SISKIYOU COMMUNITY HEALTH CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SISKIYOU COMMUNITY HEALTH CENTER INC (EIN 93-0628804)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202341359349311519
- Schema version
- 2021v4.2
- 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 | 2023-05-15T14:08:19-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | 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 100 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930628804 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SISKIYOU COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SISK | BusinessNameControlTxt |
| Phone | 5414724777 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 NW HAWTHORNE AVENUE | AddressLine1Txt |
| City | GRANTS PASS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97526 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD BOOTH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5414724777 | PhoneNum |
| Signature | 2023-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RICHARD | PersonFirstNm |
| Person Last | BOOTH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2023-05-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RICHARD BOOTH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 NW HAWTHORNE AVENUE | AddressLine1Txt |
| City | GRANTS PASS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97526 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $28,033,905 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SISKIYOUHEALTHCENTER.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1975 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | TO IDENTIFY AND PROVIDE CARE FOR PRIMARY HEALTH NEEDS OF OUR COMMUNITY IN A PROFESSIONAL AND COMPASSIONATE MANNER | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 274 | TotalEmployeeCnt |
| Total Volunteers | 17 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,747,760 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,887,662 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,425,552 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,867,747 | CYProgramServiceRevenueAmt |
| PY Investment Income | $20,118 | PYInvestmentIncomeAmt |
| CY Investment Income | $48,227 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,505,967 | PYOtherRevenueAmt |
| CY Other Revenue | $4,074,783 | CYOtherRevenueAmt |
| PY Total Revenue | $27,699,397 | PYTotalRevenueAmt |
| CY Total Revenue | $26,878,419 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,387,679 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,699,285 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,690,204 | PYOtherExpensesAmt |
| CY Other Expenses | $7,062,983 | CYOtherExpensesAmt |
| PY Total Expenses | $23,077,883 | PYTotalExpensesAmt |
| CY Total Expenses | $25,762,268 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,621,514 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,116,151 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,133,203 | TotalAssetsBOYAmt |
| Total Assets EOY | $31,762,019 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,927,410 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,440,075 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,205,793 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,321,944 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IDENTIFY AND PROVIDE CARE FOR PRIMARY HEALTH NEEDS OF OUR COMMUNITY IN A PROFESSIONAL AND COMPASSIONATE MANNER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,925,129 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $19,884,740 | RevenueAmt |
| Desc | HEALTHCARE: OUTPATIENT MEDICAL, DENTAL, MENTAL HEALTH, 340B PHARMACY, AND CASE MANAGEMENT SERVICES PROVIDED TO INDIVIDUAL PATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,211,239 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | OUTREACH: OUTREACH, EDUCATION, AND HOME VISITS TO AT RISK CHILDREN AND THEIR FAMILIES. THIS INCLUDES PARENTING EDUCATION AND HEALTHY START SERVICES TO THESE FAMILIES. OUTPATIENT MEDICAL CARE AND HEALTH EDUCATION AND PROMOTION TO STUDENTS AT THE SCHOOL BASED CARE CENTER AT THE SCHOOLS IN THE COMMUNITY IT SERVES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $20,136,368 | 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 | 0 | 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 | 0 | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 | 48 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 274 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | 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 | 0 | LocalChaptersInd |
| 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 |
| Own Website | Yes (X) | OwnWebsiteInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREG BALL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5414724777 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 NW HAWTHORNE AVENUE | AddressLine1Txt |
