LA PINE COMMUNITY HEALTH CENTER: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- LA PINE COMMUNITY HEALTH CENTER (EIN 26-3084386)
- Tax period
- 2021-11-01 to 2022-10-31
- Filed
- 2023-09-11
- IRS object ID
- 202312549349301831
- 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 | 2023-09-11T15:22:40-05:00 | ReturnTs |
| Tax Period End | 2022-10-31 | 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 STE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263084386 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LA PINE COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAPI | BusinessNameControlTxt |
| Phone | 5415363435 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3300 | AddressLine1Txt |
| City | LA PINE | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97739 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ERIN TRAPP | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 5415363435 | PhoneNum |
| Signature | 2023-09-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ERIN | PersonFirstNm |
| Person Last | TRAPP | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2023-09-11 | 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 | ERIN TRAPP | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3300 | AddressLine1Txt |
| City | LA PINE | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97739 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,977,859 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LAPINECC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2008 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | LA PINE COMMUNITY HEALTH CENTER IMPROVES LIVES IN OUR COMMUNITY THROUGH ACCESSIBLE AND AFFORDABLE HEALTHCARE PROVIDED WITH KINDNESS, INTEGRITY, AND RESPECT. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 86 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,909,918 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,164,094 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,740,637 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,225,635 | CYProgramServiceRevenueAmt |
| PY Investment Income | $185 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,273 | CYInvestmentIncomeAmt |
| PY Other Revenue | $504,653 | PYOtherRevenueAmt |
| CY Other Revenue | $544,211 | CYOtherRevenueAmt |
| PY Total Revenue | $10,155,393 | PYTotalRevenueAmt |
| CY Total Revenue | $9,935,213 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,720 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $22,595 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,012,517 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,306,465 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $3,100 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,341,285 | PYOtherExpensesAmt |
| CY Other Expenses | $2,481,492 | CYOtherExpensesAmt |
| PY Total Expenses | $7,357,522 | PYTotalExpensesAmt |
| CY Total Expenses | $7,810,552 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,797,871 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,124,661 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,022,573 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,196,978 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,018,444 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,068,188 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,004,129 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,128,790 | NetAssetsOrFundBalancesEOYAmt |
| Mission | LA PINE COMMUNITY HEALTH CENTER IMPROVES LIVES IN OUR COMMUNITY THROUGH ACCESSIBLE AND AFFORDABLE HEALTHCARE PROVIDED WITH KINDNESS, INTEGRITY, AND RESPECT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,565,230 | ExpenseAmt |
| Grant | $22,595 | GrantAmt |
| Revenue | $6,616,502 | RevenueAmt |
| Desc | LA PINE COMMUNITY HEALTH CENTER (LCHC), A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) FORMED IN 2009, SERVES THE GENERAL POPULATION WITH AN EMPHASIS ON DISADVANTAGED AND MEDICALLY UNDER-SERVED RESIDENTS. LCHC PROVIDES PATIENT-CENTERED, COMPREHENSIVE, AFFORDABLE PRIMARY MEDICAL, BEHAVIORAL/MENTAL HEALTH AND ANCILLARY (OUTREACH) CARE TO PATIENTS LIVING IN THE SERVICE AREA WHICH INCLUDES SOUTH DESCHUTES COUNTY, NORTHERN KLAMATH, AND NORTHWESTERN LAKE COUNTIES. OUR SERVICES INCLUDE PREVENTION, DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC ILLNESS, CHRONIC DISEASE MANAGEMENT, REFERRALS, AND FOLLOW-UP FOR SPECIALTY DIAGNOSTIC TREATMENT. | Desc |
| Total Program Service Expenses | $5,565,230 | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 86 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| 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 | ERIN TRAPP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5415363435 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3300 | AddressLine1Txt |
| City | LA PINE | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97739 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| CHARLA DEHATE | ||||||||
| CHIEF EXECUTIVE OFFICER | 60.00 | Yes (X) | $173,927 | $0 | $9,607 | |||
| JOAN FRIDERICI MD | ||||||||
| PHYSICIAN | 40.00 | $164,949 | $0 | $10,159 | Yes (X) | |||
| MICHAEL ALLEN DO | ||||||||
| FORMER KEY EMPLOYEE | 0.00 | $167,255 | $0 | $5,147 | Yes (X) | |||
| RITA GOEHRING NP | ||||||||
