BAY CLINIC INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- BAY CLINIC INC (EIN 99-0222784)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2022-11-16
- IRS object ID
- 202203209349302620
- Schema version
- 2019v5.2
- 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 | 2022-11-16T16:30:39-06:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 930623286 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALDRICH CPAS AND ADVISORS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5665 SW MEADOWS RD SUITE 200 | AddressLine1Txt |
| City | LAKE OSWEGO | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97035 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 990222784 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAY CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BAYC | BusinessNameControlTxt |
| Phone | 8083333600 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 450 KILAUEA AVE SUITE 105 | AddressLine1Txt |
| City | HILO | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96720 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISTIAN KIMO ALAMEDA | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 8083333600 | PhoneNum |
| Signature | 2022-01-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DEBRA D SMITH | PreparerPersonNm |
| PTIN | P00646873 | PTIN |
| Phone | 5036204489 | PhoneNum |
| Preparation | 2022-01-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | Yes (X) | AmendedReturnInd |
| Principal Officer | CHRISTIAN KIMO ALAMEDA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 450 KILAUEA AVE SUITE 105 | AddressLine1Txt |
| City | HILO | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96720 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,375,818 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BAYCLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | HI | LegalDomicileStateCd |
| Activity Or Mission | COMMUNITY-DIRECTED HEALTHCARE ORGANIZATION THAT PROVIDES QUALITY PRIMARY AND PREVENTIVE CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 245 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $45,568 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $35,062 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,751,756 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,137,169 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,773,398 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,072,213 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,745 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,418 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$12,692 | PYOtherRevenueAmt |
| CY Other Revenue | $62,280 | CYOtherRevenueAmt |
| PY Total Revenue | $16,520,207 | PYTotalRevenueAmt |
| CY Total Revenue | $16,273,080 | 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 | $11,534,230 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,070,686 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $24,619 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,803,026 | PYOtherExpensesAmt |
| CY Other Expenses | $5,147,014 | CYOtherExpensesAmt |
| PY Total Expenses | $17,337,256 | PYTotalExpensesAmt |
| CY Total Expenses | $17,217,700 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$817,049 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$944,620 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,002,458 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,178,533 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,108,443 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,229,138 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,894,015 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,949,395 | NetAssetsOrFundBalancesEOYAmt |
| Mission | A COMMUNITY-DIRECTED HEALTHCARE ORGANIZATION THAT PROVIDES QUALITY PRIMARY AND PREVENTIVE CARE SERVICES TO THE PEOPLE OF EAST HAWAII. WE ENSURE THAT PATIENT CENTERED, CULTURALLY RESPONSIVE, AND AFFORDABLE HEALTHCARE SERVICES ARE LOCALLY ACCESSIBLE IN OUR COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,765,328 | ExpenseAmt |
| Revenue | $13,072,213 | RevenueAmt |
| Desc | THE BAY CLINIC INC. IS A NETWORK OF FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS SERVING 21,040 ETHNICALLY DIVERSE PATIENTS WITH 67,426 VISITS IN THE DISTRICTS OF HILO, PUNA AND KAU IN EAST AND SOUTH HAWAII ISLAND. IN THE FISCAL YEAR ENDING 2020, THE BAY CLINIC, INC. CONTINUED TO EXPAND BEHAVIORAL HEALTH ACCESS FOR THE UNDERSERVED BY PROVIDING ADDITIONAL SERVICES. BAY CLINIC'S STATE-OF-THE-ART MOBILE HEALTH UNIT IS THE FIRST DUAL USE , PRIMARY MEDICAL AND DENTAL, VEHICLE IN THE STATE THE UNIT EXPANDS ACCESS TO COMPREHENSIVE HEALTH CARE SERVICES TO THE MOST REMOTE AND RURAL EAST HAWAI'I COMMUNITIES. | Desc |
