LA PINE COMMUNITY HEALTH CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- LA PINE COMMUNITY HEALTH CENTER (EIN 26-3084386)
- Tax period
- 2016-11-01 to 2017-10-31
- Filed
- 2018-09-11
- IRS object ID
- 201802549349301350
- Schema version
- 2016v3.1
- 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 | 2018-09-11T14:08:51-07:00 | ReturnTs |
| Tax Period End | 2017-10-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 930819646 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JONES & ROTH PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 SW COLUMBIA SUITE 201 | AddressLine1Txt |
| City | BEND | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97702 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263084386 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LA PINE COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAPI | BusinessNameControlTxt |
| Phone | 5415363435 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3300 | AddressLine1Txt |
| City | LA PINE | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97739 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHARLA DEHATE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5415363435 | PhoneNum |
| Signature | 2018-09-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRIAN G NEWTON | PreparerPersonNm |
| PTIN | P01330154 | PTIN |
| Phone | 5413823590 | PhoneNum |
| Preparation | 2018-09-10 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | C9E21E635FBF3B49EFFC6769C6377F6DC1330F24 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | C9E21E635FBF3B49EFFC6769C6377F6DC1330F24 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHARLA DEHATE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3300 | AddressLine1Txt |
| City | LA PINE | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97739 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $7,626,222 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LAPINECC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2008 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE PRIMARY CARE, MENTAL HEALTH AND DENTAL SERVICES REGARDLESS OF THE ABILITY TO PAY TO INDIVIDUALS AND FAMILIES IN CENTRAL OREGON. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 68 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,597,891 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,648,357 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,661,256 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,851,877 | CYProgramServiceRevenueAmt |
| CY Investment Income | $688 | CYInvestmentIncomeAmt |
| PY Other Revenue | $478,657 | PYOtherRevenueAmt |
| CY Other Revenue | $529,877 | CYOtherRevenueAmt |
| PY Total Revenue | $6,737,804 | PYTotalRevenueAmt |
| CY Total Revenue | $7,030,799 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,088,332 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,482,505 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,836,501 | PYOtherExpensesAmt |
| CY Other Expenses | $1,999,634 | CYOtherExpensesAmt |
| PY Total Expenses | $5,924,833 | PYTotalExpensesAmt |
| CY Total Expenses | $6,482,139 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $812,971 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $548,660 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,172,527 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,724,070 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $433,021 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $435,904 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,739,506 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,288,166 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE PRIMARY CARE, MENTAL HEALTH AND DENTAL SERVICES REGARDLESS OF THE ABILITY TO PAY TO INDIVIDUALS AND FAMILIES IN CENTRAL OREGON. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $5,354,205 | ExpenseAmt |
| Revenue | $4,851,877 | RevenueAmt |
| Desc | PROVIDING HEALTHCARE TO THE UNDERSERVED POPULATION (I.E. UNINSURED, UNDERINSURED, MEDICAID AND MEDICARE). | Desc |
| Total Program Service Expenses | $5,354,205 | 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 | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | 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 |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 20 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 68 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | OR | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHARLA DEHATE | PersonNm |
| Phone | 5415363435 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3300 | AddressLine1Txt |
| City | LA PINE | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97739 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| VICTOR RUSSELL | |||||||
| EX-CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARILYN WAGGONER | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LINDA VASSALLI | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVE SCHNEIDER | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVID GOSSER | |||||||
| CHAIR ELECT | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOAN WALTER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL KING | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMMY LESUEUR | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARIAN MENGEL | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHELLEY MIESEN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LYMAN FLENNER III | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LAURA PENNAVARIA | |||||||
| EX-MEDICAL D | 40.00 | Yes (X) | $241,293 | $0 | $7,395 | ||
| MICHAEL ALLEN | |||||||
| MEDICAL DIRE | 40.00 | Yes (X) | $185,649 | $0 | $6,526 | ||
| CHARLA DEHATE | |||||||
| CEO | 40.00 | Yes (X) | $132,276 | $0 | $6,912 | ||
| SCOTT BLACK | |||||||
| MD | 40.00 | $202,061 | $0 | $6,526 | Yes (X) | ||
| JENNIFER CURTIS | |||||||
| EX-FNP | 40.00 | $111,865 | $0 | $7,395 | Yes (X) | ||
| KRISTINA TIMMONS | |||||||
| FNP | 40.00 | $103,936 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $977,080 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $34,754 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WESTON TECHNOLOGIES | |||||
