WILLAMETTE HEALTH COUNCIL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- WILLAMETTE HEALTH COUNCIL (EIN 84-2658002)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-07
- IRS object ID
- 202213119349304406
- 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 | 2022-11-07T15:31:27-08:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 931122378 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDY MITCHELL CPA PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 N First St | AddressLine1Txt |
| City | Silverton | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97381 | 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 | 842658002 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLAMETTE HEALTH COUNCIL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WILL | BusinessNameControlTxt |
| Phone | 5037402952 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3759 | AddressLine1Txt |
| City | SALEM | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97302 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Justin Hopkins | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Signature | 2022-11-03 | SignatureDt |
| Discuss With Paid Preparer | false | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Justin | PersonFirstNm |
| Person Last | Hopkins | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RANDALL E MITCHELL CPA | PreparerPersonNm |
| PTIN | P00182074 | PTIN |
| Phone | 5038732310 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Federated Assurance Level | FAL1 | FederatedAssuranceLevelCd |
| 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 | JUSTIN HOPKINS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2580 BOLTON TER S | AddressLine1Txt |
| City | SALEM | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97302 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,667,856 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | willamettehealthcouncil.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2020 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | The Willamette Health Council improves the well-being of residents in our region by governing our local Coordinated Care Organization, investing in our communities, and fostering collaborative partnerships. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 5 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $8,280,679 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,667,856 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $8,280,679 | PYTotalRevenueAmt |
| CY Total Revenue | $6,667,856 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,018,292 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $4,856,307 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $165,225 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $165,155 | PYOtherExpensesAmt |
| CY Other Expenses | $451,281 | CYOtherExpensesAmt |
| PY Total Expenses | $7,183,447 | PYTotalExpensesAmt |
| CY Total Expenses | $5,472,813 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,097,232 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,195,043 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,130,999 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,326,042 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,130,999 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,326,042 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The Willamette Health Council improves the well-being of residents in our region by governing our local Coordinated Care Organization, investing in our communities, and fostering collaborative partnerships. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $5,472,813 | ExpenseAmt |
| Desc | To improve the well-being of residents in our region by governing our local Coordinated Care Organization, investing in our communities, and fostering collaborative partnerships. | Desc |
| Total Program Service Expenses | $5,472,813 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | 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 | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | 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 | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 5 | EmployeeCnt |
| Employment Tax Returns Filed | false | 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 |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| 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 | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Randy Mitchell CPA | PersonNm |
| Phone | 5038732310 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 N First Street | AddressLine1Txt |
| City | Silverton | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97381 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| JUSTIN HOPKINS | |||||||
| Executive Dir. | 40.00 | 0.00 | Yes (X) | $129,895 | $0 | $0 | |
| MARK HELM | |||||||
| Chairman | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| ELIZABETH SPINNING | |||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| SARAH BREWER | |||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| MATT BOLES | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| CLAY PETERSON | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| LISA LILLICO | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| JOSH GRAVES | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| DAVID FENDER | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| LESLIE HUGGINS | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| PETER DAVIDSON | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| PAUL LOGAN | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| JACKIE HADDON | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| TINA FOSS | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| ROBERT STEELE | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| NOELLE CARROLL | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| COLM WILLIS | |||||||
| Director | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $129,895 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $6,667,856 | AllOtherContributionsAmt |
| Total Contributions | $6,667,856 | TotalContributionsAmt |
