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MT ENTERPRISE COMMUNITY HEALTH CLINIC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
MT ENTERPRISE COMMUNITY HEALTH CLINIC (EIN 43-2016287)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-10
IRS object ID
202233149349301968
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

FieldValueIRS element (for citing)
Return2022-11-10T08:55:41-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110700 NORTHUP WAY SUITE 200AddressLine1Txt
CityBELLEVUECityNm
State AbbreviationWAStateAbbreviationCd
ZIP98004ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN432016287EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MT ENTERPRISE COMMUNITY HEALTH CLINICBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMTENBusinessNameControlTxt
Phone9033928203PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 489AddressLine1Txt
CityMT ENTERPRISECityNm
State AbbreviationTXStateAbbreviationCd
ZIP75681ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJESTIN STOWEPersonNm
Person TitleCFOPersonTitleTxt
Phone9033928203PhoneNum
Signature2022-11-02SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJESTINPersonFirstNm
Person LastSTOWEPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKURT BENNION CPAPreparerPersonNm
PTINP01469618PTIN
Phone4252506100PhoneNum
Preparation2022-11-02PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1CROSSROADS FAMILY CAREBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerKENNETH WHITEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 489AddressLine1Txt
CityMT ENTERPRISECityNm
State AbbreviationTXStateAbbreviationCd
ZIP75681ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$6,791,076GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTPS://CROSSROADSFAMILYCARE.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2003FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionTO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee83TotalEmployeeCnt
Total Volunteers14TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$3,028,764PYContributionsGrantsAmt
CY Contributions Grants$4,195,628CYContributionsGrantsAmt
PY Program Service Revenue$2,336,735PYProgramServiceRevenueAmt
CY Program Service Revenue$2,571,544CYProgramServiceRevenueAmt
PY Investment Income$152PYInvestmentIncomeAmt
CY Investment Income$789CYInvestmentIncomeAmt
PY Other Revenue$24,216PYOtherRevenueAmt
CY Other Revenue$23,115CYOtherRevenueAmt
PY Total Revenue$5,389,867PYTotalRevenueAmt
CY Total Revenue$6,791,076CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,994,517PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,000,458CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,178,162PYOtherExpensesAmt
CY Other Expenses$1,537,475CYOtherExpensesAmt
PY Total Expenses$5,172,679PYTotalExpensesAmt
CY Total Expenses$5,537,933CYTotalExpensesAmt
PY Revenues Less Expenses$217,188PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,253,143CYRevenuesLessExpensesAmt
Total Assets BOY$2,817,189TotalAssetsBOYAmt
Total Assets EOY$3,576,225TotalAssetsEOYAmt
Total Liabilities BOY$925,870TotalLiabilitiesBOYAmt
Total Liabilities EOY$405,401TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,891,319NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,170,824NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$4,486,833ExpenseAmt
Grant$0GrantAmt
Revenue$2,571,544RevenueAmt
DescAT THREE LOCATIONS (MT. ENTERPRISE, HENDERSON AND PALESTINE, TEXAS), MT. ENTERPRISE COMMUNITY HEALTH CLINIC (DBA: CROSSROADS FAMILY CARE) PROVIDES PRIMARY CARE, DENTAL, AND BEHAVIORAL HEALTH SERVICES TO ALL MEMBERS OF THE COMMUNITY, WITH AN EMPHASIS ON ENSURING MEDICAL CARE FOR THE LOW-INCOME AND UNINSURED POPULATION. IN 2021, THE HEALTH CENTER PROVIDED OVER 22,600 VISITS TO THE OVER 8,100 PATIENTS SERVED. 41% OF THESE PATIENTS DID NOT HAVE INSURANCE AT THE TIME OF THEIR VISIT AND 37% WERE BELOW 100% OF THE FEDERAL POVERTLY LEVEL.Desc
Total Program Service Expenses$4,486,833TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document16IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee83EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJESTIN STOWEPersonNm
Phone9033928203PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 489AddressLine1Txt
CityMT ENTERPRISECityNm
State AbbreviationTXStateAbbreviationCd
ZIP75681ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
LACEE PIERCE APRN FNP-C
PROVIDER40.00Yes (X)$146,915$0$5,877
ROBIN WATSON APRN PMHNP-BC
PROVIDER40.00Yes (X)$142,069$0$9,768
JEREMIAH SANDERS APRN PMHNP-C
PROVIDER40.00Yes (X)$138,451$0$4,085
TAREK ELMAJIE DDS
PROVIDER40.00Yes (X)$137,314$0$4,085
AMBERLY HOPSON APRN FNP-C
PROVIDER40.00Yes (X)$136,831$0$4,085
KENNETH WHITE
CEO40.00$117,300$0$8,777Yes (X)
JESTIN STOWE
CFO40.00$89,244$0$7,771Yes (X)
LEO GONZALEZ
PRESIDENT1.00$0$0$0Yes (X)Yes (X)
BECKY ELDRIDGE-CLARK
VICE PRESIDENT1.00$0$0$0Yes (X)Yes (X)
JOHN GRUBBS
SECRETARY & BOARD MEMBER1.00$0$0$0Yes (X)Yes (X)
YOLANDA DELEON
BOARD MEMBER & SECRETARY1.00$0$0$0Yes (X)Yes (X)
MICHELLE SIMMONS
TREASURER1.00$0$0$0Yes (X)Yes (X)
PATSY FOGLEMAN
BOARD MEMBER1.00$0$0$0Yes (X)
MATT GHOLSON
BOARD MEMBER (THROUGH APRIL 2021)1.00$0$0$0Yes (X)
