SOUTHBRIDGE MEDICAL ADVISORY CONCIL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHBRIDGE MEDICAL ADVISORY CONCIL INC (EIN 23-7047824)
- Tax period
- 2021-02-01 to 2022-01-31
- Filed
- 2022-11-01
- IRS object ID
- 202203059349300125
- Schema version
- 2021v4.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-01T11:46:58-04:00 | ReturnTs |
| Tax Period End | 2022-01-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 203934956 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHISMAN GIORDANO & ASSOCIATES LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 CONTINENTAL DR STE 210 | AddressLine1Txt |
| City | NEWARK | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 197134330 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-02-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237047824 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHBRIDGE MEDICAL ADVISORY | BusinessNameLine1Txt |
| Business Name Line2 | COUNCIL INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SOUT | BusinessNameControlTxt |
| Phone | 3026556187 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 NEW CASTLE AVENUE | AddressLine1Txt |
| City | WILMINGTON | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 19801 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NACHET SCOTT | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3026556187 | PhoneNum |
| Signature | 2022-10-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | NACHET | PersonFirstNm |
| Person Last | SCOTT | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOSEPH V GIORDANO CPA | PreparerPersonNm |
| PTIN | P01249336 | PTIN |
| Phone | 3022660202 | PhoneNum |
| Preparation | 2022-10-28 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRIETTA JOHNSON MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | NACHET SCOTT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 NEW CASTLE AVENUE | AddressLine1Txt |
| City | WILMINGTON | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 19801 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,482,214 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HJMC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1968 | FormationYr |
| Legal Domicile State | DE | LegalDomicileStateCd |
| Activity Or Mission | PROVIDER OF PRIMARY HEALTH CARE TO RESIDENTS OF WILMINGTON AND NEW CASTLE COUNTY, DELAWARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 80 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,778,820 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,993,835 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,626,693 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,717,096 | CYProgramServiceRevenueAmt |
| PY Investment Income | $558 | PYInvestmentIncomeAmt |
| CY Investment Income | $73 | CYInvestmentIncomeAmt |
| PY Other Revenue | $987,434 | PYOtherRevenueAmt |
| CY Other Revenue | $771,210 | CYOtherRevenueAmt |
| PY Total Revenue | $5,393,505 | PYTotalRevenueAmt |
| CY Total Revenue | $5,482,214 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,718,534 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,254,591 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,182,415 | PYOtherExpensesAmt |
| CY Other Expenses | $2,178,050 | CYOtherExpensesAmt |
| PY Total Expenses | $4,900,949 | PYTotalExpensesAmt |
| CY Total Expenses | $5,432,641 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $492,556 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $49,573 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,791,372 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,458,095 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,679,888 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,297,038 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,111,484 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,161,057 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDER OF PRIMARY HEALTH CARE TO RESIDENTS OF WILMINGTON AND NEW CASTLE COUNTY, DELAWARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,269,471 | ExpenseAmt |
| Revenue | $1,717,096 | RevenueAmt |
| Desc | PROVIDES MEDICAL, DENTAL, AND INTEGRATED BEHAVIORAL SERVICES FOR THE COMMUNITY. | Desc |
| Total Program Service Expenses | $4,269,471 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 80 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID GRUBE | PersonNm |
| Phone | 3026556187 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 NEW CASTLE AVENUE | AddressLine1Txt |
| City | WILMINGTON | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 19801 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| YVETTE GBEMUDU | |||||||
