BEAR LAKE COMMUNITY HEALTH CENTER INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- BEAR LAKE COMMUNITY HEALTH CENTER INC (EIN 81-0587644)
- Tax period
- 2016-05-01 to 2017-04-30
- Filed
- 2018-03-14
- IRS object ID
- 201820739349301307
- 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 | 2018-03-14T14:34:29-06:00 | ReturnTs |
| Tax Period End | 2017-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 870343246 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SQUIRE & COMPANY PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1329 SOUTH 800 EAST | AddressLine1Txt |
| City | OREM | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 840977737 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810587644 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BEAR LAKE COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BEAR | BusinessNameControlTxt |
| Phone | 4359463660 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 W LOGAN HIGHWAY | AddressLine1Txt |
| City | GARDEN CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84028 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAVAL JENSEN | PersonNm |
| Person Title | EXEC. DIRECTOR | PersonTitleTxt |
| Phone | 4359463660 | PhoneNum |
| Signature | 2017-03-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | M PAUL WINWARD CPA | PreparerPersonNm |
| PTIN | P00290039 | PTIN |
| Phone | 8012256900 | PhoneNum |
| Preparation | 2018-03-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | 84EF7F0412F8930BF78A9C5F1AF2848E1C3315C2 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 84EF7F0412F8930BF78A9C5F1AF2848E1C3315C2 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CACHE VALLEY COMMUNITY HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LAVAL JENSEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1047 SOUTH 100 WEST SUITE 270 | AddressLine1Txt |
| City | LOGAN | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84321 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,151,180 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BLCHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | UT | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE ACCESS TO QUALITY PRIMARY AND URGENT HEALTH CARE, REGARDLESS OF ABILITY TO PAY. THE CENTER TAKES A HOLISTIC APPROACH TO MAINTAINING A HEALTH COMMUNITY THROUGH EDUCATION, PREVENTION, AND A COMMUNITY NETWORKING SYSTEM. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 171 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,864,023 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,708,338 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,477,305 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,659,630 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$21,620 | PYInvestmentIncomeAmt |
| CY Investment Income | -$1,699 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,908,407 | PYOtherRevenueAmt |
| CY Other Revenue | $2,329,882 | CYOtherRevenueAmt |
| PY Total Revenue | $8,228,115 | PYTotalRevenueAmt |
| CY Total Revenue | $9,696,151 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,711,259 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,876,342 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,043,461 | PYOtherExpensesAmt |
| CY Other Expenses | $3,023,178 | CYOtherExpensesAmt |
| PY Total Expenses | $7,754,720 | PYTotalExpensesAmt |
| CY Total Expenses | $9,899,520 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $473,395 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$203,369 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,945,253 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,367,853 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,510,935 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,136,904 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,434,318 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,230,949 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE ACCESS TO QUALITY PRIMARY AND URGENT HEALTH CARE, REGARDLESS OF ABILITY TO PAY. THE CENTER TAKES A HOLISTIC APPROACH TO MAINTAINING A HEALTH COMMUNITY THROUGH EDUCATION, PREVENTION, AND A COMMUNITY NETWORKING SYSTEM. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $5,302,327 | ExpenseAmt |
| Revenue | $3,110,229 | RevenueAmt |
| Desc | PROVIDED MEDICAL SERVICES TO LOW-INCOME FAMILIES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $681,504 | ExpenseAmt |
| Revenue | $300,049 | RevenueAmt |
| Desc | PROVIDED DENTAL SERVICES TO LOW-INCOME FAMILIES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $499,470 | ExpenseAmt |
| Revenue | $244,486 | RevenueAmt |
| Desc | PROVIDED MENTAL HEALTH SERVICES TO LOW-INCOME FAMILIES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,438,142 | ExpenseAmt |
| Revenue | $4,866 | RevenueAmt |
| Desc | PROVIDED PHARMACY SERVICES & HEALTH AND WELLNESS SERVICES TO LOW-INCOME FAMILIES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,438,142 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $4,866 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $7,921,443 | 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 | Yes (true) | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 171 | 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 |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BECKY LOWE | PersonNm |
| Phone | 4359463660 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 W LOGAN HWY | AddressLine1Txt |
| City | GARDEN CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84028 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 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 |
|---|---|---|---|---|---|---|---|
| DAREN WALLENTINE | |||||||
| CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LARAINE SCHNETZER | |||||||
| VICE CHAIR | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAWN BRADY | |||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| TARA MCMULLIN | |||||||
| SECRETARY | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROY BUNDERSON | |||||||
| TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHNSON SMITH | |||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| TAMALYN CALDER | |||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| AMY KEARL | |||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| YENNY LOPEZ | |||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| LAVAL JENSEN | |||||||
| EXEC. DIRECT | 40.00 | Yes (X) | $237,715 | $0 | $29,568 | ||
| REX NIELSEN | |||||||
| PHYSICIAN | 40.00 | $261,986 | $0 | $13,555 | Yes (X) | ||
| CULLEN ARCHER | |||||||
| PHYSICIAN | 40.00 | $246,355 | $0 | $9,754 | Yes (X) | ||
| DAVID J BALLINGHAM | |||||||
| PHYSICIAN | 40.00 | $183,321 | $0 | $26,808 | Yes (X) | ||
| MICHAEL ADAMS | |||||||
| PHYSICIAN | 40.00 | $135,597 | $0 | $16,233 | Yes (X) | ||
| COLT DARLEY | |||||||
| PHARMACIST | 40.00 | $130,222 | $0 | $18,300 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,195,196 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $114,218 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $2,819,388 | GovernmentGrantsAmt |
| All Other Contributions | $888,950 | AllOtherContributionsAmt |
| Noncash Contributions | $875,293 | NoncashContributionsAmt |
| Total Contributions | $3,708,338 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FEES FOR SERVICES, NET | Desc |
| Total Revenue Column | $3,659,630 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,659,630 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,659,630 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $96 | TotalRevenueColumnAmt |
| Exclusion | $96 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,295 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$1,795 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,795 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$1,795 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $3,740,840 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,448,734 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,292,106 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,292,106 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Total Revenue Column | $37,776 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,776 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $37,776 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,696,151 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,987,717 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $96 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,715 | TotalAmt |
| Management And General | $237,715 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,679,129 | TotalAmt |
| Program Services | $4,502,861 | ProgramServicesAmt |
| Management And General | $1,176,268 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,601 | TotalAmt |
| Program Services | $68,384 | ProgramServicesAmt |
| Management And General | $11,217 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $443,197 | TotalAmt |
| Program Services | $336,830 | ProgramServicesAmt |
| Management And General | $106,367 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,700 | TotalAmt |
| Program Services | $331,892 | ProgramServicesAmt |
| Management And General | $104,808 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,236 | TotalAmt |
| Program Services | $2,236 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,925 | TotalAmt |
| Program Services | $14,020 | ProgramServicesAmt |
| Management And General | $6,905 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,276 | TotalAmt |
| Program Services | $44,908 | ProgramServicesAmt |
| Management And General | $19,368 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,235 | TotalAmt |
| Program Services | $177,995 | ProgramServicesAmt |
| Management And General | $110,240 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,897 | TotalAmt |
| Program Services | $172,018 | ProgramServicesAmt |
| Management And General | $10,879 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,687 | TotalAmt |
| Program Services | $367,662 | ProgramServicesAmt |
| Management And General | $48,025 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,105 | TotalAmt |
| Program Services | $29,382 | ProgramServicesAmt |
| Management And General | $101,723 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,055 | TotalAmt |
| Program Services | $145,336 | ProgramServicesAmt |
| Management And General | $16,719 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $230,769 | TotalAmt |
| Program Services | $208,570 | ProgramServicesAmt |
| Management And General | $22,199 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,697 | TotalAmt |
| Program Services | $49,053 | ProgramServicesAmt |
| Management And General | $5,644 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| SUPPLIES | $1,266,616 | $1,266,616 |
| RECRUITING | $68,248 | $68,248 |
| BANK FEES | $50,383 | $50,383 |
| OTHER | $44,635 | $44,635 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,414 | TotalAmt |
| Program Services | $40,414 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,899,520 | TotalAmt |
| Program Services | $7,921,443 | ProgramServicesAmt |
| Management And General | $1,978,077 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $311,317 | BOYAmt |
| EOY | $168,829 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,050 | BOYAmt |
| EOY | $63,358 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $867,061 | BOYAmt |
| EOY | $908,138 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $362,473 | BOYAmt |
| EOY | $323,279 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,500 | BOYAmt |
| EOY | $10,450 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,362,935 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,514,670 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,198,736 | BOYAmt |
| EOY | $4,848,265 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,116 | BOYAmt |
| EOY | $45,534 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,945,253 | BOYAmt |