| City | GRANTS PASS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97526 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| KRISTIN MILLER | ||||||||
| CHIEF MEDICAL DIRECTOR | 40.00 | Yes (X) | $392,432 | $0 | $61,626 | |||
| DUSTIN DURHAM | ||||||||
| PHYSICIAN | 40.00 | $352,978 | $0 | $62,871 | Yes (X) | |||
| JOE DUNN CHIEF | ||||||||
| ADMINISTRATIVE & DENTAL OFFICER | 40.00 | Yes (X) | $331,349 | $0 | $64,240 | |||
| CHRISTIAN HOLLAND | ||||||||
| PHYSICIAN | 40.00 | $293,018 | $0 | $38,310 | Yes (X) | |||
| LINFORD BEACHY | ||||||||
| PHYSICIAN | 30.00 | $281,449 | $0 | $45,957 | Yes (X) | |||
| RICHARD BOOTH | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $262,347 | $0 | $43,512 | Yes (X) | |||
| BRUCE TOWERS | ||||||||
| MEDICAL PROVIDER | 40.00 | $211,658 | $0 | $47,532 | Yes (X) | |||
| DANIEL MCDONNELL | ||||||||
| BEHAVIORAL HEALTH DIRECTOR | 40.00 | $198,180 | $0 | $46,838 | Yes (X) | |||
| BRUCE MCKEE | ||||||||
| CO-CFO (THROUGH MARCH 2022) | 40.00 | $186,194 | $0 | $48,020 | Yes (X) | |||
| BRIAN LAUBSCHER | ||||||||
| CHIEF COMPLIANCE OFFICER | 40.00 | Yes (X) | $192,773 | $0 | $33,960 | |||
| GREGORY BALL | ||||||||
| CO-CFO & CFO | 40.00 | $152,819 | $0 | $40,869 | Yes (X) | |||
| WARREN KENDALL MD | ||||||||
| CHAIR | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| BRAD LAMONT | ||||||||
| VICE CHAIR | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DERRICK KLEINER | ||||||||
| TREASURER | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DENISE TERRELL | ||||||||
| SECRETARY | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| RICHARD COHEN MD | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| RUSS DUNHAM | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| ROBIN HAUSEN | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| LYLE JACKSON MD | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| MONICA MCFADDEN JD | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| JENNIFER ROBERTS PHD | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| JOHN SEIDEL EDM | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| WILLIAM WARD | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,855,197 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $533,735 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 36 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DIAMOND MEDICAL MAINTENANCE INC | |||||
| PO BOX 3071 | CENTRAL POINT | OR | 97502 | CLEANING SERVICES | $330,535 |
| CENTERLOGIC INC | |||||
| 7414 NE HAZEL DELL AVE STE B | VANCOUVER | WA | 98665 | IT CONSULTING | $307,102 |
| BARTON & ASSOCIATES INC | |||||
| PO BOX 417844 | BOSTON | MA | 02241 | LOCUMS MEDICAL PROVIDER | $273,779 |
| J AND J THOMAS INC | |||||
| 897 ROYAL AVE STE B | MEDFORD | OR | 97502 | SECURITY | $144,276 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $27,098 | FundraisingAmt |
| Government Grants | $5,200,381 | GovernmentGrantsAmt |
| All Other Contributions | $1,660,183 | AllOtherContributionsAmt |
| Total Contributions | $6,887,662 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICES | 621300 | $15,187,150 | $15,187,150 |
| MEDICAL INCENTIVE REVENUE | 621300 | $680,597 | $680,597 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,867,747 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,784 | TotalRevenueColumnAmt |
| Exclusion | $22,784 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,912 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $39,912 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,912 | TotalRevenueColumnAmt |
| Exclusion | $39,912 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $25,443 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $25,443 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,443 | TotalRevenueColumnAmt |
| Exclusion | $25,443 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $13,407 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $27,098 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $16,728 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,321 | TotalRevenueColumnAmt |
| Exclusion | -$3,321 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $5,155,751 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,138,758 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,016,993 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,016,993 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $21,199 | TotalRevenueColumnAmt |
| Exclusion | $21,199 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $21,199 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,878,419 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,884,740 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $106,017 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,853,373 | TotalAmt |
| Program Services | $476,750 | ProgramServicesAmt |
