2021-11-09T10:59:10-06:00 2020-12-31 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2020-01-01 432016287 MT ENTERPRISE COMMUNITY HEALTH CLINIC MTEN 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 KENNETH WHITE CEO 9033928203 2021-11-09 1 KENNETH WHITE 999009999 KURT BENNION P01469618 4252506100 2021-11-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CROSSROADS FAMILY CARE KENNETH WHITE PO BOX 489 MT ENTERPRISE TX 75681 5389867 0 X HTTPS://CROSSROADSFAMILYCARE.COM X 2003 TX TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 14 14 71 17 0 0 2406136 3028764 2398888 2336735 49 152 62963 24216 4868036 5389867 0 0 0 0 3464139 3994517 0 0 0 1216788 1178162 4680927 5172679 187109 217188 1927976 2817189 253846 925870 1674130 1891319 TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 0 0 4164997 0 2336735 AT THREE LOCATIONS (MT. ENTERPRISE, HENDERSON AND PALESTINE, TEXAS), MT. ENTERPRISE COMMUNITY HEALTH CLINIC (DBA: CROSSROADS FAMILY CARE) PROVIDES PRIMARY CARE, DENTAL, AND BEHAVIORAL HEALTH SERVICES TO ALL MEMBERS OF THE COMMUNITY, WITH AN EMPHASIS ON ENSURING MEDICAL CARE FOR THE LOW-INCOME AND UNINSURED POPULATION. IN 2020, THE HEALTH CENTER PROVIDED OVER 19,600 VISITS TO THE OVER 7,500 PATIENTS SERVED. 43% OF THESE PATIENTS DID NOT HAVE INSURANCE AT THE TIME OF THEIR VISIT AND 39% WERE BELOW 100% OF THE FEDERAL POVERTLY LEVEL. 4164997 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 14 0 71 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X JESTIN STOWE 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 AMSALE DERESE DDS PROVIDER 40.00 X 144923 0 11190 TAREK ELMAJIE DDS PROVIDER 40.00 X 140259 0 11785 JEREMIAH SANDERS APRN PMHNP-C PROVIDER 40.00 X 144573 0 4044 ROBIN WATSON APRN PMHNP-BC PROVIDER 40.00 X 136000 0 9404 BROOKE MARTIN APRN FNP-C PROVIDER 40.00 X 131753 0 8946 KENNETH WHITE CEO 40.00 X 114566 0 8586 JESTIN STOWE CFO 40.00 X 89249 0 9474 BECKY ELDRIDGE PRESIDENT & VICE PRESIDENT 1.00 X X 0 0 0 LEO GONZALEZ VICE PRESIDENT & PRESIDENT 1.00 X X 0 0 0 YOLANDA DELEON SECRETARY 1.00 X X 0 0 0 MICHELLE SIMMONS TREASURER 1.00 X X 0 0 0 PATSY FOGLEMAN BOARD MEMBER 1.00 X 0 0 0 MATT GHOLSON BOARD MEMBER 1.00 X 0 0 0 HARVEY GRAVES BOARD MEMBER 1.00 X 0 0 0 JOHN GRUBBS BOARD MEMBER 1.00 X 0 0 0 MAMIE HODGE BOARD MEMBER (THROUGH FEB 2020) 1.00 X 0 0 0 ROBERT HOLLENSHEAD BOARD MEMBER 1.00 X 0 0 0 J GUADALUPE OVIEDO BOARD MEMBER 1.00 X 0 0 0 CASSANDRA SHAW BOARD MEMBER 1.00 X 0 0 0 POLLY VARDEMAN BOARD MEMBER 1.00 X 0 0 0 TOM VAUGHT BOARD MEMBER (THROUGH FEB 2020) 1.00 X 0 0 0 RD WHITTNER BOARD MEMBER 1.00 X 0 0 0 JEAN WILLIAMS BOARD MEMBER 1.00 X 0 0 0 JOYCE YBARRA BOARD MEMBER (THROUGH FEB 2020) 1.00 X 0 0 0 901323 0 63429 10 0 1 0 MEDCON PO BOX 935 FORNEY TX 75126 MEDICAL SUPERVISION (CMO) SERVICES 137400 GENESIS PRIMECARE 1500 W GRAND STREET MARSHALL TX 75670 BILLING SERVICES 121998 2 2998524 30240 3028764 MEDICAL SERVICE INCOME 624100 2336735 2336735 2336735 152 152 OTHER REVENUE 624110 24216 24216 24216 5389867 2336735 0 24368 221875 221875 3259895 3016365 243530 53846 50634 3212 213282 175639 37643 245619 194878 50741 4625 4625 498814 425949 72865 159728 23687 136041 82220 69951 12269 172903 74862 98041 46525 1092 45433 28922 11299 17623 4282 4282 107765 86771 20994 19453 19453 MEDICAL SUPPLIES 38481 27954 10527 REPAIRS & MAINTENANCE 12235 3892 8343 DUES & SEMINARS 2209 2024 185 5172679 4164997 1007682 0 487400 1320166 92103 116784 32700 46127 2526843 1192731 1315773 1334112 1927976 2817189 169689 253447 598700 84157 73723 253846 925870 X 1674130 1891319 1674130 1891319 1927976 2817189 217188 0 X 0 1 X 1 0 X 1644094 1972114 2835367 2406136 3028764 11886475 1644094 1972114 2835367 2406136 3028764 11886475 11886475 50 75 95 49 152 421 5389 17198 73788 62963 24216 183554 12070450 9919490 0.98480 0.98490 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 34320 34320 1299624 171509 1128115 595948 555795 40153 596951 465427 131524 1334112 X 5389867 0 5389867 0 5389867 5172679 0 5172679 0 5172679 PART X, LINE 2: THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE ORGANIZATION EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2020 AND 2019, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. ALL TAX EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE, AND OTHER APPLICABLE STATE STATUTES. X X 0 0 0 0 0 0 0 0 0 AMSALE DERESE DDS PROVIDER 144923 0 0 0 0 0 7146 0 4044 0 156113 0 0 0 TAREK ELMAJIE DDS PROVIDER 140259 0 0 0 0 0 7741 0 4044 0 152044 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD AND THE CEO. THE EXECUTIVE COMMITTEE SERVES IN PLACE OF THE FULL BOARD IN EMERGENCY SITUATIONS WHEN A FULL BOARD QUORUM AT AN EMERGENCY MEETING CANNOT BE PRESENT. THE EXECUTIVE COMMITTEE ALSO REVIEWS CERTAIN PROSPECTIVE BUSINESS TRANSACTIONS AND MAKES RECOMMENDATIONS ON SUCH MATTERS TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 DURING 2020, MEDICAL MANAGEMENT SERVICES (THE CMO POSITION) WERE PROVIDED BY MEDCON. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO AND THE FINANCE COMMITTEE AND PROVIDED TO THE BOARD OF DIRECTORS BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST FORMS ARE COMPLETED EVERY YEAR BY BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES. FORMS RECEIVED ARE REVIEWED BY THE CFO AND FINANCE COMMITTEE AND MONITORED AS NECESSARY. NO BOARD MEMBER MAY VOTE ON ANY MATTER IN WHICH THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE COMPENSATION OF THE CEO IS DISCUSSED AT LENGTH BY THE BOARD OF DIRECTORS YEARLY. AS PART OF THEIR ANNUAL EVALUATION/REVIEW OF THE CEO, THEY REVIEW WHETHER ESTABLISHED GOALS WERE MET AND REVIEW COMPENSATION IN COMPARISON WITH OTHER COMMUNITY HEALTH ORGANIZATION CEO'S WITH THE HELP OF AN ANNUAL SALARY COMPARISON REPORT ISSUED BY THE NATIONAL ORGANIZATION OF COMMUNITY HEALTH ORGANIZATIONS. ALL OF THESE DISCUSSIONS ARE DOCUMENTED IN THE ORGANIZATION'S BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST.