CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL INC (EIN 73-0955756)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-15
- IRS object ID
- 201942279349302514
- Schema version
- 2017v2.2
- 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 | 2019-08-15T11:20:56-07:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HSPG & ASSOCIATES PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5400 N GRAND BLVD STE 330 | AddressLine1Txt |
| City | OKLAHOMA CITY | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73112 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 730955756 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CENT | BusinessNameControlTxt |
| Phone | 4059484900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4913 W RENO | AddressLine1Txt |
| City | OKLAHOMA CITY | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73127 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRIS VAN ESS | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 4059484900 | PhoneNum |
| Signature | 2019-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MATTHEW L COLE | PreparerPersonNm |
| PTIN | P02039803 | PTIN |
| Phone | 4058449995 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 68.15.96.148 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-08-15 | IPDt |
| IP Tm | 11:20:47 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 7FCB63B9625E61D80D8819DEE6E30987D620B1CA | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 75C50C30533264212B908FFE499980292D2CC562 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OKLAHOMA CITY INDIAN CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBYN SUNDAY-ALLEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4913 W RENO | AddressLine1Txt |
| City | OKLAHOMA CITY | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73127 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $27,563,763 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | THE ORGANIZATION'S MISSION IS TO PROVIDE EXCELLENT HEALTH CARE TO AMERICAN INDIANS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 203 | TotalEmployeeCnt |
| Total Volunteers | 84 | TotalVolunteersCnt |
| Total Gross UBI | $93,625 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $69,651 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $11,059,972 | PYContributionsGrantsAmt |
| CY Contributions Grants | $11,586,663 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,304,775 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,661,972 | CYProgramServiceRevenueAmt |
| PY Investment Income | $33,246 | PYInvestmentIncomeAmt |
| CY Investment Income | $71,217 | CYInvestmentIncomeAmt |
| PY Other Revenue | $188,886 | PYOtherRevenueAmt |
| CY Other Revenue | $2,952 | CYOtherRevenueAmt |
| PY Total Revenue | $24,586,879 | PYTotalRevenueAmt |
| CY Total Revenue | $27,322,804 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $4,747,033 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,603,934 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,249,348 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $30,731 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,789,838 | PYOtherExpensesAmt |
| CY Other Expenses | $4,807,738 | CYOtherExpensesAmt |
| PY Total Expenses | $22,393,772 | PYTotalExpensesAmt |
| CY Total Expenses | $24,804,119 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,193,107 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,518,685 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,879,407 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,327,987 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,055,336 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,977,665 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,824,071 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,350,322 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE ORGANIZATION'S MISSION IS TO PROVIDE | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $18,220,501 | ExpenseAmt |
| Grant | $4,747,033 | GrantAmt |
| Revenue | $15,661,972 | RevenueAmt |
| Desc | PROVIDED COMPREHENSIVE OUTPATIENT MEDICAL, DENTAL, BEHAVIORAL, AND PREVENTATIVE HEALTH SERVICES TO THE URBAN INDIAN POPULATION OF OKLAHOMA CITY, OK AND THE SURROUNDING AREAS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,099,706 | ExpenseAmt |
| Desc | PROVIDED A SPECIAL DIABETES AND DIABETES PREVENTION PROGRAM FOR NATIVE AMERICANS AND PROMOTED HEALTHY LIFESTYLES THROUGH EDUCATION, NUTRITION, INFORMATION AND PHYSICAL ACTIVITY INSTRUCTION. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $226,636 | ExpenseAmt |
| Desc | MSPI IS A NATIONALLY-COORDINATED PROGRAM FOCUSING ON PROVIDING MUCH NEEDED METHAMPHETAMINE AND SUICIDE PREVENTION AND INTERVENTION RESOURCES FOR INDIAN COUNTRY. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $74,562 | ExpenseAmt |