| Management And General | $1,376,623 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,250,568 | TotalAmt |
| Program Services | $11,853,187 | ProgramServicesAmt |
| Management And General | $1,397,381 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $458,713 | TotalAmt |
| Program Services | $346,434 | ProgramServicesAmt |
| Management And General | $112,279 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,013,815 | TotalAmt |
| Program Services | $1,654,590 | ProgramServicesAmt |
| Management And General | $359,225 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,122,816 | TotalAmt |
| Program Services | $881,901 | ProgramServicesAmt |
| Management And General | $240,915 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,958 | TotalAmt |
| Management And General | $8,958 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,645 | TotalAmt |
| Management And General | $50,645 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,329,754 | TotalAmt |
| Program Services | $1,054,513 | ProgramServicesAmt |
| Management And General | $275,241 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,256 | TotalAmt |
| Program Services | $28,505 | ProgramServicesAmt |
| Management And General | $163,751 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,072 | TotalAmt |
| Program Services | $124,303 | ProgramServicesAmt |
| Management And General | $769 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,142,116 | TotalAmt |
| Program Services | $1,136,684 | ProgramServicesAmt |
| Management And General | $5,432 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,644 | TotalAmt |
| Program Services | $101,637 | ProgramServicesAmt |
| Management And General | $47,007 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,668 | TotalAmt |
| Program Services | $202,118 | ProgramServicesAmt |
| Management And General | $21,550 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,305,391 | TotalAmt |
| Program Services | $484,729 | ProgramServicesAmt |
| Management And General | $820,662 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,075 | TotalAmt |
| Program Services | $42,682 | ProgramServicesAmt |
| Management And General | $63,393 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $784,605 | $772,784 | $11,821 |
| REPAIRS & MAINTENANCE | $761,988 | $346,083 | $415,905 |
| MISCELLANEOUS | $453,550 | $291,698 | $161,852 |
| RECRUITMENT & PROVIDER | $324,783 | $268,120 | $56,663 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,478 | TotalAmt |
| Program Services | $69,650 | ProgramServicesAmt |
| Management And General | $35,828 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,762,268 | TotalAmt |
| Program Services | $20,136,368 | ProgramServicesAmt |
| Management And General | $5,625,900 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,976,252 | BOYAmt |
| EOY | $2,803,814 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,687,354 | BOYAmt |
| EOY | $2,643,614 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,812 | BOYAmt |
| EOY | $335,996 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,166,572 | BOYAmt |
| EOY | $3,416,007 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $334,680 | BOYAmt |
| EOY | $361,287 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $247,280 | BOYAmt |
| EOY | $264,269 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $30,648,799 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,026,987 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,163,565 | BOYAmt |
| EOY | $21,621,812 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,688 | BOYAmt |
| EOY | $315,220 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,133,203 | BOYAmt |
| EOY | $31,762,019 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,211,446 | BOYAmt |
| EOY | $1,797,600 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,670 | BOYAmt |
| EOY | $150,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,332,832 | BOYAmt |
| EOY | $11,172,657 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $309,462 | BOYAmt |
| EOY | $319,818 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,927,410 | BOYAmt |
| EOY | $13,440,075 | 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 | $17,205,793 | BOYAmt |
| EOY | $18,321,944 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,205,793 | BOYAmt |
| EOY | $18,321,944 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,133,203 | BOYAmt |
| EOY | $31,762,019 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,116,151 | 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,767,860 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,942,572 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,909,482 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,747,760 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,887,662 | CurrentTaxYearAmt |
