PARK WEST HEALTH SYSTEMS INCORPORATED: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- PARK WEST HEALTH SYSTEMS INCORPORATED (EIN 52-0976937)
- Tax period
- 2019-12-01 to 2020-11-30
- Filed
- 2021-11-22
- IRS object ID
- 202103269349300205
- Schema version
- 2019v5.0
- 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 | 2021-11-22T07:23:19-08:00 | ReturnTs |
| Tax Period End | 2020-11-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 521854049 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ABRAMS FOSTER NOLE & WILLIAMS PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2 Hamill Rd Suite 241 West Quadrang | AddressLine1Txt |
| City | Baltimore | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-12-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 520976937 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARK WEST HEALTH SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PARK | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3319 W BELVEDERE AVE | AddressLine1Txt |
| City | BALTIMORE | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21215 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ELIZABETH LEE | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2021-11-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | GERALD ABRAMS | PreparerPersonNm |
| PTIN | P00260771 | PTIN |
| Phone | 4104336830 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3319 W BELVEDERE AVE | AddressLine1Txt |
| City | BALTIMORE | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,146,253 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | MD | LegalDomicileStateCd |
| Activity Or Mission | HEALTH CARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 145 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $6,642,390 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,944,003 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,675,213 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,202,250 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $10,317,603 | PYTotalRevenueAmt |
| CY Total Revenue | $12,146,253 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,484,349 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,091,914 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,289,653 | PYOtherExpensesAmt |
| CY Other Expenses | $4,254,965 | CYOtherExpensesAmt |
| PY Total Expenses | $9,774,002 | PYTotalExpensesAmt |
| CY Total Expenses | $11,346,879 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $543,601 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $799,374 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,758,242 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,580,210 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,308,687 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,331,281 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,449,555 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,248,929 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE COMPREHENSIZE HEALTH CARE AND SCREENING TO THE GENERAL PUBLIC. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $6,500,544 | ExpenseAmt |
| Desc | TO PROVIDE PRIMARY HEALTHCARE AND PREVENTITIVE HEALTH SERVICES TO NORTHWEST BALTIMORE COMMUNITY. | Desc |
| Total Program Service Expenses | $6,500,544 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 145 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MD | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PARK WEST HEALTH SYSTEM INC | PersonNm |
| Phone | 4105427800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3319 W BELVEDERE AVE | AddressLine1Txt |
| City | BALTIMORE | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| ALLEN BENNETT | |||||||
| CEO/PRESIDENT | 40.00 | 0.00 | $214,000 | $0 | $0 | ||
| LAWRENCE JOHNSON | |||||||
| CHIEF MEDICAL OFFICER | 40.00 | 0.00 | $179,902 | $0 | $0 | ||
| NATALIE SPICYN | |||||||
| CHIEF INT MEDICINE | 40.00 | 0.00 | $162,779 | $0 | $0 | ||
| HEINZ NAGEL | |||||||
| PEDIATRICIAN | 40.00 | 0.00 | $143,456 | $0 | $0 | ||
| STEWART BUTLER | |||||||
| DENTISTRY PRACTITI | 40.00 | 0.00 | $136,552 | $0 | $0 | ||
| ELIZABETH LEE | |||||||
| CFO | 40.00 | 0.00 | $134,153 | $0 | $0 | ||
| NKECHI OGUIKE | |||||||
| PEDIATRICIAN | 40.00 | 0.00 | $133,420 | $0 | $0 | ||
| SHIRLEY EVANS | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| CYRUS LAWYER MD | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| RUDOLPH ISAACS JR CPA | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| ROCHELLE SPECTOR | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| EARL PARKER | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| CORDELIA SYKES | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| NORMA BROOKS-PERRY | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| ANTIONETTE WILLIAMS | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| STEWART D BECKHAM | |||||||
| Director | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| FRANCES WATKINS | |||||||
| Vice Chair | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| SHARON BRATCHER-THOMAS | |||||||
| Board Chair | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| STANLEY ARNOLD | |||||||
| Treasurer | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| DEBORAH WOOLFORD | |||||||
| Secretary | 10.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,104,262 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| CompensationCompensationAmt |
|---|
| CARDINAL HEALTH |
| $211,637 |
| DAVIS & DAVIS |
| $166,924 |
| JACKSON & COKER |
| $234,429 |
| SPPS |
| $279,204 |
| RPAI |
| $204,898 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $5,944,003 | AllOtherContributionsAmt |
| Total Contributions | $5,944,003 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| OTHER MISC REVENUE | $2,330,881 | $2,330,881 |
| PATIENT SERVICE REVENUE | $3,871,369 | $3,871,369 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,202,250 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,146,253 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,202,250 | RelatedOrExemptFuncIncomeAmt |
| 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 | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $405,816 | TotalAmt |
| Management And General | $405,816 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,464,020 | TotalAmt |
| Program Services | $3,804,742 | ProgramServicesAmt |
| Management And General | $1,659,278 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,222,078 | TotalAmt |
| Program Services | $467,208 | ProgramServicesAmt |
| Management And General | $754,870 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,691 | TotalAmt |
| Management And General | $38,691 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,317 | TotalAmt |
| Management And General | $47,317 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,837 | TotalAmt |
| Program Services | $6,972 | ProgramServicesAmt |
| Management And General | $16,865 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,118 | TotalAmt |
| Program Services | $160,418 | ProgramServicesAmt |
| Management And General | $191,700 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,891 | TotalAmt |
| Program Services | $55 | ProgramServicesAmt |
| Management And General | $9,836 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,572 | TotalAmt |
| Management And General | $25,572 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,565 | TotalAmt |
| Management And General | $315,565 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,347 | TotalAmt |
| Management And General | $78,347 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PATIENT CARE SERVICES | $741,161 | $741,161 | |
| CLINICAL SUPPLIES | $538,822 | $538,822 | |
| CONSULTANTS | $503,463 | $397,625 | $105,838 |
| BAD DEBTS | $340,389 | $340,389 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,239,792 | TotalAmt |
| Program Services | $383,541 | ProgramServicesAmt |
| Management And General | $856,251 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,346,879 | TotalAmt |
| Program Services | $6,500,544 | ProgramServicesAmt |
| Management And General | $4,846,335 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,750 | BOYAmt |
| EOY | $2,097 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $432,577 | BOYAmt |
| EOY | $1,128,557 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,251,037 | BOYAmt |
| EOY | $1,431,842 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,567 | BOYAmt |
| EOY | $15,567 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,866 | BOYAmt |
| EOY | $26,522 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,695,025 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,780,584 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,857,890 | BOYAmt |
| EOY | $1,914,441 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,555 | BOYAmt |
| EOY | $61,184 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,758,242 | BOYAmt |
| EOY | $4,580,210 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,210,440 | BOYAmt |
| EOY | $1,175,158 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,098,247 | BOYAmt |
| EOY | $1,156,123 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,308,687 | BOYAmt |
| EOY | $2,331,281 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,274,555 | BOYAmt |
| EOY | $2,098,929 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $175,000 | BOYAmt |
| EOY | $150,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,449,555 | BOYAmt |
| EOY | $2,248,929 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,758,242 | BOYAmt |
| EOY | $4,580,210 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $799,374 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | 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 | $5,734,602 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,621,275 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,642,390 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,995,455 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,944,003 | CurrentTaxYearAmt |
| Total | $29,937,725 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,734,602 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,621,275 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,642,390 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,995,455 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,944,003 | CurrentTaxYearAmt |
| Total | $29,937,725 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $0 | SubstantialContributorsTotAmt |