| Desc | CONDUCTED HIV/AIDS SCREENING AND ENGAGEMENT CARE INITIATIVE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $74,562 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $19,621,405 | 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 |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | 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 | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | 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 With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | 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 |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 50 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 203 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 |
| States Where Copy Of Return Is Fld | OK | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL OKLAHOMA AMERICAN INDIAN HEALATH COUNCIL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4059484900 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4913 W RENO | AddressLine1Txt |
| City | OKLAHOMA CITY | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73127 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DR EVERETT RHOADES | ||||||||
| CHAIRMAN | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BRIAN GABBARD | ||||||||
| VICE-CHAIR | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MEREDITH RIVAS BROCKMAN | ||||||||
| SECRETARY | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DAVID THOMAS | ||||||||
| TREASURER | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DR SEAN LUDLOW | ||||||||
| MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| REVEREND DAVID WILSON | ||||||||
| MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN DAUGHERTY JR | ||||||||
| MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| DR JAMES KENNEDYE | ||||||||
| MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| BILL VEAZEY | ||||||||
| MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| REVEREND ALVIN BURKE DEER | ||||||||
| MEMBER | 3.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBYN SUNDAY-ALLEN | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $235,802 | $0 | $31,397 | |||
| LYSA ROSS | ||||||||
| CHIEF OPERATING OFFICER | 40.00 | Yes (X) | $161,097 | $0 | $27,662 | |||
| CHRIS VAN ESS | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $170,301 | $0 | $28,122 | |||
| DR DANIEL MOLINA | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $228,659 | $0 | $0 | |||
| DAVID TOAHTY | ||||||||
| CHIEF DEVELOPMENT OFFICER | 40.00 | Yes (X) | $118,311 | $0 | $13,120 | |||
| MONICA KRIENKE | ||||||||
| CHIEF HUMAN RESOURCES OFFICER | 40.00 | Yes (X) | $114,969 | $0 | $12,952 | |||
| HAZEL LONEWOLF | ||||||||
| CHIEF QUALITY OFFICER | 40.00 | Yes (X) | $111,420 | $0 | $25,178 | |||
| DR JANICE HIXSON | ||||||||
| PHYSICIAN | 40.00 | $185,614 | $0 | $28,888 | Yes (X) | |||
| DRJIN KONG | ||||||||
| PHYSICIAN | 40.00 | $221,373 | $0 | $30,676 | Yes (X) | |||
| DR KRISTEN JORDAN | ||||||||
| PHYSICIAN | 40.00 | $178,191 | $0 | $28,517 | Yes (X) | |||
| DR DEKODA BOST | ||||||||
| PHYSICIAN | 40.00 | $173,209 | $0 | $28,267 | Yes (X) | |||
| DR JENNIFER WILLIAMS | ||||||||
| PHYSICIAN | 40.00 | $166,763 | $0 | $21,052 | Yes (X) | |||
| DR NALINI KALYANAM | ||||||||
| PHYSICIAN | 40.00 | $147,266 | $0 | $23,702 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,212,975 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $299,533 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 24 | 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 |
|---|---|---|---|---|---|
| DIAGNOSTIC LABORATORY OF OKLAHOMA | |||||
| PO BOX 676324 | DALLAS | TX | 75267 | LABORATORY SERVICES | $848,465 |
| OKLAHOMA CITY AREA INDIAN HEALTH SERVICE | |||||
| 701 MARKET DRIVE | OKLAHOMA CITY | OK | 73131 | HEALTH SERVICES | $482,103 |
| GOLDSBY CONSTRUCTION | |||||
| 834 W INTERSTATE DRIVE | NORMAN | OK | 73072 | CONSTRUCTION | $479,517 |
| MCKESSON MEDICAL SURGICAL | |||||
| 6555 STATE HWY 161 | IRVING | TX | 75039 | MEDICAL SUPPLIES | $357,992 |
| UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER | |||||
| 865 RESEARCH PKWY | OKLAHOMA CITY | OK | 73104 | PHYSICIAN SERVICES | $223,413 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $136,399 | FundraisingAmt |
| Government Grants | $11,027,277 | GovernmentGrantsAmt |
| All Other Contributions | $422,987 | AllOtherContributionsAmt |
| Total Contributions | $11,586,663 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt |
|---|---|---|
| MEDICAID INCOME - MEDICAL | 621400 | $4,554,921 |
| MEDICAID INCOME - PHARMACY | 621400 | $3,020,845 |