| Total | $32,255,336 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,767,860 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,942,572 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,909,482 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,747,760 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,887,662 | CurrentTaxYearAmt |
| Total | $32,255,336 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $32,255,336 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $56,862 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $94,463 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $86,396 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $57,289 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $62,696 | CurrentTaxYearAmt |
| Total | $357,706 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $28,784 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $22,248 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $41,705 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $49,469 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $34,606 | CurrentTaxYearAmt |
| Total | $176,812 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $32,789,854 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $88,485,035 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.98370 | PublicSupportCY170Pct |
| Public Support PY170 | 0.98180 | 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, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME FUNDRAISING EVENT INCOME | 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 | $1,246,527 | OtherCostOrOtherBasisAmt |
| Book Value | $1,246,527 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,686,721 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,312,995 | DepreciationAmt |
| Book Value | $15,373,726 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,067,098 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,488,494 | DepreciationAmt |
| Book Value | $2,578,604 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,514,537 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,277,233 | DepreciationAmt |
| Book Value | $2,237,304 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,133,916 | OtherCostOrOtherBasisAmt |
| Depreciation | $948,265 | DepreciationAmt |
| Book Value | $185,651 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,621,812 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED COMPENSATION | Desc |
| Amt | $319,818 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $319,818 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $27,901,554 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,155,486 | OtherRevenueAmt |
| Revenue Not Reported | $1,155,486 | RevenueNotReportedAmt |
| Revenue Subtotal | $26,746,068 | RevenueSubtotalAmt |
| Other Revenues Not Included | $132,351 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $132,351 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $26,878,419 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,894,741 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1,155,486 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,155,486 | ExpensesNotReportedAmt |
| Expenses Subtotal | $25,739,255 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $23,013 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $23,013 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $25,762,268 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE CENTER IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) EXCEPT ON NET INCOME DERIVED FROM UNRELATED BUSINESS ACTIVITIES. MANAGEMENT BELIEVES THERE WAS NO UNRELATED BUSINESS INCOME DURING THE YEAR ENDED JUNE 30, 2022; THEREFORE, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT ANY PROVISION FOR INCOME TAXES. THE CENTER HAS BEEN CLASSIFIED AS AN ENTITY THAT IS NOT A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) AND QUALIFIES FOR DEDUCTIBLE CONTRIBUTIONS AS PROVIDED IN SECTION 170(B)(1)(A)(III). THE CENTER IS EXEMPT FROM PROPERTY TAX ON DEVELOPED LAND UNDER OREGON REVISED STATUTE (ORS) 307.130. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EVENT EXPENSES 16,728. COST OF GOODS SOLD 1,138,758. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | OTHER NONOPERATING INCOME 109,338. BAD DEBT EXPENSE 23,013. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | FUNDRAISING EVENT EXPENSES 16,728. COST OF GOODS SOLD 1,138,758. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 23,013. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | TEE OFF FOR KIDS | Event1Nm |
