 |
| KELLY SHRUM MD | ||||||||||||||
| MEDICAL DOCTOR | $250,006 | $0 | $71,929 | $0 | $0 | $0 | $13,034 | $0 | $7,708 | $0 | $342,677 | $0 | $0 | $0 |
| CONSTANCE CHAPMAN MD | ||||||||||||||
| MEDICAL DOCTOR | $336,630 | $0 | $4,800 | $0 | $0 | $0 | $0 | $0 | $7,708 | $0 | $349,138 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part I, Line 7 Non-fixed payments | FormAndLineReferenceDesc |
| Explanation | INCENTIVE PAY IS OFFERED FOR PROVIDERS AND CLINICAL STAFF WHO MEET VARIOUS PRODUCTIVITY GOALS AND FINANCIAL AND QUALITY MEASURES ON A QUARTERLY BASIS. CLINICAL STAFF: LEVEL 1 = $200 LEVEL 2 = $400 LEVEL 3 = $600 LEVEL 4 = $800 INCENTIVE PAY WAS OFFERED TO THE CEO BASED ON LEVEL OF PCMH REACHED, PATIENT GROWTH, AND BOARD EVALUATION. INCENTIVE PAY WAS OFFERED TO THE MEDICAL DIRECTOR BASED ON LEVEL OF PCMH REACHED, PATIENT GROWTH, PATIENT SATISFACTION, AND QUALITY PERFORMANCE. INCENTIVE PAY WAS OFFERED TO THE CFO BASED ON LEVEL OF PCMH REACHED, LEVEL OF PROFIT, AUDIT PERFORMANCE, AND EVALUATION BY THE CEO. PROVIDER BONUSES ARE BASED ON THE NUMBER OF ENCOUNTERS OVER THE MINIMUM REQUIREMENT AND AVERAGE QUALITY METRICS FOR THE QUARTER. | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $351,928 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Market value | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule M, Part I Explanations of reporting method for number of contributions | FormAndLineReferenceDesc |
| Explanation | Drugs and medical supplies - COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS MADE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b Review of form 990 by governing body | CFO REVIEWS FORM 990 AND PRESENTS IT TO THE BOARD FOR REVIEW PRIOR TO FILING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | MANAGEMENT INVESTIGATES ANY POTENTIAL CONFLICTS AND TAKES THE APPROPRIATE ACTION AS NEEDED/NECESSARY. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | ACH SETTLEMENT - Total Revenue: 12, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 12; MID DELTA - Total Revenue: 12900, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 12900; WINTHROP - Total Revenue: 5300, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 5300; CHASE CASHBACK - Total Revenue: 6159, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 6159; ALEDADE PAYMENT CORRECTION - Total Revenue: 2895, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 2895; |
| FORM 990, PART VI, LINE 15A & 15B | COMPENSATION COMMITTEE BASES CEO'S COMPENSATION ON THE NUMBER OF SITES SERVED. THE COMMITTEE COMPARES TO OTHER SYSTEMS IN THE STATE WITH REGARD TO THE NUMBER OF SITES SERVED TO DETERMINE COMPENSATION. COMPENSATION COMMITTEE PRESENTS PROPOSED COMPENSATION TO THE BOARD FOR APPROVAL. THERE IS A WRITTEN EMPLOYMENT CONTRACT WHICH PROVIDES FOR AN INCREASE IN PAY AFTER 90 DAYS OF EMPLOYMENT. THE CEO DETERMINES THE C-SUITE'S SALARY. A COMPENSATION REVIEW IS COMPLETED EVERY AUGUST/SEPTEMBER. |