| MEDICARE INCOME - PHARMACY | 621400 | $2,692,879 |
| PRIVATE INSURANCE INCOME - PHARMACY | 621400 | $2,370,544 |
| PRIVATE INSURANCE INCOME - MEDICAL | 621400 | $1,853,058 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,169,725 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,661,972 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $71,217 | TotalRevenueColumnAmt |
| Exclusion | $71,217 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $214,911 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $121,286 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $93,625 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $93,625 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $93,625 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $29,000 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $136,399 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $119,673 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$90,673 | TotalRevenueColumnAmt |
| Exclusion | -$90,673 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,322,804 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,661,972 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $93,625 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$19,456 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,747,033 | TotalAmt |
| Program Services | $4,747,033 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,309,433 | TotalAmt |
| Program Services | $370,206 | ProgramServicesAmt |
| Management And General | $922,465 | ManagementAndGeneralAmt |
| Fundraising | $16,762 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,865,546 | TotalAmt |
| Program Services | $8,535,252 | ProgramServicesAmt |
| Management And General | $1,316,325 | ManagementAndGeneralAmt |
| Fundraising | $13,969 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,074,369 | TotalAmt |
| Program Services | $3,283,945 | ProgramServicesAmt |
| Management And General | $790,424 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,936 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $22,936 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,500 | TotalAmt |
| Program Services | $18,000 | ProgramServicesAmt |
| Management And General | $7,500 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,018,215 | TotalAmt |
| Program Services | $975,895 | ProgramServicesAmt |
| Management And General | $42,320 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,298 | TotalAmt |
| Program Services | $140,160 | ProgramServicesAmt |
| Management And General | $36,138 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $890,451 | TotalAmt |
| Program Services | $133,771 | ProgramServicesAmt |
| Management And General | $756,680 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $872,759 | TotalAmt |
| Program Services | $554,218 | ProgramServicesAmt |
| Management And General | $318,541 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,756 | TotalAmt |
| Program Services | $36,764 | ProgramServicesAmt |
| Management And General | $140,992 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,327 | TotalAmt |
| Program Services | $18,230 | ProgramServicesAmt |
| Management And General | $167,097 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,795 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $71,795 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,751 | TotalAmt |
| Program Services | $88,759 | ProgramServicesAmt |
| Management And General | $210,992 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $260,912 | TotalAmt |
| Program Services | $192,679 | ProgramServicesAmt |
| Management And General | $68,233 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| REPAIRS AND MAINTENANCE | $494,396 | $252,305 | $242,091 | $0 |
| SPECIAL PROGRAMS | $182,438 | $182,438 | $0 | $0 |
| SMALL GRANTS EXPENSE | $68,559 | $68,559 | $0 | $0 |
| ASSISTANCE FUND | $16,126 | $0 | $16,126 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,519 | TotalAmt |
| Program Services | $23,191 | ProgramServicesAmt |
| Management And General | $21,328 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,804,119 | TotalAmt |
| Program Services | $19,621,405 | ProgramServicesAmt |
| Management And General | $5,151,983 | ManagementAndGeneralAmt |
| Fundraising | $30,731 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,582,267 | BOYAmt |
| EOY | $6,977,757 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,332 | BOYAmt |
| EOY | $54,470 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,311 | BOYAmt |
| EOY | $98,879 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $357,626 | BOYAmt |
| EOY | $402,355 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $152,038 | BOYAmt |
| EOY | $171,253 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,870,897 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,261,108 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,565,562 | BOYAmt |
| EOY | $10,609,789 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,271 | BOYAmt |
| EOY | $13,484 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,879,407 | BOYAmt |
| EOY | $18,327,987 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,466,064 | BOYAmt |
| EOY | $1,594,162 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $535,215 | BOYAmt |
| EOY | $2,009,961 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,054,057 | BOYAmt |
| EOY | $3,373,542 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,055,336 | BOYAmt |
| EOY | $6,977,665 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,890,203 | BOYAmt |
| EOY | $11,020,425 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $933,868 | BOYAmt |
| EOY | $329,897 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,824,071 | BOYAmt |
| EOY | $11,350,322 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,879,407 | BOYAmt |
| EOY | $18,327,987 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,518,685 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $7,566 | NetUnrlzdGainsLossesInvstAmt |
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,020,730 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,387,022 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,140,982 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,059,972 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,586,663 | CurrentTaxYearAmt |
| Total | $54,195,369 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,020,730 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,387,022 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,140,982 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,059,972 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,586,663 | CurrentTaxYearAmt |
| Total | $54,195,369 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $54,195,369 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $447,933 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $440,543 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $444,834 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $468,144 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $506,116 | CurrentTaxYearAmt |
| Total | $2,307,570 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $43,244 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $129,034 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $93,625 | CurrentTaxYearAmt |
| Total | $265,903 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,763,892 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,355,583 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,742,723 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,929,729 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,256,072 | CurrentTaxYearAmt |
| Total | $54,047,999 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $110,816,841 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $54,018,999 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.48910 | PublicSupportCY170Pct |
| Public Support PY170 | 0.95620 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt II Ln 10 | FormAndLineReferenceDesc |
| Explanation | Other Income Part II, Line 10 Description: REVENUES FROM PART VIII NOT INCLUDED IN OTHER LINES OF PART II 2013: 6763892. 2014: 8355583. 2015: 10742723. 2016: 12929729. 2017: 15227072. Description: GROSS INCOME FROM FUNDRAISING EVENTS 2017: 29000. | ExplanationTxt |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,015,718 | OtherCostOrOtherBasisAmt |
| Book Value | $1,015,718 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,779,370 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,512,122 | DepreciationAmt |
| Book Value | $8,267,248 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,075,809 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,748,986 | DepreciationAmt |
| Book Value | $1,326,823 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,609,789 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $27,571,329 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $7,566 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $240,959 | OtherRevenueAmt |
| Revenue Not Reported | $248,525 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,322,804 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $27,322,804 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $25,045,078 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $240,959 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $240,959 | ExpensesNotReportedAmt |