| EOY | $6,367,853 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $636,254 | BOYAmt |
| EOY | $1,022,226 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,392 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,477,177 | BOYAmt |
| EOY | $3,623,785 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $387,112 | BOYAmt |
| EOY | $490,893 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,510,935 | BOYAmt |
| EOY | $5,136,904 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,434,318 | BOYAmt |
| EOY | $1,230,949 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,434,318 | BOYAmt |
| EOY | $1,230,949 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,945,253 | BOYAmt |
| EOY | $6,367,853 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$203,369 | 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,265,697 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,387,917 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,880,541 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,864,023 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,708,338 | CurrentTaxYearAmt |
| Total | $11,106,516 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,265,697 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,387,917 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,880,541 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,864,023 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,708,338 | CurrentTaxYearAmt |
| Total | $11,106,516 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $11,106,516 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $56 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $18 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $19 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $196 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $96 | CurrentTaxYearAmt |
| Total | $385 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $11,106,901 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $7,438,246 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 | $103,000 | OtherCostOrOtherBasisAmt |
| Book Value | $103,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,619,146 | OtherCostOrOtherBasisAmt |
| Depreciation | $556,240 | DepreciationAmt |
| Book Value | $4,062,906 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $375,330 | OtherCostOrOtherBasisAmt |
| Depreciation | $260,790 | DepreciationAmt |
| Book Value | $114,540 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,265,459 | OtherCostOrOtherBasisAmt |
| Depreciation | $697,640 | DepreciationAmt |
| Book Value | $567,819 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,848,265 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $11,146,680 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,450,529 | OtherRevenueAmt |
| Revenue Not Reported | $1,450,529 | RevenueNotReportedAmt |
| Revenue Subtotal | $9,696,151 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $9,696,151 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,350,049 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1,450,529 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,450,529 | ExpensesNotReportedAmt |
| Expenses Subtotal | $9,899,520 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $9,899,520 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | PHARMACY COST OF GOODS SOLD 1,448,734 LOSS ON DISPOSAL OF EQUIPMENT 1,795 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | PHARMACY COST OF GOODS SOLD 1,448,734 LOSS ON DISPOSAL OF EQUIPMENT 1,795 |
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 | Yes (true) | 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 (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| LAVAL JENSEN | |||||
| EXEC. DIRECTOR | $201,151 | $36,564 | $9,613 | $19,955 | $267,283 |
| REX NIELSEN | |||||
| PHYSICIAN | $261,986 | $13,555 | $275,541 | ||
| CULLEN ARCHER | |||||
| PHYSICIAN | $246,355 | $9,754 | $256,109 | ||
| DAVID J BALLINGHAM | |||||
| PHYSICIAN | $183,321 | $8,182 | $18,626 | $210,129 | |
| MICHAEL ADAMS | |||||
| PHYSICIAN | $135,597 | $6,032 | $10,201 | $151,830 | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 6A | FormAndLineReferenceDesc |
| Explanation | THE EXECUTIVE DIRECTOR'S COMPENSATION INCLUDES A BONUS COMPONENT CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION, CONTRACTUALLY BOUND BY COMPENSATION LIMITATION AND SALARY CAPS. | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 3 | ContributionCnt |
| Noncash Contributions Rpt F990 | $875,293 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | ESTIMATED MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, ITEM C | CENTER, EVANSTON COMMUNITY HEALTH CENTER, AND BOX ELDER COMMUNITY HEALTH CENTER |
| FORM 990 - ORGANIZATION'S MISSION | TO PROVIDE ACCESS TO QUALITY PRIMARY AND URGENT HEALTH CARE, REGARDLESS OF ABILITY TO PAY. THE CENTER TAKES A HOLISTIC APPROACH TO MAINTAINING A HEALTH COMMUNITY THROUGH EDUCATION, PREVENTION, AND A COMMUNITY NETWORKING SYSTEM. |
| FORM 990, PAGE 2, PART III, LINE 4D | PROVIDED PHARMACY SERVICES & HEALTH AND WELLNESS SERVICES TO LOW-INCOME FAMILIES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS PREPARED BY OUTSIDE ACCOUNTANT AND PROVIDED TO EXECUTIVE DIRECTOR FOR APPROVAL PRIOR TO SUBMISSION. FORM 990 IS THEN PROVIDED TO BOARD FOR REVIEW AND APPROVAL PRIOR TO SUBMISSION. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE CONFLICTS OF INTEREST POLICY IS REVIEWED AND DISCUSSED ANNUALLY AT THE BOARD RETREAT. |
| FORM 990, PAGE 6, PART VI, LINE 15A | NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) SALARY SURVEY INFORMATION IS USED TO IDENTIFY WAGE RANGES FOR SIMILAR POSITIONS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) SALARY SURVEY INFORMATION IS USED TO IDENTIFY WAGE RANGES FOR SIMILAR POSITIONS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST JUST AS FORMS 990. |
| FORM 990, PART XI, LINE 9 | PHARMACY COST OF GOODS SOLD 1,448,734 LOSS ON DISPOSAL OF EQUIPMENT 1,795 PHARMACY COST OF GOODS SOLD -1,448,734 LOSS ON DISPOSAL OF EQUIPMENT -1,795 |