2018-11-12T13:04:42-06:00 2017-12-31 481032601 ALLEN GIBBS & HOULIK LC 301 N MAIN SUITE 1700 WICHITA KS 672024868 990 2017-01-01 481159633 GRACEMED HEALTH CLINIC INC GRAC 3168662000 1122 N TOPEKA WICHITA KS 67214 DAVID SANFORD CEO 3168662011 2018-11-09 1 JENNIFER A ALLEN P01338336 3162677231 70.167.48.183 2018-11-09 14:02:52 CS P 4918CE023130551FD7C0080C3613213674048EA3 966CC01752AD4FACEB31175D41CD75F114E623CF 2017 2019-02-21 02:37:17Z DAVID SANFORD 1122 N TOPEKA WICHITA KS 67214 24506630 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. 15 15 404 75 0 0 9487166 11113551 11067226 13213387 -4985 -17943 60133 52240 20609540 24361235 0 0 0 0 10843948 14564712 0 0 157780 5363760 5612176 16207708 20176888 4401832 4184347 21818945 24736698 4544457 3156161 17274488 21580537 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 16152603 13254092 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 16152603 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 0 0 0 0 0 0 0 0 0 1 36 0 1 404 1 0 0 0 0 0 0 0 0 X 15 15 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 1122 N TOPEKA WICHITA KS 67214 ROB DAKIN VICE - PRESIDENT 4.00 X X 0 0 0 MARLON KING TREASURER 4.00 X X 0 0 0 MARCIA NEWTON SECRETARY 4.00 X X 0 0 0 MARC MINNIS PRESIDENT 4.00 X X 0 0 0 FRED ERVIN BOARD MEMBER 4.00 X 0 0 0 GAROLD MINNS BOARD MEMBER 4.00 X 0 0 0 RON ENGELBRECHT BOARD MEMBER 4.00 X 0 0 0 LAURIE LABARCA BOARD MEMBER 4.00 X 0 0 0 MICHAEL GOOD BOARD MEMBER 4.00 X 0 0 0 SUSAN HOWEY BOARD MEMBER 4.00 X 0 0 0 GLORIA OSORIO BOARD MEMBER 4.00 X 0 0 0 LAZARO VASQUEZ BOARD MEMBER 4.00 X 0 0 0 JOE WHITAKER 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 JULIE A ELDER OFFICER 40.00 X 246132 0 15839 VENUS L LEE OFFICER 40.00 X 145068 0 4738 ROGER G NOLTE OFFICER 40.00 X 159737 0 4954 DAVID WUTHNOW OFFICER 40.00 X 110734 0 9839 DAVID SANFORD CHIEF EXECUTIVE OFFICER 40.00 X 173873 0 10789 VALERIYA V GREENWOOD HIGHLY COMPENSATED EMPLOYE 40.00 X 158423 0 7216 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYE 40.00 X 147701 0 7725 GIAO PHAM HIGHLY COMPENSATED EMPLOYE 40.00 X 171816 0 11561 JOSHUA TIBBE HIGHLY COMPENSATED EMPLOYE 40.00 X 157734 0 9686 AMANDA WILLIS HIGHLY COMPENSATED EMPLOYE 40.00 X 149811 0 9448 1621029 0 91795 20 0 1 0 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 600550241 MEDICAL/DENTAL EQUIPMENT AND SUPPLIES 796795 MCKESSON PO BOX 848442 DALLAS TX 752848442 340B PHARMACEUTICALS 350032 HUTTON CONSTRUCTION CORP 2229 S WEST STREET WICHITA KS 67213 CONSTRUCTION 263986 COX COMMUNICATIONS PO BOX 248871 OKLAHOMA CITY OK 731248871 PHONE & DATA COMMUNICATIONS 206279 ECLINICALWORKS LLC PO BOX 847950 BOSTON MA 022847950 PRACTICE MANAGEMENT SOFTWARE 205436 13 35685 6998717 4079149 11113551 MEDICAL & DENTAL SERVICES 621110 13047637 13047637 HIT CERT INCENTIVE 621110 165750 165750 13213387 46482 46482 49608 1750 61108 54675 -11500 -52925 -64425 -64425 41147 35685 29612 11535 11535 MISC REVENUE 900099 40705 40705 40705 24361235 13254092 0 -6408 835544 668437 167107 12652414 10014720 2504454 133240 135403 114757 20341 305 941351 764355 169556 7440 147479 147479 579344 562099 17245 95781 3467 91594 720 213900 127774 86081 45 593036 508788 84248 79319 16110 63209 5311 5311 745436 634103 111333 49341 1794 47547 MEDICAL SUPPLIES 1219084 1214550 4534 CONSULTING & COMPUTER E 678213 558327 119886 REPAIRS 471950 423591 48359 UTILITIES 429080 376738 52342 304902 162993 125879 16030 20176888 16152603 3866505 157780 114574 219378 8658298 5380087 950765 1088436 420339 571137 20534 24487 31528 34692 14596947 3302283 10859297 11294664 11836 2054806 750000 4067100 1774 1911 21818945 24736698 1306915 1272198 2487542 1883963 750000 0 4544457 3156161 X 16876343 20667105 398145 913432 17274488 21580537 21818945 24736698 X 4184347 121788 904502 -904588 X X 0 1 X 1 1 1 X 3211861 4095940 5019173 9487166 11113551 32927691 3211861 4095940 5019173 9487166 11113551 32927691 32927691 -58447 48409 36303 19328 49734 95327 33023018 52794563 0.99710 0.99650 X 408280 408280 5100739 198022 4902717 5263751 1179233 4084518 3543279 1925028 1618251 280898 280898 11294664 CERTIFICATES OF DEPOSIT 4067100 C 4067100 25417018 121788 904502 29612 1055902 24361116 119 119 24361235 21110969 904502 29612 934114 20176855 33 33 20176888 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 29,612. PART XI, LINE 4B - OTHER ADJUSTMENTS: K-1 INTEREST 3. K-1 DIVIDENDS 116. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 29,612. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE FROM K-1 33. 5K RACE 76832 35685 41147 975 14391 0 14246 76832 35685 41147 975 14391 14246 29612 11535 X X 0 0 0 0 0 0 0 0 0 JULIE A ELDER OFFICER 246132 0 0 0 0 0 7384 0 8455 0 261971 0 0 0 ROGER G NOLTE OFFICER 159737 0 0 0 0 0 0 0 4954 0 164691 0 0 0 DAVID SANFORD CHIEF EXECUTIVE OFFICER 173873 0 0 0 0 0 5200 0 5589 0 184662 0 0 0 VALERIYA V GREENWOOD HIGHLY COMPENSATED EMPLOYE 158423 0 0 0 0 0 2262 0 4954 0 165639 0 0 0 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYE 147701 0 0 0 0 0 3394 0 4331 0 155426 0 0 0 GIAO PHAM HIGHLY COMPENSATED EMPLOYE 171816 0 0 0 0 0 4295 0 7266 0 183377 0 0 0 JOSHUA TIBBE HIGHLY COMPENSATED EMPLOYE 157734 0 0 0 0 0 4732 0 4954 0 167420 0 0 0 AMANDA WILLIS HIGHLY COMPENSATED EMPLOYE 149811 0 0 0 0 0 4494 0 4954 0 159259 0 0 0 CHAD SANFORD SON OF CEO 53272 CHAD SANFORD IS THE SON OF DAVID SANFORD, CEO OF GRACEMED. CHAD IS AN EMPLOYEE OF GRACEMED. 0 SARA BAYLESS DAUGHTER OF OFFICER 41384 SARA BAYLESS IS THE DAUGHTER OF ROGER NOLTE, GRACEMED'S CHIEF DENTAL OFFICER. SARA BAYLESS IS AN EMPLOYEE OF GRACEMED. 0 KYLE BOWEN SON OF DIRECTOR OF MARKETING 30778 KYLE BOWEN IS THE SON OF LARRY BOWEN, GRACEMED'S DIRECTOR OF MARKETING. KYLE BOWEN IS THE OWNER OF TURTLE BOX DESIGN, LLC WHO DEVELOPED AND MAINTAINS GRACEMED'S WEBSITE. 0 JACQUELYN E SMITH DAUGHTER OF BOARD MEMBER 61072 JACQUELYN SMITH IS THE DAUGHTER OF RON ENGELBRECHT, A BOARD MEMBER OF GRACEMED. JACQUELYN SMITH IS AN EMPLOYEE OF GRACEMED. 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 XI, LINE 9: INVESTMENT INCOME - BROOKFIELD INFRASTRUCTURE PARTNERS, L.P. -86. DONATED SERVICES AND USE OF FACILITIES EXPENSES -904,502. 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.