| NURSE PRACTITIONER | 40.00 | $138,272 | $0 | $8,844 | Yes (X) | |||
| MEGAN LEWIS NP | ||||||||
| NURSE PRACTITIONER | 40.00 | $133,225 | $0 | $9,533 | Yes (X) | |||
| DENISE GRIFFITHS FNP | ||||||||
| FAMILY NURSE PRACTITIONER | 40.00 | $126,276 | $0 | $9,834 | Yes (X) | |||
| REBECCA BREWER PA-C | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $125,570 | $0 | $9,863 | Yes (X) | |||
| DAVID GOSSER | ||||||||
| CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| RELINDA REYNOLDS | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JOAN WALTER | ||||||||
| SECRETARY (THROUGH APRIL 2022) | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SHELLEY MIESEN | ||||||||
| BOARD MEMBER & SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| HANNAH OLMSTEAD | ||||||||
| TREASURER (THROUGH JAN 2022) | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MARY DOUGLAS | ||||||||
| BOARD MEMBER & TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| LINDA BAUMAN | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| DONNY BURKLOW | ||||||||
| BOARD MEMBER (THROUGH MARCH 2022) | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| RICK DAVIS | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| FRANK HERNANDEZ | ||||||||
| BOARD MEMBER (THROUGH MAY 2022) | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| ANDREA HINE | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| TAMMY LESUEUR | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| RYAN MACIEJ | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| MARIAN MENGEL | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| PAMELA PERRINE | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,029,474 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $62,987 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WESTON TECHNOLOGY SOLUTIONS | |||||
| 19795 VILLAGE OFFICE COURT | BEND | OR | 97702 | IT SUPPORT | $232,167 |
| OCHIN | |||||
| PO BOX 5426 | PORTLAND | OR | 97228 | EMR SUPPORT | $230,962 |
| COMMUNITY LINK CONSULTING INC | |||||
| PO BOX 276 | NEWMAN LAKE | WA | 99052 | ACCOUNTING SUPPORT | $115,859 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,736,745 | GovernmentGrantsAmt |
| All Other Contributions | $427,349 | AllOtherContributionsAmt |
| Noncash Contributions | $25,970 | NoncashContributionsAmt |
| Total Contributions | $3,164,094 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621300 | $5,681,443 | $5,681,443 |
| PAYOR INCENTIVE REVENUE | 621300 | $544,192 | $544,192 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,225,635 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,273 | TotalRevenueColumnAmt |
| Exclusion | $1,273 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $134,564 | 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 | $134,564 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $134,564 | TotalRevenueColumnAmt |
| Exclusion | $134,564 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $1,433,513 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,042,646 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $390,867 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $390,867 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $18,780 | TotalRevenueColumnAmt |
| Exclusion | $18,780 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $18,780 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,935,213 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,616,502 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $154,617 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,620 | TotalAmt |
| Program Services | $3,620 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,975 | TotalAmt |
| Program Services | $18,975 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $442,159 | TotalAmt |
| Program Services | $64,657 | ProgramServicesAmt |
| Management And General | $377,502 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,808,312 | TotalAmt |
| Program Services | $3,338,643 | ProgramServicesAmt |
| Management And General | $469,669 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,395 | TotalAmt |
| Program Services | $84,559 | ProgramServicesAmt |
| Management And General | $18,836 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $575,750 | TotalAmt |
| Program Services | $471,475 | ProgramServicesAmt |
| Management And General | $104,275 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $376,849 | TotalAmt |
| Program Services | $302,675 | ProgramServicesAmt |
| Management And General | $74,174 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,123 | TotalAmt |
| Management And General | $12,123 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,792 | TotalAmt |
| Management And General | $45,792 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $658,896 | TotalAmt |
| Program Services | $356,989 | ProgramServicesAmt |
| Management And General | $298,807 | ManagementAndGeneralAmt |
| Fundraising | $3,100 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,735 | TotalAmt |
| Management And General | $56,735 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,833 | TotalAmt |
| Program Services | $86,266 | ProgramServicesAmt |
| Management And General | $21,567 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $201,733 | TotalAmt |
