2019-11-07T14:59:10-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-01-01 432016287 MT ENTERPRISE COMMUNITY HEALTH CLINIC MTEN 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 KENNETH WHITE CEO 9033928203 2019-09-24 1 KURT BENNION P01469618 4252506100 2019-09-24 67.137.57.251 2019-09-24 09:07:32 PD P 9DCB77BB5DA20F06DC527A2BE3898FDA4E15C9A7 AA627A63F630E2EFD1435F04ECCF881DFF3D020E 2018 2020-03-31 21:24:44Z CROSSROADS FAMILY CARE KENNETH WHITE PO BOX 489 MT ENTERPRISE TX 75681 4795755 0 X HTTPS://CROSSROADSFAMILYCARE.COM X 2003 TX TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 13 13 58 13 0 0 1972114 2835367 1726539 1886505 75 95 17198 73788 3715926 4795755 0 0 0 0 2490690 2884864 0 0 0 938996 1099698 3429686 3984562 286240 811193 1081850 1763985 406022 276964 675828 1487021 TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 0 0 3236368 0 1886505 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 2018, THE HEALTH CENTER PROVIDED OVER 18,000 VISITS TO THE 6,800 PATIENTS SERVED. 45% OF THESE PATIENTS DID NOT HAVE INSURANCE AT THE TIME OF THEIR VISIT AND 39% WERE BELOW 100% OF THE FEDERAL POVERTLY LEVEL. 3236368 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 1 0 0 0 0 0 0 0 0 1 10 0 58 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X KENNETH WHITE 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 BECKY ELDRIDGE PRESIDENT 1.00 X X 0 0 0 LEO GONZALEZ VICE PRESIDENT 1.00 X X 0 0 0 JOHN GRUBBS SECRETARY 1.00 X X 0 0 0 TOM VAUGHT 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 MAMIE HODGE BOARD MEMBER 1.00 X 0 0 0 MICHELLE SIMMONS BOARD MEMBER 1.00 X 0 0 0 POLLY VARDEMAN BOARD MEMBER 1.00 X 0 0 0 JEAN WILLIAMS BOARD MEMBER 1.00 X 0 0 0 RD WHITTNER BOARD MEMBER 1.00 X 0 0 0 JOYCE YBARRA BOARD MEMBER 1.00 X 0 0 0 KENNETH WHITE CEO 40.00 X 102518 0 0 MICHELLE KELLEY CFO (THROUGH JULY 2018) 7.00 X 0 0 0 JULIE STOWE CFO 7.00 X 0 0 0 SHARAVANA GAJAPATHI MD DENTAL DIRECTOR 20.00 X 118707 0 0 BROOKE MARTIN FNP-C PROVIDER 40.00 X 124499 0 0 AMBERLY HOPSON FNP-C PROVIDER 40.00 X 129152 0 0 LACEE PIERCE FNP-C PROVIDER 40.00 X 120739 0 0 ROBIN WATSON PMHNP-BC PROVIDER 40.00 X 133000 0 0 728615 0 0 6 0 0 0 DOUBLE EAGLE CONSTRUCTION 302 HIGHWAY 43 HENDERSON TX 75652 GENERAL CONTRACTOR 277681 MEDCON PO BOX 935 FORNEY TX 75126 MEDICAL SUPERVISION (CMO) SERVICES 106000 2 2734249 101118 57188 2835367 MEDICAL SERVICE INCOME 624100 1886505 1886505 1886505 95 95 OTHER REVENUE 624110 73788 73788 73788 4795755 1886505 0 73883 X 102518 92266 10252 2325137 2097479 227658 38149 34410 3739 243178 219347 23831 175882 158646 17236 3620 3620 484775 357689 127086 147462 40074 107388 71145 71145 96786 50422 46364 52520 5009 47511 26229 10642 15587 9068 9068 42035 33900 8135 15316 15316 OTHER EXPENSES 123037 57189 65848 REPAIRS & MAINTENANCE 14455 3793 10662 DUES & SEMINARS 13250 4357 8893 3984562 3236368 748194 0 293998 467915 60775 9383 96620 95229 28790 28790 2192497 1029829 601667 1162668 1081850 1763985 141386 146607 91545 0 173091 130357 406022 276964 X 675828 1487021 675828 1487021 1081850 1763985 811193 0 X 0 1 X 1 0 X 1779136 1937836 1644094 1972114 2835367 10168547 1779136 1937836 1644094 1972114 2835367 10168547 10168547 124 50 75 95 344 5937 6302 5389 17198 73788 108614 10277505 7296766 0.98940 0.99590 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 34320 34320 561109 81455 479654 569033 550488 18545 460499 397886 62613 567536 567536 1162668 X 4705137 0 4705137 90618 90618 4795755 3984562 0 3984562 0 3984562 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, 2018 AND 2017, 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FROM DEBT FORGIVENESS 90,618. X 12 57188 INVOICE PRICE 0 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 FINANCIAL MANAGEMENT SERVICES (THE CFO POSITION) WERE PROVIDED BY COMMUNITY LINK CONSULTING THROUGH JULY 2018 AND BY GENESIS PRIME CARE AS OF AUGUST 2018. 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. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 354,067. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 354,067. OTHER SERVICES: PROGRAM SERVICE EXPENSES 3,622. MANAGEMENT AND GENERAL EXPENSES 127,086. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130,708.