HARVEY GRAVES
BOARD MEMBER1.00$0$0$0Yes (X)
ROBERT HOLLENSHEAD
BOARD MEMBER1.00$0$0$0Yes (X)
J GUADALUPE OVIEDO
BOARD MEMBER1.00$0$0$0Yes (X)
CASSANDRA SHAW
BOARD MEMBER1.00$0$0$0Yes (X)
POLLY VARDEMAN
BOARD MEMBER1.00$0$0$0Yes (X)
RD WHITTNER
BOARD MEMBER1.00$0$0$0Yes (X)
JEAN WILLIAMS
BOARD MEMBER1.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$908,124TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$44,448TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
GENESIS PRIMECARE
1500 W GRAND STREETMARSHALLTX75670BILLING SERVICES$139,054
MEDCON
PO BOX 935FORNEYTX75126MEDICAL SUPERVISION (CMO) SERVICES$135,000
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$4,164,145GovernmentGrantsAmt
All Other Contributions$31,483AllOtherContributionsAmt
Noncash Contributions$67,495NoncashContributionsAmt
Total Contributions$4,195,628TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescMEDICAL SERVICE INCOMEDesc
Business624100BusinessCd
Total Revenue Column$2,571,544TotalRevenueColumnAmt
Related Or Exempt Func Income$2,571,544RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$2,571,544TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$789TotalRevenueColumnAmt
Exclusion$789ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business624110BusinessCd
Total Revenue Column$23,115TotalRevenueColumnAmt
Exclusion$23,115ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$23,115OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,791,076TotalRevenueColumnAmt
Related Or Exempt Func Income$2,571,544RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$23,904ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$223,092TotalAmt
Management And General$223,092ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,272,849TotalAmt
Program Services$3,022,661ProgramServicesAmt
Management And General$250,188ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$52,748TotalAmt
Program Services$47,917ProgramServicesAmt
Management And General$4,831ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$188,412TotalAmt
Program Services$154,103ProgramServicesAmt
Management And General$34,309ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$263,357TotalAmt
Program Services$206,448ProgramServicesAmt
Management And General$56,909ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$4,160TotalAmt
Management And General$4,160ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$698,704TotalAmt
Program Services$601,874ProgramServicesAmt
Management And General$96,830ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$173,748TotalAmt
Program Services$33,610ProgramServicesAmt
Management And General$140,138ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$97,451TotalAmt
Program Services$85,803ProgramServicesAmt
Management And General$11,648ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$185,221TotalAmt
Program Services$87,661ProgramServicesAmt
Management And General$97,560ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$39,523TotalAmt
Program Services$612ProgramServicesAmt
Management And General$38,911ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$40,148TotalAmt
Program Services$18,224ProgramServicesAmt
Management And General$21,924ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,636TotalAmt
Management And General$3,636ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$118,868TotalAmt
Program Services$96,307ProgramServicesAmt
Management And General$22,561ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$19,019TotalAmt
Management And General$19,019ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$127,664$120,385$7,279
REPAIRS & MAINTENANCE$26,799$9,072$17,727
DUES & SEMINARS$2,534$2,156$378

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$5,537,933TotalAmt
Program Services$4,486,833ProgramServicesAmt
Management And General$1,051,100ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,320,166BOYAmt
EOY$1,859,665EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$116,784BOYAmt
EOY$120,769EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$46,127BOYAmt
EOY$61,205EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$3,046EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,843,138LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,311,598LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,334,112BOYAmt
EOY$1,531,540EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,817,189BOYAmt
EOY$3,576,225EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$253,447BOYAmt
EOY$255,072EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$598,700BOYAmt
EOY$87,685EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$73,723BOYAmt
EOY$62,644EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$925,870BOYAmt
EOY$405,401EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,891,319BOYAmt
EOY$3,170,824EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,891,319BOYAmt
EOY$3,170,824EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,817,189BOYAmt
EOY$3,576,225EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,253,143ReconcilationRevenueExpnssAmt