| Total Program Service Expenses | $13,765,328 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | 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 | 30 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 245 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BAY CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8089614071 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 450 KILAUEA AVE SUITE 105 | AddressLine1Txt |
| City | HILO | CityNm |
| State Abbreviation | HI | StateAbbreviationCd |
| ZIP | 96720 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|---|---|---|
| HAROLD WALLACE | ||||||||||
| FORMER CEO TERM 4.30.19 | 0.00 | Yes (X) | $244,662 | $0 | $27,292 | |||||
| SHUANA PAYLOR | ||||||||||
| DEPUTY MEDICAL DIRECTOR | 40.00 | $191,428 | $0 | $30,771 | Yes (X) | |||||
| YOULSAU BELLS | ||||||||||
| INTERIM CEO/COO | 40.00 | $191,257 | $0 | $19,383 | Yes (X) | |||||
| MICHAEL TREECE | ||||||||||
| PHYSICIAN | 40.00 | $177,796 | $0 | $7,039 | Yes (X) | |||||
| BRIAN HIGA | ||||||||||
| DENTIST | 40.00 | $168,119 | $0 | $15,445 | Yes (X) | |||||
| TAMARA TODD | ||||||||||
| PHYSICIAN | 40.00 | $139,336 | $0 | $0 | Yes (X) | |||||
| ANGELA LIND | ||||||||||
| PHYSICIAN | 40.00 | $132,002 | $0 | $0 | Yes (X) | |||||
| KOA YAMASHITA | ||||||||||
| DENTIST | 40.00 | $121,041 | $0 | $0 | Yes (X) | |||||
| CHRISTIAN ALAMEDA | ||||||||||
| CEO | 40.00 | $65,852 | $0 | $2,292 | Yes (X) | |||||
| DEBORAH JONES | ||||||||||
| CFO | 40.00 | $41,059 | $0 | $696 | Yes (X) | |||||
| KATHARYN DAUB | ||||||||||
| BOARD CHAIR | 5.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||||
| BRANDEE MENINO | ||||||||||
| VICE CHAIR | 5.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||||
| HAIDEE ABE | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| PATRICIA KAY HENSLEY | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| BRITTA ZIMMER ND | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| MARY KENOI-OKAJIMA | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| MIKE SAYAMA | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| MIKE MCGEE | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| ADAM BAUER | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| LISSANDRA C BALDAN-JENKINS | ||||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||||
| CHRISTIAN KIMO ALAMEDA | ||||||||||
| DEFACTO - EXECUTIVE DIRECTOR | 0.00 | $0 | $0 | $0 | Yes (X) | 0.00 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,472,552 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $102,918 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | 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 |
|---|---|---|---|---|---|
| UNIVERSITY CLINICAL EDUCATION & RESEARC | |||||
| PO BOX 31000 | HONOLULU | HI | 96849 | PHYSICIAN SERVICES | $370,793 |
| NINU ALEXANDRI QUIRK | |||||
| PO BOX 5533 | PAHOA | HI | 96778 | PHYSICIAN SERVICES | $283,380 |
| KARL KAHO'ONEI | |||||
| 151 KUAKOLU PLACE | HILO | HI | 96720 | CLEANING SERVICES | $174,285 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,652,935 | GovernmentGrantsAmt |
| All Other Contributions | $484,234 | AllOtherContributionsAmt |
| Noncash Contributions | $163,479 | NoncashContributionsAmt |
| Total Contributions | $3,137,169 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621110 | $13,061,542 | $13,061,542 |
| MEDICAL RECORDS INCOME | 621110 | $10,671 | $10,671 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,072,213 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,418 | TotalRevenueColumnAmt |
| Exclusion | $1,418 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $163,472 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $102,738 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $60,734 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,734 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $45,568 | UnrelatedBusinessRevenueAmt |
| Exclusion | $15,166 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | REIMBURSEMENTS & REFUNDS | Desc |
| Business | 900999 | BusinessCd |
| Total Revenue Column | $1,546 | TotalRevenueColumnAmt |
| Exclusion | $1,546 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,546 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,273,080 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,072,213 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $45,568 | UnrelatedBusinessRevenueAmt |
| Exclusion | $18,130 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $692,519 | TotalAmt |
| Management And General | $692,519 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,174,720 | TotalAmt |
| Program Services | $8,255,395 | ProgramServicesAmt |
| Management And General | $899,333 | ManagementAndGeneralAmt |
| Fundraising | $19,992 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,396 | TotalAmt |
| Program Services | $145,063 | ProgramServicesAmt |
| Management And General | $27,969 | ManagementAndGeneralAmt |
| Fundraising | $364 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,088,941 | TotalAmt |
| Program Services | $911,008 | ProgramServicesAmt |
| Management And General | $175,646 | ManagementAndGeneralAmt |
| Fundraising | $2,287 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $941,110 | TotalAmt |
| Program Services | $787,333 | ProgramServicesAmt |
| Management And General | $151,801 | ManagementAndGeneralAmt |
| Fundraising | $1,976 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,746 | TotalAmt |
| Management And General | $150,746 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,129 | TotalAmt |
| Management And General | $40,129 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $857,300 | TotalAmt |
| Program Services | $581,688 | ProgramServicesAmt |
| Management And General | $275,612 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413,115 | TotalAmt |
| Program Services | $318,532 | ProgramServicesAmt |
| Management And General | $94,583 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,140,753 | TotalAmt |
| Program Services | $1,002,986 | ProgramServicesAmt |
| Management And General | $137,767 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,147 | TotalAmt |
| Program Services | $78,432 | ProgramServicesAmt |
| Management And General | $8,715 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,273 | TotalAmt |
| Program Services | $25,395 | ProgramServicesAmt |
| Management And General | $162,878 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $520,399 | TotalAmt |
| Program Services | $511,120 | ProgramServicesAmt |
| Management And General | $9,279 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,846 | TotalAmt |
| Program Services | $60,219 | ProgramServicesAmt |
| Management And General | $10,627 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| PHARMACEUTICALS/PATIENT | $703,972 | $703,972 | $0 | $0 |
| EQUIPMENT LEASES/EXPENS | $487,695 | $48,770 | $438,925 | $0 |
| OTHER EXPENSES | $207,889 | $68,192 | $139,697 | $0 |
| NONCASH MEDICAL ITEMS | $163,479 | $163,479 | $0 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,271 | TotalAmt |
| Program Services | $103,744 | ProgramServicesAmt |
| Management And General | $11,527 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,217,700 | TotalAmt |
| Program Services | $13,765,328 | ProgramServicesAmt |
| Management And General | $3,427,753 | ManagementAndGeneralAmt |
| Fundraising | $24,619 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,684,243 | BOYAmt |
| EOY | $5,907,588 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $806,230 | BOYAmt |
| EOY | $780,405 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $394,220 | BOYAmt |
| EOY | $96,879 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $634,222 | BOYAmt |
| EOY | $1,032,579 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $198,032 | BOYAmt |
| EOY | $198,628 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,424,686 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,344,656 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,186,904 | BOYAmt |
| EOY | $9,080,030 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,607 | BOYAmt |
| EOY | $82,424 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,002,458 | BOYAmt |
| EOY | $17,178,533 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,062,296 | BOYAmt |
| EOY | $687,818 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $205,154 | BOYAmt |
| EOY | $1,475,876 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,820,122 | BOYAmt |
| EOY | $4,770,037 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,461 | BOYAmt |
| EOY | $2,283,740 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,410 | BOYAmt |
| EOY | $11,667 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,108,443 | BOYAmt |
| EOY | $9,229,138 | 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 | $8,889,283 | BOYAmt |
| EOY | $7,944,663 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,732 | BOYAmt |
| EOY | $4,732 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,894,015 | BOYAmt |
| EOY | $7,949,395 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,002,458 | BOYAmt |
| EOY | $17,178,533 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$944,620 | 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 | $1,469,517 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,950,147 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,652,708 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,751,756 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,137,169 | CurrentTaxYearAmt |
| Total | $9,961,297 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,183,243 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,689,772 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,078,567 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,773,398 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,072,213 | CurrentTaxYearAmt |
| Total | $71,797,193 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,652,760 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $15,639,919 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,731,275 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,525,154 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $16,209,382 | CurrentTaxYearAmt |
| Total | $81,758,490 | 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) |
|---|---|---|
| Current Tax Year Minus1 Year | $1,114,144 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,044,917 | CurrentTaxYearAmt |
| Total | $2,159,061 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $1,114,144 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,044,917 | CurrentTaxYearAmt |
| Total | $2,159,061 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $79,599,429 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $581 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $552 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $878 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,745 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $42,233 | CurrentTaxYearAmt |
| Total | $51,989 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $581 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $552 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $878 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,745 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $42,233 | CurrentTaxYearAmt |
| Total | $51,989 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,479 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $10,994 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $45,568 | CurrentTaxYearAmt |
| Total | $60,041 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $160 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year | $1,546 | CurrentTaxYearAmt |
| Total | $1,706 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,656,980 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $15,640,471 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,743,147 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,532,899 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $16,298,729 | CurrentTaxYearAmt |
| Total | $81,872,226 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.97220 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99970 | PublicSupportPY509Pct |
| Investment Income CY | 0.00060 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| 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) |
|---|---|---|
| Other Cost Or Other Basis | $2,525,547 | OtherCostOrOtherBasisAmt |
| Book Value | $2,525,547 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,061,540 | OtherCostOrOtherBasisAmt |
| Depreciation | $998,272 | DepreciationAmt |
| Book Value | $5,063,268 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,193,539 | OtherCostOrOtherBasisAmt |
| Depreciation | $934,217 | DepreciationAmt |
| Book Value | $259,322 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,749,360 | OtherCostOrOtherBasisAmt |
| Depreciation | $976,567 | DepreciationAmt |
| Book Value | $772,793 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,894,700 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,435,600 | DepreciationAmt |
| Book Value | $459,100 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,080,030 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASES | Desc |
| Amt | $11,667 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $11,667 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $16,375,818 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $102,738 | OtherRevenueAmt |
| Revenue Not Reported | $102,738 | RevenueNotReportedAmt |