| Gross Receipts Event1 | $40,505 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $27,098 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $13,407 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $300 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $4,407 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $6,180 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $308 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $5,533 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $40,505 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $27,098 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $13,407 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $300 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $4,407 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $6,180 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $308 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $5,533 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $16,728 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$3,321 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KRISTIN MILLER | ||||||||||||||
| CHIEF MEDICAL DIRECTOR | $324,656 | $0 | $7,187 | $0 | $60,589 | $0 | $11,848 | $0 | $49,778 | $0 | $454,058 | $0 | $0 | $0 |
| DUSTIN DURHAM | ||||||||||||||
| PHYSICIAN | $262,452 | $0 | $20,757 | $0 | $69,769 | $0 | $11,848 | $0 | $51,023 | $0 | $415,849 | $0 | $0 | $0 |
| JOE DUNN CHIEF | ||||||||||||||
| ADMINISTRATIVE & DENTAL OFFICER | $311,286 | $0 | $14,407 | $0 | $5,656 | $0 | $11,848 | $0 | $52,392 | $0 | $395,589 | $0 | $0 | $0 |
| CHRISTIAN HOLLAND | ||||||||||||||
| PHYSICIAN | $254,631 | $0 | $8,166 | $0 | $30,221 | $0 | $11,848 | $0 | $26,462 | $0 | $331,328 | $0 | $0 | $0 |
| LINFORD BEACHY | ||||||||||||||
| PHYSICIAN | $238,684 | $0 | $6,491 | $0 | $36,274 | $0 | $11,682 | $0 | $34,275 | $0 | $327,406 | $0 | $0 | $0 |
| RICHARD BOOTH | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $227,615 | $0 | $1,500 | $0 | $33,232 | $0 | $248 | $0 | $43,264 | $0 | $305,859 | $0 | $0 | $0 |
| BRUCE TOWERS | ||||||||||||||
| MEDICAL PROVIDER | $159,802 | $0 | $7,384 | $0 | $44,472 | $0 | $8,815 | $0 | $38,717 | $0 | $259,190 | $0 | $0 | $0 |
| DANIEL MCDONNELL | ||||||||||||||
| BEHAVIORAL HEALTH DIRECTOR | $186,759 | $0 | $4,610 | $0 | $6,811 | $0 | $8,276 | $0 | $38,562 | $0 | $245,018 | $0 | $0 | $0 |
| BRUCE MCKEE | ||||||||||||||
| CO-CFO (THROUGH MARCH 2022) | $185,709 | $0 | $1,700 | $0 | -$1,215 | $0 | $7,970 | $0 | $40,050 | $0 | $234,214 | $0 | $0 | $0 |
| BRIAN LAUBSCHER | ||||||||||||||
| CHIEF COMPLIANCE OFFICER | $190,553 | $0 | $1,700 | $0 | $520 | $0 | $8,121 | $0 | $25,839 | $0 | $226,733 | $0 | $0 | $0 |
| GREGORY BALL | ||||||||||||||
| CO-CFO & CFO | $143,846 | $0 | $12,355 | $0 | -$3,382 | $0 | $6,497 | $0 | $34,372 | $0 | $193,688 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE COMPRISED OF THE OFFICERS OF THE BOARD. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS IN EMERGENCY SITUATIONS WHEN AN IMMEDIATE DECISION MUST BE MADE TO AVOID A DELETERIOUS OUTCOME. ANY EMERGENCY ACTION TAKEN BY THE EXECUTIVE COMMITTEE MUST BE RATIFIED BY A MAJORITY VOTE OF THE BOARD AT ITS NEXT REGULAR MEETING. THE EXECUTIVE COMMITTEE'S RESPONSIBILITIES ALSO INCLUDE (A) COORDINATING ACTIVITIES OF THE BOARD; (B) CONDUCTING AN ANNUAL PERFORMANCE EVALUATION OF THE CEO AND RECOMMENDING ADJUSTMENTS TO THE CEO'S COMPENSATION PACKAGE CONSISTENT WITH THE RESULTS OF THE EVALUATION; (C) OVERSEEING THE RESEARCH, DEVELOPMENT AND RECOMMENDATION OF A LONG-RANGE PLAN; (D) MAKING SPECIFIC FISCAL GOALS AND OBJECTIVE RECOMMENDATIONS FOR ADOPTION BY THE BOARD BASED ON THE STRATEGIC PLAN; (E) REVIEWING AND RECOMMENDING CONTRACTUAL RELATIONSHIPS FOR OUTSIDE SERVICES WITH CONSULTANTS AND SPECIALISTS; (F) REVIEWING, DEVELOPING AND RECOMMENDING THE ORGANIZATION'S HUMAN RESOURCES POLICIES; AND (G) ANNUALLY REVIEWING EMPLOYMENT CLASSIFICATIONS, SALARIES AND BENEFITS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED BY THE EXECUTIVE STAFF AND WAS MADE AVAILABLE TO MEMBERS OF THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EMPLOYEES, DIRECTORS, CONSULTANTS, AND THOSE WHO PROVIDE SERVICES OR FURNISH GOODS TO THE CORPORATION SHALL AVOID ANY CONFLICT OF INTEREST OR THE APPEARANCE OF CONFLICT OF INTEREST BY EXEMPTING THEMSELVES FROM CONSIDERING ANY INDIVIDUAL ISSUES ON WHICH THEY HAVE AN ACTUAL OR APPARENT CONFLICT OF INTEREST. THE BOARD REQUIRES THAT EACH MEMBER FILL OUT AN ANNUAL CONFLICT OF INTEREST DISCLOSURE DOCUMENTING ALL COMPANIES OWNED BY BOARD MEMBERS OR OTHER BOARDS THAT THE MEMBER MAY BELONG TO. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE COMMITTEE CONDUCTS AN ANNUAL PERFORMANCE EVALUATION OF THE CHIEF EXECUTIVE OFFICER AND RECOMMENDS ADJUSTMENTS TO THE CHIEF EXECUTIVE OFFICER'S COMPENSATION PACKAGE CONSISTENT WITH THE RESULTS OF THE ANNUAL EVALUATION AND THE MOST RECENT MGMA SALARY SURVEY STANDARDS. EACH YEAR A MARKET REVIEW OF KEY EMPLOYEES' COMPENSATION IS PREPARED USING THE NORTHWEST REGIONAL PRIMARY CARE ASSOCIATIONS EVALUATIONS FOR REGION X, SPECIFIC TO FQHC'S.. COMPENSATION COMPARISONS ARE ALSO EVALUATED USING THE NATIONAL MGMA AND THE OREGON CHAPTER OF THE MGMA. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATMEENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |