KENTUCKY HEALTH CENTER NETWORK INCORPORATED: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- KENTUCKY HEALTH CENTER NETWORK INCORPORATED (EIN 46-0763588)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-24
- IRS object ID
- 202222979349300437
- 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 | 2022-10-24T09:48:35-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2650 EASTPOINT PKWY SUITE 300 | AddressLine1Txt |
| City | LOUISVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40223 | 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 | 460763588 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KENTUCKY HEALTH CENTER NETWORK INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KENT | BusinessNameControlTxt |
| Phone | 8592747115 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1127 | AddressLine1Txt |
| City | MT STERLING | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40353 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER NESMITH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8592747115 | PhoneNum |
| Signature | 2022-10-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JENNIFER | PersonFirstNm |
| Person Last | NESMITH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANGELA N CRAWFORD CPA | PreparerPersonNm |
| PTIN | P00573197 | PTIN |
| Phone | 5029923500 | PhoneNum |
| Preparation | 2022-10-24 | 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 | JENNIFER NESMITH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1127 | AddressLine1Txt |
| City | MT STERLING | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40353 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,027,631 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KYHCN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | THE KENTUCKY HEALTH CENTER NETWORK HAS BEEN FUNDED BY HRSA FOR IMPROVING QUALITY THROUGH HEALTH INFORMATION TECHNOLOGY AT THE NETWORK'S MEMBER COMMUNITY HEALTH CENTER. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 20 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $725,594 | PYContributionsGrantsAmt |
| CY Contributions Grants | $998,150 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,694 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,209 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $800 | PYOtherRevenueAmt |
| CY Other Revenue | $12,272 | CYOtherRevenueAmt |
| PY Total Revenue | $758,088 | PYTotalRevenueAmt |
| CY Total Revenue | $1,027,631 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $76,706 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $258,992 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $216,365 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $588,165 | PYOtherExpensesAmt |
| CY Other Expenses | $745,195 | CYOtherExpensesAmt |
| PY Total Expenses | $847,157 | PYTotalExpensesAmt |
| CY Total Expenses | $1,038,266 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$89,069 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$10,635 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $230,533 | TotalAssetsBOYAmt |
| Total Assets EOY | $235,930 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,357 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,389 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $220,176 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $209,541 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | KENTUCKY HEALTH CENTER NETWORK SUSTAINS KENTUCKY HEALTH COMMUNITY CENTERS AND THEIR CAPACITY TO PROVIDE QUALITY PATIENT SERVICES, TO INSTITUTE BEST PRACTICES, AND TO PURSUE CONTINUOUS IMPROVEMENT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $882,529 | ExpenseAmt |
| Grant | $76,706 | GrantAmt |
| Revenue | $29,481 | RevenueAmt |
| Desc | IN 2021, KHCN CONTINUED ITS WORK TO SUPPORT MEMBER ORGANIZATIONS IN THE AREAS OF INCREASING PATIENT ENGAGEMENT, SECURING PROTECTING HEALTH INFORMATION, DECREASING PROVIDER BURDEN, IMPROVING DATA ANALYSIS, INCREASING TELEHEALTH SERVICES, AND USING SOCIAL DETERMINANTS OF HEALTH DATA IN CARE PLANNING. GOALS WERE ACCOMPLISHED THROUGH TRAININGS, PEER TEAM MEETINGS, AND PROVIDING TOOLS AND RESOURCES TO MEMBER ORGANIZATIONS THAT SUPPORT THIS WORK. KHCN SUPPORTED MEMBER HEALTH CENTERS IN 2021 THROUGH HOSTING PEER TEAM MEETINGS, SHARING IMPORTANT RESOURCES ON TOPICS OF INTEREST, PROVIDING SECURITY RISK ASSESSMENTS, EHR OPTIMIZATION SERVICES, VIRTUAL CIO SERVICES, AND VARIOUS WEBINARS TO HELP MEMBER ORGANIZATIONS DEAL WITH CONTINUED IMPACTS OF COVID-19. | Desc |
| Total Program Service Expenses | $882,529 | 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 | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | 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 | 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 | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 2 | 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 |
| 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 | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 20 | 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 | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER NESMITH | PersonNm |
| Phone | 8592747115 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1127 | AddressLine1Txt |
| City | MT STERLING | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 40353 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| MICHAEL STANLEY | ||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DR SWANNIE JETT | ||||||
| VICE PRESIDENT (BEG 12/8/21) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ANN HAGAN-GRIGSBY | ||||||
| VICE PRESIDENT (END 12/8/21) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DAVE GERWIG | ||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ELLEN NAPIER | ||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ADAM CRAFT | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| CHRIS KEYSER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DERRICK HAMILTON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| EMERSON GOODWIN | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| JACK MINIARD | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| LESLEY DOTSON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MIKE CAUDILL | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| ROSIE WOOLUM | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| SAMANTHA TAYLOR-KAAI | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| SHELLY GOBIN | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STAN WARDLAW | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE MOORE | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| TINA BRYANT | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| TRACEY ANTLE | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| BART IRWIN | ||||||
| DIRECTOR (BEG 8/11/21) | 0.50 | Yes (X) | $0 | $0 | $0 | |
| BILL WAGNER | ||||||
| DIRECTOR (END 8/11/21) | 0.50 | Yes (X) | $0 | $0 | $0 | |
| KERRY KELLY | ||||||
| DIRECTOR (BEG 12/8/21) | 0.50 | Yes (X) | $0 | $0 | $0 | |
| JENNIFER NESMITH | ||||||
| CEO | 40.00 | Yes (X) | $131,454 | $0 | $9,141 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $131,454 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $9,141 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| KENTUCKY REGIONAL EXTENSION CENTER | |||||
| 2355 HUGUENARD DRIVE SUITE 201A | LEXINGTON | KY | 40503 | SECURITY RISK ASSESSMENT | $127,443 |
| CSI SOLUTIONS LLC | |||||
| PO BOX 428 | KENSINGTON | MD | 20895 | IT SUPPORT SERVICES | $120,246 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $998,150 | GovernmentGrantsAmt |
| Total Contributions | $998,150 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PROJECT REVENUE | 900099 | $10,009 | $10,009 |
| MEMBER DUES | 900099 | $7,200 | $7,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,209 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ALL OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $12,272 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,272 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $12,272 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,027,631 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,481 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,706 | TotalAmt |
| Program Services | $76,706 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,595 | TotalAmt |
| Program Services | $91,468 | ProgramServicesAmt |
| Management And General | $49,127 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,075 | TotalAmt |
| Program Services | $35,180 | ProgramServicesAmt |
| Management And General | $18,895 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,608 | TotalAmt |
| Program Services | $3,648 | ProgramServicesAmt |
| Management And General | $1,960 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $462 | TotalAmt |
| Program Services | $301 | ProgramServicesAmt |
| Management And General | $161 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,625 | TotalAmt |
| Program Services | $10,165 | ProgramServicesAmt |
| Management And General | $5,460 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $258 | TotalAmt |
| Management And General | $258 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,936 | TotalAmt |
| Program Services | $18,162 | ProgramServicesAmt |
| Management And General | $1,774 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $395,040 | TotalAmt |
| Program Services | $359,882 | ProgramServicesAmt |
| Management And General | $35,158 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $439 | TotalAmt |
| Program Services | $400 | ProgramServicesAmt |
| Management And General | $39 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,961 | TotalAmt |
| Management And General | $4,961 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,735 | TotalAmt |
| Program Services | $2,469 | ProgramServicesAmt |
| Management And General | $2,266 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,152 | TotalAmt |
| Program Services | $2,837 | ProgramServicesAmt |
| Management And General | $315 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,771 | TotalAmt |
| Program Services | $7,063 | ProgramServicesAmt |
| Management And General | $4,708 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,944 | TotalAmt |
| Program Services | $18,566 | ProgramServicesAmt |
| Management And General | $12,378 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,090 | TotalAmt |
| Program Services | $8,090 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,432 | TotalAmt |
| Program Services | $3,089 | ProgramServicesAmt |
| Management And General | $343 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DUES AND SUBSCRIPTIONS | $173,368 | $163,084 | $10,284 |
