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MT ENTERPRISE COMMUNITY HEALTH CLINIC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
MT ENTERPRISE COMMUNITY HEALTH CLINIC (EIN 43-2016287)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-13
IRS object ID
201733179349308218
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

FieldValueIRS element (for citing)
Return2017-11-13T17:17:05-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110700 NORTHUP WAY SUITE 200AddressLine1Txt
CityBELLEVUECityNm
State AbbreviationWAStateAbbreviationCd
ZIP98004ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN432016287EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MT ENTERPRISE COMMUNITY HEALTH CLINICBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMTENBusinessNameControlTxt
Phone9033928203PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 489AddressLine1Txt
CityMT ENTERPRISECityNm
State AbbreviationTXStateAbbreviationCd
ZIP75681ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKENNETH WHITEPersonNm
Person TitleCEOPersonTitleTxt
Phone9033928203PhoneNum
Signature2017-11-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKURT BENNIONPreparerPersonNm
PTINP01469618PTIN
Phone4252506100PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.137.57.251IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-13IPDt
IP Tm13:10:42IPTm
IP TimezonePSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdB6B6F2B8D30A14866FB848EA848D3547AA51FF29AtSubmissionCreationDeviceId
At Submission Filing Device IdA0046212CE9672327E854F40E28815F016E88894AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1CROSSROADS FAMILY CAREBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerKENNETH WHITEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 489AddressLine1Txt
CityMT ENTERPRISECityNm
State AbbreviationTXStateAbbreviationCd
ZIP75681ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$3,220,356GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2003FormationYr
Legal Domicile StateTXLegalDomicileStateCd
Activity Or MissionTO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee46TotalEmployeeCnt
Total Volunteers13TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,828,832PYContributionsGrantsAmt
CY Contributions Grants$1,644,094CYContributionsGrantsAmt
PY Program Service Revenue$976,073PYProgramServiceRevenueAmt
CY Program Service Revenue$1,570,823CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$50CYInvestmentIncomeAmt
PY Other Revenue$115,306PYOtherRevenueAmt
CY Other Revenue$5,389CYOtherRevenueAmt
PY Total Revenue$2,920,211PYTotalRevenueAmt
CY Total Revenue$3,220,356CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,980,011PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,221,336CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$990,960PYOtherExpensesAmt
CY Other Expenses$938,445CYOtherExpensesAmt
PY Total Expenses$2,970,971PYTotalExpensesAmt
CY Total Expenses$3,159,781CYTotalExpensesAmt
PY Revenues Less Expenses-$50,760PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$60,575CYRevenuesLessExpensesAmt
Total Assets BOY$841,436TotalAssetsBOYAmt
Total Assets EOY$785,079TotalAssetsEOYAmt
Total Liabilities BOY$512,423TotalLiabilitiesBOYAmt
Total Liabilities EOY$395,491TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$329,013NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$389,588NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE PREVENTICE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,548,324ExpenseAmt
Grant$0GrantAmt
Revenue$1,570,823RevenueAmt
DescMT. ENTERPRISE COMMUNITY HEALTH CLINIC (DBA: CROSSROADS FAMILY CARE) PROVIDES PRIMARY CARE, DENTAL, AND BEHAVIORAL HEALTH SERVICES TO ALL MEMBERS OF THE COMMUNITY, WITH AN EMPHASIS ON ENSURING MEDICAL CARE FOR THE LOW-INCOME AND UNINSURED POPULATION. IN 2016, THE HEALTH CENTER PROVIDED OVER 17,000 VISITS TO THE 6,500 PATIENTS SERVED. OF THESE PATIENTS 43% DID NOT HAVE INSURANCE AT THE TIME OF THEIR VISIT, AND NEARLY 35% WERE BELOW 100% OF THE FEDERAL POVERTY LEVEL.Desc
Total Program Service Expenses$2,548,324TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document14IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee46EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KENNETH WHITEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9033928203PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 489AddressLine1Txt
CityMT ENTERPRISECityNm
State AbbreviationTXStateAbbreviationCd
ZIP75681ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
BECKY ELDRIDGE
PRESIDENT2.00Yes (X)Yes (X)$0$0$0
LEO GONZALEZ
VICE PRESIDENT2.00Yes (X)Yes (X)$0$0$0
JOHN GRUBBS
SECRETARY2.00Yes (X)Yes (X)$0$0$0
TOM VAUGHT
TREASURER5.00Yes (X)Yes (X)$0$0$0
PATSY FOGLEMAN
BOARD MEMBER2.00Yes (X)$0$0$0
MATT GHOLSON
BOARD MEMBER2.00Yes (X)$0$0$0
HARVEY GRAVES
BOARD MEMBER2.00Yes (X)$0$0$0
MAMIE HODGE
BOARD MEMBER2.00Yes (X)$0$0$0
MICHELLE SIMMONS
BOARD MEMBER2.00Yes (X)$0$0$0
POLLY VARDEMAN
BOARD MEMBER2.00Yes (X)$0$0$0
JEAN WILLIAMS
BOARD MEMBER2.00Yes (X)$0$0$0
RD WHITTNER
BOARD MEMBER2.00Yes (X)$0$0$0
JOYCE YBARRA
BOARD MEMBER2.00Yes (X)$0$0$0
KENNETH WHITE
CEO40.00Yes (X)$88,292$0$7,458
MICHELLE KELLEY
CFO7.00Yes (X)$0$0$0
SHARAVANA GAJAPATHI
DENTIST40.00$175,990$0$5,464Yes (X)
KIMBERLY PAGE
CMO40.00$195,678$0$10,980Yes (X)
BROOKE MARTIN
PROVIDER40.00$111,690$0$4,654Yes (X)
AMBERLY HOPSON
PROVIDER40.00$128,153$0$0Yes (X)
LACEE PIERCE
PROVIDER40.00$117,446$0$2,434Yes (X)
SUSAN THIVIERGE
PROVIDER40.00$110,036$0$3,520Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$927,285TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$34,510TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$17,500FederatedCampaignsAmt
Government Grants$1,560,163GovernmentGrantsAmt
All Other Contributions$66,431AllOtherContributionsAmt
Noncash Contributions$46,431NoncashContributionsAmt
Total Contributions$1,644,094TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescMEDICAL SERVICE INCOMEDesc
Business624100BusinessCd
Total Revenue Column$1,570,823TotalRevenueColumnAmt
Related Or Exempt Func Income$1,570,823RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$1,570,823TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$50TotalRevenueColumnAmt
Exclusion$50ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business624110BusinessCd
Total Revenue Column$5,389TotalRevenueColumnAmt
Exclusion$5,389ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$5,389OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,220,356TotalRevenueColumnAmt
Related Or Exempt Func Income$1,570,823RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$5,439ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$483,862TotalAmt
Program Services$432,682ProgramServicesAmt
Management And General$51,180ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,457,864TotalAmt
Program Services$1,303,661ProgramServicesAmt
Management And General$154,203ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$18,839TotalAmt
Program Services$16,846ProgramServicesAmt
Management And General$1,993ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$126,082TotalAmt
Program Services$112,746ProgramServicesAmt
Management And General$13,336ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$134,689TotalAmt
Program Services$120,442ProgramServicesAmt
Management And General$14,247ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$3,990TotalAmt
Management And General$3,990ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$19,826TotalAmt
Management And General$19,826ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$443,221TotalAmt
Program Services$331,095ProgramServicesAmt
Management And General$112,126ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$127,869TotalAmt
Program Services$42,075ProgramServicesAmt
Management And General$85,794ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$59,352TotalAmt
Program Services$10,900ProgramServicesAmt
Management And General$48,452ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$63,126TotalAmt
Program Services$49,022ProgramServicesAmt
Management And General$14,104ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$9,615TotalAmt
Program Services$37ProgramServicesAmt
Management And General$9,578ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$29,070TotalAmt
Program Services$12,270ProgramServicesAmt
Management And General$16,800ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$12,757TotalAmt
Management And General$12,757ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$41,413TotalAmt
Program Services$33,399ProgramServicesAmt
Management And General$8,014ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$16,339TotalAmt
Management And General$16,339ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$46,431$46,431
BAD DEBTS$27,810$27,810
OTHER EXPENSES$20,300$3,460$16,840
DUES & SEMINARS$12,471$5,336$7,135

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$4,855TotalAmt
Program Services$112ProgramServicesAmt
Management And General$4,743ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,159,781TotalAmt
Program Services$2,548,324ProgramServicesAmt
Management And General$611,457ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$118,082BOYAmt
EOY$80,147EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$29,521BOYAmt
EOY$30,281EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$82,871BOYAmt
EOY$72,576EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$15,636BOYAmt
EOY$20,729EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,523,439LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$942,093LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$595,326BOYAmt
EOY$581,346EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$841,436BOYAmt
EOY$785,079EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$176,071BOYAmt
EOY$100,283EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$98,756BOYAmt
EOY$95,196EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$237,596BOYAmt
EOY$200,012EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$512,423BOYAmt
EOY$395,491EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$329,013BOYAmt
EOY$389,588EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$329,013BOYAmt
EOY$389,588EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$841,436BOYAmt
EOY$785,079EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$60,575ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,973,024CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,630,025CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,779,136CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,937,836CurrentTaxYearMinus1YearAmt