| PHYSICIAN, C | 40.00 | Yes (X) | $190,781 | $0 | $0 | ||
| TANYA WILSON | |||||||
| PSYCHATRIC N | 40.00 | $153,756 | $0 | $0 | Yes (X) | ||
| ELIZABETH ANN POLECK | |||||||
| DENTIST | 40.00 | $130,763 | $0 | $0 | Yes (X) | ||
| KATHLEEN T ANDERSON | |||||||
| NURSE PRACTI | 40.00 | $130,597 | $0 | $0 | Yes (X) | ||
| NACHET SCOTT | |||||||
| CEO | 40.00 | Yes (X) | $112,091 | $0 | $0 | ||
| DEBORAH M PARKER | |||||||
| COO | 40.00 | $101,538 | $0 | $0 | Yes (X) | ||
| HOWARD BARNES | |||||||
| DIRECTOR | 0.75 | $0 | $0 | $0 | Yes (X) | ||
| MARTHA BEARD | |||||||
| DIRECTOR | 0.75 | $0 | $0 | $0 | Yes (X) | ||
| DESHERYL E BROADWATER | |||||||
| DIRECTOR | 0.75 | $0 | $0 | $0 | Yes (X) | ||
| MICHELLE GLADNEY | |||||||
| DIRECTOR | 0.75 | $0 | $0 | $0 | Yes (X) | ||
| DEBORAH LUDLUM LOPEZ | |||||||
| DIRECTOR | 0.75 | $0 | $0 | $0 | Yes (X) | ||
| KATHERINE SAHM MD | |||||||
| BOARD CHAIR | 0.75 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| CLAUDINE JURKOVITZ MD MPH | |||||||
| BOARD VICE C | 0.75 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| CATALINA NATALINI | |||||||
| DIRECTOR | 0.75 | $0 | $0 | $0 | Yes (X) | ||
| AMERE ROBINSON | |||||||
| SECRETARY | 0.75 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| NANCY L SCOTT | |||||||
| DIRECTOR | 0.75 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| GUIRLENE CLERVOIX - SHEPHERD | |||||||
| DIRECTOR | 0.75 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $819,526 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HIGHMARK DELAWARE | |||||
| 800 DELAWARE AVENUE | WILMINGTON | DE | 19801 | HEALTH INSUR. | $242,051 |
| CARDINAL HEALTH | |||||
| 7000 CARDINAL PLACE | DUBLIN | OH | 43017 | PHARM SUPPLIES | $146,807 |
| DELAWARE HEALTH NET INC | |||||
| 601 NEW CASTLE AVENUE | WILMINGTON | DE | 19801 | IT SERVICES | $120,586 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,990,435 | GovernmentGrantsAmt |
| All Other Contributions | $3,400 | AllOtherContributionsAmt |
| Total Contributions | $2,993,835 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $1,717,096 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,717,096 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,717,096 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $73 | TotalRevenueColumnAmt |
| Exclusion | $73 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $3,253 | FundraisingGrossIncomeAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,253 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| PPP LOAN FORGIVENESS | 900099 | $571,242 | $571,242 |
| ALL OTHER REVENUE | 900099 | $196,715 | $196,715 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $767,957 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,482,214 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,717,096 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $768,030 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,732,430 | TotalAmt |
| Program Services | $2,137,034 | ProgramServicesAmt |
| Management And General | $595,396 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $313,344 | TotalAmt |
| Program Services | $245,066 | ProgramServicesAmt |
| Management And General | $68,278 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,817 | TotalAmt |
| Program Services | $163,316 | ProgramServicesAmt |
| Management And General | $45,501 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,074 | TotalAmt |
| Program Services | $8,160 | ProgramServicesAmt |
| Management And General | $1,914 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,230 | TotalAmt |
| Program Services | $45,546 | ProgramServicesAmt |
| Management And General | $10,684 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $641,139 | TotalAmt |
| Program Services | $401,985 | ProgramServicesAmt |
| Management And General | $239,154 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,814 | TotalAmt |
| Program Services | $11,814 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,057 | TotalAmt |
| Program Services | $25,966 | ProgramServicesAmt |
| Management And General | $6,091 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,085 | TotalAmt |
| Program Services | $111,849 | ProgramServicesAmt |
| Management And General | $26,236 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,425 | TotalAmt |
| Program Services | $3,584 | ProgramServicesAmt |
| Management And General | $841 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,932 | TotalAmt |
| Program Services | $47,735 | ProgramServicesAmt |
| Management And General | $11,197 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $286,126 | TotalAmt |
