KNOX WINAMAC COMMUNITY HEALTH CENTERS INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: KNOX WINAMAC COMMUNITY HEALTH CENTERS INC (EIN 87-0778393)
Tax period: 2020-01-01 to 2020-12-31
Filed: 2021-06-22
IRS object ID: 202121739349300712
Schema version: 2020v4.1
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-06-22T15:44:15-05:00	ReturnTs
Tax Period End	2020-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	352102008	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	CNA TAX PROFESSIONALS INC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	10475 CROSSPOINT BOULEVARD SUITE	AddressLine1Txt
Address Line2	200	AddressLine2Txt
City	INDIANAPOLIS	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46256	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	870778393	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KNOX WINAMAC COMMUNITY HEALTH	BusinessNameLine1Txt
Business Name Line2	CENTERS INC	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	KNOX	BusinessNameControlTxt
Phone	5747726030	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1002 SOUTH EDGEWOOD DR	AddressLine1Txt
City	KNOX	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46534	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	KATHY ROBB	PersonNm
Person Title	EXECUTIVE DIRECTOR	PersonTitleTxt
Phone	5747726030	PhoneNum
Signature	2021-06-22	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	KATHY	PersonFirstNm
Person Last	ROBB	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	SHAWN D DREIMAN CPA	PreparerPersonNm
PTIN	P00380913	PTIN
Phone	3178413393	PhoneNum
Preparation	2021-06-17	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	KATHY ROBB	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1002 SOUTH EDGEWOOD DR	AddressLine1Txt
City	KNOX	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46534	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$3,316,164	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	NA	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	2006	FormationYr
Legal Domicile State	IN	LegalDomicileStateCd
Activity Or Mission	THE ORGANIZATION PROVIDES PRIMARY AND PREVENTIVE HEALTH SERVICES TO THE AREA'S UNDER-SERVED AND MOST VULNERABLE POPULATIONS THROUGH HIGH QUALITY CLINICAL CARE WITH A DEMONSTRATED IMPACT ON THE HEALTH OUTCOMES OF THE COMMUNITIES WE SERVE.	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	31	TotalEmployeeCnt
Total Volunteers	2	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$0	PYContributionsGrantsAmt
CY Contributions Grants	$270,243	CYContributionsGrantsAmt
PY Program Service Revenue	$2,733,396	PYProgramServiceRevenueAmt
CY Program Service Revenue	$2,735,873	CYProgramServiceRevenueAmt
PY Investment Income	$0	PYInvestmentIncomeAmt
CY Investment Income	-$4,901	CYInvestmentIncomeAmt
PY Other Revenue	$62,299	PYOtherRevenueAmt
CY Other Revenue	$310,048	CYOtherRevenueAmt
PY Total Revenue	$2,795,695	PYTotalRevenueAmt
CY Total Revenue	$3,311,263	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	$1,442,149	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$1,548,320	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,164,768	PYOtherExpensesAmt
CY Other Expenses	$1,167,193	CYOtherExpensesAmt
PY Total Expenses	$2,606,917	PYTotalExpensesAmt
CY Total Expenses	$2,715,513	CYTotalExpensesAmt
PY Revenues Less Expenses	$188,778	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$595,750	CYRevenuesLessExpensesAmt
Total Assets BOY	$776,680	TotalAssetsBOYAmt
Total Assets EOY	$1,165,401	TotalAssetsEOYAmt
Total Liabilities BOY	$634,366	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$427,337	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$142,314	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$738,064	NetAssetsOrFundBalancesEOYAmt
Mission	THE ORGANIZATION PROVIDES PRIMARY AND PREVENTIVE HEALTH SERVICES TO THE AREA'S UNDER-SERVED AND MOST VULNERABLE POPULATIONS THROUGH HIGH QUALITY CLINICAL CARE WITH A DEMONSTRATED IMPACT ON THE HEALTH OUTCOMES OF THE COMMUNITIES WE SERVE.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$1,938,969	ExpenseAmt
Revenue	$2,730,972	RevenueAmt
Desc	THE ORGANIZATION PROVIDES AN ARRAY OF HEALTH CARE SERVICES THAT ARE AVAILABLE TO ALL PERSONS, REGARDLESS OF THE ABILITY TO PAY. WE HAVE A TEAM OF DOCTORS AND NURSE PRACTITIONERS WHO STAFF OUR OFFICE IN KNOX. OUR TEAM OF PROFESSIONALS OFFERS LOCAL ACCESS TO A COMPREHENSIVE RANGE OF AFFORDABLE PREVENTIVE AND PRIMARY HEALTH CARE SERVICES. ADDITIONALLY, THE ORGANIZATION PROVIDES MENTAL HEALTH CARE SERVICES, WHICH ENCOMPASSES, AMONG OTHER THINGS, SUBSTANCE ABUSE. THE ORGANIZATION ALSO PROVIDES SERVICES FOR MOTHERS AND MOTHERS-TO-BE. DURING CALENDAR YEAR 2020, OUR OFFICE PROVIDED CARE FOR 2,962 PERSONS, OF WHOM 823 WERE MEDICAID ELIGIBLE, 763 WERE MEDICARE ELIGIBLE, 1,109 WERE COVERED UNDER SOME FORM OF INSURANCE, AND 267 WERE UNINSURED.	Desc
Total Program Service Expenses	$1,938,969	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	0	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	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	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	4	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	31	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
Form8899 Filedind	0	Form8899Filedind
Form1098 C Filed	0	Form1098CFiledInd
DAF Excess Business Holdings	0	DAFExcessBusinessHoldingsInd
Taxable Distributions	0	TaxableDistributionsInd
Distribution To Donor	0	DistributionToDonorInd
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	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	IN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	EILEEN BLANKE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	5747726030	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1002 SOUTH EDGEWOOD DR	AddressLine1Txt
City	KNOX	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46534	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
JUDY CAUDILL
DIRECTOR	1.00	Yes (X)	$0	$0	$0
PAUL LISOWSKI
DIRECTOR	1.00	Yes (X)	$0	$0	$0
BILL DULIN
DIRECTOR	1.00	Yes (X)	$0	$0	$0
DEBRA TROIKE
DIRECTOR	1.00	Yes (X)	$0	$0	$0
ROSEANNE VONBAMPUS
DIRECTOR	1.00	Yes (X)	$0	$0	$0
JEFF HOUSTON
DIRECTOR	1.00	Yes (X)	$0	$0	$0
RUTH ANN CONNER
SECRETARY	1.00		$0	$0	$0	Yes (X)
AJ GAPPA
TREASURER	1.00		$0	$0	$0	Yes (X)
GAYLE SMITH
PRESIDENT	1.00		$0	$0	$0	Yes (X)
NANCY DEMBOWSKI
VICE PRESIDENT	1.00		$0	$0	$0	Yes (X)
KATHLEEN ROBB
EXECUTIVE DIR.	40.00		$90,736	$0	$9,973	Yes (X)
EILEEN BLANKE
CFO	40.00		$82,519	$0	$9,973	Yes (X)
DR WALTER E FRITZ
MEDICAL DIRECTOR	40.00		$209,908	$0	$19,946		Yes (X)
TRACY L HADDIX
NURSE PRACTITIONER	40.00		$109,288	$0	$0		Yes (X)
KIM M MCCULLOUGH
NURSE PRACTITIONER	40.00		$111,398	$0	$0		Yes (X)
DAVID COOK
MEDICAL DOCTOR	40.00		$109,983	$0	$18,451		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$713,832	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$58,343	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	4	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
CARDINAL HEALTH
7000 CARDINAL PLACE	DUBLIN	OH	43017	340B DRUG COSTS	$171,715
OMEGA HEALTHCARE INVESTORS
200 INTL CIRCLE STE 3500	HUNT VALLEY	MD	21030	RENT	$165,410
MCKESSON MEDICAL SURGICAL
5604 FORTUNE CIR S	INDIANAPOLIS	IN	46241	MEDICAL SUPPLIES	$126,350
NORTH AMERICAN HEALTHCARE MANAGEMENT SER
9245 WATSON INDUSTRIAL PARK	ST LOUIS	MO	63126	BILLING CONTRACT	$124,507
DR ALEXANDER GATZIMOS
212 W EDISON RD	MISHAWAKA	IN	46545	CONTRACTED PROVIDER	$111,150

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	5	CntrctRcvdGreaterThan100KCnt
Government Grants	$254,443	GovernmentGrantsAmt
All Other Contributions	$15,800	AllOtherContributionsAmt
Total Contributions	$270,243	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	PATIENT SERVICE FEE	Desc
Business	900099	BusinessCd
Total Revenue Column	$2,735,873	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,735,873	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$2,735,873	TotalProgramServiceRevenueAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$4,901	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	-$4,901	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$4,901	TotalRevenueColumnAmt
Related Or Exempt Func Income	-$4,901	RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
CANCELLATION OF DEBT	900099	$285,400	$285,400
OTHER INCOME	900099	$24,648	$24,648

Field	Value	IRS element (for citing)
Other Revenue Total	$310,048	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,311,263	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,730,972	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$310,048	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$772,175	TotalAmt
Program Services	$544,872	ProgramServicesAmt
Management And General	$227,303	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$776,145	TotalAmt
Program Services	$547,673	ProgramServicesAmt
Management And General	$228,472	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$51,457	TotalAmt
Management And General	$51,457	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$18,675	TotalAmt
Management And General	$18,675	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$199,108	TotalAmt
Program Services	$199,108	ProgramServicesAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$29,842	TotalAmt
Management And General	$29,842	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$23,374	TotalAmt
Management And General	$23,374	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$211,420	TotalAmt
Program Services	$145,220	ProgramServicesAmt
Management And General	$66,200	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$620	TotalAmt
Program Services	$620	ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$8,361	TotalAmt
Program Services	$8,361	ProgramServicesAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$3,268	TotalAmt
Management And General	$3,268	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$46,954	TotalAmt
Management And General	$46,954	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$218,574	TotalAmt
Program Services	$148,891	ProgramServicesAmt
Management And General	$69,683	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL LAB FEES	$159,214	$159,214
CONTRACT LABOR	$144,839	$115,752	$29,087
MISCELLANEOUS	$45,986	$32,449	$13,537
EQUIPMENT	$19,218	$19,218

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	-$13,717	TotalAmt
Program Services	$17,591	ProgramServicesAmt
Management And General	-$31,308	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,715,513	TotalAmt
Program Services	$1,938,969	ProgramServicesAmt
Management And General	$776,544	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$467,100	BOYAmt
EOY	$767,333	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$203,869	BOYAmt
EOY	$275,873	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$13,651	BOYAmt
EOY	$13,935	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$202,252	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$93,992	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$92,060	BOYAmt
EOY	$108,260	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$776,680	BOYAmt
EOY	$1,165,401	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$147,073	BOYAmt
EOY	$215,617	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$342,984	BOYAmt
EOY	$211,720	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$144,309	BOYAmt
EOY	$0	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$634,366	BOYAmt
EOY	$427,337	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	$142,314	BOYAmt
EOY	$669,742	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$68,322	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$142,314	BOYAmt
EOY	$738,064	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$776,680	BOYAmt
EOY	$1,165,401	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$595,750	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

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 D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$51,165	OtherCostOrOtherBasisAmt
Depreciation	$35,844	DepreciationAmt
Book Value	$15,321	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$151,087	OtherCostOrOtherBasisAmt
Depreciation	$58,148	DepreciationAmt
Book Value	$92,939	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$108,260	TotalBookValueLandBuildingsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$3,347,263	TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts	$36,000	DonatedServicesAndUseFcltsAmt
Revenue Not Reported	$36,000	RevenueNotReportedAmt
Revenue Subtotal	$3,311,263	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$3,311,263	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$2,751,513	TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts	$36,000	DonatedServicesUseFcltsAmt
Expenses Not Reported	$36,000	ExpensesNotReportedAmt
Expenses Subtotal	$2,715,513	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$2,715,513	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART X, LINE 2:	FormAndLineReferenceDesc
Explanation	FIN 48 FOOTNOTE THE ORGANIZATION ADOPTED THE ACCOUNTING POLICY TO RECOGNIZE A TAX BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED WILL BE THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE MORE LIKELY-THAN-NOT TEST, NO TAX BENEFIT WILL BE RECORDED. THE ORGANIZATION HAS EXAMINED THIS ISSUE AND HAS DETERMINED THERE ARE NO MATERIAL CONTINGENT TAX LIABILITIES. THE ORGANIZATIONS FEDERAL EXEMPT ORGANIZATION INCOME TAX RETURNS (FORM 990) ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY ARE FILED.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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

Field	Value	IRS element (for citing)
Person	DR WALTER E FRITZ	PersonNm
Title	MEDICAL DIRECTOR	TitleTxt
Base Compensation Filing Org	$209,908	BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs	$0	CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization	$0	BonusFilingOrganizationAmount
Bonus Related Organizations	$0	BonusRelatedOrganizationsAmt
Other Compensation Filing Org	$0	OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs	$0	OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org	$0	DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs	$0	DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org	$19,946	NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs	$0	NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org	$229,854	TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs	$0	TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org	$0	CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs	$0	CompReportPrior990RltdOrgsAmt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SEE BELOW	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Relationship Description	FAMILY OF MANAGEMENT	RelationshipDescriptionTxt
Transaction	SEE BELOW	TransactionDesc
Sharing Of Revenues	0	SharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART IV, LN 1	FormAndLineReferenceDesc
Explanation	THE ORGANIZATION OBTAINS MANUAL LABOR SERVICES FROM OUTSIDE VENDORS THAT ARE FAMILY MEMBERS TO BOARD MEMBERS OR MANAGEMENT. AMOUNTS PAID TO SUCH VENDORS, IN AGGREGATE, WERE $24,844 AND $33,848 FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, RESPECTIVELY.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11B	LINE 11B EXPLANATION - COPIES OF THE FINAL FORM 990 ARE PROVIDED TO THE BOARD MEMBERS THROUGH EMAIL WITH INSTRUCTIONS THAT THEY ARE TO RESPOND IMMEDIATELY WITH QUESTIONS DUE TO TIMELINESS OF FILING THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C	EACH YEAR THE CFO PROVIDES CONFLICT OF INTEREST STATEMENTS TO ALL BOARD MEMBERS FOR THEIR REVIEW AND SIGNATURES. THE CORPORATION AVOIDS ACTIVE PARTICIPATION OF ANY DIRECTOR IN A MANNER THAT POSES A CONFLICT OF INTEREST WITH RESPECT TO THAT DIRECTOR.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARD OF DIRECTORS USES COMPARATIVE COMPENSATION DATA AND HISTORICAL FINANCIAL DATA FROM THE CLINIC TO DETERMINE AN APPROPRIATE SALARY FOR THE ORGANIZATION OFFICERS.
FORM 990, PART VI, SECTION C, LINE 19	UPON REQUEST.