Current Tax Year$1,644,094CurrentTaxYearAmt
Total$8,964,115TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,973,024CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,630,025CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,779,136CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,937,836CurrentTaxYearMinus1YearAmt
Current Tax Year$1,644,094CurrentTaxYearAmt
Total$8,964,115TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$8,964,115PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$114CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$124CurrentTaxYearMinus2YearsAmt
Current Tax Year$50CurrentTaxYearAmt
Total$288TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,887CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,122CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,937CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$6,302CurrentTaxYearMinus1YearAmt
Current Tax Year$5,389CurrentTaxYearAmt
Total$22,637TotalAmt
FieldValueIRS element (for citing)
Total Support$8,987,040TotalSupportAmt
Gross Receipts Rltd Activities$5,895,853GrossReceiptsRltdActivitiesAmt
Public Support CY1700.99740PublicSupportCY170Pct
Public Support PY1700.78800PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationOTHER INCOMEExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,320OtherCostOrOtherBasisAmt
Book Value$11,320BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$561,109OtherCostOrOtherBasisAmt
Depreciation$302,701DepreciationAmt
Book Value$258,408BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$555,012OtherCostOrOtherBasisAmt
Depreciation$299,412DepreciationAmt
Book Value$255,600BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$395,998OtherCostOrOtherBasisAmt
Depreciation$339,980DepreciationAmt
Book Value$56,018BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$581,346TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$3,220,356TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$3,220,356RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$3,220,356TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$3,159,781TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$3,159,781ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$3,159,781TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE ORGANIZATION EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2016 AND 2015, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. ALL TAX EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE, AND OTHER APPLICABLE STATE STATUTES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
SHARAVANA GAJAPATHI
DENTIST$175,990$0$0$0$0$0$5,464$0$0$0$181,454$0$0$0
KIMBERLY PAGE
CMO$195,678$0$0$0$0$0$6,286$0$4,694$0$206,658$0$0$0

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonRUSSELL HALLPersonNm
Relationship With OrgFORMER BOARD MEMBERRelationshipWithOrgTxt
Loan PurposeEMERGENCY FINANCING TO KEEP ENTITY OPERATINGLoanPurposeTxt
Loan To OrganizationYes (X)LoanToOrganizationInd
Original Principal$114,500OriginalPrincipalAmt
Balance Due$95,196BalanceDueAmt
Default0DefaultInd
Board Or Committee ApprovalYes (1)BoardOrCommitteeApprovalInd
Written AgreementYes (1)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$95,196TotalBalanceDueAmt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution1ContributionCnt
Noncash Contributions Rpt F990$46,431NoncashContributionsRptF990Amt
Method Of Determining RevenuesRETAIL VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD AND THE CEO. THE EXECUTIVE COMMITTEE SERVES IN PLACE OF THE FULL BOARD IN EMERGENCY SITUATIONS WHEN A FULL BOARD QUORUM AT AN EMERGENCY MEETING CANNOT BE PRESENT. THE EXECUTIVE COMMITTEE ALSO REVIEWS CERTAIN PROSPECTIVE BUSINESS TRANSACTIONS AND MAKES RECOMMENDATIONS ON SUCH MATTERS TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 3DURING 2016, FINANCIAL MANAGEMENT SERVICES WERE PROVIDED BY COMMUNITY LINK CONSULTING.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 WAS REVIEWED BY THE CFO AND THE FINANCE COMMITTEE BEFORE BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST FORMS ARE COMPLETED EVERY YEAR BY BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES. FORMS RECEIVED ARE REVIEWED BY THE CFO AND FINANCE COMMITTEE AND MONITORED AS NECESSARY. NO BOARD MEMBER MAY VOTE ON ANY MATTER IN WHICH THEY HAVE A CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15ATHE COMPENSATION OF THE CEO IS DISCUSSED AT LENGTH BY THE BOARD OF DIRECTORS YEARLY. AS PART OF THEIR ANNUAL EVALUATION/REVIEW OF THE CEO, THEY REVIEW WHETHER ESTABLISHED GOALS WERE MET AND REVIEW COMPENSATION IN COMPARISON WITH OTHER COMMUNITY HEALTH ORGANIZATION CEO'S WITH THE HELP OF AN ANNUAL SALARY COMPARISON REPORT ISSUED BY THE NATIONAL ORGANIZATION OF COMMUNITY HEALTH ORGANIZATIONS. ALL OF THESE DISCUSSIONS ARE DOCUMENTED IN THE ORGANIZATION'S BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GMEDICAL SERVICES: PROGRAM SERVICE EXPENSES 325,057. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 325,057. OTHER SERVICES: PROGRAM SERVICE EXPENSES 6,038. MANAGEMENT AND GENERAL EXPENSES 112,126. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 118,164.