| Program Services | $231,762 | ProgramServicesAmt |
| Management And General | $54,364 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,615 | TotalAmt |
| Program Services | $32,088 | ProgramServicesAmt |
| Management And General | $7,527 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $489,808 | $489,808 | |
| DUE AND SUBSCRIPTIONS | $75,733 | $59,390 | $16,343 |
| REPAIRS AND MAINTENANCE | $69,408 | $34,704 | $34,704 |
| MISCELLANEOUS | $67,132 | $54,377 | $12,755 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,472 | TotalAmt |
| Program Services | $165,287 | ProgramServicesAmt |
| Management And General | $32,185 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,432,641 | TotalAmt |
| Program Services | $4,269,471 | ProgramServicesAmt |
| Management And General | $1,163,170 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $435,535 | BOYAmt |
| EOY | $518,476 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $302,633 | BOYAmt |
| EOY | $219,337 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $318,229 | BOYAmt |
| EOY | $246,651 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $446,222 | BOYAmt |
| EOY | $435,386 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,268 | BOYAmt |
| EOY | $30,901 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,553,630 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,546,286 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,258,485 | BOYAmt |
| EOY | $2,007,344 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,791,372 | BOYAmt |
| EOY | $3,458,095 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $613,315 | BOYAmt |
| EOY | $338,590 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,686 | BOYAmt |
| EOY | $30,552 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,047,887 | BOYAmt |
| EOY | $927,896 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,679,888 | BOYAmt |
| EOY | $1,297,038 | 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 | $2,111,484 | BOYAmt |
| EOY | $2,161,057 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,111,484 | BOYAmt |
| EOY | $2,161,057 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,791,372 | BOYAmt |
| EOY | $3,458,095 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $49,573 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,939,713 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,792,828 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,025,150 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,778,820 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,993,835 | CurrentTaxYearAmt |
| Total | $14,530,346 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,939,713 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,792,828 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,025,150 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,778,820 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,993,835 | CurrentTaxYearAmt |
| Total | $14,530,346 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $14,530,346 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $713 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $681 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $438 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $558 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $73 | CurrentTaxYearAmt |
| Total | $2,463 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $255,304 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $106,503 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $183,115 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $987,434 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $767,957 | CurrentTaxYearAmt |
| Total | $2,300,313 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $16,833,122 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $3,347,042 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.86320 | PublicSupportCY170Pct |
| Public Support PY170 | 0.89600 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, LINE 10 | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME 2,300,313 | 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 | $53,122 | OtherCostOrOtherBasisAmt |
| Book Value | $53,122 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,935,874 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,109,849 | DepreciationAmt |
| Book Value | $1,826,025 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,564,634 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,436,437 | DepreciationAmt |