| Total Program Service Revenue | $0 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,667,856 | TotalRevenueColumnAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,856,307 | TotalAmt |
| Program Services | $4,856,307 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,895 | TotalAmt |
| Program Services | $129,895 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,330 | TotalAmt |
| Program Services | $35,330 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,425 | TotalAmt |
| Program Services | $3,425 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,904 | TotalAmt |
| Program Services | $3,904 | ProgramServicesAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $361,730 | TotalAmt |
| Program Services | $361,730 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315 | TotalAmt |
| Program Services | $315 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,567 | TotalAmt |
| Program Services | $14,567 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,750 | TotalAmt |
| Program Services | $30,750 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $735 | TotalAmt |
| Program Services | $735 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,897 | TotalAmt |
| Program Services | $14,897 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,710 | TotalAmt |
| Program Services | $7,710 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| DUES & SUBSCRIPTIONS | $5,813 | $5,813 |
| SOFTWARE | $2,520 | $2,520 |
| CAC STIPENDS | $1,729 | $1,729 |
| TELEPHONE | $1,015 | $1,015 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,171 | TotalAmt |
| Program Services | $2,171 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,472,813 | TotalAmt |
| Program Services | $5,472,813 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,127,605 | BOYAmt |
| EOY | $2,256,905 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $80,930 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,393 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,394 | BOYAmt |
| EOY | $65,537 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,600 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,130,999 | BOYAmt |
| EOY | $2,326,042 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,130,999 | BOYAmt |
| EOY | $2,326,042 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,130,999 | BOYAmt |
| EOY | $2,326,042 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,130,999 | BOYAmt |
| EOY | $2,326,042 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,195,043 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,650 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,261 | DepreciationAmt |
| Book Value | $14,389 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,410 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,758 | DepreciationAmt |
| Book Value | $21,652 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,870 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,374 | DepreciationAmt |
| Book Value | $29,496 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $65,537 | TotalBookValueLandBuildingsAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | false | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (63 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|
| ADVANTAGE DENTAL SERVICES | ||||||
| PO BOX 11470 | EUGENE | OR | 97440 | $100,069 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| ADVENTURES WITH AUTISM | ||||||
| 4300 CHERRY AVE NE | KEIZER | OR | 97303 | $20,478 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| AMAZING TREATMENT - SUD | ||||||
| 525 FERRY ST SE STE 203 | SALEM | OR | 97302 | $12,261 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| ARMSTRONG WELLNESS | ||||||
| 1655 STATE ST | SALEM | OR | 97302 | $36,975 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| BRAD DEHLER BS | ||||||
| 185 13TH ST NE | SALEM | OR | 97301 | $6,360 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| BRIDGEWAY RECOVERY SERVICES | ||||||
| PO BOX 17818 | SALEM | OR | 97305 | $115,661 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CANYON FAMILY HEALTH INC | ||||||
| 1095 N 1ST ST | STAYTON | OR | 97383 | $11,454 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CAPITOL DENTAL CARE | ||||||
| 3000 MARKET ST NE 228 | SALEM | OR | 97301 | $195,797 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CASTILLO JUAN L | ||||||
| PO BOX 23249 | BELFAST | ME | 04915 | $9,935 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CATHOLIC COMMUNITY SERVICES | ||||||
| 3737 PORTLAND RD | SALEM | OR | 97301 | $18,231 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CENTER FOR ADDICTION AND COUN | ||||||
| 460 LANCASTER DR NE | SALEM | OR | 97301 | $7,420 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CENTER FOR AUTISM AND RELATED | ||||||
| 21600 OXNARD ST STE 1800 | WOODLAND HILLS | CA | 91367 | $49,793 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CHILDHOOD HEALTH ASSOCIATES | ||||||
| 891 23RD ST NE | SALEM | OR | 97301 | $299,076 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CLEAR PATHS | ||||||
| 3793 RIVER ROAD N | SALEM | OR | 97303 | $27,864 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CONNECTIONS 365 | ||||||
| 4890 32ND AVE SE | SALEM | OR | 97317 | $12,160 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| COORDINATED COUNSELING FOR CH | ||||||
| 295 CHURCH ST SE 305 | SALEM | OR | 97301 | $6,843 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CORPORATION FOR SUPPORT HOUSE | ||||||
| 2441 GREAR ST NE | SALEM | OR | 97301 | $115,000 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CREATING PATHWAYS PEDIATRIC T | ||||||
| 3871 FAIRVIEW INDUSTRIAL DR S | SALEM | OR | 97302 | $18,121 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CREEKSIDE COUNSELING INC | ||||||
| PO BOX 4169 | SALEM | OR | 97302 | $8,318 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| CROSSING BRIDGES COUNSELING C | ||||||
| PO BOX 873 | TUALATIN | OR | 97062 | $13,847 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| DR TIMOTHY PETERS | ||||||
| 605 WELCH ST | SILVERTON | OR | 97381 | $16,050 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| HOPE FAMILY MEDICINE | ||||||
