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MAPLE CITY HEALTH CARE CENTER INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
MAPLE CITY HEALTH CARE CENTER INC (EIN 35-1749398)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-08-16
IRS object ID
202342289349300114
Schema version
2022v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-08-16T07:06:23-05:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN351307701PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KRUGGEL LAWTON & COMPANY LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1317 W FRANKLIN STAddressLine1Txt
CityELKHARTCityNm
State AbbreviationINStateAbbreviationCd
ZIP46516ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351749398EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MAPLE CITY HEALTH CARE CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMAPLBusinessNameControlTxt
Phone5745343300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP465282956ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAIME ALVAREZPersonNm
Person TitleDIRECTOR OF FINANCEPersonTitleTxt
Phone5745343300PhoneNum
Signature2023-08-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJAIMEPersonFirstNm
Person LastALVAREZPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARGENE ZINKPreparerPersonNm
PTINP01222961PTIN
Phone5742642247PhoneNum
Preparation2023-08-10PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1VISTA COMMUNITY HC NORTHSIDE COMMUNITY HC AND MAPLE CITY DENTALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerJAIME ALVAREZPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP465282956ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$10,047,304GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MCHCC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1988FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTHE MISSION OF MAPLE CITY HEALTH CARE CENTER IS TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee137TotalEmployeeCnt
Total Volunteers4TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$7,599,658PYContributionsGrantsAmt
CY Contributions Grants$4,612,199CYContributionsGrantsAmt
PY Program Service Revenue$4,499,584PYProgramServiceRevenueAmt
CY Program Service Revenue$5,420,321CYProgramServiceRevenueAmt
PY Investment Income$5,669PYInvestmentIncomeAmt
CY Investment Income$6,203CYInvestmentIncomeAmt
PY Other Revenue$7,000PYOtherRevenueAmt
CY Other Revenue$8,581CYOtherRevenueAmt
PY Total Revenue$12,111,911PYTotalRevenueAmt
CY Total Revenue$10,047,304CYTotalRevenueAmt
PY Grants And Similar Paid$5,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$5,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,729,491PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,893,821CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,748,059PYOtherExpensesAmt
CY Other Expenses$2,784,048CYOtherExpensesAmt
PY Total Expenses$10,482,550PYTotalExpensesAmt
CY Total Expenses$10,682,869CYTotalExpensesAmt
PY Revenues Less Expenses$1,629,361PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$635,565CYRevenuesLessExpensesAmt
Total Assets BOY$5,934,046TotalAssetsBOYAmt
Total Assets EOY$5,367,814TotalAssetsEOYAmt
Total Liabilities BOY$982,148TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,051,481TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,951,898NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,316,333NetAssetsOrFundBalancesEOYAmt
MissionTHE MISSION OF MAPLE CITY HEALTH CARE CENTER IS TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$8,592,091ExpenseAmt
Grant$5,000GrantAmt
Revenue$5,428,902RevenueAmt
DescFOSTERING HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE. WE PROVIDE MEDICAL, BEHAVIOR HEALTH, DENTAL, VISION, AND SOCIAL SERVICES.Desc
Total Program Service Expenses$8,592,091TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document9IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee137EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKAREN MILLER RUSHPersonNm
Phone5745343300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP46528ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
ADAM SCHARF
TREASURER1.00Yes (X)Yes (X)$0$0$5,640
MIGUEL MILLAN
BOARD MEMBER1.00Yes (X)$0$0$536
IRMA PEREZ
BOARD MEMBER1.00Yes (X)$0$0$1,330
JENNY MARTINEZ
SECRETARY1.00Yes (X)Yes (X)$0$0$0
ROEL CERVANTES
BOARD MEMBER1.00Yes (X)$0$0$60
DENICE METTERT
BOARD MEMBER1.00Yes (X)$0$0$60
KEVIN FARMWALD
BOARD MEMBER1.00Yes (X)$0$0$1,595
SARAH METZLER
PRESIDENT2.00Yes (X)Yes (X)$0$0$25
YEIMI PEREZ GARCIA
BOARD MEMBER1.00Yes (X)$0$0$3,877
MAX MERTZ
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
KAREN MILLER RUSH
DIRECTOR OF FINANCE42.00Yes (X)$76,191$0$15,253
CHARLENE MAST
INTERIM EXECUTIVE DIRECTOR45.00Yes (X)$94,887$0$20,802
PAUL SHETLER FAST
EXECUTIVE DIRECTOR45.00Yes (X)$23,483$0$3,172
STEPHEN HARMON
GUARDIAN OF MEDICAL SERVICE45.00$159,454$0$25,819Yes (X)
ANNA GRADY
DOCTOR45.00$120,291$0$25,237Yes (X)
THOMAS KREIDER
PSYCHIATRIST40.00$140,092$0$20,584Yes (X)
REBECCA JOHNSON
NURSE MIDWIFE45.00$107,435$0$9,337Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$721,833TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$133,327TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MG TRUST COMPANY