| Book Value | $128,197 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,007,344 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $5,482,214 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $5,482,214 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $5,482,214 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $5,432,641 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $5,432,641 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $5,432,641 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | ALTHOUGH THE ENTITY IS NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES, THE ENTITY IS REQUIRED TO ADHERE TO ASC 740 "ACCOUNTING FOR INCOME TAXES", WHICH APPLIES TO ALL ENTITIES INCLUDING THOSE THAT ARE TAX EXEMPT UNDER 501(C)(3). ASC 740 CLARIFIES THE ACCOUNTING AND REPORTING FOR INCOME TAXES WHERE INTERPRETATION OF THE TAX LAW MAY BE UNCERTAIN. ASC 740 PRESCRIBES A COMPREHENSIVE MODEL FOR THE FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, PRESENTATION AND DISCLOSURE OF INCOME TAX UNCERTAINTIES WITH RESPECT TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN INCOME TAX RETURNS. MANAGEMENT HAS REVIEWED ITS CURRENT AND PAST FEDERAL INCOME TAX POSITIONS AND HAS DETERMINED, BASED ON CLEAR AND UNAMBIGUOUS TAX LAW AND REGULATIONS, THAT THE TAX POSITIONS TAKEN ARE CERTAIN AND THAT THERE IS NO LIKELIHOOD THAT A MATERIAL TAX ASSESSMENT WOULD BE MADE IF THE RESPECTIVE GOVERNMENT AGENCY EXAMINED TAX RETURNS SUBJECT TO AUDIT. ACCORDINGLY, NO PROVISION FOR THE EFFECTS OF UNCERTAIN TAX POSITIONS HAS BEEN RECORDED. AS OF JANUARY 31, 2022, THE 2019, 2020, AND 2021 TAX YEARS, ARE OPEN AND SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. HOWEVER, THE ENTITY IS NOT CURRENTLY UNDER AUDIT NOR HAS THE ENTITY BEEN CONTACTED BY THIS JURISDICTION. ANY INTEREST AND PENALTIES RELATED TO INCOME TAXES WOULD BE RECORDED AS INCOME TAX EXPENSE. THERE ARE NO INTEREST AND PENALTIES AS OF JANUARY 31, 2022. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| YVETTE GBEMUDU | ||
| PHYSICIAN, CMO | $190,781 | $190,781 |
| TANYA WILSON | ||
| PSYCHATRIC NURSE | $153,756 | $153,756 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 1A | THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON URGENT MATTERS WHEN THE FULL BOARD IS NOT IN SESSION. IT SHALL REVIEW OPERATING POLICY MATTERS AND BRING RECOMMENDATIONS TO THE BOARD WHERE BOARD APPROVAL IS REQUIRED, COORDINATE THE WORK OF THE COMMITTEE, EVALUATE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER, NEGOTIATE THE CHIEF EXECUTIVE OFFICER'S CONTRACT, REVIEW AND RECOMMEND BY-LAW CHANGES, IN CONJUNCTION WITH CHIEF EXECUTIVE OFFICER'S CONTRACT, DESIGNATE A REPRESENTATIVE OF THE BOARD TO PARTICIPATE WITH APPROPRIATE BOARD MEMBERS OF THE BOARD TO RESOLVE PATIENT GRIEVANCES. THE EXECUTIVE COMMITTEE WILL ALSO DEVELOP MECHANISMS FOR EVALUATING BOARD MEMBERS' PERFORMANCE ON AN ANNUAL BASIS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE CFO. A COPY OF THE FORM 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO THE BOARD MEETING TO APPROVE THE RETURN BEFORE THE FINAL COPY IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | IT IS THE ORGANIZATION'S POLICY TO AVOID THE PARTICIPATION OF ANY DIRECTOR IN THE BOARD OF DIRECTORS' CONSIDERATION OF A MATTER WHICH POSES A CONFLICT OF INTEREST FOR THAT DIRECTOR. WHENEVER ANY MATTER COMES BEFORE A MEETING OF THE BOARD OF DIRECTORS WHICH GIVES RISE TO A POTENTIAL CONFLICT OF INTEREST, THEN THE FOLLOWING PROCEDURE SHALL APPLY. THE MINUTES OF A MEETING AT WHICH A CONFLICT OF INTEREST ARISES SHALL REFLECT THAT THE DISCLOSURE WAS MADE, THE AFFECTED DIRECTOR'S WITHDRAWAL FROM THE MEETING AND ABSTAIN FROM VOTING, AND IF ACTION IS TAKEN ON THAT MATTER, THE CONTINUED PRESENCE OF QUORUM. THE BOARD OF DIRECTORS AND MANAGEMENT MEET QUARTERLY TO DISCUSS ANY ISSUES PERTAINING TO THE ORGANIZATION'S CONFLICT OF INTEREST POLICIES AND PROCEDURES AND THEY ARE ASKED TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MIGHT ARISE DURING THE YEAR. FOR THE CONFLICTS THAT ARE NOTED, THE BOARD EVALUATES HOW THE CONFLICT CAN BE MITIGATED AND ESTABLISH APPROPRIATE CONTROLS AND OVERSIGHT TO MONITOR AND ENSURE THE POLICY IS IN PLACE. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE CEO'S COMPENSATION IS REVIEWED BY THE PERSONNEL COMMITTEE. THE CHAIRPERSON AND MEMBERS OF THE PERSONNEL COMMITTEE ARE APPOINTED BY THE BOARD CHAIRPERSON. THE PERSONNEL COMMITTEE COMPARE THE CEO COMPENSATION TO THE COMMUNITY HEALTH CENTER ORGANIZATION'S BENCHMARK DATA TO DETERMINE A REASONABLE AND COMPETITIVE CONTRACT. THE CEO'S COMPENSATION IS REVIEWED ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES 375,375 232,913 0 INTERPRETING 17,323 4,063 0 CREDENTIALING 9,287 2,178 0 TOTAL 401,985 239,154 0 |