| Revenue Subtotal | $16,273,080 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $16,273,080 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,320,438 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $102,738 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $102,738 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,217,700 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,217,700 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE CLINIC FOLLOWS US GAAP RELATED TO THE RECOGNITION OF UNCERTAIN TAX POSITIONS. THESE STANDARDS PROVIDE DETAILED GUIDANCE FOR FINANCIAL STATEMENT RECOGNITION, MEASUREMENT, AND DISCLOSURE OF UNCERTAIN TAX POSITIONS. THESE STANDARDS REQUIRE AN ENTITY TO RECOGNIZE THE FINANCIAL STATEMENT IMPACT OF A TAX POSITION WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WOULD NOT BE SUSTAINED IF EXAMINED BY A TAXING AUTHORITY. MANAGEMENT HAS DETERMINED THAT THE CLINIC HAD NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2020. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES NETTED WITH REVENUE 102,738. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES NETTED WITH REVENUE 102,738. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HAROLD WALLACE | ||||||||||||||
| FORMER CEO TERM 4.30.19 | $199,812 | $0 | $44,850 | $0 | $0 | $0 | $25,000 | $0 | $2,292 | $0 | $271,954 | $0 | $0 | $0 |
| SHUANA PAYLOR | ||||||||||||||
| DEPUTY MEDICAL DIRECTOR | $187,719 | $0 | $3,709 | $0 | $0 | $0 | $23,732 | $0 | $7,039 | $0 | $222,199 | $0 | $0 | $0 |
| YOULSAU BELLS | ||||||||||||||
| INTERIM CEO/COO | $191,257 | $0 | $0 | $0 | $0 | $0 | $12,344 | $0 | $7,039 | $0 | $210,640 | $0 | $0 | $0 |
| MICHAEL TREECE | ||||||||||||||
| PHYSICIAN | $176,902 | $0 | $894 | $0 | $0 | $0 | $0 | $0 | $7,039 | $0 | $184,835 | $0 | $0 | $0 |
| BRIAN HIGA | ||||||||||||||
| DENTIST | $168,119 | $0 | $0 | $0 | $0 | $0 | $8,406 | $0 | $7,039 | $0 | $183,564 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - THE ORGANIZATION MAINTAINS A MEMBERSHIP AT A LOCAL SOCIAL CLUB FOR THE PURPOSES OF MEALS WITH PROSPECTIVE AND ACTIVE EMPLOYEES, DONORS, AND BUSINESS ASSOCIATES. THE MEMBERSHIP IS UNDER THE NAME OF THE CHIEF EXECUTIVE OFFICER. DUE TO THE LIMITED AVAILABILITY OF DINING OPPORTUNITIES IN THE LOCAL AREA, THE BOARD OF DIRECTORS FEELS IT IS IMPORTANT TO HAVE THIS OPPORTUNITY AVAILABLE FOR SUCH BUSINESS PURPOSES. THIS HAS NOT BEEN TREATED AS TAXABLE COMPENSATION AS IT IS USED ONLY FOR BUSINESS PURPOSES. IN THE FALL OF 2019, BAY CLINIC, INC. TERMINATED THE MEMBERSHIP. |
| PART I, LINE 1B | THE BAY CLINIC, INC. DOES NOT HAVE A WRITTEN REIMBURSEMENT POLICY. HOWEVER, THE CEO AND THE BOARD HAVE A WRITTEN EMPLOYMENT CONTRACT, WHICH INCLUDES ACCOMMODATION FOR SPECIAL TRAVEL REQUIREMENTS THAT IS BASED ON A COMPENSATION SURVEY, AMONG OTHER THINGS, OF COMPARABLE POSITIONS, AND IS APPROVED BY THE BOARD OF DIRECTORS. CHARGES RELATED TO THE SOCIAL CLUB ARE SUBJECT TO THE SAME REVIEW/APPROVAL PROCESS AS OTHER EXPENDITURES AND ARE PAID DIRECTLY TO THE SOCIAL CLUB. |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $163,479 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 AMENDED RETURN STATEMENT | THE ORGANIZATION IS FILING AN AMENDED RETURN TO REFLECT FINANCIAL AMOUNT CHANGES. THE AUDITED FINANCIAL STATEMENTS WERE NOT ISSUED UNTIL AFTER THE ORIGINAL DUE DATE OF THE RETURN. THE FOLLOWING CHANGES ARE REFLECTED ON THE AMENDED FORM 990 RETURN: PART VIII UPDATES TO THE STATEMENT OF REVENUES TO MATCH THE AUDITED FINANCIAL STATEMENTS, PART IX UPDATES TO THE STATEMENT OF FUNCTIONAL EXPENSES TO MATCH THE AUDITED FINANCIAL STATEMENTS, PART X UPDATES TO THE BALANCE SHEET TO MATCH THE AUDITED FINANCIAL STATEMENTS. BASED ON THE CHANGES TO PART VIII, PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS LINE 4A HAS BEEN UPDATED TO AGREE TO PART VIII LINE 12 COLUMN B AND PART XI LINE 25 COLUMN B. ADDITIONALLY SCHEDULE A PART III HAS BEEN UPDATED TO REFLECT THE CHANGES IN PART VIII OF THE FORM 990. IN ADDITION FORM 990-T HAS ALSO BEEN AMENDED TO REFLECT CHANGES TO THE AUDITED FINANCIAL STATEMENTS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE INTERIM CEO REVIEWED THE FORM 990 AND THE BOARD REVIEWED AND APPROVED THE FORM 990 AT THE MAY 2021 BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CLINIC ESTABLISHED A CONFLICT OF INTEREST POLICY WHICH IS PRESENTED IN THE EMPLOYEE HANDBOOK. ALL EMPLOYEES ARE EXPECTED TO ADHERE TO THIS POLICY. THE ORGANIZATION REVIEWS THIS POLICY WITH NEW HIRES. MANAGEMENT MONITORS EMPLOYEES ON ANY ISSUE THAT MAY INVOLVE A CONFLICT OF INTEREST. AN ANNUAL DISCLOSURE FORM IS COMPLETED BY EACH BOARD MEMBER AND MONITORED BY THE BOARD CHAIRPERSON. IF A CONFLICT ARISES, THE ASSOCIATED BOARD PERSON MUST RECUSE THEMSELVES FROM VOTING ON RELATED MATTERS. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS BASED ON THE ORGANIZATION'S BUDGET, MARKET DATA FOR THE POSITION, COMPARABLE STUDIES OF SIMILAR ENTITIES, AND THE LOCAL COMPENSATION RATES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FORM 990 IS AVAILABLE UPON REQUEST AS WELL AS ON GUIDESTAR.ORG. ALL OTHER GOVERNING DOCUMENTS AND POLICIES, INCLUDING THE CONFLICT OF INTEREST POLICY, IS AVAILABLE UPON REQUEST. |