| Program Services | $69,119 | ProgramServicesAmt |
| Management And General | $132,614 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,395 | TotalAmt |
| Program Services | $121,916 | ProgramServicesAmt |
| Management And General | $42,479 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,427 | TotalAmt |
| Program Services | $26,860 | ProgramServicesAmt |
| Management And General | $43,567 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,373 | TotalAmt |
| Management And General | $131,373 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,878 | TotalAmt |
| Management And General | $248,878 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,809 | TotalAmt |
| Program Services | $37,563 | ProgramServicesAmt |
| Management And General | $8,246 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $327,652 | $313,252 | $14,400 |
| RECRUITMENT/RETENTION | $127,282 | $118,332 | $8,950 |
| BAD DEBT EXPENSE | $89,063 | $89,063 | |
| DUES & SUBSCRIPTIONS | $87,758 | $14,866 | $72,892 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,743 | TotalAmt |
| Program Services | $46,400 | ProgramServicesAmt |
| Management And General | $59,343 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,810,552 | TotalAmt |
| Program Services | $5,565,230 | ProgramServicesAmt |
| Management And General | $2,242,222 | ManagementAndGeneralAmt |
| Fundraising | $3,100 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,234,885 | BOYAmt |
| EOY | $9,760,717 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,851,261 | BOYAmt |
| EOY | $1,852,503 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,303 | BOYAmt |
| EOY | $107,094 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $748,931 | BOYAmt |
| EOY | $809,064 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,035 | BOYAmt |
| EOY | $18,044 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,860 | BOYAmt |
| EOY | $35,085 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,188,075 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,577,874 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,088,759 | BOYAmt |
| EOY | $6,610,201 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,539 | BOYAmt |
| EOY | $4,270 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,022,573 | BOYAmt |
| EOY | $19,196,978 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,138 | BOYAmt |
| EOY | $659,852 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,000,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,562,306 | BOYAmt |
| EOY | $5,408,336 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,018,444 | BOYAmt |
| EOY | $9,068,188 | 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 | $8,004,129 | BOYAmt |
| EOY | $10,128,790 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,004,129 | BOYAmt |
| EOY | $10,128,790 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,022,573 | BOYAmt |
| EOY | $19,196,978 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,124,661 | 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,564,536 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,712,353 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,621,234 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,909,918 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,164,094 | CurrentTaxYearAmt |
| Total | $12,972,135 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,921,832 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,186,139 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,677,459 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,676,779 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,659,148 | CurrentTaxYearAmt |
| Total | $34,121,357 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,486,368 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,898,492 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,298,693 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,586,697 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,823,242 | CurrentTaxYearAmt |
| Total | $47,093,492 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $47,093,492 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $25,789 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,942 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,875 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $131,476 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $135,837 | CurrentTaxYearAmt |
| Total | $348,919 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $25,789 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,942 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,875 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $131,476 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $135,837 | CurrentTaxYearAmt |
| Total | $348,919 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $14,480 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,780 | CurrentTaxYearAmt |
| Total | $33,260 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,512,157 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,926,434 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,326,568 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,732,653 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,977,859 | CurrentTaxYearAmt |
