KINSTON COMMUNITY HEALTH CENTER INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- KINSTON COMMUNITY HEALTH CENTER INC (EIN 56-1833275)
- Tax period
- 2019-12-01 to 2020-11-30
- Filed
- 2021-09-29
- IRS object ID
- 202132729349301408
- 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 | 2021-09-29T10:54:28-05:00 | ReturnTs |
| Tax Period End | 2020-11-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 202102404 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETWAY MILLS & PEARSON PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1036 | AddressLine1Txt |
| City | ZEBULON | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 275971036 | 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 | 561833275 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KINSTON COMMUNITY HEALTH | BusinessNameLine1Txt |
| Business Name Line2 | CENTER INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KINS | BusinessNameControlTxt |
| Phone | 2525229800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 2278 | AddressLine1Txt |
| City | KINSTON | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28502 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LISA WALLACE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2525224350 | PhoneNum |
| Signature | 2021-08-26 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAMES A RIDOUTT | PreparerPersonNm |
| PTIN | P00394550 | PTIN |
| Phone | 9192697405 | PhoneNum |
| Preparation | 2021-08-26 | 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 | LISA WALLACE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 2278 | AddressLine1Txt |
| City | KINSTON | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28502 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,027,074 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KINSTONHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY AND ACCESSIBLE HEALTH CARE TO CITIZENS OF LENOIR COUNTY BY OFFERING COMPREHENSIVE DENTAL, ADULT MEDICINE, PEDIATRIC AND OB/GYN SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 130 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $3,587,831 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,874,109 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,179,755 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,128,469 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,701 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,916 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,782 | PYOtherRevenueAmt |
| CY Other Revenue | $18,580 | CYOtherRevenueAmt |
| PY Total Revenue | $8,780,069 | PYTotalRevenueAmt |
| CY Total Revenue | $9,027,074 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,897,399 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,974,674 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,931,001 | PYOtherExpensesAmt |
| CY Other Expenses | $3,471,115 | CYOtherExpensesAmt |
| PY Total Expenses | $8,828,400 | PYTotalExpensesAmt |
| CY Total Expenses | $9,445,789 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$48,331 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$418,715 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,671,796 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,031,535 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $996,265 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,774,719 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,675,531 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,256,816 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE QUALITY AND ACCESSIBLE HEALTH CARE TO CITIZENS OF LENOIR COUNTY BY OFFERING COMPREHENSIVE DENTAL, ADULT MEDICINE, PEDIATRIC AND OB/GYN SERVICES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $6,253,884 | ExpenseAmt |
| Revenue | $5,128,469 | RevenueAmt |
| Desc | PROVIDED MEDICAL AND DENTAL SERVICES TO APPROXIMATELY 7,493 CITIZENS OF LENOIR COUNTY, REGARDLESS OF ABILITY TO PAY, DURING THE FISCAL YEAR ENDED 11/30/20. | Desc |
| Total Program Service Expenses | $6,253,884 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | 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 | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | 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 | Yes (true) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | 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 | 25 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 130 | 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (true) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAPHNE BETTS-HEMBY | PersonNm |
| Phone | 2525229800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 2278 | AddressLine1Txt |
| City | KINSTON | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28502 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ROSALIND MCDONALD | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JAMES WILKINS | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| VINCENT R JONES | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TYRONE JONES | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ALEXIS B WELCH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GERALDINE MURPHY LOFTIN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JUAN ALLEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MELISSA B CASTILLO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MODESTO ARRIBAS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LISA WALLACE | |||||||
| CEO | 40.00 | Yes (X) | $30,859 | $0 | $0 | ||
| LASHAWN WEAVER-LEE | |||||||
| CMO | 40.00 | Yes (X) | $295,556 | $0 | $0 | ||
| DAPHNE BETTS-HEMBY | |||||||
| CFO | 40.00 | Yes (X) | $115,449 | $0 | $0 | ||
| FRANCISCO RIOS-MERCADO | |||||||
| DMD, CDO | 40.00 | Yes (X) | $173,261 | $0 | $0 | ||
| MARION WRIGHT | |||||||
| PHYSICIAN | 40.00 | $181,705 | $0 | $0 | Yes (X) | ||
| KUSHATHA WEST-QUIRE | |||||||
| PHYSICIAN | 40.00 | $102,898 | $0 | $0 | Yes (X) | ||
| ANA VAZQUEZ | |||||||
| DENTIST | 40.00 | $122,509 | $0 | $0 | Yes (X) | ||
| EMILIO MARTY | |||||||
| DENTIST | 40.00 | $124,917 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,147,154 | 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)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WEATHERBY LOCUMS INC | |||||
| PO BOX 792633 | DALLAS | TX | 75397 | RECRUITING | $353,473 |
| MEDIVISE LLC | |||||
| 1735 WATERBROOK DRIVE | CHARLESTON | SC | 29414 | CONSULTING | $223,409 |
| BLACKWELL HEALTHCARE STAFFING LLC | |||||
| PO BOX 152642 | ARLINGTON | TX | 76015 | STAFFING | $189,593 |
| CHG COMPANIES INC | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | RECRUITING | $167,519 |
| 340B TECHNOLOGIES | |||||
| 309 FELLOWSHIP RD STE 200 | MOUNT LAUREL | NJ | 08054 | TECH SVCS | $133,026 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,466,263 | GovernmentGrantsAmt |
| All Other Contributions | $407,846 | AllOtherContributionsAmt |
| Noncash Contributions | $243,239 | NoncashContributionsAmt |
| Total Contributions | $3,874,109 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT FEES | $3,040,844 | $3,040,844 |
| COST REPORT SETTLEMENTS | $2,058,602 | $2,058,602 |
| QUALITY INCENTIVE PROGRAMS | $24,750 | $24,750 |
| MECICAL RECORDS FEES | $4,273 | $4,273 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,128,469 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,916 | TotalRevenueColumnAmt |
| Exclusion | $5,916 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| VENDOR REFUNDS/REBATES | $15,130 | $15,130 |
| OTHER REVENUE | $3,450 | $3,450 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $18,580 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,027,074 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,147,049 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $5,916 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $615,125 | TotalAmt |
| Program Services | $399,831 | ProgramServicesAmt |
| Management And General | $215,294 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,364,426 | TotalAmt |
| Program Services | $2,711,277 | ProgramServicesAmt |
| Management And General | $1,653,149 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,735 | TotalAmt |
| Program Services | $9,206 | ProgramServicesAmt |
| Management And General | $5,529 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $638,431 | TotalAmt |
| Program Services | $398,877 | ProgramServicesAmt |
| Management And General | $239,554 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,957 | TotalAmt |
| Program Services | $213,647 | ProgramServicesAmt |
| Management And General | $128,310 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,122 | TotalAmt |
| Management And General | $4,122 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,600 | TotalAmt |
| Management And General | $1,600 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $760,711 | TotalAmt |
| Program Services | $491,961 | ProgramServicesAmt |
| Management And General | $268,750 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,698 | TotalAmt |
| Management And General | $26,698 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $428,576 | TotalAmt |
| Program Services | $152,516 | ProgramServicesAmt |
| Management And General | $276,060 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,612 | TotalAmt |
| Program Services | $44,709 | ProgramServicesAmt |
| Management And General | $14,903 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,264 | TotalAmt |
| Program Services | $47,369 | ProgramServicesAmt |
| Management And General | $57,895 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,499 | TotalAmt |
| Management And General | $10,499 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $261,142 | TotalAmt |
| Program Services | $182,513 | ProgramServicesAmt |
| Management And General | $78,629 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,293 | TotalAmt |
| Program Services | $5,823 | ProgramServicesAmt |
| Management And General | $17,470 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PATIENT CARE EXPENSES | $908,188 | $908,188 | |
| SUPPLIES | $389,441 | $362,515 | $26,926 |
| MEDICAL SUPPLIES | $243,239 | $243,239 | |
| REPAIRS & MAINTENANCE | $118,430 | $79,753 | $38,677 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,300 | TotalAmt |
| Program Services | $2,460 | ProgramServicesAmt |
| Management And General | $127,840 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,445,789 | TotalAmt |
| Program Services | $6,253,884 | ProgramServicesAmt |
| Management And General | $3,191,905 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $126,624 | BOYAmt |
| EOY | $315,571 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,864,041 | BOYAmt |
| EOY | $1,590,498 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $244,873 | BOYAmt |
| EOY | $380,247 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $932,781 | BOYAmt |
| EOY | $509,769 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,965 | BOYAmt |