| 19795 VILLAGE OFFICE CT | BEND | OR | 97702 | IT | $275,549 |
| SUN INVESTORS BUILDING LEASE | |||||
| 3749 NORWICH AVENUE | EUGENE | OR | 97408 | LEASING | $245,764 |
| OCHIN | |||||
| 1881 SW NATIO PARKWAY | PORLTAND | OR | 97201 | CONSULTING | $155,457 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,570,983 | GovernmentGrantsAmt |
| All Other Contributions | $77,374 | AllOtherContributionsAmt |
| Total Contributions | $1,648,357 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT SERVICE REVENUES | $4,172,624 | $4,172,624 |
| PAYOR INCENTIVE REVENUES | $645,253 | $645,253 |
| MEANINGFUL USE INCENTIVE REV. | $34,000 | $34,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,851,877 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $688 | TotalRevenueColumnAmt |
| Exclusion | $688 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $23,547 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $23,547 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,547 | TotalRevenueColumnAmt |
| Exclusion | $23,547 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $1,084,121 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $595,423 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $488,698 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $488,698 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Total Revenue Column | $17,632 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,632 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $17,632 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,030,799 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,358,207 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $24,235 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $549,324 | TotalAmt |
| Program Services | $333,488 | ProgramServicesAmt |
| Management And General | $215,836 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,262,254 | TotalAmt |
| Program Services | $2,932,541 | ProgramServicesAmt |
| Management And General | $329,713 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $320,484 | TotalAmt |
| Program Services | $281,916 | ProgramServicesAmt |
| Management And General | $38,568 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $350,443 | TotalAmt |
| Program Services | $300,904 | ProgramServicesAmt |
| Management And General | $49,539 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,279 | TotalAmt |
| Program Services | $4,070 | ProgramServicesAmt |
| Management And General | $2,209 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,636 | TotalAmt |
| Program Services | $15,968 | ProgramServicesAmt |
| Management And General | $8,668 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $508,851 | TotalAmt |
| Program Services | $351,264 | ProgramServicesAmt |
| Management And General | $157,587 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,050 | TotalAmt |
| Program Services | $38,921 | ProgramServicesAmt |
| Management And General | $9,129 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,263 | TotalAmt |
| Program Services | $109,074 | ProgramServicesAmt |
| Management And General | $32,189 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $507,568 | TotalAmt |
| Program Services | $375,107 | ProgramServicesAmt |
| Management And General | $132,461 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,309 | TotalAmt |
| Management And General | $2,309 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,609 | TotalAmt |
| Program Services | $62,158 | ProgramServicesAmt |
| Management And General | $62,451 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,199 | TotalAmt |
| Program Services | $971 | ProgramServicesAmt |
| Management And General | $228 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,904 | TotalAmt |
| Program Services | $122,232 | ProgramServicesAmt |
| Management And General | $28,672 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,286 | TotalAmt |
| Program Services | $24,015 | ProgramServicesAmt |
| Management And General | $5,271 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $243,229 | $243,229 | |
| RECRUITMENT | $131,738 | $101,139 | $30,599 |
| TAXES AND LICENSES | $45,699 | $45,603 | $96 |
| DUES AND SUBSCRIPTIONS | $30,362 | $11,605 | $18,757 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,652 | TotalAmt |
| Management And General | $3,652 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,482,139 | TotalAmt |
| Program Services | $5,354,205 | ProgramServicesAmt |
| Management And General | $1,127,934 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,241,667 | BOYAmt |
| EOY | $1,161,137 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,297,405 | BOYAmt |
| EOY | $1,948,039 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,039,642 | BOYAmt |
| EOY | $842,128 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,831 | BOYAmt |
| EOY | $7,725 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,576 | BOYAmt |
| EOY | $86,407 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,623,691 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $970,645 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $480,553 | BOYAmt |
| EOY | $653,046 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,853 | BOYAmt |
| EOY | $25,588 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,172,527 | BOYAmt |
| EOY | $4,724,070 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $247,455 | BOYAmt |
| EOY | $276,416 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,107 | BOYAmt |
| EOY | $129,873 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,459 | BOYAmt |
| EOY | $29,615 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $433,021 | BOYAmt |
| EOY | $435,904 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,683,485 | BOYAmt |
| EOY | $4,288,166 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,021 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,739,506 | BOYAmt |
| EOY | $4,288,166 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,172,527 | BOYAmt |
| EOY | $4,724,070 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $548,660 | ReconcilationRevenueExpnssAmt |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $769,117 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $911,923 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,269,117 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,597,891 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,648,357 | CurrentTaxYearAmt |
| Total | $6,196,405 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $769,117 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $911,923 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,269,117 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,597,891 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,648,357 | CurrentTaxYearAmt |
| Total | $6,196,405 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $6,196,405 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $180 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,314 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,551 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,498 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $24,235 | CurrentTaxYearAmt |
| Total | $101,778 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $6,298,183 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $22,813,876 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.98380 | PublicSupportCY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $769,117 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $911,923 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,269,117 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,597,891 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,648,357 | CurrentTaxYearAmt |
| Total | $6,196,405 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,588,451 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,610,140 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,941,797 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,719,858 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,953,630 | CurrentTaxYearAmt |
| Total | $22,813,876 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,357,568 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,522,063 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,210,914 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,317,749 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,601,987 | CurrentTaxYearAmt |
| Total | $29,010,281 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $29,010,281 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $180 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,314 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,551 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,498 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $24,235 | CurrentTaxYearAmt |
| Total | $101,778 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $180 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,314 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,551 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,498 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $24,235 | CurrentTaxYearAmt |
| Total | $101,778 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,357,748 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,547,377 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,238,465 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,342,247 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,626,222 | CurrentTaxYearAmt |
| Total | $29,112,059 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99650 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99690 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $407,061 | OtherCostOrOtherBasisAmt |
| Depreciation | $60,872 | DepreciationAmt |
| Book Value | $346,189 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,184,916 | OtherCostOrOtherBasisAmt |
| Depreciation | $898,145 | DepreciationAmt |
| Book Value | $286,771 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,714 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,628 | DepreciationAmt |
| Book Value | $20,086 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $653,046 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $7,059,829 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $29,030 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $29,030 | RevenueNotReportedAmt |
| Revenue Subtotal | $7,030,799 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $7,030,799 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $6,511,169 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $29,030 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $29,030 | ExpensesNotReportedAmt |
| Expenses Subtotal | $6,482,139 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $6,482,139 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|
| LAURA PENNAVARIA | |||
| EX-MEDICAL DIRECTOR | $241,293 | $7,395 | $248,688 |
| MICHAEL ALLEN | |||
| MEDICAL DIRECTOR | $185,649 | $6,526 | $192,175 |
| SCOTT BLACK | |||
| MD | $202,061 | $6,526 | $208,587 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | SERVES ON THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE BOARD RECEIVES IT ELECTRONICALLY PRIOR TO THE BOARD MEETING FOR THEM TO REVIEW. ANY QUESTIONS ARE ANSWERED AT THE BOARD MEETING AND IF NECESSARY THE APPROPRIATE CHANGES ARE MADE. THE BOARD VOTES ON THE APPROVAL OF THE FROM 990 AT THE MEETING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE POLICY IS REVIEWED ANNUALLY WITH THE BOARD MEMBERS, DIRECTORS, MANAGERS AND KEY EMPLOYEES. THE DISCLOSURE STATEMENT AND CONFLICT OF INTEREST ARE SIGNED BY EACH PERSON. |
| FORM 990, PAGE 6, PART VI, LINE 15A | INFORMATION FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS IS ASSESSED AND THE SALARIES ARE BASED ON SURVEYS OF COMMUNITY HEALTH CENTERS IN REGION. |
| FORM 990, PAGE 6, PART VI, LINE 15B | INFORMATION FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS IS ASSESSED AND THE SALARIES ARE BASED ON SURVEYS OF COMMUNITY HEALTH CENTERS IN REGION. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS ARE AVALIABLE UPON REQUEST. |