STAYWELL HEALTH CARE INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- STAYWELL HEALTH CARE INC (EIN 22-3160873)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-04-13
- IRS object ID
- 202101039349301255
- Schema version
- 2019v5.2
- 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 | 2021-04-13T12:37:10-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 221478099 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COHNREZNICK LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 350 CHURCH STREET 12TH FLOOR | AddressLine1Txt |
| City | HARTFORD | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06103 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 223160873 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STAYWELL HEALTH CARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STAY | BusinessNameControlTxt |
| Phone | 2037568021 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 80 PHOENIX AVENUE NO 201 | AddressLine1Txt |
| City | WATERBURY | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06702 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DONALD J THOMPSON JR | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 2037568021 | PhoneNum |
| Signature | 2021-04-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LORI ROTHE YOKOBOSKY CPA | PreparerPersonNm |
| PTIN | P01273422 | PTIN |
| Phone | 9592007000 | PhoneNum |
| Preparation | 2021-04-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DONALD J THOMPSON JR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 80 PHOENIX AVENUE NO 201 | AddressLine1Txt |
| City | WATERBURY | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06702 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,082,693 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STAYWELLHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | CT | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 270 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $7,803,540 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,319,281 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,291,153 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,615,578 | CYProgramServiceRevenueAmt |
| PY Investment Income | $34,692 | PYInvestmentIncomeAmt |
| CY Investment Income | $33,755 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$24,186 | PYOtherRevenueAmt |
| CY Other Revenue | $100,087 | CYOtherRevenueAmt |
| PY Total Revenue | $25,105,199 | PYTotalRevenueAmt |
| CY Total Revenue | $26,068,701 | 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 | $18,014,642 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,682,336 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,030,293 | PYOtherExpensesAmt |
| CY Other Expenses | $7,354,588 | CYOtherExpensesAmt |
| PY Total Expenses | $25,044,935 | PYTotalExpensesAmt |
| CY Total Expenses | $26,036,924 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $60,264 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $31,777 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,437,753 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,355,059 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,284,561 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,172,227 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,153,192 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,182,832 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDE PRIMARY HEALTH CARE, DENTAL, MENTAL HEALTH, AND SOCIAL SERVICES, TO THE UNDERSERVED POPULATION OF THE GREATER WATERBURY COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $21,982,395 | ExpenseAmt |
| Revenue | $18,691,479 | RevenueAmt |
| Desc | MEDICAL CLINIC, HEALTHY START, AND DENTAL CLINIC WHICH PROVIDE MEDICAL, PRENATAL, AND CHILDCARE FOR INNER CITY RESIDENTS AND UNINSURED RESIDENTS AND RESTORATIVE DENTAL CARE FOR INNER CITY CHILDREN. THE TOTAL NUMBER OF VISITS DURING FISCAL YEAR 2020 WAS 103,503. | Desc |
| Total Program Service Expenses | $21,982,395 | 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 | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 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 | 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 | 138 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 270 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CT | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LULE TRACEY | PersonNm |
| Phone | 2037568021 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 80 PHOENIX AVENUE SUITE 201 | AddressLine1Txt |
| City | WATERBURY | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06702 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ANGELICA CRUZ | ||||||||
| OUTGOING BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| CAROLYN A HIGHSMITH | ||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DANA M EVORA | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| ELIZABETH BURGOS | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| HERBERT L TERRY III | ||||||||
| OUTGOING BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| LINDA RICCIARDI | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| MARK BRIGGS | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| NILDA REYES | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| QUY TRAN | ||||||||
| OUTGOING BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| REV DR MAYNER TYSON | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD LEE | ||||||||
| OUTGOING BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| SANDRA J SOREL-LEDUC | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| THOMAS JOHNSON | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| WALTER R MACHNICZ | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| WANDA DUNBAR | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| DONALD J THOMPSON JR | ||||||||
| CEO | 40.00 | $242,485 | $0 | $89,702 | Yes (X) | |||
| LULE TRACEY | ||||||||
| CFO | 40.00 | $391,556 | $0 | $47,959 | Yes (X) | |||
| AMIT PATEL | ||||||||
| DENTAL DIRECTOR | 40.00 | $220,248 | $0 | $83,819 | Yes (X) | |||
| TESS LOMBARD MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $266,366 | $0 | $53,153 | Yes (X) | |||
| ALISON GROVER | ||||||||
| INTERNIST MD | 40.00 | $203,354 | $0 | $41,157 | Yes (X) | |||
| ELIE HELOU | ||||||||
| INTERNIST MD | 40.00 | $212,243 | $0 | $24,308 | Yes (X) | |||
| MONIKA MISHRA | ||||||||
| INTERNIST MD | 40.00 | $189,038 | $0 | $864 | Yes (X) | |||
| NICOLE MAKSYMIW | ||||||||
| INTERNIST MD | 40.00 | $184,699 | $0 | $13,662 | Yes (X) | |||
| STEPHEN SPEAR | ||||||||
| INTERNIST MD | 40.00 | $202,296 | $0 | $29,176 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,112,285 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $383,800 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | 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 |
|---|---|---|---|---|---|
| WELLMORE INC | |||||
| 141 E MAIN STREET | WATERBURY | CT | 06702 | BEHAVIORIAL HEALTH SERVICES | $611,472 |
| GREENWAY HEALTH | |||||
| PO BOX 203658 | DALLAS | TX | 75320 | SOFTWARE PURCHASER, SOFTWARE SUPPORT & M | $323,081 |
| ALLEHEALTH SERVICES LLC | |||||
| 13127 KINGS LAKE DRIVE 102 | GIBSONTON | FL | 33534 | ALLERGY HEALTH SERVICES | $203,078 |
| JANI-KING OF HARTFORD INC | |||||
| PO BOX 415346 | BOSTON | MA | 02241 | JANITORIAL SERVICES | $108,903 |
| TOWER GENERATOR SYSTEMS | |||||
| 20A CANTON SPRINGS RD | CANTON | CT | 06019 | CONTRACTORS | $107,478 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $28,692 | FederatedCampaignsAmt |
| Government Grants | $6,834,151 | GovernmentGrantsAmt |
| All Other Contributions | $456,438 | AllOtherContributionsAmt |
| Noncash Contributions | $1,027,775 | NoncashContributionsAmt |
| Total Contributions | $7,319,281 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICAID | 621400 | $12,077,938 | $12,077,938 |
| PHARMACY 340B | 446110 | $4,553,783 | $4,553,783 |
| MEDICARE | 621400 | $1,120,881 | $1,120,881 |
| SELF-PAY PATIENTS | 621400 | $432,327 | $432,327 |
| THIRD-PARTY PAYORS | 621400 | $430,649 | $430,649 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,615,578 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,755 | TotalRevenueColumnAmt |
| Exclusion | $33,755 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $38,178 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,992 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $24,186 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,186 | TotalRevenueColumnAmt |
| Exclusion | $24,186 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INCENTIVE PAYMENTS | 900099 | $47,196 | $47,196 |
| MEDICAL RECORDS COPYING FEES | 900099 | $28,705 | $28,705 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $75,901 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,068,701 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,691,479 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $57,941 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,286,166 | TotalAmt |
| Program Services | $1,103,111 | ProgramServicesAmt |
| Management And General | $183,055 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,397,343 | TotalAmt |
| Program Services | $12,057,609 | ProgramServicesAmt |
| Management And General | $1,339,734 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $809,917 | TotalAmt |
| Program Services | $492,334 | ProgramServicesAmt |
| Management And General | $317,583 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,110,132 | TotalAmt |
| Program Services | $1,282,711 | ProgramServicesAmt |
| Management And General | $827,421 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,078,778 | TotalAmt |
| Program Services | $655,769 | ProgramServicesAmt |
| Management And General | $423,009 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,123 | TotalAmt |
| Management And General | $76,123 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,177 | TotalAmt |
| Management And General | $56,177 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,467,696 | TotalAmt |
| Program Services | $2,035,322 | ProgramServicesAmt |
| Management And General | $432,374 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,783 | TotalAmt |
| Program Services | $19,776 | ProgramServicesAmt |
| Management And General | $2,007 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,938 | TotalAmt |
| Program Services | $24,455 | ProgramServicesAmt |
| Management And General | $2,483 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $289,989 | TotalAmt |
| Program Services | $289,989 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $409,435 | TotalAmt |
| Program Services | $370,415 | ProgramServicesAmt |
| Management And General | $39,020 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,437 | TotalAmt |
| Program Services | $53,052 | ProgramServicesAmt |
| Management And General | $5,385 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,318 | TotalAmt |
| Program Services | $85,626 | ProgramServicesAmt |
| Management And General | $8,692 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,360 | TotalAmt |
| Management And General | $12,360 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,734 | TotalAmt |
| Program Services | $302,072 | ProgramServicesAmt |
| Management And General | $30,662 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,907 | TotalAmt |
| Program Services | $87,977 | ProgramServicesAmt |
| Management And General | $8,930 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CLINIC SUPPLIES | $1,846,539 | $1,610,205 | $236,334 |
| VACCINES | $1,023,110 | $1,023,110 | |
| EQUIP RENTAL & MAINT | $276,050 | $250,611 | $25,439 |
| $85,494 | $77,615 | $7,879 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,498 | TotalAmt |
| Program Services | $160,636 | ProgramServicesAmt |
| Management And General | $19,862 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,036,924 | TotalAmt |
| Program Services | $21,982,395 | ProgramServicesAmt |
| Management And General | $4,054,529 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,984,319 | BOYAmt |
| EOY | $5,998,288 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,178,081 | BOYAmt |
| EOY | $3,416,942 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $785,620 | BOYAmt |
| EOY | $442,105 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,248,312 | BOYAmt |
| EOY | $1,455,711 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $353,753 | BOYAmt |
| EOY | $134,541 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,823,515 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,298,181 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,616,534 | BOYAmt |
| EOY | $4,525,334 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,980 | BOYAmt |
| EOY | $23,127 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,333 | BOYAmt |
| EOY | $83,333 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $162,821 | BOYAmt |
| EOY | $275,678 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,437,753 | BOYAmt |
| EOY | $16,355,059 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,343,632 | BOYAmt |
| EOY | $1,706,241 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,689 | BOYAmt |
| EOY | $1,150,711 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,248,125 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $794,240 | BOYAmt |
| EOY | $1,067,150 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,284,561 | BOYAmt |
| EOY | $7,172,227 | 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 | $9,153,192 | BOYAmt |
| EOY | $9,182,832 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,153,192 | BOYAmt |
| EOY | $9,182,832 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,437,753 | BOYAmt |
| EOY | $16,355,059 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $31,777 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$2,137 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 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 | $5,787,182 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,413,613 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,585,180 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,803,540 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,319,281 | CurrentTaxYearAmt |
| Total | $35,908,796 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,787,182 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,413,613 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,585,180 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,803,540 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,319,281 | CurrentTaxYearAmt |
| Total | $35,908,796 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $35,908,796 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $132,727 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $125,490 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $45,794 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $63,678 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $71,933 | CurrentTaxYearAmt |
| Total | $439,622 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $127,115 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $106,621 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $63,314 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $132,599 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $75,901 | CurrentTaxYearAmt |
| Total | $505,550 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $36,853,968 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $79,477,342 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.97440 | PublicSupportCY170Pct |
