GOOD SAMARITAN HEALTH CENTER OF COBB INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- GOOD SAMARITAN HEALTH CENTER OF COBB INC (EIN 32-0045238)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-11
- IRS object ID
- 202242849349301329
- 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 | 2022-10-11T15:02:34-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 582475857 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NICHOLS CAULEY & ASSOCIATES LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1300 BELLEVUE AVENUE | AddressLine1Txt |
| City | DUBLIN | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 310214152 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320045238 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HEALTH CENTER OF | BusinessNameLine1Txt |
| Business Name Line2 | COBB INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 7704193120 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1605 ROBERTA DR SW | AddressLine1Txt |
| City | MARIETTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 300083855 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CYRL KITCHENS | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 7704193120 | PhoneNum |
| Signature | 2022-10-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CYRL | PersonFirstNm |
| Person Last | KITCHENS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | GREGORY M CHAPMAN | PreparerPersonNm |
| PTIN | P01019632 | PTIN |
| Phone | 4782751163 | PhoneNum |
| Preparation | 2022-10-11 | 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 | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CYRL KITCHENS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1605 ROBERTA DR SW | AddressLine1Txt |
| City | MARIETTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 300083855 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,448,165 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GOODSAMCOBB.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | THE ORGANIZATION'S MISSION IS TO SPREAD THE LOVE OF CHRIST BY PROVIDING QUALITY HEALTHCARE TO THOSE IN NEED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 65 | TotalEmployeeCnt |
| Total Volunteers | 69 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,195,817 | PYContributionsGrantsAmt |
| CY Contributions Grants | $9,776,048 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,304,737 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,540,475 | CYProgramServiceRevenueAmt |
| PY Investment Income | $741 | PYInvestmentIncomeAmt |
| CY Investment Income | $709 | CYInvestmentIncomeAmt |
| PY Other Revenue | $100,429 | PYOtherRevenueAmt |
| CY Other Revenue | $93,792 | CYOtherRevenueAmt |
| PY Total Revenue | $10,601,724 | PYTotalRevenueAmt |
| CY Total Revenue | $11,411,024 | 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 | $2,748,269 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,192,782 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $54,765 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,153,052 | PYOtherExpensesAmt |
| CY Other Expenses | $7,333,796 | CYOtherExpensesAmt |
| PY Total Expenses | $9,901,321 | PYTotalExpensesAmt |
| CY Total Expenses | $10,526,578 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $700,403 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $884,446 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,809,951 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,735,122 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $168,864 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $209,589 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,641,087 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,525,533 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE ORGANIZATION'S MISSION IS TO SPREAD THE LOVE OF CHRIST BY PROVIDING QUALITY HEALTHCARE TO THOSE IN NEED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,067,899 | ExpenseAmt |
| Revenue | $1,542,756 | RevenueAmt |
| Desc | THE ORGANIZATION IS A PRIMARY HEALTHCARE CENTER FOR LOW-INCOME UNINSURED INDIVIDUALS THAT INCLUDES MEDICAL, DENTAL, DISPENSARY, AND COUNSELING SERVICES. IT PROVIDED CARE FOR 30,968 PATIENT VISITS IN 2020 WITH EXPENSE OF 8.6 MILLION WHICH INCLUDES DONATED SERVICES OF $5.3 MILLION AND DONATED MEDICATIONS OF $477 THOUSAND. | Desc |
| Total Program Service Expenses | $9,067,899 | 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 | 0 | 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 | 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 | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 65 | 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 |
| 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | 0 | 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 | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GAYLE NELSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7704193120 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1605 ROBERTA DR SW | AddressLine1Txt |
| City | MARIETTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 300083855 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| DR CHRIS SMITH | ||||||
| CHAIRMAN OF BOARD | 0.00 | Yes (X) | $0 | $0 | $0 | |
| REV GRANT COLE | ||||||
| SECRETARY | 0.00 | Yes (X) | $0 | $0 | $0 | |
| GREG GRIGGS | ||||||
| TREASURER | 0.00 | Yes (X) | $0 | $0 | $0 | |
| HICKS POOR | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BARRY TEAGUE | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| LYNDA AUSBURN | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BRENDA GASKINS | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ANNA LONGACRE MD | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JOSE VAZQUEZ | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| FELIX LORA | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR JOHN SHERRER | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CHAN WILKES | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ISRAEL BROWN | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| HECTOR GUZMAN-MORENO | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ENERY LUCENA VELEZ | ||||||
| BOARD OF DIRECTORS | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CYRL KITCHENS | ||||||
| CEO | 40.00 | $212,538 | $0 | $0 | Yes (X) | |
| STEVEN HANSARD DDM | ||||||
| DENTAL DIRECTOR | 40.00 | $128,221 | $0 | $0 | Yes (X) | |
| GAYLE NELSON | ||||||
| CFO | 40.00 | $103,578 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $444,337 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,989,378 | GovernmentGrantsAmt |
| All Other Contributions | $6,786,670 | AllOtherContributionsAmt |
| Noncash Contributions | $5,806,439 | NoncashContributionsAmt |
| Total Contributions | $9,776,048 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICAL PROGRAM REVENUES | 621300 | $588,770 | $588,770 |
| DENTAL PROGRAM REVENUES | 621300 | $587,719 | $587,719 |
| DISPENSARY REVENUES | 446110 | $272,778 | $272,778 |
| INSURANCE PAYMENTS | 621300 | $40,656 | $40,656 |
| MEDICARE AND MEDICAID | 621300 | $39,452 | $39,452 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,100 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,100 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,540,475 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $709 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $709 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $129,361 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $37,141 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,220 | TotalRevenueColumnAmt |
| Exclusion | $92,220 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $1,572 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,572 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,572 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,411,024 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,542,756 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $92,220 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $444,337 | TotalAmt |
| Program Services | $128,221 | ProgramServicesAmt |
| Management And General | $316,116 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,329,200 | TotalAmt |
| Program Services | $1,831,540 | ProgramServicesAmt |
| Management And General | $444,232 | ManagementAndGeneralAmt |
| Fundraising | $53,428 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,825 | TotalAmt |
| Program Services | $167,383 | ProgramServicesAmt |
| Management And General | $69,336 | ManagementAndGeneralAmt |
| Fundraising | $106 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,420 | TotalAmt |
| Program Services | $128,202 | ProgramServicesAmt |
| Management And General | $52,987 | ManagementAndGeneralAmt |
| Fundraising | $1,231 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,762 | TotalAmt |
| Management And General | $51,762 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,961 | TotalAmt |
| Program Services | $22,352 | ProgramServicesAmt |
| Management And General | $5,609 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,552 | TotalAmt |
| Management And General | $19,552 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,206 | TotalAmt |
| Program Services | $110,206 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,007 | TotalAmt |
| Management And General | $29,007 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,035 | TotalAmt |
| Management And General | $18,035 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,116 | TotalAmt |
| Program Services | $37,029 | ProgramServicesAmt |
| Management And General | $124,087 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,886 | TotalAmt |
| Management And General | $53,886 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROFESSIONAL SERVICES | $4,848,028 | $4,848,028 | |
| DISPENSARY COSTS | $1,036,579 | $1,036,579 | |
| DENTAL SUPPLIES | $217,717 | $217,717 | |
| REPAIRS AND MAINTENANCE | $172,049 | $115,377 | $56,672 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,898 | TotalAmt |
| Program Services | $425,265 | ProgramServicesAmt |
| Management And General | $162,633 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,526,578 | TotalAmt |
| Program Services | $9,067,899 | ProgramServicesAmt |
| Management And General | $1,403,914 | ManagementAndGeneralAmt |
| Fundraising | $54,765 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,215,813 | BOYAmt |
| EOY | $2,724,560 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,186 | BOYAmt |
| EOY | $25,818 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,404 | BOYAmt |
| EOY | $12,514 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,814 | BOYAmt |
| EOY | $40,639 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,311,427 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,380,076 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,512,423 | BOYAmt |
| EOY | $2,931,351 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,311 | BOYAmt |
| EOY | $240 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,809,951 | BOYAmt |
| EOY | $5,735,122 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,967 | BOYAmt |
| EOY | $123,601 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,897 | BOYAmt |
| EOY | $85,988 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $168,864 | BOYAmt |
| EOY | $209,589 | 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 | $4,641,087 | BOYAmt |
| EOY | $5,525,533 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,641,087 | BOYAmt |
| EOY | $5,525,533 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,809,951 | BOYAmt |
| EOY | $5,735,122 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $884,446 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| 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 | $11,728,346 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,207,568 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,440,282 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,195,817 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,776,048 | CurrentTaxYearAmt |
| Total | $60,348,061 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $675,591 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,140,006 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,508,117 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,334,940 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,542,047 | CurrentTaxYearAmt |
| Total | $6,200,701 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,403,937 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,347,574 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,948,399 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,530,757 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,318,095 | CurrentTaxYearAmt |
| Total | $66,548,762 | 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 | $66,548,762 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $709 | CurrentTaxYearAmt |
| Total | $709 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $709 | CurrentTaxYearAmt |
| Total | $709 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $35,459 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $55,970 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $74,352 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $69,967 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $235,748 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,439,396 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,403,544 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $19,022,751 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,600,724 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,318,804 | CurrentTaxYearAmt |
| Total | $66,785,219 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99650 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99600 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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) |
|---|---|---|
| Investment Cost Or Other Basis | $583,821 | InvestmentCostOrOtherBasisAmt |
| Book Value | $583,821 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $2,637,160 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $571,993 | DepreciationAmt |
| Book Value | $2,065,167 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,090,446 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $808,083 | DepreciationAmt |
| Book Value | $282,363 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,931,351 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED LEAVE | Desc |
| Amt | $85,988 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $85,988 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $11,448,165 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,448,165 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$37,141 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$37,141 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,411,024 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,563,719 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $37,141 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $37,141 | ExpensesNotReportedAmt |
| Expenses Subtotal | $10,526,578 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,526,578 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | DIRECT FUNDRAISING EXPENSE -37,141. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT FUNDRAISING EXPENSE 37,141. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $129,361 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $129,361 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $37,141 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $129,361 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $129,361 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $37,141 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $37,141 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $92,220 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CYRL KITCHENS | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $212,538 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $212,538 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | MEDICAL SERVICES | Desc |
| Contribution | 0 | ContributionCnt |
| Noncash Contributions Rpt F990 | $5,806,439 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | RETURN WILL BE REVIEWED PRIOR TO FILING |
| FORM 990, PART VI, SECTION B, LINE 12C | THE OFFICERS, DIRECTORS AND KEY EMPLOYEES MUST SIGN THE DISCLOSURE FORM ANNUALLY. THESE FORMS ARE MATCHED AGAINST A LIST OF SUCH PEOPLE. |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE BOARD RESEARCHES AND PROVIDES INFORMATION TO MAKE A RECOMMENDATION TO THE FULL BOARD FOR THE SALARY AND BENEFITS OF HIGHLY COMPENSATED EMPLOYEES AND CONSULTANTS BASED ON A REVIEW OF COMPARABLE DATA. THE BOARD THEN DOCUMENTS HOW IT REACHED ITS DECISION. |
| FORM 990, PART VI, SECTION C, LINE 19 | WEBSITE |