PO BOX 3144MOBILEAL36652RETIREMENT BENEFITS$806,831
OCHIN INC
1881 SW NAITO PARKWAYPORTLANDOR97201ELECTRONIC MEDICAL RECORD SYSTEM$449,717
MCKESSON MEDICAL SURGICAL
PO BOX 634404CINCINNATIOH452634404MEDICINE, VACCINES & MISC MEDICAL SUPPLI$250,781
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$3,867,107GovernmentGrantsAmt
All Other Contributions$745,092AllOtherContributionsAmt
Noncash Contributions$550,941NoncashContributionsAmt
Total Contributions$4,612,199TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE FEES621400$5,173,269$5,173,269
PHARMACY621400$169,143$169,143
MHS CONTRACTS621400$67,080$67,080
CAPITATION621400$10,829$10,829
FieldValueIRS element (for citing)
Total Program Service Revenue$5,420,321TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,203TotalRevenueColumnAmt
Exclusion$6,203ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISC. REVENUE-RELATED-990Desc
Business621110BusinessCd
Total Revenue Column$8,581TotalRevenueColumnAmt
Related Or Exempt Func Income$8,581RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$8,581OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,047,304TotalRevenueColumnAmt
Related Or Exempt Func Income$5,428,902RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$6,203ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,000TotalAmt
Program Services$5,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$233,787TotalAmt
Program Services$233,787ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,548,958TotalAmt
Program Services$4,370,343ProgramServicesAmt
Management And General$1,178,615ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$433,957TotalAmt
Program Services$341,646ProgramServicesAmt
Management And General$92,311ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,255,829TotalAmt
Program Services$992,388ProgramServicesAmt
Management And General$263,441ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$421,290TotalAmt
Program Services$334,838ProgramServicesAmt
Management And General$86,452ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$37,766TotalAmt
Management And General$37,766ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$27,641TotalAmt
Management And General$27,641ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$149,774TotalAmt
Management And General$149,774ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$124,227TotalAmt
Program Services$83,171ProgramServicesAmt
Management And General$41,056ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$743,964TotalAmt
Program Services$591,297ProgramServicesAmt
Management And General$152,667ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$166,508TotalAmt
Program Services$150,166ProgramServicesAmt
Management And General$16,342ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$69,734TotalAmt
Program Services$61,631ProgramServicesAmt
Management And General$8,103ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$8,428TotalAmt
Management And General$8,428ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$167,804TotalAmt
Program Services$150,689ProgramServicesAmt
Management And General$17,115ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$17,640TotalAmt
Program Services$17,640ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$635,751$635,751
VACCINES$550,941$550,941
PROFESSIONAL DUES$53,933$42,866$11,067
MISCELLANEOUS PATIENT S$29,937$29,937

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$10,682,869TotalAmt
Program Services$8,592,091ProgramServicesAmt
Management And General$2,090,778ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$112,741BOYAmt
EOY$229,553EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,302,580BOYAmt
EOY$504,805EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$120,855BOYAmt
EOY$32,288EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$867,447BOYAmt
EOY$1,297,400EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$136,456BOYAmt
EOY$110,479EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$211,736BOYAmt
EOY$102,138EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,159,519LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,068,368LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,182,231BOYAmt
EOY$3,091,151EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$5,934,046BOYAmt
EOY$5,367,814EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$759,813BOYAmt
EOY$845,714EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$222,335BOYAmt
EOY$205,767EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$982,148BOYAmt
EOY$1,051,481EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,951,898BOYAmt
EOY$4,316,333EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,951,898BOYAmt
EOY$4,316,333EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,934,046BOYAmt
EOY$5,367,814EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$635,565ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$440,827OtherCostOrOtherBasisAmt
Book Value$440,827BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,013,670OtherCostOrOtherBasisAmt
Depreciation$222,889DepreciationAmt
Book Value$1,790,781BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$766,352OtherCostOrOtherBasisAmt
Depreciation$375,321DepreciationAmt
Book Value$391,031BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$510,320OtherCostOrOtherBasisAmt
Depreciation$282,654DepreciationAmt
Book Value$227,666BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$428,350OtherCostOrOtherBasisAmt
Depreciation$187,504DepreciationAmt
Book Value$240,846BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$3,091,151TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$10,054,842TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts$7,538DonatedServicesAndUseFcltsAmt
Revenue Not Reported$7,538RevenueNotReportedAmt
Revenue Subtotal$10,047,304RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$10,047,304TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$10,690,407TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$7,538DonatedServicesUseFcltsAmt
Expenses Not Reported$7,538ExpensesNotReportedAmt
Expenses Subtotal$10,682,869ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$10,682,869TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT THE ORGANIZATION IS NOT A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A). THE INCOME TAXES TOPIC, FASB ASC 740, CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. ASC 740 REQUIRES AN ENTITY TO DISCLOSE THE NATURE OF UNCERTAIN TAX POSITIONS TAKEN, IF ANY, WHEN FILING ITS INCOME TAX RETURN UTILIZING A TWO-STEP PROCESS TO RECOGNIZE AND MEASURE ANY UNCERTAIN TAX POSITIONS TAKEN. THE ENTITY RECOGNIZES A TAX BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THE POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. NO TAX BENEFIT WILL BE RECORDED ON TAX POSITIONS NOT MEETING THE MORE LIKELY THAN NOT TEST. INTEREST AND PENALTIES ACCRUED OR INCURRED, IF ANY, AS A RESULT OF APPLYING ASC 740 WILL BE RECORDED TO INTEREST EXPENSE AND OTHER EXPENSE, RESPECTIVELY. BASED ON ITS EVALUATION, THE ORGANIZATION HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS REQUIRING RECOGNITION IN ITS FINANCIAL STATEMENTS. THE ORGANIZATION'S EVALUATION WAS PERFORMED FOR ALL FEDERAL AND STATE TAX PERIODS STILL SUBJECT TO EXAMINATION. THE ORGANIZATION'S 2019 THROUGH 2021 FEDERAL AND STATE EXEMPT ORGANIZATION RETURNS REMAIN SUBJECT TO EXAMINATION BY THE IRS AND STATE TAXING AUTHORITIES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
STEPHEN HARMON
GUARDIAN OF MEDICAL SERVICE$159,454$0$0$0$0$0$0$0$25,819$0$185,273$0$0$0
THOMAS KREIDER
PSYCHIATRIST$140,092$0$0$0$0$0$0$0$20,584$0$160,676$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationTHE GUARDIAN OF MEDICAL SERVICE'S COMPENSATION IS SET USING THE SAME STANDARD MCHCC / VCHC WAGE SCALE USED FOR ESTABLISHING COMPENSATION FOR ALL OF OUR STAFF. THIS WAGE SCALE FACTORS IN: EDUCATION AND TRAINING, EXPERIENCE, LANGUAGE, CALL (IF APPLICABLE) AND MOST IMPORTANTLY RESPONSIBILITY LEVEL. EACH FACTOR IS ASSIGNED A POINT VALUE WHICH THEN TRANSLATES INTO HOURLY WAGE AMOUNTS. ALL NEW STAFF LEVELS ARE EVALUATED BY TWO STAFF MEMBERS AND A WRITTEN EMPLOYMENT CONTRACT IS ISSUED. IN SUBSEQUENT YEARS, ALL STAFF RECEIVE A LETTER INDICATING THEIR ANNUAL PAY INCREASE. ANNUAL INCREASES ARE BASED ON EXPERIENCE RAISES AND ANNUAL COST OF LIVING RAISES.ExplanationTxt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution12ContributionCnt
Noncash Contributions Rpt F990$550,941NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION'S MEMBERSHIP INCLUDES HEALTH CARE CENTER STAFF AND PATIENTS AND IS OPEN TO ANYONE ELSE INTERESTED IN FURTHERING THE PURPOSE OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AMEMBERS ON THE BOARD OF DIRECTORS APPOINT NEW MEMBERS TO THE BOARD OF DIRECTORS AFTER A CONSULTATION PROCESS.
FORM 990, PART VI, SECTION B, LINE 11BA DRAFT OF THE FORM 990 IS EMAILED TO BOARD MEMBERS BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE BOARD OF DIRECTORS REVIEWS CONFLICTS OF INTEREST ANNUALLY. STAFF IS MADE AWARE OF THE POLICY AND IN RELEVANT SITUATIONS, THE POLICY IS REVIEWED.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION HAS A POINT SYSTEM TO DETERMINE SALARY LEVELS FOR ALL STAFF INCLUDING ALL MANAGEMENT PERSONNEL. THE POINT SYSTEM IS BASED ON: EDUCATION, EXPERIENCE, LANGUAGE ABILITY, RESPONSIBILITY LEVEL, AND WHETHER OR NOT THEY HAVE CALL RESPONSIBILITIES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
PAGE 12, LINE 2CTHE ORGANIZATION DOES HAVE A COMMITTEE THAT OVERSEES THE FINANCIAL STATEMENT PREPARATION PROCESS AND THE SELECTION OF EXTERNAL ACCOUNTANTS. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTHSIDE COMMUNITY HEALTH CENTER INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1808 NORTH THIRD STREETAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP46528ZIPCd
FieldValueIRS element (for citing)
EIN473368774EIN
Primary ActivitiesTO PROVIDE HEALTH CARE IN THE GOSHEN, INDIANA COMMUNITYPrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MAPLE CITY HEALTH CARE CENTER INC DBA VISTA COMMUNITY HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd