2020-11-13T13:33:14-06:00 2019-12-31 550486667 ARNETT CARBIS TOOTHMAN LLP PO BOX 908 BRIDGEPORT WV 26330 990 2019-01-01 550768457 SUSAN DEW HOFF MEMORIAL CLINIC INC SUSA 3047453700 623 LIBERTY AVENUE WEST MILFORD WV 26451 DR JD HISSEM EXECUTIVE DIRECTOR 3047453700 2020-11-12 1 WILLIAM H PHILLIPS CPA P00197505 3046245471 2020-11-11 216.12.119.47 2020-11-12 09:32:13 ES P BB6CF1CC58227981A42609CAEFD4304A4FF92B7A 0A5DD38EA065775B411159C43ADC2543815EB3C6 2019 2021-01-29 14:40:06Z SUSAN DEW HOFF MEMORIAL CLINIC DR JD HISSEM 623 LIBERTY AVENUE WEST MILFORD WV 26451 382449 0 X N/A X OTHER 1999 WV PROVIDE HEALTH AND DENTAL CARE TO THE UNINSURED WORKING POOR. 24 24 2 0 0 0 331103 375267 0 0 6033 7182 1120 0 338256 382449 400 300 0 0 60512 69357 0 0 0 288894 344071 349806 413728 -11550 -31279 635033 607838 3191 7275 631842 600563 TO PROVIDE HEALTH ASSESSMENT, PROMOTION AND REFERRAL SERVICES TO THE WORKING POOR WHO LACK MEDICAL AND DENTAL INSURANCE. 0 0 317519 300 IN 2019, THE CLINIC HELD 120 CLINICS AND SAW 1,808 PATIENTS. THERE WERE 3,052 PROCEDURES PERFORMED, WHICH INCLUDED: 1,120 X-RAYS, 140 CLEANINGS, 820 FILLINGS, FASHIONED 51 PARTIALS AND 32 DENTURES, 16 REPAIRS, 607 EXTRACTIONS, 13 ROOT CANALS, 20 CROWNS AND 5 REFERRALS TO ORAL SURGEON AND 228 REFERRALS TO OUTSIDE DENTISTS. INCLUDED IN THIS WAS SERVICE TO 210 NEW PATIENTS AND 170 VETERAN VISITS, THOSE WHO NO LONGER QUALIFIED FOR SERVICE AT THE LOCAL VA HOSPITAL. 317519 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 0 1 2 1 0 0 0 0 0 0 0 0 0 0 X 24 24 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 WV X X SUSAN DEW HOFF MEMORIAL CLINIC INC 3047453700 623 LIBERTY STREET WEST MILFORD WV 26451 X GINA SHARPS DIRECTOR 1.00 X 0 0 0 BERNICE JEAN LUCAS DIRECTOR 1.00 X 0 0 0 MARY LOU VARGO DIRECTOR 1.00 X 0 0 0 DR ROBERT WRANKER DDS DIRECTOR 1.00 X 0 0 0 FRANK NUZUM DIRECTOR 1.00 X 0 0 0 DR MARY BETH HINKLE DDS DIRECTOR 1.00 X 0 0 0 DR ANDREW MINIGH DDS DIRECTOR 1.00 X 0 0 0 LADONNE WETZEL DIRECTOR 1.00 X 0 0 0 GARY WETZEL DIRECTOR 1.00 X 0 0 0 SANDRA MANO DIRECTOR 1.00 X 0 0 0 VIRGIL SMITH DIRECTOR 1.00 X 0 0 0 DR MARK SPIKER DDS DIRECTOR 1.00 X 0 0 0 ANDY WHARTON DIRECTOR 1.00 X 0 0 0 CECILIA REID DIRECTOR 1.00 X 0 0 0 REV JIM MURPHY DIRECTOR 1.00 X 0 0 0 BEVERLY TALBERT DIRECTOR 1.00 X 0 0 0 JOELLEN KEMMNER CHAIR 1.00 X 0 0 0 TODD SOMMERS DIRECTOR 1.00 X 0 0 0 LOU ORTENZIO DIRECTOR 1.00 X 0 0 0 SISTER MARY REBECCA FIDLER RSM MD CEO 20.00 X 0 0 0 DR JD HISSEM DDS EXECUTIVE DIRECTOR 1.00 X 0 0 0 DR RICHARD MECKSTROTH DDS VICE-CHAIR 1.00 X 0 0 0 TERRY WAXMAN SECRETARY 1.00 X 0 0 0 BARBARA PRINCE TREASURER 1.00 X 0 0 0 0 0 0 0 0 0 0 0 375267 375267 7182 7182 382449 0 0 7182 300 300 62837 62837 6520 6520 4897 4897 14500 14500 4379 4379 26503 26503 3328 3328 10458 10458 CONTRACT SERVICES 256908 256908 DENTAL SUPPLIES 15450 15450 UTILITIES 2827 2827 REPAIRS & MAINTENANCE 1855 1855 2966 1745 1221 413728 317519 96209 0 106254 77692 506377 512814 1742 0 6743 6743 58508 47919 13917 10589 635033 607838 3191 7275 3191 7275 X 631842 600563 631842 600563 635033 607838 -31279 0 X X 0 0 0 X 326012 196214 281379 331104 375267 1509976 326012 196214 281379 331104 375267 1509976 1509976 3545 13212 12312 6379 7182 42630 906 2718 3666 7290 1559896 0.96800 0.96410 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 58508 47919 10589 10589 X 382449 0 382449 0 382449 413728 0 413728 0 413728 PART X, LINE 2: THE CLINIC IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON ITS INCOME UNDER SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES AS BEEN PROVIDED. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRED THE CLINIC TO EVALUATE TAX POSITIONS TAKEN BY THE CLINIC AND RECOGNIZE A TAX LIABILITY OR ASSET IF THE CLINIC HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS). THE CLINIC HAS CONCLUDED THAT AS OF DECEMBER 31, 2019 THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR DISCLOSURE IN THE FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD MEMBERS ARE PROVIDED A COPY OF THE 990 AND IT IS REVIEWED AT BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CLINIC ENFORCES AN ANNUAL DISCLOSURE REQUIREMENT WITH ITS CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C THE ORGANIZATION HAS A COMMITEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS. THE SELECTION PROCESS FOR CHOOSING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PREVIOUS YEAR.