PCC COMMUNITY WELLNESS CENTER: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- PCC COMMUNITY WELLNESS CENTER (EIN 36-3828320)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-02-09
- IRS object ID
- 202120409349301167
- 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 | 2021-02-09T13:16:57-06:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 WEST 22ND STREET SUITE 1100 | AddressLine1Txt |
| City | OAK BROOK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60523 | 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 | 363828320 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PCC COMMUNITY WELLNESS CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PCCC | BusinessNameControlTxt |
| Phone | 7083830113 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 WEST LAKE STREET | AddressLine1Txt |
| City | OAK PARK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60302 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT J URSO | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 7083830113 | PhoneNum |
| Signature | 2021-02-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CHRIS MANDERFIELD | PreparerPersonNm |
| PTIN | P01238973 | PTIN |
| Phone | 6305738600 | PhoneNum |
| Preparation | 2021-02-01 | 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 | ROBERT J URSO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 WEST LAKE STREET | AddressLine1Txt |
| City | OAK PARK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60302 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $44,383,620 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PCCWELLNESS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | PROMOTE HEALTHCARE SERVICE PROGRAMS FOR MEDICALLY UNDERSERVED LIVING IN CHICAGO COMMUNITIES | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 487 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,192,025 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,676,737 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $32,111,240 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $33,457,398 | CYProgramServiceRevenueAmt |
| PY Investment Income | $160,854 | PYInvestmentIncomeAmt |
| CY Investment Income | $114,637 | CYInvestmentIncomeAmt |
| PY Other Revenue | $190,821 | PYOtherRevenueAmt |
| CY Other Revenue | $134,848 | CYOtherRevenueAmt |
| PY Total Revenue | $41,654,940 | PYTotalRevenueAmt |
| CY Total Revenue | $44,383,620 | 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 | $25,336,272 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $29,381,459 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $26,525 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,513,980 | PYOtherExpensesAmt |
| CY Other Expenses | $13,726,775 | CYOtherExpensesAmt |
| PY Total Expenses | $37,850,252 | PYTotalExpensesAmt |
| CY Total Expenses | $43,108,234 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,804,688 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,275,386 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $31,361,317 | TotalAssetsBOYAmt |
| Total Assets EOY | $37,124,002 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,473,419 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,960,718 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $21,887,898 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,163,284 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF PCC COMMUNITY WELLNESS CENTER IS TO IMPROVE HEALTH OUTCOMES FOR THE MEDICALLY UNDERSERVED COMMUNITY THROUGH THE PROVISION OF HIGH QUALITY, AFFORDABLE, AND ACCESSIBLE PRIMARY HEALTH CARE AND SUPPORT SERVICES. ANCHORED WITH FAMILY MEDICINE, WE ARE COMMITTED TO SERVING THE NEEDS OF ALL PEOPLE IN ALL STAGES OF LIFE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $37,518,105 | ExpenseAmt |
| Revenue | $33,592,246 | RevenueAmt |
| Desc | PCC PROVIDES HEALTH CARE SERVICES TO THE COMMUNITY. PCC HEALTH CARE SERVICES INCLUDE: PEDIATRIC AND ADOLESCENT HEALTH CARE THAT INCLUDES WELL-CHILD EXAMS, IMMUNIZATIONS, SICK INFANT/CHILD EXAMS, SCHOOL AND SPORTS PHYSICALS, AND LEAD SCREENINGS; WOMEN'S HEALTH CARE (OB/GYN) THAT INCLUDES MATERNITY CARE AND DELIVERY, PAP SMEARS, AND BREAST CANCER SCREENINGS; ADULT HEALTH CARE; SENIOR HEALTH CARE; DIAGNOSIS AND TREATMENT OF ILLNESS; DISEASE SCREENING AND PREVENTION; FAMILY PLANNING (BIRTH CONTROL); MANAGEMENT OF CHRONIC ILLNESSES SUCH AS ASTHMA, DIABETES, AND HIGH BLOOD PRESSURE; HIV TESTING, COUNSELING, AND PRIMARY CARE; AND DENTAL CARE AND REFERRAL. | Desc |
| Total Program Service Expenses | $37,518,105 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 76 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 487 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PATRICK GARRICK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7083830113 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 WEST LAKE STREET | AddressLine1Txt |
| City | OAK PARK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60302 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| RON AUSTIN | ||||||||
| DIRECTOR | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KENNETH BLAIR MD | ||||||||
| TREASURER | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| VELDA BRUNNER | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA DIGGINS | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CAROLYN FITZPATRICK MD | ||||||||
| CHAIRPERSON | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PATRICIA FORD | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| MELINDA MALECKI | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JOHN MCDONNELL | ||||||||
| DIRECTOR | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MARIANA OSORIA | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| TERESA REYES | ||||||||
| VICE CHAIRPERSON | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| BARBARA VANEK | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| WRENETHA JULION | ||||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| ROBERT J URSO | ||||||||
| PRESIDENT & CEO | 40.00 | 2.00 | $340,013 | $0 | $8,344 | Yes (X) | ||
| PATRICK R GARRICK | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 2.00 | $140,406 | $0 | $6,378 | Yes (X) | ||
| PAUL S LUNING MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $247,603 | $0 | $21,577 | Yes (X) | |||
| TONI BUSH | ||||||||
| REGIONAL DIRECTOR OF CLINI | 40.00 | $103,519 | $0 | $11,597 | Yes (X) | |||
| SARA HOGUE | ||||||||
| CHIEF PERFORMANCE IMPROVEMENT OFFICER | 40.00 | $83,580 | $0 | $0 | Yes (X) | |||
| AMANDA BROOKS | ||||||||
| CHIEF POPULATION HEALTH OFFICER | 40.00 | $126,587 | $0 | $0 | Yes (X) | |||
| YAM-SHUN TONG | ||||||||
| OB/GYN PHYSICIAN | 40.00 | $307,822 | $0 | $9,552 | Yes (X) | |||
| BERTHA LOPEZ | ||||||||
| OB/GYN PHYSICIAN | 40.00 | $260,203 | $0 | $23,546 | Yes (X) | |||
| KAROLE A LAKOTA-TREESE MD | ||||||||
| MEDICAL DIRECTOR OF PI | 40.00 | $276,876 | $0 | $17,998 | Yes (X) | |||
| CHRISTINE SWARTZ | ||||||||
| MEDICAL DIRECTOR | 40.00 | $334,616 | $0 | $1,565 | Yes (X) | |||
| SHERIF MILIK | ||||||||
| FAMILY PRACTICE PHYSICIAN | 40.00 | $343,736 | $0 | $17,998 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,564,961 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $118,555 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | 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 |
|---|---|---|---|---|---|
| ATHENAHEALTH INC | |||||
| 311 ARSENAL STREET | WATERTOWN | MA | 02472 | MEDICAL BILLING SERVICES | $1,228,705 |
| US SECURITY ASSOCIATES INC | |||||
| 200 MANSELL COURT 5TH FLOOR | ROSWELL | GA | 30076 | SECURITY GUARD SERVICES | $276,248 |
| STAFF CARE INC | |||||
| 12400 HIGH BLUFF DRIVE | SAN DIEGO | CA | 92130 | STAFFING SERVICE | $222,468 |
| DABROWSKI MAINTENANCE SERVICE | |||||
| 7015 W 72ND STREET | STICKNEY | IL | 60638 | MAINTENANCE SERVICES | $210,043 |
| B AND B MAINTENANCE INC | |||||
| 537 CAPITAL DRIVE | LAKE ZURICH | IL | 60047 | PROFESSIONAL BUILDING SERVICES | $181,485 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $510,000 | RelatedOrganizationsAmt |
| Government Grants | $9,201,769 | GovernmentGrantsAmt |
| All Other Contributions | $964,968 | AllOtherContributionsAmt |
| Total Contributions | $10,676,737 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE FEES | 621400 | $23,445,244 | $23,445,244 |
| 340B | 621400 | $8,434,676 | $8,434,676 |
| BONUSES & INCENTIVES | 621400 | $1,577,478 | $1,577,478 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $33,457,398 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $114,637 | TotalRevenueColumnAmt |
| Exclusion | $114,637 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISC INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $134,848 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $134,848 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $134,848 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,383,620 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,592,246 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $114,637 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $699,865 | TotalAmt |
| Program Services | $72,305 | ProgramServicesAmt |
| Management And General | $627,560 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,004,591 | TotalAmt |
| Program Services | $22,791,557 | ProgramServicesAmt |
| Management And General | $2,213,034 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,904,347 | TotalAmt |
| Program Services | $1,693,898 | ProgramServicesAmt |
| Management And General | $210,449 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,772,656 | TotalAmt |
| Program Services | $1,576,760 | ProgramServicesAmt |
| Management And General | $195,896 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,668 | TotalAmt |
| Program Services | $56,949 | ProgramServicesAmt |
| Management And General | $24,719 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,289 | TotalAmt |
| Program Services | $6,477 | ProgramServicesAmt |
| Management And General | $2,812 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,927,523 | TotalAmt |
| Program Services | $2,720,270 | ProgramServicesAmt |
| Management And General | $1,180,728 | ManagementAndGeneralAmt |
| Fundraising | $26,525 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $763,618 | TotalAmt |
| Program Services | $632,666 | ProgramServicesAmt |
| Management And General | $130,952 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $201,758 | TotalAmt |
| Program Services | $140,691 | ProgramServicesAmt |
| Management And General | $61,067 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $354,513 | TotalAmt |
| Program Services | $323,720 | ProgramServicesAmt |
| Management And General | $30,793 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,738 | TotalAmt |
| Program Services | $104,926 | ProgramServicesAmt |
| Management And General | $26,812 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,317 | TotalAmt |
| Program Services | $206,575 | ProgramServicesAmt |
| Management And General | $76,742 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,142,195 | TotalAmt |
| Program Services | $891,202 | ProgramServicesAmt |
| Management And General | $250,993 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,057 | TotalAmt |
| Program Services | $2,763 | ProgramServicesAmt |
| Management And General | $237,294 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $4,124,570 | $4,109,925 | $14,645 |
| DUES AND LICENSES | $2,090,034 | $2,011,254 | $78,780 |
| REPAIRS AND MAINTENANCE | $260,427 | $157,139 | $103,288 |
| STAFF EXPENSES | $72,769 | $2,915 | $69,854 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,299 | TotalAmt |
| Program Services | $16,113 | ProgramServicesAmt |
| Management And General | $27,186 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,108,234 | TotalAmt |
| Program Services | $37,518,105 | ProgramServicesAmt |
| Management And General | $5,563,604 | ManagementAndGeneralAmt |
| Fundraising | $26,525 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,846,114 | BOYAmt |
| EOY | $15,774,317 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,250,934 | BOYAmt |
| EOY | $2,195,239 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $548,117 | BOYAmt |
| EOY | $329,603 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,268,038 | BOYAmt |
| EOY | $526,581 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $502,153 | BOYAmt |
| EOY | $500,421 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $26,136,616 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,322,597 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,585,124 | BOYAmt |
| EOY | $14,814,019 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,500 | BOYAmt |
| EOY | $7,500 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,353,337 | BOYAmt |
| EOY | $2,976,322 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,361,317 | BOYAmt |
| EOY | $37,124,002 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,784,007 | BOYAmt |
| EOY | $3,278,095 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,985 | BOYAmt |
| EOY | $319,167 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,619,427 | BOYAmt |
| EOY | $10,363,456 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,473,419 | BOYAmt |
| EOY | $13,960,718 | 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 | $21,887,898 | BOYAmt |
| EOY | $23,163,284 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,887,898 | BOYAmt |
| EOY | $23,163,284 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,361,317 | BOYAmt |
| EOY | $37,124,002 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,275,386 | ReconcilationRevenueExpnssAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $0 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | NACHC CONFERENCE(ADVOCACY COMMITTEE) - EMPLOYEE TRAVEL AND TIME: $2,098 | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $519,000 | BeginningYearBalanceAmt |
| End Year Balance | $519,000 | EndYearBalanceAmt |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $519,000 | OtherCostOrOtherBasisAmt |
| Book Value | $519,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,934,385 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,710,844 | DepreciationAmt |
| Book Value | $11,223,541 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,269,490 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,177,894 | DepreciationAmt |
| Book Value | $2,091,596 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,708,787 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,950,402 | DepreciationAmt |
| Book Value | $758,385 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,704,954 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,483,457 | DepreciationAmt |
| Book Value | $221,497 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,814,019 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| COMMERCIAL CAPITATION RECEIVABLE | $1,007,166 |
| OTHER RECEIVABLES | $991,611 |
| PROFESSIONAL SERVICE RECEIVABLE | $977,545 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,976,322 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND RELATED STATE OF ILLINOIS STATUTES; THEREFORE THE ORGANIZATION HAS MADE NO PROVISION FOR FEDERAL INCOME TAXES IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION ADOPTED THE REQUIREMENTS IN FINANCIAL ACCOUNTING STANDARDS BOARD(FASB) ACCOUNTING STANDARDS UPDATE (ASU) 2009-06 REGARDING UNCERTAIN TAX POSITIONS. ASU 2009-06 DEFINES HOW UNCERTAIN TAX POSITIONS SHOULD BE RECOGNIZED, MEASURED, PRESENTED, AND DISCLOSED IN THE FINANCIAL STATEMENTS. THE AUTHORITATIVE GUIDANCE REQUIRES ENTITIES TO RECOGNIZE A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE POSITION IS SUSTAINABLE BASED SOLELY ON ITS TECHNICAL MERITS AND CONSIDERATION OF THE RELEVANT TAXING AUTHORITY'S WIDELY UNDERSTOOD ADMINISTRATIVE PRACTICES AND PRECEDENTS. THE ORGANIZATION EVALUATED ITS TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN TO DETERMINE WHETHER THE TAX POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED BY THE APPLICABLE TAXING AUTHORITY, AND HAS DETERMINED THAT IT CURRENTLY DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT J URSO | ||||||||||||||
| PRESIDENT & CEO | $320,013 | $0 | $20,000 | $0 | $0 | $0 | $0 | $0 | $8,344 | $0 | $348,357 | $0 | $0 | $0 |
| PAUL S LUNING MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $222,253 | $0 | $25,350 | $0 | $0 | $0 | $0 | $0 | $21,577 | $0 | $269,180 | $0 | $0 | $0 |
| YAM-SHUN TONG | ||||||||||||||
| OB/GYN PHYSICIAN | $307,222 | $0 | $600 | $0 | $0 | $0 | $0 | $0 | $9,552 | $0 | $317,374 | $0 | $0 | $0 |
| BERTHA LOPEZ | ||||||||||||||
| OB/GYN PHYSICIAN | $259,403 | $0 | $800 | $0 | $0 | $0 | $0 | $0 | $23,546 | $0 | $283,749 | $0 | $0 | $0 |
| KAROLE A LAKOTA-TREESE MD | ||||||||||||||
| MEDICAL DIRECTOR OF PI | $237,640 | $0 | $39,236 | $0 | $0 | $0 | $0 | $0 | $17,998 | $0 | $294,874 | $0 | $0 | $0 |
| CHRISTINE SWARTZ | ||||||||||||||
| MEDICAL DIRECTOR | $285,826 | $0 | $48,790 | $0 | $0 | $0 | $0 | $0 | $1,565 | $0 | $336,181 | $0 | $0 | $0 |
| SHERIF MILIK | ||||||||||||||
| FAMILY PRACTICE PHYSICIAN | $341,935 | $0 | $1,801 | $0 | $0 | $0 | $0 | $0 | $17,998 | $0 | $361,734 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THERE IS AN INTERNAL REVIEW PROCESS WHICH IS PERFORMED BY THE CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER. SUBSEQUENT TO THAT REVIEW, THE 990 IS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS WHO THEN SUBMITS THE RETURN TO THE ENTIRE BOARD FOR APPROVAL. A COPY OF THE RETURN IS KEPT ON RECORD FOR PUBLIC REVIEW SHOULD THERE BE SUCH A REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL TRANSACTIONS AND PROCESSES ARE REVIEWED AND MONITORED THROUGH POLICY, EXECUTIVE MANAGEMENT, AND RATIFIED BY THE VOTING MEMBERS OF THE BOARD, IF NECESSARY. ALL STAFF AND BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT WHICH IS KEPT IN EACH STAFF AND BOARD MEMBERS' FILES. DISCLOSURE OF CONFLICT OF INTEREST POLICY QUESTION IS PRESENTED TO EVERY STAFF OR BOARD MEMBER DURING THE RECRUITING OR HIRING PROCESS. FURTHERMORE, AT ANY JUNCTURE WHEN MAJOR DECISIONS ARE ABOUT TO BE MADE, INDIVIDUALS RAE ASKED TO DISCLOSE ANY CONFLICTS THAT MAY EXIST. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS OF DETERMINING COMPENSATION FOR THE CEO AND OTHER KEY OFFICERS OF THE ORGANIZATION IS DONE THROUGH A REVIEW AND APPROVAL PROCESS VIA THE GOVERNING BODY, AND SUBJECT TO RATIFICATION OF THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |
| FORM 990, PART XII, LINE 2C | THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PCC FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 LAKE STREET | AddressLine1Txt |
| City | OAK PARK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60302 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 475608703 | EIN |
| Primary Activities | SEE PART VII | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PCC COMMUNITY WELLNESS CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PCC FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $510,000 | InvolvedAmt |
| Method Of Amount Determination | FAIR MARKET VALUE | MethodOfAmountDeterminationTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE R, PART II, COLUMN (B) | FormAndLineReferenceDesc |
| Explanation | THE PCC FOUNDATION CONDUCTS FUNDRAISING ACTIVITIES FOR PCC COMMUNITY WELLNESS CENTER ("CENTER") AND INTENDS TO AWARD GRANTS TO THE CENTER UPON REQUEST. | ExplanationTxt |