KNOX WINAMAC COMMUNITY HEALTH CENTERS INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- KNOX WINAMAC COMMUNITY HEALTH CENTERS INC (EIN 87-0778393)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202213199349315236
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T13:26:48-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 352102008 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CNA TAX PROFESSIONALS INC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10475 CROSSPOINT BOULEVARD SUITE | AddressLine1Txt |
| Address Line2 | 200 | AddressLine2Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46256 | 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 | 870778393 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KNOX WINAMAC COMMUNITY HEALTH | BusinessNameLine1Txt |
| Business Name Line2 | CENTERS INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KNOX | BusinessNameControlTxt |
| Phone | 5747726030 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1002 SOUTH EDGEWOOD DR | AddressLine1Txt |
| City | KNOX | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46534 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHY ROBB | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 5747726030 | PhoneNum |
| Signature | 2022-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KATHY | PersonFirstNm |
| Person Last | ROBB | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWN D DREIMAN CPA | PreparerPersonNm |
| PTIN | P00380913 | PTIN |
| Phone | 3178413393 | PhoneNum |
| Preparation | 2022-11-07 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KATHY ROBB | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1002 SOUTH EDGEWOOD DR | AddressLine1Txt |
| City | KNOX | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46534 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,648,397 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | NA | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2006 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | THE ORGANIZATION PROVIDES PRIMARY AND PREVENTIVE HEALTH SERVICES TO THE AREA'S UNDER-SERVED AND MOST VULNERABLE POPULATIONS THROUGH HIGH QUALITY CLINICAL CARE WITH A DEMONSTRATED IMPACT ON THE HEALTH OUTCOMES OF THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 35 | TotalEmployeeCnt |
| Total Volunteers | 1 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $270,243 | PYContributionsGrantsAmt |
| CY Contributions Grants | $213,781 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,735,873 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,281,088 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$4,901 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $310,048 | PYOtherRevenueAmt |
| CY Other Revenue | $153,528 | CYOtherRevenueAmt |
| PY Total Revenue | $3,311,263 | PYTotalRevenueAmt |
| CY Total Revenue | $2,648,397 | 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 | $1,548,320 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,699,575 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,167,193 | PYOtherExpensesAmt |
| CY Other Expenses | $1,064,625 | CYOtherExpensesAmt |
| PY Total Expenses | $2,715,513 | PYTotalExpensesAmt |
| CY Total Expenses | $2,764,200 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $595,750 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$115,803 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,165,401 | TotalAssetsBOYAmt |
| Total Assets EOY | $733,061 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $427,337 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $110,800 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $738,064 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $622,261 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE ORGANIZATION PROVIDES PRIMARY AND PREVENTIVE HEALTH SERVICES TO THE AREA'S UNDER-SERVED AND MOST VULNERABLE POPULATIONS THROUGH HIGH QUALITY CLINICAL CARE WITH A DEMONSTRATED IMPACT ON THE HEALTH OUTCOMES OF THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,843,904 | ExpenseAmt |
| Revenue | $2,281,088 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES AN ARRAY OF HEALTH CARE SERVICES THAT ARE AVAILABLE TO ALL PERSONS, REGARDLESS OF THE ABILITY TO PAY. WE HAVE A TEAM OF DOCTORS AND NURSE PRACTITIONERS WHO STAFF OUR OFFICE IN KNOX. OUR TEAM OF PROFESSIONALS OFFERS LOCAL ACCESS TO A COMPREHENSIVE RANGE OF AFFORDABLE PREVENTIVE AND PRIMARY HEALTH CARE SERVICES. ADDITIONALLY, THE ORGANIZATION PROVIDES MENTAL HEALTH CARE SERVICES, WHICH ENCOMPASSES, AMONG OTHER THINGS, SUBSTANCE ABUSE. THE ORGANIZATION ALSO PROVIDES SERVICES FOR MOTHERS AND MOTHERS-TO-BE. DURING CALENDAR YEAR 2021, OUR OFFICE PROVIDED CARE FOR 2,377 PERSONS, OF WHOM 765 WERE MEDICAID ELIGIBLE, 612 WERE MEDICARE ELIGIBLE, 629 WERE COVERED UNDER SOME FORM OF INSURANCE, AND 371 WERE UNINSURED. | Desc |
| Total Program Service Expenses | $1,843,904 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 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 | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | 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 | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 35 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| DAF Excess Business Holdings | 0 | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | 0 | TaxableDistributionsInd |
| Distribution To Donor | 0 | DistributionToDonorInd |
| 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EILEEN BLANKE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5747726030 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1002 SOUTH EDGEWOOD DR | AddressLine1Txt |
| City | KNOX | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46534 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| PAUL LISOWSKI | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL DULIN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEBRA TROIKE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFF HOUSTON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL TOLSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BECKY ANSPACH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CARLA MUSIAL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TARA MINIX | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| AJ GAPPA | |||||||
| TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| GAYLE SMITH | |||||||
| PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| NANCY DEMBOWSKI | |||||||
| VICE PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| KATHLEEN ROBB | |||||||
| EXECUTIVE DIR. | 40.00 | $92,204 | $0 | $11,210 | Yes (X) | ||
| EILEEN BLANKE | |||||||
| CFO | 40.00 | $83,416 | $0 | $11,210 | Yes (X) | ||
| DR WALTER E FRITZ | |||||||
| MEDICAL DIRECTOR | 40.00 | $213,822 | $0 | $22,421 | Yes (X) | ||
| DAVID COOK | |||||||
| MEDICAL DOCTOR | 40.00 | $191,103 | $0 | $22,639 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $580,545 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $67,480 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| CARDINAL HEALTH | |||||
| 7000 CARDINAL PLACE | DUBLIN | OH | 43017 | 340B DRUG COSTS | $200,156 |
| OMEGA HEALTHCARE INVESTORS | |||||
| 200 INTL CIRCLE STE 3500 | HUNT VALLEY | MD | 21030 | RENT | $169,099 |
| NORTH AMERICAN HEALTHCARE MANAGEMENT SER | |||||
| 9245 WATSON INDUSTRIAL PARK | ST LOUIS | MO | 63126 | BILLING CONTRACT | $108,937 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $208,281 | GovernmentGrantsAmt |
| All Other Contributions | $5,500 | AllOtherContributionsAmt |
| Total Contributions | $213,781 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE FEE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $2,281,088 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,281,088 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,281,088 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CANCELLATION OF DEBT | 900099 | $129,000 | $129,000 |
| OTHER INCOME | 900099 | $24,528 | $24,528 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $153,528 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,648,397 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,281,088 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $153,528 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $646,126 | TotalAmt |
| Program Services | $452,288 | ProgramServicesAmt |
| Management And General | $193,838 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,053,449 | TotalAmt |
| Program Services | $737,414 | ProgramServicesAmt |
| Management And General | $316,035 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,380 | TotalAmt |
| Program Services | $66,380 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,950 | TotalAmt |
| Program Services | $20,950 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,195 | TotalAmt |
| Program Services | $167,195 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,862 | TotalAmt |
| Management And General | $60,862 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,766 | TotalAmt |
| Management And General | $25,766 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,068 | TotalAmt |
| Program Services | $148,028 | ProgramServicesAmt |
| Management And General | $69,040 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414 | TotalAmt |
| Program Services | $414 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,196 | TotalAmt |
| Program Services | $11,196 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $601 | TotalAmt |
| Management And General | $601 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,930 | TotalAmt |
| Management And General | $37,930 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,270 | TotalAmt |
| Program Services | $31,130 | ProgramServicesAmt |
| Management And General | $217,140 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL LAB FEES | $82,616 | $82,616 | |
| MISCELLANEOUS | $58,313 | $40,819 | $17,494 |
| CONTRACT LABOR | $54,956 | $54,956 | |
| BAD DEBT | $22,748 | $22,748 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$10,640 | TotalAmt |
| Program Services | $30,518 | ProgramServicesAmt |
| Management And General | -$41,158 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,764,200 | TotalAmt |
| Program Services | $1,843,904 | ProgramServicesAmt |
| Management And General | $920,296 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $767,333 | BOYAmt |
| EOY | $492,194 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $275,873 | BOYAmt |
| EOY | $149,687 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,935 | BOYAmt |
| EOY | $14,144 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $208,449 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $131,413 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,260 | BOYAmt |
| EOY | $77,036 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,165,401 | BOYAmt |
| EOY | $733,061 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $215,617 | BOYAmt |
| EOY | $110,800 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,720 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $427,337 | BOYAmt |
| EOY | $110,800 | 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 | $669,742 | BOYAmt |
| EOY | $622,261 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,322 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $738,064 | BOYAmt |
| EOY | $622,261 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,165,401 | BOYAmt |
| EOY | $733,061 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$115,803 | 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $54,165 | OtherCostOrOtherBasisAmt |
| Depreciation | $43,721 | DepreciationAmt |
| Book Value | $10,444 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $154,284 | OtherCostOrOtherBasisAmt |
| Depreciation | $87,692 | DepreciationAmt |
| Book Value | $66,592 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $77,036 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,690,397 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $42,000 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $42,000 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,648,397 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,648,397 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,806,200 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $42,000 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $42,000 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,764,200 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,764,200 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | FIN 48 FOOTNOTE THE ORGANIZATION ADOPTED THE ACCOUNTING POLICY TO RECOGNIZE A TAX BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED WILL BE THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE MORE LIKELY-THAN-NOT TEST, NO TAX BENEFIT WILL BE RECORDED. THE ORGANIZATION HAS EXAMINED THIS ISSUE AND HAS DETERMINED THERE ARE NO MATERIAL CONTINGENT TAX LIABILITIES. THE ORGANIZATIONS FEDERAL EXEMPT ORGANIZATION INCOME TAX RETURNS (FORM 990) ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR WALTER E FRITZ | ||||||||||||||
| MEDICAL DIRECTOR | $213,822 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,421 | $0 | $236,243 | $0 | $0 | $0 |
| DAVID COOK | ||||||||||||||
| MEDICAL DOCTOR | $191,103 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,639 | $0 | $213,742 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE BELOW | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY OF MANAGEMENT | RelationshipDescriptionTxt |
| Transaction | SEE BELOW | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, LN 1 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION OBTAINS MANUAL LABOR SERVICES FROM OUTSIDE VENDORS THAT ARE FAMILY MEMBERS TO BOARD MEMBERS OR MANAGEMENT. AMOUNTS PAID TO SUCH VENDORS, IN AGGREGATE, WERE $47,622 AND $24,844 FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020, RESPECTIVELY. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | LINE 11B EXPLANATION - COPIES OF THE FINAL FORM 990 ARE PROVIDED TO THE BOARD MEMBERS THROUGH EMAIL WITH INSTRUCTIONS THAT THEY ARE TO RESPOND IMMEDIATELY WITH QUESTIONS DUE TO TIMELINESS OF FILING THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH YEAR THE CFO PROVIDES CONFLICT OF INTEREST STATEMENTS TO ALL BOARD MEMBERS FOR THEIR REVIEW AND SIGNATURES. THE CORPORATION AVOIDS ACTIVE PARTICIPATION OF ANY DIRECTOR IN A MANNER THAT POSES A CONFLICT OF INTEREST WITH RESPECT TO THAT DIRECTOR. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS USES COMPARATIVE COMPENSATION DATA AND HISTORICAL FINANCIAL DATA FROM THE CLINIC TO DETERMINE AN APPROPRIATE SALARY FOR THE ORGANIZATION OFFICERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST. |