| PROTECTIVE EQUIPMENT | $73,100 | $65,790 | $7,310 |
| DATA WAREHOUSE | $13,500 | $13,500 | |
| TAXES/LICENSE/FEES | $15 | $15 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,454 | TotalAmt |
| Program Services | $2,129 | ProgramServicesAmt |
| Management And General | $325 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,038,266 | TotalAmt |
| Program Services | $882,529 | ProgramServicesAmt |
| Management And General | $155,737 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,245 | BOYAmt |
| EOY | $42,512 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,975 | BOYAmt |
| EOY | $29,325 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,730 | BOYAmt |
| EOY | $136,600 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $534,569 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $507,076 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,583 | BOYAmt |
| EOY | $27,493 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,533 | BOYAmt |
| EOY | $235,930 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,357 | BOYAmt |
| EOY | $26,389 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,357 | BOYAmt |
| EOY | $26,389 | 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 | $220,176 | BOYAmt |
| EOY | $209,541 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $220,176 | BOYAmt |
| EOY | $209,541 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,533 | BOYAmt |
| EOY | $235,930 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$10,635 | 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 | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $826,679 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $867,006 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $838,154 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $725,594 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $998,150 | CurrentTaxYearAmt |
| Total | $4,255,583 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $826,679 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $867,006 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $838,154 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $725,594 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $998,150 | CurrentTaxYearAmt |
| Total | $4,255,583 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $4,255,583 | PublicSupportTotal170Amt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,131 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $1,350 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $800 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $12,272 | CurrentTaxYearAmt |
| Total | $16,553 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,272,136 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $147,692 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99610 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99870 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME - 2017 AMOUNT: $ 2,131. 2019 AMOUNT: $ 1,350. 2020 AMOUNT: $ 800. 2021 AMOUNT: $ 12,272. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $94,569 | OtherCostOrOtherBasisAmt |
| Depreciation | $67,076 | DepreciationAmt |
| Book Value | $27,493 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $440,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $440,000 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $27,493 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $1,027,631 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,027,631 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,027,631 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,038,266 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,038,266 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,038,266 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. HOWEVER, AS OF THE DATE THE FINANCIAL STATEMENTS WERE AVAILABLE TO BE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| BIG SANDY HEALTH CARE | ||||||||
| 1709 KY ROUTE 321 STE 3 | PRESTONBURG | KY | 41653 | 610849776 | 501(C)(3) | $25,569 | $0 | SUPPORT ACTIVITIES |
| PENNYROYAL HEALTHCARE SERVICES DBA COMMUNITY MEDICAL CLINIC | ||||||||
| 310 HAWTHORNE STREET | PRINCETON | KY | 42445 | 273618164 | $25,569 | $0 | SUPPORT ACTIVITIES | |
| GRACE HEALTH | ||||||||
| 1019 CUMBERLAND FALLS HIGHWAY | CORBIN | KY | 40701 | 261779437 | $25,568 | $0 | SUPPORT ACTIVITIES | |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE DRAFT 990 IS EMAILED TO ALL BOARD MEMBERS AND VOTED UPON FOR APPROVAL ELECTRONICALLY. A MAJORITY OF VOTING MEMBERS MUST APPROVE BEFORE SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS AND FULL TIME STAFF ARE COVERED UNDER THE POLICY. CEO, FINANCE COMMIITEE, AND BOARD MONITOR COMPLIANCE ON AN ONGOING BASIS. ANY CONFLICTS THAT ARISE WOULD BE HANDLED BY REMOVING PERSON WITH CONFLICT FROM DISCUSSION AND DECISION MAKING. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE FULL BOARD, COMPRISED OF INDEPENDENT MEMBERS, APPROVED THE ANNUAL COMPENSATION PAID TO THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONSULTING: PROGRAM SERVICE EXPENSES 197,570. MANAGEMENT AND GENERAL EXPENSES 19,301. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 216,871. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 162,312. MANAGEMENT AND GENERAL EXPENSES 15,857. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 178,169. |