| Expenses Subtotal | $24,804,119 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $24,804,119 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt XI, Line 2d | FUNDRAISING EVENT EXPENSES OF $119,673 AND RENTAL EXPENSES OF $121,286. |
| Pt XII, Line 2d | FUNDRAISING EVENT EXPENSES OF $119,673 AND RENTAL EXPENSES OF $121,286. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | RED FEATHER GALA | Event1Nm |
| Gross Receipts Event1 | $165,399 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $136,399 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $29,000 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $4,012 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $69,000 | RentFacilityCostsEvent1Amt |
| Entertainment Event1 | $8,813 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $37,848 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $165,399 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $136,399 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $29,000 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $4,012 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $69,000 | RentFcltyCostsTotalEventsAmt |
| Entertainment Total Events | $8,813 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $37,848 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $119,673 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$90,673 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | MEDICAL SUPPLIES AND SERVICES | GrantTypeTxt |
| Recipient | 14332 | RecipientCnt |
| Non Cash Assistance | $4,747,033 | NonCashAssistanceAmt |
| Valuation Method Used | COST | ValuationMethodUsedDesc |
| Non Cash Assistance | MEDICAL SUPPLIES AND SERVICES | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt I Line 2 | FormAndLineReferenceDesc |
| Explanation | PATIENTS ARE PRE-QUALIFIED TO RECEIVE SERVICES AND ASSISTANCE BY THE ORGANIZATION. NO FURTHER MONITORING OF ASSISTANCE PROVIDED IS CONSIDERED NECESSARY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| ROBYN SUNDAY-ALLEN | |||||
| $222,639 | $12,549 | $614 | $11,790 | $19,607 | $267,199 |
| LYSA ROSS | |||||
| $159,715 | $1,083 | $299 | $8,055 | $19,607 | $188,759 |
| CHRIS VAN ESS | |||||
| $168,742 | $1,083 | $476 | $8,515 | $19,607 | $198,423 |
| DR DANIEL MOLINA | |||||
| $228,659 | $228,659 | ||||
| DR JANICE HIXSON | |||||
| $184,350 | $433 | $831 | $9,281 | $19,607 | $214,502 |
| DRJIN KONG | |||||
| $215,168 | $3,433 | $2,772 | $11,069 | $19,607 | $252,049 |
| DR KRISTEN JORDAN | |||||
| $177,482 | $433 | $276 | $8,910 | $19,607 | $206,708 |
| DR DEKODA BOST | |||||
| $172,507 | $433 | $269 | $8,660 | $19,607 | $201,476 |
| DR JENNIFER WILLIAMS | |||||
| $164,073 | $2,433 | $257 | $8,338 | $12,714 | $187,815 |
| DR NALINI KALYANAM | |||||
| $146,019 | $1,000 | $247 | $7,363 | $16,339 | $170,968 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt I Line 7 | A PORTION OF THE EXECUTIVE DIRECTOR'S BONUS IS AWARDED AT THE DISCRETION OF THE BOARD. |
| Other | DANIEL MOLINA SERVES AS THE CLINIC'S CHIEF MEDICAL OFFICER. DR. MOLINA IS CONTRACTED WITH THE CLINIC THROUGH THE INDIAN HEALTH SERVICE. DR. MOLINA'S EMPLOYER IS THE INDIAN HEALTH SERVICE. THE AMOUNT REPORTED ABOVE FOR DR. MOLINA IS THE AMOUNT PAID BY THE CLINIC TO THE INDIAN HEALTH SERVICE FOR DR. MOLINA'S ASSIGNMENT AT THE CLINIC. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 11b | EACH BOARD MEMBER IS GIVEN A DRAFT COPY OF THE 990 TO REVIEW. THE BOARD HAS AN OPPORTUNITY TO REVIEW THE FORM 990 AND SUGGEST ANY NEEDED CHANGES PRIOR TO ITS FILING. |
| Pt VI, Line 12c | ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS PROVIDES DOCUMENTATION IN REFERENCE TO ANY POTENTIAL CONFLICTS OF INTEREST. THE EXECUTIVE MANAGEMENT HAS MEETINGS WITH THE SUPERVISORS AND KEY EMPLOYEES TO DISCUSS AND ENSURE COMPLIANCE WITH THE CLINIC'S CONFLICT OF INTEREST POLICY. |
| Pt VI, Line 15a | COMPARABILITY DATA AND A SALARY SURVEY WAS UTILIZED IN DETERMINING THE COMPENSATION FOR THE KEY EMPLOYEES. |
| Pt VI, Line 15b | COMPARABILITY DATA AND A SALARY SURVEY WAS UTILIZED IN DETERMINING THE COMPENSATION FOR THE KEY EMPLOYEES. |
| Pt VI, Line 19 | GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND OTHER INFORMATION IS MADE AVAILABLE TO THE PUBLIC VIA A WRITTEN REQUEST TO THE CHIEF EXECUTIVE OFFICER OR BOARD CHAIR. |
| Other | DANIEL MOLINA SERVES AS THE CLINIC'S CHIEF MEDICAL OFFICER. DR. MOLINA IS CONTRACTED WITH THE CLINIC THROUGH THE INDIAN HEALTH SERVICE. DR. MOLINA'S EMPLOYER IS THE INDIAN HEALTH SERVICE. THE AMOUNT REPORTED ON PART VII IS THE AMOUNT PAID BY THE CLINIC TO THE INDIAN HEALTH SERVICE FOR DR. MOLINA'S ASSIGNMENT AT THE CLINIC. |
| Form 990, Part III, Line 4d | CONDUCTED HIV/AIDS SCREENING AND ENGAGEMENT CARE INITIATIVE. 74562. 0. 0. |