| Public Support Total170 | $29,937,725 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $29,937,725 | TotalSupportAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $145,400 | OtherCostOrOtherBasisAmt |
| Book Value | $145,400 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,993,684 | OtherCostOrOtherBasisAmt |
| Book Value | $2,993,684 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,370,361 | OtherCostOrOtherBasisAmt |
| Book Value | $1,370,361 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,039,428 | OtherCostOrOtherBasisAmt |
| Book Value | $2,039,428 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $146,152 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,780,584 | DepreciationAmt |
| Book Value | -$4,634,432 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,914,441 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED REVENUE | $500,000 |
| LINE OF CREDIT | $268,623 |
| NOTE PAYABLE | $387,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,156,123 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $12,146,253 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $12,146,253 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $12,146,253 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,346,879 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $11,346,879 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $11,346,879 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| ALLEN BENNETT | ||
| CEO/PRESIDENT | $214,000 | $214,000 |
| LAWRENCE JOHNSON | ||
| CHIEF MEDICAL OFFICER | $179,902 | $179,902 |
| NATALIE SPICYN | ||
| CHIEF INT MEDICINE | $162,779 | $162,779 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (23 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | THE FORM 990 IS PRESENTED TO THE BOARD FOR REVIEW PRIOR TO FILING. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | OFFICERS AND DIRECTORS ARE REQUIRED TO ANSWER ANNUAL QUESTIONNAIRE. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. A MARKET ANALYSIS IS PERFORMED TO DETERMINE FAIR AND COMPARABLE COMPENSATION. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | UPON REQUEST |
| Form 990, Part IX, Line 24e: Other Expenses | : Column (A) - Total = $0; Column (B) - Program Services = $0; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | BANK FEES: Column (A) - Total = $7955; Column (B) - Program Services = $0; Column (C) - Management & General = $7955; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | CARES-HRSA: Column (A) - Total = $114856; Column (B) - Program Services = $114856; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | COMMUNITY SERVICE: Column (A) - Total = $46; Column (B) - Program Services = $46; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | COMPUTER MAINTENANCE: Column (A) - Total = $250479; Column (B) - Program Services = $0; Column (C) - Management & General = $250479; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | COMPUTER TRAINING: Column (A) - Total = $40637; Column (B) - Program Services = $40637; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | COVID-19: Column (A) - Total = $53713; Column (B) - Program Services = $53713; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | DATA PROCESSING: Column (A) - Total = $19406; Column (B) - Program Services = $0; Column (C) - Management & General = $19406; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | DUES & SUBSCRIPTIONS: Column (A) - Total = $35053; Column (B) - Program Services = $560; Column (C) - Management & General = $34493; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | EQUIPMENT RENTAL: Column (A) - Total = $56733; Column (B) - Program Services = $5205; Column (C) - Management & General = $51528; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | LICENSE & PERMITS: Column (A) - Total = $120; Column (B) - Program Services = $120; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | OFFICE SUPPLIES: Column (A) - Total = $36361; Column (B) - Program Services = $8098; Column (C) - Management & General = $28263; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | Postage and Shipping: Column (A) - Total = $5134; Column (B) - Program Services = $500; Column (C) - Management & General = $4634; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | PROFESSIONAL DEVELOPMENT: Column (A) - Total = $17311; Column (B) - Program Services = $10848; Column (C) - Management & General = $6463; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | REPAIRS AND MAINTENANCE: Column (A) - Total = $92143; Column (B) - Program Services = $16128; Column (C) - Management & General = $76015; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | RYAN WHITE PATIENT CARE EXP: Column (A) - Total = $132830; Column (B) - Program Services = $132830; Column (C) - Management & General = $0; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | SECURITY: Column (A) - Total = $181613; Column (B) - Program Services = $0; Column (C) - Management & General = $181613; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | UTILITES : Column (A) - Total = $188540; Column (B) - Program Services = $0; Column (C) - Management & General = $188540; Column (D) - Fundraising = $0 |
| Form 990, Part IX, Line 24e: Other Expenses | VEHICLE EXPENSE: Column (A) - Total = $6862; Column (B) - Program Services = $0; Column (C) - Management & General = $6862; Column (D) - Fundraising = $0 |