SHINGLETOWN MEDICAL CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SHINGLETOWN MEDICAL CENTER (EIN 68-0063054)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-03-14
- IRS object ID
- 201810739349301176
- Schema version
- 2016v3.0
- 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 | 2018-03-14T17:04:15-07:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRICE WATERMAN | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 125 E MILL ST | AddressLine1Txt |
| City | UKIAH | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 954824929 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680063054 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHINGLETOWN MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHIN | BusinessNameControlTxt |
| Phone | 5304743390 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 31292 ALPINE MEADOWS RD | AddressLine1Txt |
| City | SHINGLETOWN | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96088 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TAMI FRASER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2018-03-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Judith P Waterman | PreparerPersonNm |
| PTIN | P00231656 | PTIN |
| Phone | 7074631463 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TAMI FRASER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9453 MOUNTAIN MEADOW RD | AddressLine1Txt |
| City | SHINGLETOWN | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96088 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,822,569 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.shingletownmedcenter.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1985 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | SHINGLETOWN MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY PRIMARY AND PREVENTIVE CARE, BEHAVIORAL HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE RESIDENTS AND VISITORS OF THE GREATER SHINGLETOWN AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 30 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,276,023 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,370,663 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,429,535 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,429,108 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$3,205 | PYInvestmentIncomeAmt |
| CY Investment Income | $862 | CYInvestmentIncomeAmt |
| PY Other Revenue | $113,360 | PYOtherRevenueAmt |
| CY Other Revenue | $16,002 | CYOtherRevenueAmt |
| PY Total Revenue | $2,815,713 | PYTotalRevenueAmt |
| CY Total Revenue | $2,816,635 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,587,785 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,837,355 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $928,135 | PYOtherExpensesAmt |
| CY Other Expenses | $986,584 | CYOtherExpensesAmt |
| PY Total Expenses | $2,515,920 | PYTotalExpensesAmt |
| CY Total Expenses | $2,823,939 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $299,793 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$7,304 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,906,715 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,798,239 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $815,620 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $709,201 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,091,095 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,089,038 | NetAssetsOrFundBalancesEOYAmt |
| Mission | SHINGLETOWN MEDICAL CENTER IS COMMITTED TO PROVIDING QUALITY PRIMARY AND PREVENTIVE CARE, BEHAVIORAL HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE RESIDENTS AND VISITORS OF THE GREATER SHINGLETOWN AREA. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,584,626 | ExpenseAmt |
| Revenue | $1,273,256 | RevenueAmt |
| Desc | SHINGLETOWN MEDICAL CENTER PROVIDES QUALITY MEDICAL CARE SERVICES TO THE RURAL RESIDENTS OF APPROXIMATELY A 1,000 SQUARE MILE AREA. DURING THE CURRENT FISCAL YEAR ENDED JUNE 30, THE NUMBER OF PATIENT VISITS TO THE MEDICAL DEPARTMENT WAS 6,575. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $211,284 | ExpenseAmt |
| Revenue | $155,852 | RevenueAmt |
| Desc | SHINGLETOWN MEDICAL CENTER PROVIDES QUALITY BEHAVIORAL HEALTH CARE SERVICES TO THE RURAL RESIDENTS OF APPROXIMATELY A 1,000 SQUARE MILE AREA. DURING THE CURRENT FISCAL YEAR ENDED JUNE 30, THE NUMBER OF PATIENT VISITS TO THE BEHAVIORAL HEALTH DEPARTMENT WAS 1,186. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,795,910 | 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 | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| 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 |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 30 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | 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 | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| 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 |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| 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 | CA | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TAMI FRASER | PersonNm |
| Phone | 5304743390 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 31292 ALPINE MEADOWS RD | AddressLine1Txt |
| City | SHINGLETOWN | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 96088 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LORENE JEFFERSON | ||||||||
| Board Chair | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARY WILLIAMSON | ||||||||
| Vice Chair | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CYNTHIA WHITT | ||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| EDWARD GARCIA III | ||||||||
| Secretary | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEPHANIE PECK | ||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| PHILIP GRAHAM | ||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LARRY COWAN | ||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN SWANSON | ||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMI DIAB | ||||||||
| Treasurer | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NANETTE ZIMMERMAN | ||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ERIN FABBRI | ||||||||
| Director | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMI FRASER | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $99,081 | $0 | $6,825 | ||
| JUDITH P WATERMAN | ||||||||
| CONTRACTED CFO | 6.00 | 0.00 | Yes (X) | $42,752 | $0 | $0 | ||
| CANDY STOCKTON-JORETEG MD | ||||||||
| PHYSICIAN | 30.00 | 0.00 | $202,937 | $0 | $2,602 | Yes (X) | ||
| ALBERT G LUI | ||||||||
| PHYSICIAN | 36.00 | 0.00 | $99,285 | $0 | $5,550 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $444,055 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $14,977 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARTON ASSOCIATES | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 417844 | AddressLine1Txt |
| City | BOSTON | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 022417844 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | CONTRACTED PROVIDERS | ServicesDesc |
| Compensation | $145,049 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,213,442 | GovernmentGrantsAmt |
| All Other Contributions | $157,221 | AllOtherContributionsAmt |
| Total Contributions | $1,370,663 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Total Revenue Column | $1,429,108 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,429,108 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,429,108 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $862 | TotalRevenueColumnAmt |
| Exclusion | $862 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $21,936 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $5,934 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,002 | TotalRevenueColumnAmt |