| Total | $47,475,671 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99200 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99430 | PublicSupportPY509Pct |
| Investment Income CY | 0.00730 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00540 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS 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 | $403,375 | OtherCostOrOtherBasisAmt |
| Book Value | $403,375 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,345,032 | OtherCostOrOtherBasisAmt |
| Depreciation | $298,022 | DepreciationAmt |
| Book Value | $6,047,010 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,011,725 | OtherCostOrOtherBasisAmt |
| Depreciation | $874,272 | DepreciationAmt |
| Book Value | $137,453 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $427,943 | OtherCostOrOtherBasisAmt |
| Depreciation | $405,580 | DepreciationAmt |
| Book Value | $22,363 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,610,201 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,385,625 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $48,000 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $491,475 | OtherRevenueAmt |
| Revenue Not Reported | $539,475 | RevenueNotReportedAmt |
| Revenue Subtotal | $9,846,150 | RevenueSubtotalAmt |
| Other Revenues Not Included | $89,063 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $89,063 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $9,935,213 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,260,964 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $48,000 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $491,475 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $539,475 | ExpensesNotReportedAmt |
| Expenses Subtotal | $7,721,489 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $89,063 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $89,063 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $7,810,552 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS A NONPROFIT ORGANIZATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A)(III) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PHARMACY 340B SUPPLIES 491,475. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 89,063. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | PHARMACY 340B SUPPLIES 491,475. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 89,063. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (5 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| DENTAL ASSISTANCE | 71 | $5,500 |
| TRANSPORTATION ASSISTANCE | 275 | $10,000 |
| RX/DME ASSISTANCE | 70 | $2,600 |
| FOOD ASSISTANCE | 10 | $225 |
| DIAPER ASSISTANCE | 80 | $650 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | TO ENSURE PROPER USE, INDIVIDUALS ARE GIVEN VOUCHERS FOR ASSISTANCE WITH TRANSPORTATION, FOOD, ETC., OR ARE GIVEN THE ITEMS THEY NEED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHARLA DEHATE | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $173,127 | $0 | $800 | $0 | $0 | $0 | $1,886 | $0 | $7,721 | $0 | $183,534 | $0 | $0 | $0 |
| JOAN FRIDERICI MD | ||||||||||||||
| PHYSICIAN | $164,149 | $0 | $800 | $0 | $0 | $0 | $2,438 | $0 | $7,721 | $0 | $175,108 | $0 | $0 | $0 |
| MICHAEL ALLEN DO | ||||||||||||||
| FORMER KEY EMPLOYEE | $167,255 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $5,147 | $0 | $172,402 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6 | OPERATING MARGIN IS ONE OF SEVERAL FACTORS USED BY THE BOARD IN DETERMINING WHETHER TO PROVIDE BONUSES TO ALL EMPLOYEES. OTHER FACTORS INCLUDE QUALITY METRICS, PATIENT SATISFACTION, AND EMPLOYEE SATISFACTION/RETENTION. |
| PART I, LINE 7 | DURING 2021, THE BOARD OF DIRECTORS CHOSE TO GIVE ALL EMPLOYEES A ONE-TIME BONUS OF $800. |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1275 | ContributionCnt |
| Noncash Contributions Rpt F990 | $25,970 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | INVOICE PRICE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | THE NUMBER REPORTED IN COLUMN B IS THE NUMBER OF DONATED ITEMS RECEIVED DURING THE FISCAL YEAR. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE BOARD RECEIVED THE FORM 990 ELECTRONICALLY PRIOR TO THE BOARD MEETING FOR THEM TO REVIEW. THE DOCUMENT WAS REVIEWED BY THE CEO DURING THE BOARD MEETING. ANY QUESTIONS WERE ANSWERED AT THE BOARD MEETING AND IF NECESSARY THE APPROPRIATE CHANGES WERE MADE. THE BOARD VOTED ON THE APPROVAL OF THE FORM 990 AT THE MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE POLICY IS REVIEWED ANNUALLY WITH THE BOARD MEMBERS, DIRECTORS, MANAGERS AND KEY EMPLOYEES. THE DISCLOSURE STATEMENT AND CONFLICT OF INTEREST ARE SIGNED BY EACH PERSON. A TRANSACTION IN WHICH A BOARD MEMBER HAS A CONFLICT OF INTEREST MAY BE APPROVED BY MAJORITY VOTE OF A QUORUM OF THE BOARD OF DIRECTORS IF THE MATERIAL FACTS OR THE TRANSACTION AND THE DIRECTOR'S INTEREST ARE DISCLOSED OR KNOWN TO THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S SALARY IS ASSESSED BY THE BOARD BASED ON A SURVEY OF COMMUNITY HEALTH CENTERS IN OUR REGION FROM NORTHWEST REGIONAL PRIMARY CARE. THE LAST COMPENSATION REVIEW OCCURRED IN 2023. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |