2017-11-13T17:17:05-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2016-01-01 432016287 MT ENTERPRISE COMMUNITY HEALTH CLINIC MTEN 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 KENNETH WHITE CEO 9033928203 2017-11-13 1 KURT BENNION P01469618 4252506100 67.137.57.251 2017-11-13 13:10:42 PS P B6B6F2B8D30A14866FB848EA848D3547AA51FF29 A0046212CE9672327E854F40E28815F016E88894 2016 2017-02-10 21:41:12Z CROSSROADS FAMILY CARE KENNETH WHITE PO BOX 489 MT ENTERPRISE TX 75681 3220356 0 X N/A X 2003 TX TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 13 13 46 13 0 0 1828832 1644094 976073 1570823 0 50 115306 5389 2920211 3220356 0 0 0 0 1980011 2221336 0 0 0 990960 938445 2970971 3159781 -50760 60575 841436 785079 512423 395491 329013 389588 TO PROVIDE PREVENTICE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 0 0 2548324 0 1570823 MT. 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. 2548324 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 14 0 46 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 0 0 X KENNETH WHITE 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 BECKY ELDRIDGE PRESIDENT 2.00 X X 0 0 0 LEO GONZALEZ VICE PRESIDENT 2.00 X X 0 0 0 JOHN GRUBBS SECRETARY 2.00 X X 0 0 0 TOM VAUGHT TREASURER 5.00 X X 0 0 0 PATSY FOGLEMAN BOARD MEMBER 2.00 X 0 0 0 MATT GHOLSON BOARD MEMBER 2.00 X 0 0 0 HARVEY GRAVES BOARD MEMBER 2.00 X 0 0 0 MAMIE HODGE BOARD MEMBER 2.00 X 0 0 0 MICHELLE SIMMONS BOARD MEMBER 2.00 X 0 0 0 POLLY VARDEMAN BOARD MEMBER 2.00 X 0 0 0 JEAN WILLIAMS BOARD MEMBER 2.00 X 0 0 0 RD WHITTNER BOARD MEMBER 2.00 X 0 0 0 JOYCE YBARRA BOARD MEMBER 2.00 X 0 0 0 KENNETH WHITE CEO 40.00 X 88292 0 7458 MICHELLE KELLEY CFO 7.00 X 0 0 0 SHARAVANA GAJAPATHI DENTIST 40.00 X 175990 0 5464 KIMBERLY PAGE CMO 40.00 X 195678 0 10980 BROOKE MARTIN PROVIDER 40.00 X 111690 0 4654 AMBERLY HOPSON PROVIDER 40.00 X 128153 0 0 LACEE PIERCE PROVIDER 40.00 X 117446 0 2434 SUSAN THIVIERGE PROVIDER 40.00 X 110036 0 3520 927285 0 34510 6 0 1 0 0 17500 1560163 66431 46431 1644094 MEDICAL SERVICE INCOME 624100 1570823 1570823 1570823 50 50 OTHER REVENUE 624110 5389 5389 5389 3220356 1570823 0 5439 X 483862 432682 51180 1457864 1303661 154203 18839 16846 1993 126082 112746 13336 134689 120442 14247 3990 3990 19826 19826 443221 331095 112126 127869 42075 85794 59352 10900 48452 63126 49022 14104 9615 37 9578 29070 12270 16800 12757 12757 41413 33399 8014 16339 16339 MEDICAL SUPPLIES 46431 46431 BAD DEBTS 27810 27810 OTHER EXPENSES 20300 3460 16840 DUES & SEMINARS 12471 5336 7135 4855 112 4743 3159781 2548324 611457 0 118082 80147 29521 30281 82871 72576 15636 20729 1523439 942093 595326 581346 841436 785079 176071 100283 98756 95196 237596 200012 512423 395491 X 329013 389588 329013 389588 841436 785079 60575 0 X 0 1 X 1 1 1 X 1973024 1630025 1779136 1937836 1644094 8964115 1973024 1630025 1779136 1937836 1644094 8964115 8964115 114 124 50 288 2887 2122 5937 6302 5389 22637 8987040 5895853 0.99740 0.78800 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11320 11320 561109 302701 258408 555012 299412 255600 395998 339980 56018 581346 X 3220356 0 3220356 0 3220356 3159781 0 3159781 0 3159781 PART X, LINE 2: THE 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. X X 0 0 0 0 0 0 0 0 0 SHARAVANA GAJAPATHI DENTIST 175990 0 0 0 0 0 5464 0 0 0 181454 0 0 0 KIMBERLY PAGE CMO 195678 0 0 0 0 0 6286 0 4694 0 206658 0 0 0 RUSSELL HALL FORMER BOARD MEMBER EMERGENCY FINANCING TO KEEP ENTITY OPERATING X 114500 95196 0 1 1 95196 X 1 46431 RETAIL VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE 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 3 DURING 2016, FINANCIAL MANAGEMENT SERVICES WERE PROVIDED BY COMMUNITY LINK CONSULTING. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO AND THE FINANCE COMMITTEE BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT 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 15A THE 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL 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.