| Exclusion | $16,002 | ExclusionAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,816,635 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,429,108 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $16,864 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,833 | TotalAmt |
| Management And General | $141,833 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,378,601 | TotalAmt |
| Program Services | $1,089,093 | ProgramServicesAmt |
| Management And General | $289,508 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,830 | TotalAmt |
| Program Services | $133,436 | ProgramServicesAmt |
| Management And General | $65,394 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,091 | TotalAmt |
| Program Services | $88,313 | ProgramServicesAmt |
| Management And General | $29,778 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133 | TotalAmt |
| Management And General | $133 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,828 | TotalAmt |
| Management And General | $101,828 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,751 | TotalAmt |
| Program Services | $221,657 | ProgramServicesAmt |
| Management And General | $49,094 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,512 | TotalAmt |
| Management And General | $8,512 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,105 | TotalAmt |
| Program Services | $2,135 | ProgramServicesAmt |
| Management And General | $14,970 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,788 | TotalAmt |
| Management And General | $105,788 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,267 | TotalAmt |
| Program Services | $58,312 | ProgramServicesAmt |
| Management And General | $17,955 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,645 | TotalAmt |
| Program Services | $22,406 | ProgramServicesAmt |
| Management And General | $28,239 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,672 | TotalAmt |
| Program Services | $5,301 | ProgramServicesAmt |
| Management And General | $9,371 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$2,082 | TotalAmt |
| Management And General | -$2,082 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,764 | TotalAmt |
| Program Services | $52,191 | ProgramServicesAmt |
| Management And General | $19,573 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,307 | TotalAmt |
| Program Services | $4,995 | ProgramServicesAmt |
| Management And General | $8,312 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| T-1 LINES | $62,998 | $62,998 | |
| SUPPLIES - MEDICAL | $58,256 | $58,256 | |
| DUES/MEMBERSHIPS/SUBSCRIPTIONS | $28,936 | $21,920 | $7,016 |
| RECRUITMENT | $20,550 | $12,750 | $7,800 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,154 | TotalAmt |
| Program Services | $44,999 | ProgramServicesAmt |
| Management And General | $42,155 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,823,939 | TotalAmt |
| Program Services | $1,795,910 | ProgramServicesAmt |
| Management And General | $1,028,029 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $723,719 | BOYAmt |
| EOY | $812,309 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $466,705 | BOYAmt |
| EOY | $403,870 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,130 | BOYAmt |
| EOY | $96,773 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $514,125 | BOYAmt |
| EOY | $368,126 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,442 | BOYAmt |
| EOY | $25,331 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,897,375 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $805,545 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,163,594 | BOYAmt |
| EOY | $1,091,830 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,906,715 | BOYAmt |
| EOY | $2,798,239 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $580,146 | BOYAmt |
| EOY | $498,736 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $8,007 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $230,474 | BOYAmt |
| EOY | $202,458 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $815,620 | BOYAmt |
| EOY | $709,201 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,083,046 | BOYAmt |
| EOY | $2,075,742 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,049 | BOYAmt |
| EOY | $13,296 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,091,095 | BOYAmt |
| EOY | $2,089,038 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,906,715 | BOYAmt |
| EOY | $2,798,239 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$7,304 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $5,247 | OtherChangesInNetAssetsAmt |
| 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 | false | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $159,657 | OtherCostOrOtherBasisAmt |
| Book Value | $159,657 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,268,119 | OtherCostOrOtherBasisAmt |
| Depreciation | $508,838 | DepreciationAmt |
| Book Value | $759,281 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $168,667 | OtherCostOrOtherBasisAmt |
| Depreciation | $55,794 | DepreciationAmt |
| Book Value | $112,873 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $300,932 | OtherCostOrOtherBasisAmt |
| Depreciation | $240,913 | DepreciationAmt |
| Book Value | $60,019 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,091,830 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $2,822,569 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $5,934 | OtherRevenueAmt |
| Revenue Not Reported | $5,934 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,816,635 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $2,816,635 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,829,873 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $5,934 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $5,934 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,823,939 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $2,823,939 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 2d: Other revenue amounts included in F/S but not included on form 990 | FUNDRAISING EXPENSES - PART VIII LINE 8B $5934 |
| Part XII, Line 2d: Other expenses and losses per audited F/S | FUNDRAISING EXPENSES - PART VIII LINE 8B $5934 |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agrmt Prof Fundraising Acty | false | AgrmtProfFundraisingActyInd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | FUNDRAISING | Event1Nm |
| Gross Receipts Event1 | $21,936 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $21,936 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $5,934 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $21,936 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $21,936 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $5,934 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $5,934 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $16,002 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CANDY STOCKTON-JORETEG MD | PersonNm |
| Title | PHYSICIAN | TitleTxt |
| Base Compensation Filing Org | $202,937 | BaseCompensationFilingOrgAmt |
| Nontaxable Benefits Filing Org | $2,602 | NontaxableBenefitsFilingOrgAmt |
| Total Compensation Filing Org | $205,539 | TotalCompensationFilingOrgAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | A COPY OF THE FORM 990 AND ALL RELATED SCHEDULES AND STATEMENTS WAS PROVIDED TO THE BOARD ONE WEEK BEFORE FILING IN ORDER TO ALLOW SUFFICIENT TIME FOR REVIEW AND COMMENT. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | CONFLICT OF INTEREST STATEMENTS ARE UPDATED AND REVIEWED ANNUALLY. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | COMPENSATION OF KEY EMPLOYEES IS REVIEWED BY THE FULL BOARD OF DIRECTORS. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | PROVIDED UPON REQUEST OR ON WWW.GUIDESTAR.ORG AND WWW.SHINGLETOWNMEDCENTER.ORG. |
| Other Changes In Net Assets Or Fund Balances - Other Increases | CHANGE IN TEMPORARILY RESTRICTED NET ASSETS = $5247 |