| Public Support PY170 | 0.96490 | 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 | MEANINGFUL USE INCENTIVE - 2015 AMOUNT: $ 102,000. 2016 AMOUNT: $ 63,750. 2018 AMOUNT: $ 68,596. 2019 AMOUNT: $ 47,196. MISCELLANEOUS - 2015 AMOUNT: $ 25,115. 2016 AMOUNT: $ 42,871. 2017 AMOUNT: $ 59,114. 2018 AMOUNT: $ 56,913. 2019 AMOUNT: $ 28,705. FUNDRAISING - 2017 AMOUNT: $ 4,200. 2018 AMOUNT: $ 7,090. | 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $384,297 | OtherCostOrOtherBasisAmt |
| Book Value | $384,297 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,985,440 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,088,988 | DepreciationAmt |
| Book Value | $3,896,452 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,453,778 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,209,193 | DepreciationAmt |
| Book Value | $244,585 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,525,334 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PROFIT SHARING | $858,982 |
| SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN | $208,168 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,067,150 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $26,080,556 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$2,137 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$2,137 | RevenueNotReportedAmt |
| Revenue Subtotal | $26,082,693 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$13,992 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$13,992 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $26,068,701 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,050,916 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $13,992 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $13,992 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,036,924 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,036,924 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE CENTER HAS NO UNRECOGNIZED TAX BENEFITS AT JUNE 30, 2020 AND 2019. THE CENTER'S FEDERAL AND STATE INFORMATION RETURNS PRIOR TO FISCAL YEAR 2017 ARE CLOSED AND MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF THE CENTER HAS UNRELATED BUSINESS INCOME TAXES, IT WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE STATEMENTS OF FINANCIAL POSITION. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENT EXPENSES -13,992. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENT EXPENSES 13,992. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DONALD J THOMPSON JR | ||||||||||||||
| CEO | $236,485 | $0 | $6,000 | $0 | $0 | $0 | $39,967 | $0 | $49,735 | $0 | $332,187 | $0 | $0 | $0 |
| LULE TRACEY | ||||||||||||||
| CFO | $202,442 | $0 | $6,000 | $0 | $183,114 | $0 | $31,500 | $0 | $16,459 | $0 | $439,515 | $0 | $0 | $0 |
| AMIT PATEL | ||||||||||||||
| DENTAL DIRECTOR | $214,248 | $0 | $6,000 | $0 | $0 | $0 | $32,050 | $0 | $51,769 | $0 | $304,067 | $0 | $0 | $0 |
| TESS LOMBARD MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $250,366 | $0 | $16,000 | $0 | $0 | $0 | $15,288 | $0 | $37,865 | $0 | $319,519 | $0 | $0 | $0 |
| ALISON GROVER | ||||||||||||||
| INTERNIST MD | $203,354 | $0 | $0 | $0 | $0 | $0 | $9,260 | $0 | $31,897 | $0 | $244,511 | $0 | $0 | $0 |
| ELIE HELOU | ||||||||||||||
| INTERNIST MD | $210,803 | $0 | $1,440 | $0 | $0 | $0 | $12,125 | $0 | $12,183 | $0 | $236,551 | $0 | $0 | $0 |
| MONIKA MISHRA | ||||||||||||||
| INTERNIST MD | $189,038 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $864 | $0 | $189,902 | $0 | $0 | $0 |
| NICOLE MAKSYMIW | ||||||||||||||
| INTERNIST MD | $184,699 | $0 | $0 | $0 | $0 | $0 | $10,934 | $0 | $2,728 | $0 | $198,361 | $0 | $0 | $0 |
| STEPHEN SPEAR | ||||||||||||||
| INTERNIST MD | $202,296 | $0 | $0 | $0 | $0 | $0 | $12,283 | $0 | $16,893 | $0 | $231,472 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS PARTICIPATE IN 457(F) PLAN: - DONALD J. THOMPSON, JR., CEO - LULE TRACEY, CFO - AMIT PATEL, DENTAL DIRECTOR |
| PART I, LINE 7 | THE CENTER PROVIDED AN ANNUAL BOARD APPROVED PROFIT SHARING BONUS. |
| SCHEDULE J, PART II, COLUMN B(III): | IN 2019, LULE TRACEY RECEIVED DEFERRED COMPENSATION PAYOUT WHICH IS INCLUDED IN COLUMN B(III). |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $1,027,775 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST | MethodOfDeterminingRevenuesTxt |
| 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 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTORS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 WILL BE REVIEWED AND ACCEPTED BY THE BOARD BEFORE STAYWELL SUBMITS. |
| FORM 990, PART VI, SECTION B, LINE 12C | DONALD THOMPSON, CEO, MONITORS CONFLICT OF INTEREST POLICY BY REVIEWING AND ADDRESSING ANY POTENTIAL CONFLICTS AND FOLLOWING UP EACH YEAR FOR ANY CHANGES. BOARD MEMBERS ARE REQUIRED TO SIGN THE POLICY ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15A | INFORMATION FROM NATIONAL AND STATEWIDE SURVEYS ARE USED AS CRITERIA TO DETERMINE THE SALARY OF THE CEO. THIS INFORMATION IS GIVEN TO THE PERSONNEL COMMITTEE FOR REVIEW. THE PERSONNEL COMMITTEE NEGOTIATES AND APPROVES THE SALARY OF THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR. |