| 2410 TURNER RD SE | SALEM | OR | 97302 | $6,697 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| INTERCULTURAL CENTER FOR PSYC | ||||||
| PO BOX 256 | NEWBERG | OR | 97132 | $11,066 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| JD HEALTH AND WELLNESS CENTER | ||||||
| PO BOX 2178 | WILSONVILLE | OR | 97070 | $6,364 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| JOHN H WELLER | ||||||
| 1095 LIBERTY ST | SALEM | OR | 97301 | $7,969 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| LEGACY MEDICAL GROUP | ||||||
| PO BOX 3417 | PORTLAND | OR | 97208 | $7,471 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| LEGACY MERIDIAN PARK HOSPITAL | ||||||
| PO BOX 4037 | PORTLAND | OR | 97208 | $9,866 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| LIBERTY HOUSE | ||||||
| 2685 4TH ST NE | SALEM | OR | 97301 | $11,727 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| MARION COUNTY PUBLIC HEALTH | ||||||
| 3180 CENTER ST NE | SALEM | OR | 97301 | $595,368 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| MID VALLEY PAIN CLINIC | ||||||
| 3723 FAIRVIEW DR STE 170 | SALEM | OR | 97302 | $6,232 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| MILL CREEK FAMILY CLINIC | ||||||
| 4285 COMMERCIAL ST SE 120 | SALEM | OR | 97302 | $13,354 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| NEW PERSPECTIVES CENTER FOR C | ||||||
| PO BOX 7497 | SALEM | OR | 97303 | $75,832 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| NORTHWEST PERMANENTE | ||||||
| 7201 NORTH INTERSTATE AVE | PORTLAND | OR | 97217 | $35,928 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| NWHS-WEST SALEM CLINIC | ||||||
| 1233 EDGEWATER ST NW | SALEM | OR | 97304 | $249,937 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| OPTIONS COUNSELING FAMILY SVC | ||||||
| 3270 LIBERTY RD S | SALEM | OR | 97302 | $90,919 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| OPTIONS COUNSELING SVCS OF OR | ||||||
| 3500 CHAD DR | EUGENE | OR | 97408 | $64,588 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| OREGON DENTAL SERVICE | ||||||
| 601 SW SECOND AVE | PORTLAND | OR | 97204 | $89,904 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| OREGON FAMILY HEALTH | ||||||
| 607 SE JEFFERSON ST | DALLAS | OR | 97338 | $31,536 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| OREGON FAMILY SUPPORT | ||||||
| PO BOX 886 | SALEM | OR | 97301 | $78,000 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| OREGON RECOVERY BEHAVIORAL HE | ||||||
| PO BOX 20674 | KEIZER | OR | 97307 | $5,418 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| PHYSICIANS BUILDING GROUP | ||||||
| 1234 COMMERCIAL ST SE | SALEM | OR | 97302 | $18,079 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| POLK COUNTY HEALTH DEPARTMENT | ||||||
| 182 ACADEMY SW | DALLAS | OR | 97338 | $238,062 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| RODNEY E ORR MD PC | ||||||
| 335 FAIRVIEW ST | SILVERTON | OR | 97381 | $18,269 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SALEM CLINIC PC | ||||||
| PO BOX 8100 | SALEM | OR | 97303 | $400,587 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SALEM FAMILY MEDICINE | ||||||
| 432 LANCASTER DR NE | SALEM | OR | 97301 | $10,466 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SALEM HEALTH | ||||||
| PO BOX 5969 | PORTLAND | OR | 97228 | $322,056 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SALEM KEIZER COALITION | ||||||
| PO BOX 13129 | SALEM | OR | 97309 | $75,450 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SALEM PEDIATRIC CLINIC | ||||||
| 2478 13TH ST SE | SALEM | OR | 97302 | $200,716 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SANTIAM MEMORIAL HOSPITAL | ||||||
| PO BOX 19212 | BELFAST | ME | 04915 | $74,418 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SAPPHIRE BLUE BEHAVIORAL HEAL | ||||||
| 5200 SW MEADOWS RD STE 150 | LAKE OSWEGO | OR | 97035 | $5,664 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SHANGRI LA | ||||||
| 4080 REED RD SE STE 150 | SALEM | OR | 97302 | $25,320 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SILVER CREEK FAMILY MEDICINE | ||||||
| 111 W C ST | SILVERTON | OR | 97381 | $9,678 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| SILVERTON HEALTH | ||||||
| PO BOX 3417 | PORTLAND | OR | 97208 | $170,045 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| STAYTON FAMILY PRACTICE | ||||||
| PO BOX 19517 | BELFAST | ME | 04915 | $19,706 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| VALLEY MENTAL HEALTH | ||||||
| 821 SAGINAW ST STE S | SALEM | OR | 97302 | $108,461 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| VIDA FAMILY MEDICINE | ||||||
| PO BOX 883 | SALEM | OR | 97308 | $16,398 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| WEST SALEM FAMILY PRACTICE | ||||||
| 1275 WALLACE RD NW | SALEM | OR | 97304 | $7,733 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| WEST VALLEY HOSPITAL | ||||||
| PO BOX 94269 | SEATTLE | WA | 98124 | $10,910 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| WFMC HEALTH | ||||||
| 435 LANCASTER DR NE | SALEM | OR | 97301 | $42,429 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| WILLAMETTE FAMILY MEDICAL CEN | ||||||
| 435 LANCASTER DR NE | SALEM | OR | 97301 | $165,738 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| WILLAMETTE VALLEY HOSPICE | ||||||
| 2973 12TH ST SE | SALEM | OR | 97302 | $7,228 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| WOODBURN PEDIATRIC CLINIC | ||||||
| 2050 PROGRESS WAY | WOODBURN | OR | 97071 | $99,850 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| YVFW | ||||||
| PO BOX 190 | TOPPENISH | WA | 98948 | $394,386 | $0 | COMMUNITY IMPACT-VARIOUS HEALTH |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 0 | Total501c3OrgCnt |
| Total Other Org | 63 | TotalOtherOrgCnt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | No review was or will be conducted. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | REVIEWED AND APPROVED BY BOARD MEMBERS. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | No documents available to the public. |