Prior Period Adjustments$26,362PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,972,114CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,835,367CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,406,136CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,028,764CurrentTaxYearMinus1YearAmt
Current Tax Year$4,195,628CurrentTaxYearAmt
Total$14,438,009TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,972,114CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,835,367CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,406,136CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,028,764CurrentTaxYearMinus1YearAmt
Current Tax Year$4,195,628CurrentTaxYearAmt
Total$14,438,009TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$14,438,009PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$75CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$95CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$49CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$152CurrentTaxYearMinus1YearAmt
Current Tax Year$789CurrentTaxYearAmt
Total$1,160TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,198CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$73,788CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$62,963CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$24,216CurrentTaxYearMinus1YearAmt
Current Tax Year$23,115CurrentTaxYearAmt
Total$201,280TotalAmt
FieldValueIRS element (for citing)
Total Support$14,640,449TotalSupportAmt
Gross Receipts Rltd Activities$10,920,211GrossReceiptsRltdActivitiesAmt
Public Support CY1700.98620PublicSupportCY170Pct
Public Support PY1700.98480PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationOTHER INCOMEExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$59,320OtherCostOrOtherBasisAmt
Book Value$59,320BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,299,624OtherCostOrOtherBasisAmt
Depreciation$235,098DepreciationAmt
Book Value$1,064,526BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$595,948OtherCostOrOtherBasisAmt
Depreciation$559,979DepreciationAmt
Book Value$35,969BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$652,861OtherCostOrOtherBasisAmt
Depreciation$516,018DepreciationAmt
Book Value$136,843BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$235,385OtherCostOrOtherBasisAmt
Depreciation$503DepreciationAmt
Book Value$234,882BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,531,540TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$6,791,076TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$6,791,076RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$6,791,076TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$5,537,933TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$5,537,933ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$5,537,933TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE ORGANIZATION EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2021 AND 2020, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. ALL TAX-EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE, AND OTHER APPLICABLE STATE STATUTES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
LACEE PIERCE APRN FNP-C
PROVIDER$146,915$0$0$0$0$0$5,877$0$0$0$152,792$0$0$0
ROBIN WATSON APRN PMHNP-BC
PROVIDER$142,069$0$0$0$0$0$5,683$0$4,085$0$151,837$0$0$0

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution12ContributionCnt
Noncash Contributions Rpt F990$67,495NoncashContributionsRptF990Amt
Method Of Determining RevenuesINVOICE PRICEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Form8283 Received0Form8283ReceivedCnt
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1ATHE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD AND THE CEO. THE EXECUTIVE COMMITTEE SERVES IN PLACE OF THE FULL BOARD IN EMERGENCY SITUATIONS WHEN A FULL BOARD QUORUM AT AN EMERGENCY MEETING CANNOT BE PRESENT. THE EXECUTIVE COMMITTEE ALSO REVIEWS CERTAIN PROSPECTIVE BUSINESS TRANSACTIONS AND MAKES RECOMMENDATIONS ON SUCH MATTERS TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 3DURING 2020, MEDICAL MANAGEMENT SERVICES (THE CMO POSITION) WERE PROVIDED BY MEDCON.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 WAS REVIEWED BY THE CFO AND THE FINANCE COMMITTEE AND PROVIDED TO THE BOARD OF DIRECTORS BEFORE BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST FORMS ARE COMPLETED EVERY YEAR BY BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES. FORMS RECEIVED ARE REVIEWED BY THE CFO AND FINANCE COMMITTEE AND MONITORED AS NECESSARY. NO BOARD MEMBER MAY VOTE ON ANY MATTER IN WHICH THEY HAVE A CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15ATHE COMPENSATION OF THE CEO IS DISCUSSED AT LENGTH BY THE BOARD OF DIRECTORS YEARLY. AS PART OF THEIR ANNUAL EVALUATION/REVIEW OF THE CEO, THEY REVIEW WHETHER ESTABLISHED GOALS WERE MET AND REVIEW COMPENSATION IN COMPARISON WITH OTHER COMMUNITY HEALTH ORGANIZATION CEO'S WITH THE HELP OF AN ANNUAL SALARY COMPARISON REPORT ISSUED BY THE NATIONAL ORGANIZATION OF COMMUNITY HEALTH ORGANIZATIONS. ALL OF THESE DISCUSSIONS ARE DOCUMENTED IN THE ORGANIZATION'S BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GOTHER SERVICES: PROGRAM SERVICE EXPENSES 601,874. MANAGEMENT AND GENERAL EXPENSES 96,830. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 698,704.