2020-07-15T10:29:22-05:00 2019-12-31 481032601 ALLEN GIBBS & HOULIK LC 301 N MAIN SUITE 1700 WICHITA KS 672024868 990 2019-01-01 481159633 GRACEMED HEALTH CLINIC INC GRAC 3168662000 1150 N BROADWAY AVE WICHITA KS 67214 VENUS LEE CEO 3168662011 2020-07-14 1 ELLEN K DECKER P01411318 3162677231 70.167.48.183 2020-07-14 15:06:39 CD P DA3167E5A6D476AEB3409C27A0C53102B99FEB9B 8077F98C4D1E24DE07FDF7F80461D81F1D2A1766 2019 2021-01-29 14:40:06Z X VENUS LEE 1150 N BROADWAY AVE WICHITA KS 67214 32540866 0 X WWW.GRACEMED.ORG X 1979 KS TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 14 14 447 80 0 0 10143523 9531593 15859720 18811832 200440 234118 61109 62768 26264792 28640311 0 0 0 0 17206570 18809036 0 0 302227 6589732 7725625 23796302 26534661 2468490 2105650 26780879 29108064 3012761 2760704 23768118 26347360 TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 0 0 21402993 18871124 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 21402993 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 50 0 1 447 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 KS X DAVID WUTHNOW 3168662049 1150 N BROADWAY AVE WICHITA KS 67214 ROB DAKIN BOARD MEMBER 4.00 X 0 0 0 MARLON KING TREASURER 4.00 X X 0 0 0 FRANK CHORIEGO BOARD MEMBER 4.00 X 0 0 0 MARC MINNIS PRESIDENT 4.00 X X 0 0 0 FRED ERVIN BOARD MEMBER 4.00 X 0 0 0 MARTECIA COOPER BOARD MEMBER 4.00 X 0 0 0 JULIE HEDRICK SECRETARY 4.00 X X 0 0 0 LAURIE LABARCA BOARD MEMBER 4.00 X 0 0 0 TIM NORTON BOARD MEMBER 4.00 X 0 0 0 RON STEPHEN VICE PRESIDENT 4.00 X X 0 0 0 LAZARO VASQUEZ BOARD MEMBER 4.00 X 0 0 0 MYRON LEINWETTER BOARD MEMBER 4.00 X 0 0 0 RICK WOODS BOARD MEMBER 4.00 X 0 0 0 GAROLD MINNS BOARD MEMBER 4.00 X 0 0 0 JULIE A ELDER CHIEF MEDICAL OFFICER 40.00 X 244247 0 15643 VENUS L LEE OFFICER 40.00 X 160631 0 5287 DAVID WUTHNOW CHIEF FINANCIAL OFFICER 40.00 X 112609 0 13211 DAVID SANFORD CHIEF EXECUTIVE OFFICER 40.00 X 195553 0 11205 ERIC DESHAZER CHIEF DENTAL OFFICER 40.00 X 167673 0 16183 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYEE 40.00 X 202220 0 17094 BILLY RICHARDSON HIGHLY COMPENSATED EMPLOYEE 40.00 X 201524 0 16157 HOLLY ALLEN TERRELL HIGHLY COMPENSATED EMPLOYEE 40.00 X 172985 0 12784 REGAN M DEHART HIGHLY COMPENSATED EMPLOYEE 40.00 X 178567 0 13648 LANCE A JEPSON HIGHLY COMPENSATED EMPLOYEE 40.00 X 177060 0 11787 1813069 0 132999 26 0 1 0 HUTTON 2229 S WEST STREET WICHITA KS 67213 BUILDING CONTRACTOR 1812131 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 600550241 MEDICAL/DENTAL EQUIPMENT AND SUPPLIES 680590 MCKESSON PO BOX 848442 DALLAS TX 752848442 340B PHARMACEUTICALS 407168 QUEST DIAGNOSTICS PO BOX 772976 CHICAGO IL 60677 MEDICAL LAB 297412 COX COMMUNICATIONS PO BOX 248871 OKLAHOMA CITY OK 73124 PHONE & DATA COMMUNICATIONS 261193 14 94512 6644496 2792585 1379712 9531593 MEDICAL & DENTAL SERVICES 621110 18811832 18811832 18811832 245678 245678 3852040 3853255 10345 -1215 -10345 -11560 -11560 40431 94512 36955 3476 3476 MISC REVENUE 900099 59292 59292 59292 28640311 18871124 0 237594 X 880712 720035 160677 16282984 13100591 2924163 258230 244336 200911 38259 5166 1401004 1165183 221375 14446 92416 92416 48933 48933 790516 638294 152222 229567 229567 201607 108403 93204 497654 457761 39893 105261 31129 74001 131 1079549 889181 190368 67391 2092 65299 MEDICAL SUPPLIES 2674872 2668893 5979 CONSULTING & COMPUTER E 881618 753032 128586 REPAIRS 416474 272205 144269 UTILITIES 313839 259722 54117 325928 135561 166113 24254 26534661 21402993 4829441 302227 401646 544467 2930356 3160923 911029 454350 860083 1175589 15559 14126 61759 76503 20956829 5202701 14177720 15754128 4026750 4652321 3394066 3273393 1911 2264 26780879 29108064 1677936 1788594 1334825 972110 3012761 2760704 X 23661732 26256126 106386 91234 23768118 26347360 26780879 29108064 X 2105650 473828 95861 -96097 X X 0 1 X 1 1 1 X 5019173 9487166 11113551 10130406 9490711 45241007 5019173 9487166 11113551 10130406 9490711 45241007 45241007 36303 19328 49734 146131 243162 494658 45735665 70436409 0.98920 0.99250 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 622330 622330 10460126 820336 9639790 5258228 1514325 3743903 4608816 2868040 1740776 7329 7329 15754128 CERTIFICATES OF DEPOSIT 3273393 C 3273393 29197712 473828 95861 -11978 557711 28640001 310 310 28640311 26618470 95861 36955 132816 26485654 49007 49007 26534661 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 36,955. INVESTMENT EXPENSES REPORTED AS INCOME ON FINANCIAL STATEMENTS -48,933. PART XI, LINE 4B - OTHER ADJUSTMENTS: K-1 INTEREST 6. K-1 DIVIDENDS 304. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 36,955. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE FROM K-1 74. INVESTMENT EXPENSES REPORTED AS INCOME ON FINANCIAL STATEMENTS 48,933. 5K RACE 93676 53245 40431 925 18683 14030 HOTCAKES FUNDRAISER 41267 41267 3317 134943 94512 40431 925 18683 17347 36955 3476 X X 0 0 0 0 0 0 0 0 0 JULIE A ELDER CHIEF MEDICAL OFFICER 244247 0 0 0 0 0 7577 0 8066 0 259890 0 0 0 VENUS L LEE OFFICER 160631 0 0 0 0 0 4872 0 415 0 165918 0 0 0 DAVID SANFORD CHIEF EXECUTIVE OFFICER 195553 0 0 0 0 0 5975 0 5230 0 206758 0 0 0 ERIC DESHAZER CHIEF DENTAL OFFICER 167673 0 0 0 0 0 5322 0 10861 0 183856 0 0 0 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYEE 202220 0 0 0 0 0 6233 0 10861 0 219314 0 0 0 BILLY RICHARDSON HIGHLY COMPENSATED EMPLOYEE 201524 0 0 0 0 0 5296 0 10861 0 217681 0 0 0 HOLLY ALLEN TERRELL HIGHLY COMPENSATED EMPLOYEE 172985 0 0 0 0 0 1923 0 10861 0 185769 0 0 0 REGAN M DEHART HIGHLY COMPENSATED EMPLOYEE 178567 0 0 0 0 0 5582 0 8066 0 192215 0 0 0 LANCE A JEPSON HIGHLY COMPENSATED EMPLOYEE 177060 0 0 0 0 0 926 0 10861 0 188847 0 0 0 CHAD SANFORD SON OF CEO 56353 CHAD SANFORD IS THE SON OF DAVID SANFORD, CEO OF GRACEMED. CHAD IS AN EMPLOYEE OF GRACEMED. 0 KYLE BOWEN SON OF DIRECTOR OF MARKETING 16623 KYLE BOWEN IS THE SON OF LARRY BOWEN, GRACEMED'S DIRECTOR OF MARKETING FROM 01/01/2019 TO 06/30/2019. KYLE BOWEN IS THE OWNER OF SUPERHELPFUL (PREVIOUSLY TURTLE BOX DESIGN, LLC) WHO DEVELOPED AND MAINTAINS GRACEMED'S WEBSITE. 0 X 19693 1352419 AVG. PER UNIT CDC PRICE X DENTAL KITS & SUPPLIES 10360 21793 FAIR MARKET VALUE X EXAM TABLE 1 5500 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HIRES AN OUTSIDE CPA TO PREPARE THE FINANCIAL STATEMENT AUDIT AND THE FORM 990 EACH YEAR. AFTER THE CPA HAS COMPLETED BOTH THE AUDIT AND FORM 990, THE CFO FOR THE ORGANIZATION AND THE CPA REVIEW THE INITIAL DRAFT OF THE RETURN TO ENSURE ITS COMPLETENESS AND ACCURACY. FOLLOWING THE REVIEW, THE FORM 990 IS COMPLETED AND THE ORGANIZATION FILES THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL & CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 638,294. MANAGEMENT AND GENERAL EXPENSES 152,222. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 790,516. FORM 990, PART IX, LINE 24E MISCELLANEOUS: PROGRAM SERVICE EXPENSES 6,684. MANAGEMENT AND GENERAL EXPENSES 136,246. FUNDRAISING EXPENSES 24,254. TOTAL EXPENSES 167,184. CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 103,366. MANAGEMENT AND GENERAL EXPENSES 12,708. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116,074. STAFF RECRUITING: PROGRAM SERVICE EXPENSES 14,674. MANAGEMENT AND GENERAL EXPENSES 7,144. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,818. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 10,837. MANAGEMENT AND GENERAL EXPENSES 9,941. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,778. EXPENSE FROM K-1: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 74. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74. FORM 990, PART XI, LINE 9: INVESTMENT INCOME - BROOKFIELD INFRASTRUCTURE PARTNERS, L.P. -236. DONATED SERVICES AND USE OF FACILITIES EXPENSES -95,861. FORM 990, PART XII, LINE 2C THIS POLICY HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART XI, LINE 5 & SCH D, PART XI, LINE 2A REALIZED/UNREALIZED GAIN LOSS ON AUDIT REPORT FOOTNOTE AND THE AMOUNTS REPORTED ON FORM 990 DO NOT MATCH DUE TO THE USE OF DIFFERENT REPORTING METHODS BETWEEN THE AUDIT REPORT AND THE 990.