SHALOM HEALTH CARE CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SHALOM HEALTH CARE CENTER INC (EIN 06-1645027)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202213199349325236
- 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 | 2022-11-15T16:38:13-06:00 | 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 | 061645027 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHALOM HEALTH CARE CENTER INC | BusinessNameLine1Txt |
| Business Name Line2 | % MICHAEL NINO CFO | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHAL | BusinessNameControlTxt |
| Phone | 3172917422 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 LAFAYETTE ROAD 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46222 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LEONARDO R ORTEGA MD MPH | PersonNm |
| Person Title | CEO/EXEC DIRECT | PersonTitleTxt |
| Phone | 3172917422 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LEONARDO | PersonFirstNm |
| Person Last | ORTEGA MD MPH | 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 | 2022-11-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | 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 | LEONARDO R ORTEGA MD MPH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 LAFAYETTE ROAD 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46222 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,735,660 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SHALOMHEALTHCENTER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE A FULL RANGE OF PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO ALL RESIDENTS, REGARDLESS OF THE ABILITY FOR PAYMENT. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 147 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | -$157,406 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,042,335 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,768,528 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,524,288 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,287,791 | CYProgramServiceRevenueAmt |
| PY Investment Income | $322 | PYInvestmentIncomeAmt |
| CY Investment Income | $725 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$66,307 | PYOtherRevenueAmt |
| CY Other Revenue | $1,290,695 | CYOtherRevenueAmt |
| PY Total Revenue | $10,500,638 | PYTotalRevenueAmt |
| CY Total Revenue | $11,347,739 | 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 | $6,005,555 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,542,408 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,964,233 | PYOtherExpensesAmt |
| CY Other Expenses | $2,986,718 | CYOtherExpensesAmt |
| PY Total Expenses | $8,969,788 | PYTotalExpensesAmt |
| CY Total Expenses | $10,529,126 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,530,850 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $818,613 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,180,777 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,349,705 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,888,549 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,450,431 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,292,228 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,899,274 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE A FULL RANGE OF PRIMARY AND PREVENTIVE HEALTH CARE SERVICES TO ALL RESIDENTS, REGARDLESS OF THE ABILITY FOR PAYMENT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,134,226 | ExpenseAmt |
| Revenue | $4,287,791 | RevenueAmt |
| Desc | PRIMARY AND PREVENTIVE HEALTH CARE SERVICES: WE ARE HERE AT SHALOM HEALTH CARE CENTER SUPPORT OUR MISSION OF PROVIDING PRIMARY HEALTH CARE TO THE UNDESERVED POPULATION THAT LIVE NEAR THE LAFAYETTE SQUARE AREA (WEST SIDE OF INDIANAPOLIS). IN 2021, SHALOM SERVED 12,804 PATIENTS AND HAD 64,020 PATIENTS VISIT OUR PRIMARY CARE CENTERS AND TWENTY-NINE SCHOOL BASED CLINICS. OUR DEMOGRAPHIC DATA SHOWS THAT 77.82% OF THE PATIENTS ARE MINORITY, MANY OF THEM APPRECIATE THE FACT THAT WE OFFER BILINGUAL SERVICES TO THM AT NO ADDITIONAL COST. SCHOOL BASED CLINICS. | Desc |
| Total Program Service Expenses | $9,134,226 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | 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 | 20 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 147 | 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 |
| 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 | MICHAEL NINO CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3172917422 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 LAYFAYETTE RD STE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46222 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| EUGINA LONG | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CESAR ROMAN | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| VIRNA DIAZ | ||||||||
| BOARD | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CRISTIAN GUANDIQUE | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LUCIIA RAPIER | ||||||||
| BOARD | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DENNIS STOVER | ||||||||
| BOARD | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| FRIEDA THOMPSON | ||||||||
| BOARD | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KENDREA DERRICK | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| HANS BERNABE | ||||||||
| BOARD | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBYN CLAYBORNE | ||||||||
| BOARD | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ARIELLE ZERGER | ||||||||
| BOARD | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LEONARDO R ORTEGA MD MPH | ||||||||
| CEO | 40.00 | $203,598 | $0 | $0 | Yes (X) | |||
| MICHAEL NINO | ||||||||
| CFO | 40.00 | $124,584 | $0 | $6,254 | Yes (X) | |||
| DR MARGARITA WIERSEMA | ||||||||
| CMO | 40.00 | $186,515 | $0 | $13,077 | Yes (X) | |||
| DR HEMALATHA HEMACHANDRA | ||||||||
| MEDICAL DIRECTOR | 40.00 | $189,847 | $0 | $19,500 | Yes (X) | |||
| LYNDSEY FURRY | ||||||||
| CHIEF CLINICAL OFFICER | 40.00 | $124,939 | $0 | $11,362 | Yes (X) | |||
| TERESA DRISKELL | ||||||||
| CNO | 40.00 | $125,840 | $0 | $12,508 | Yes (X) | |||
| MYRIAM BERESKY | ||||||||
| CNO | 40.00 | $110,893 | $0 | $5,338 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,066,216 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $68,039 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| VALIC FINANCIAL ADVISORS | |||||
| 500 W MADISON ST 2850 | CHICAGO | IL | 60661 | FINANCIAL | $285,880 |
| WAYNE BANK AND TRUST | |||||
| 500 S A ST | RICHMOND | IN | 47374 | FINANCIAL | $255,439 |
| HENRY SCHEIN INC | |||||
| 5445 GUION RD | INDIANAPOLIS | IN | 46254 | SUPPLIES | $174,892 |
| ECLINICAL WORKS | |||||
| 2 TECHNOLOGY DR | WESTBOROUGH | MA | 01581 | TECHNOLOGY | $171,174 |
| C GARCIA CONSTRUCTION | |||||
| 6002 MICHIGAN RD | INDIANAPOLIS | IN | 46228 | CONSTRUCTION | $142,021 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,824,559 | GovernmentGrantsAmt |
| All Other Contributions | $943,969 | AllOtherContributionsAmt |
| Noncash Contributions | $943,969 | NoncashContributionsAmt |
| Total Contributions | $5,768,528 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE | 621400 | $3,107,700 | $3,107,700 |
| SCHOOL CLINICS | 621400 | $1,012,930 | $1,012,930 |
| PHARMACY SALES | 621400 | $167,161 | $167,161 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,287,791 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $725 | TotalRevenueColumnAmt |
| Exclusion | $725 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $230,515 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $387,921 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$157,406 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$157,406 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$157,406 | UnrelatedBusinessRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| FORGIVENESS OF DEBT | 900099 | $1,276,025 | $1,276,025 |
| OTHER INCOME | 900099 | $172,076 | $172,076 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,448,101 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,347,739 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,287,791 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$157,406 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,448,826 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,054,966 | TotalAmt |
| Program Services | $924,840 | ProgramServicesAmt |
| Management And General | $130,126 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,487,442 | TotalAmt |
| Program Services | $5,687,239 | ProgramServicesAmt |
| Management And General | $800,203 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,602 | TotalAmt |
| Program Services | $4,602 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,569 | TotalAmt |
| Program Services | $126,569 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,632 | TotalAmt |
| Program Services | $238,555 | ProgramServicesAmt |
| Management And General | $105,077 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $334,787 | TotalAmt |
| Program Services | $218,836 | ProgramServicesAmt |
| Management And General | $115,951 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,382 | TotalAmt |
| Program Services | $3,231 | ProgramServicesAmt |
| Management And General | $22,151 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,116 | TotalAmt |
| Program Services | $94,116 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,801 | TotalAmt |
| Program Services | $2,388 | ProgramServicesAmt |
| Management And General | $33,413 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & PHAR | $1,227,799 | $1,227,799 | |
| OTHER | $499,970 | $224,201 | $275,769 |
| LEASE & RENTALS | $372,012 | $332,063 | $39,949 |
| PLANT OPERATIONS | $98,270 | $49,787 | $48,483 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$176,222 | TotalAmt |
| Management And General | -$176,222 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,529,126 | TotalAmt |
| Program Services | $9,134,226 | ProgramServicesAmt |
| Management And General | $1,394,900 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,252,951 | BOYAmt |
| EOY | $2,283,718 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,203 | BOYAmt |
| EOY | $164,087 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $584,088 | BOYAmt |
| EOY | $319,726 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,400 | BOYAmt |
| EOY | $59,790 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,860,028 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,337,644 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,167,135 | BOYAmt |
| EOY | $2,522,384 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,180,777 | BOYAmt |
| EOY | $5,349,705 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $390,394 | BOYAmt |
| EOY | $508,301 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $209,094 | BOYAmt |
| EOY | $178,079 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,289,061 | BOYAmt |
| EOY | $1,951,450 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $812,601 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,888,549 | BOYAmt |
| EOY | $3,450,431 | 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 | $1,292,228 | BOYAmt |
| EOY | $1,899,274 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,292,228 | BOYAmt |
| EOY | $1,899,274 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,180,777 | BOYAmt |
| EOY | $5,349,705 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $818,613 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$211,567 | PriorPeriodAdjustmentsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 | $4,666,601 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,910,870 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,354,917 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,042,335 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,768,528 | CurrentTaxYearAmt |
| Total | $23,743,251 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,384,154 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,112,679 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,212,939 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,524,288 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,287,791 | CurrentTaxYearAmt |
| Total | $20,521,851 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,050,755 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,023,549 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,567,856 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,566,623 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,056,319 | CurrentTaxYearAmt |
| Total | $44,265,102 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $44,265,102 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $136 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $258 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $286 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $322 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $725 | CurrentTaxYearAmt |
| Total | $1,727 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $136 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $258 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $286 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $322 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $725 | CurrentTaxYearAmt |
| Total | $1,727 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,593 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $62,959 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $102,958 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $75,504 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $172,076 | CurrentTaxYearAmt |
| Total | $425,090 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,062,484 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,086,766 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,671,100 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,642,449 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,229,120 | CurrentTaxYearAmt |
| Total | $44,691,919 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99040 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99380 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $344,000 | OtherCostOrOtherBasisAmt |
| Book Value | $344,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,815,410 | OtherCostOrOtherBasisAmt |
| Depreciation | $411,661 | DepreciationAmt |
| Book Value | $1,403,749 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,047,179 | OtherCostOrOtherBasisAmt |
| Depreciation | $728,258 | DepreciationAmt |
| Book Value | $318,921 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,251,262 | OtherCostOrOtherBasisAmt |
| Depreciation | $973,345 | DepreciationAmt |
| Book Value | $277,917 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $402,177 | OtherCostOrOtherBasisAmt |
| Depreciation | $224,380 | DepreciationAmt |
| Book Value | $177,797 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,522,384 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | REFUNDABLE ADVANCE | Desc |
| Amt | $812,601 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $812,601 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $11,911,882 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $176,222 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $387,921 | OtherRevenueAmt |
| Revenue Not Reported | $564,143 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,347,739 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,347,739 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,093,269 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $176,222 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $387,921 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $564,143 | ExpensesNotReportedAmt |
| Expenses Subtotal | $10,529,126 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,529,126 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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 HEMALATHA HEMACHANDRA | ||||||||||||||
| MEDICAL DIRECTOR | $189,847 | $0 | $0 | $0 | $0 | $0 | $19,500 | $0 | $0 | $0 | $209,347 | $0 | $0 | $0 |
| LEONARDO R ORTEGA MD MPH | ||||||||||||||
| CEO | $203,598 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $203,598 | $0 | $0 | $0 |
| DR MARGARITA WIERSEMA | ||||||||||||||
| CMO | $186,515 | $0 | $0 | $0 | $0 | $0 | $13,077 | $0 | $0 | $0 | $199,592 | $0 | $0 | $0 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Noncash Contributions Rpt F990 | $913,969 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | OTHER | Desc |
| Contribution | 0 | ContributionCnt |
| Noncash Contributions Rpt F990 | $30,000 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW THE FORM 990: SHALOM HEALTH CARE CENTER, INC.'S FORM 990 AND ALL RELATED SCHEDULES, STATEMENTS AND ATTACHMENTS ARE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS CHAIRPERSON, EXECUTIVE DIRECTOR, CFO AND APPROPRIATE OTHER REPRESENTATIVE(S) FROM THE BOARD OF DIRECTOR'S FINANCIAL COMMITTEE PRIOR TO FINALIZING THESE TAX RETURNS. THE FORM 990 IS ALSO REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: SHALOM HEALTH CARE CENTER, INC. ANNUALLY REQUESTS EACH OFFICER AND MEMBER OF THE BOARD OF DIRECTORS TO COMPLETE A CONFLICT OF INTEREST POLICY QUESTIONNAIRE. THE POLICY INCLUDES STATEMENTS REGARDING OTHER EMPLOYMENT, BEING RELATED TO ANYONE ON THE BOARD AND OTHER ITEMS THAT MAY CREATE AN APPEARANCE OF A POTENTIAL INDEPENDENCE ISSUE. THE IDENTIFICATION, EVALUATION AND RESOLUTION OF THOSE ISSUES ARE DISCUSSED WITH THE APPROPRIATE LEVEL OF MANAGEMENT OR MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15 | REVIEW OF CEO OR TOP MANAGEMENT OFFICIAL COMPENSATION: SHALOM HEALTH CARE CENTER, INC.'S BOARD OF DIRECTORS' FINANCE COMMITTEE APPROVES THE PAY SCALES FOR ALL POSITIONS, WHICH ARE BASED ON A SALARY SURVEY DONE AT PERIODIC INTERVALS. THE FINANCE COMMITTEE SUBMITS THE PAY SCALES AT A BOARD MEETING AND THE MINUTES WILL REFLECT THE BOARD OF DIRECTORS APPROVAL. COMPENSATION FOR THE CEO AND TOP MANAGEMENT OFFICIAL WAS LAST REVIWED IN FEBRUARY 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: SHALOM HEALTH CARE CENTER, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, AS APPLICABLE, AVAILABLE TO THE PUBLIC BY APPOINTMENT WITH THE EXECUTIVE DIRECTOR. SHALOM HEALTH CARE CENTER, INC.'S INFORMATION IS ALSO AVAILABLE VIA THE INTERNET. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHALOM LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 LAFAYETTE ROAD STE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46222 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 471828555 | EIN |
| Primary Activities | HOLDING CO | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Total Income | -$157,406 | TotalIncomeAmt |
| End Of Year Assets | $2,394,890 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHALOM HEALTH | BusinessNameLine1Txt |