| EOY | $2,965 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,493,118 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,407,485 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,205,823 | BOYAmt |
| EOY | $2,085,633 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| 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 | $1,287,189 | BOYAmt |
| EOY | $2,139,352 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,671,796 | BOYAmt |
| EOY | $7,031,535 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $476,680 | BOYAmt |
| EOY | $383,286 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $374,322 | BOYAmt |
| EOY | $208,683 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,014,031 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $145,263 | BOYAmt |
| EOY | $168,719 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $996,265 | BOYAmt |
| EOY | $1,774,719 | 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 | $5,546,459 | BOYAmt |
| EOY | $5,103,653 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,072 | BOYAmt |
| EOY | $153,163 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,675,531 | BOYAmt |
| EOY | $5,256,816 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,671,796 | BOYAmt |
| EOY | $7,031,535 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$418,715 | 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) |
|---|---|---|
| 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $68,274 | OtherCostOrOtherBasisAmt |
| Book Value | $68,274 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,287,553 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,647,223 | DepreciationAmt |
| Book Value | $1,640,330 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,137,291 | OtherCostOrOtherBasisAmt |
| Depreciation | $760,262 | DepreciationAmt |
| Book Value | $377,029 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,085,633 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| MEDICAID COST REPORT RECEIVABLE | $2,011,137 |
| A/R - 340B PROGRAM | $56,099 |
| SALES TAX REFUND REC. | $43,034 |
| MEDICARE COST REPORT RECEIVABLE | $28,645 |
| EMPLOYEE ADVANCES | $437 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,139,352 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED VACATION PAYABLE | Desc |
| Amt | $168,719 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $168,719 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $9,027,074 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $9,027,074 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $9,027,074 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,445,789 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $9,445,789 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $9,445,789 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM INCOME TAXES AS A NOT-FOR-PROFIT ORGANIZATION UNDER INTERNAL REVENUE SERVICE (IRS) CODE SECTION 501(C)(3). DURING THE YEARS ENDED NOVEMBER 30, 2020 AND 2019, THE ORGANIZATION REPORTED NO UNRELATED BUISNESS TAXABLE INCOME WHICH IS DEFINED BY THE IRS AS GROSS INCOME DERIVED FROM ANY UNRELATED TRADE OR BUSINESS THAT IS NOT SUBSTANTIALLY RELATED TO THE ORGANIZATION'S TAX-EXEMPT PURPOSE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. THE ORGANIZATION ADOPTED THE PROVISIONS OF FASB ASC 740-10-25 (ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES). UNDER THIS PROVISION, AN ORGANIZATION MUST RECOGNIZE THE TAX BENEFIT ASSOCIATED WITH TAX POSITIONS TAKEN WHEN IT IS MORE LIKELY THAN NOT THE POSTITION WILL BE SUSTAINED. THE IMPLEMENTATION HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION DOES NOT BELIEVE THERE ARE ANY MATERIAL UNCERTAIN TAX POSITIONS AND, ACCORDINGLY, IT WILL NOT RECOGNIZE ANY LIABILITY FOR UNRECOGNIZED TAX BEFEFITS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX YEARS IN PROGRESS. AT NOVEMBER 30, 2020 AND 2019, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 |
|---|---|---|
| LASHAWN WEAVER-LEE | ||
| CMO | $295,556 | $295,556 |
| FRANCISCO RIOS-MERCADO | ||
| DMD, CDO | $173,261 | $173,261 |
| MARION WRIGHT | ||
| PHYSICIAN | $181,705 | $181,705 |
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 | UNION BANK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | LENDER | RelationshipDescriptionTxt |
| Transaction | MORTGAGE PAYMENTS | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | VINCENT JONES, THE BOARD TREASURER, IS THE PRESIDENT OF UNION BANK, THE ORGANIZATION'S MORTGAGE LENDER. | ExplanationTxt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | MEDICL SUPPLIES | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $243,239 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE ORGANIZATION'S CEO AND CFO. THE 990 IS PRESENTED TO THE BOARD AT THE NEXT SCHEDULED BOARD MEETING FOR APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTERST STATEMENTS ARE REQUIRED TO BE REVIEWED AND SIGNED ANNUALLY BY THE BOARD TO ENSURE COMPLIANCE WITH THE ORGANIZATION'S POLICY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS PERFORMS A SALARY REVIEW THAT DETERMINE'S THE CEO'S COMPENSATION LEVEL. THE ORGANIZATION USES THE NACHC AND NCCHCA ANNUAL SALARY SURVEYS, NC CAREER ONE STEP, AND BUREAU OF LABOR STATISTIC SALARY DATA TO SET SALARY RANGES FOR THE TOP MANAGEMENT OFFICAL. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE ORGANIZATION USES THE NACHC AND NCCHCA ANNUAL SALARY SURVEYS, NC CAREER ONE STEP, AND BUREAU OF LABOR STATISTIC SALARY DATA TO SET SALARY RANGES FOR OFFICERS AND KEY EMPLOYEES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |