MT OLIVE FAMILY MEDICINE CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MT OLIVE FAMILY MEDICINE CENTER INC (EIN 56-2000255)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-02-15
- IRS object ID
- 201700469349301855
- Schema version
- 2015v3.0
- 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 | 2017-02-15T09:01:51-08:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CW Dunn & Associates CPAs PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 326 West Street | AddressLine1Txt |
| City | Pittsboro | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27312 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 562000255 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mt Olive Family Medicine Center Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MTOL | BusinessNameControlTxt |
| Phone | 9196584954 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 North Breazeale Avenue | AddressLine1Txt |
| City | Mount Olive | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28365 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Lisa Hooks | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Signature | 2017-02-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Corinne W Dunn | PreparerPersonNm |
| PTIN | P00349027 | PTIN |
| Phone | 9195425228 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,225,522 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | To provide medical care for all those in need regardless of ability to pay. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 47 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $226,775 | PYContributionsGrantsAmt |
| CY Contributions Grants | $183,170 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,825,315 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,024,829 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$11,160 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,932 | CYInvestmentIncomeAmt |
| PY Other Revenue | $35,466 | PYOtherRevenueAmt |
| CY Other Revenue | $14,552 | CYOtherRevenueAmt |
| PY Total Revenue | $4,076,396 | PYTotalRevenueAmt |
| CY Total Revenue | $4,224,483 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,177,294 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,141,547 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $785,249 | PYOtherExpensesAmt |
| CY Other Expenses | $915,346 | CYOtherExpensesAmt |
| PY Total Expenses | $3,962,543 | PYTotalExpensesAmt |
| CY Total Expenses | $4,056,893 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $113,853 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $167,590 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,611,710 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,684,307 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,278,304 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,183,311 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,333,406 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,500,996 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide medical care for all those in need regardless of ability to pay. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $3,448,563 | ExpenseAmt |
| Revenue | $4,024,829 | RevenueAmt |
| Desc | Mt. Olive Family Medicine Center, Inc. is dedicated to the health and well-being of the residents of Wayne County and the surrounding areas. It is our goal to identify and minister to the medical needs of the family unit - not only to provide quality, comprehensive medical care, but also to institute health education, urgent care, wellness and preventative medicine. Accessible and affordable quality health care will be provided with dignity and respect, regardless of race, religion, gender, age or economic background. | Desc |
| Total Program Service Expenses | $3,448,563 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | 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 | false | 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 |
| 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 | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 47 | 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 | 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 | false | 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 | Lisa Hooks | PersonNm |
| Phone | 9195814981 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 North Breazeale Avenue | AddressLine1Txt |
| City | Mt Olive | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28365 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Ernie Taylor | |||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Jamal Jones | |||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Dr Tyanna Yonkers | |||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Mark Raynor | |||||||||
| President | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Donald Heisey | |||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Randy Kearns | |||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Roger Davis | |||||||||
| Vice President | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Brandi Worth | |||||||||
| Treasurer/Sec | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Jennifer Robbins | |||||||||
| Board Member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Carol Dilda | |||||||||
| Special Project | 40.00 | 0.00 | $94,659 | $0 | $15,308 | Yes (X) | |||
| Lisa Hooks | |||||||||
| CFO | 40.00 | 0.00 | $118,500 | $0 | $16,741 | Yes (X) | |||
| Robert K Talton | |||||||||
| Medical Director | 40.00 | 0.00 | $308,210 | $0 | $28,522 | Yes (X) | |||
| Jeffrey Harrison | |||||||||
| Physician | 40.00 | 0.00 | $110,808 | $0 | $0 | Yes (X) | |||
| Thomas S Draughon | |||||||||
| Physician | 40.00 | 0.00 | $276,295 | $0 | $25,597 | Yes (X) | |||
| Humayun M Kadir | |||||||||
| Physician | 40.00 | 0.00 | $294,936 | $0 | $26,909 | Yes (X) | |||
| Stephen D Fairchild | |||||||||
| Physician | 40.00 | 0.00 | $126,119 | $0 | $4,642 | Yes (X) | |||
| Sufia Siddique | |||||||||
| Physician | 40.00 | 0.00 | $316,852 | $0 | $28,715 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,646,379 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $146,434 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $183,170 | AllOtherContributionsAmt |
| Total Contributions | $183,170 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| Management Fees | $99,004 | $99,004 |
| Patient Fees | $3,925,825 | $3,925,825 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,024,829 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,727 | TotalRevenueColumnAmt |
| Exclusion | $2,727 | 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 |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,500 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $244 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,256 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,256 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,256 | RelatedOrExemptFuncIncomeAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $795 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$795 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$795 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$795 | RelatedOrExemptFuncIncomeAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
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 |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Other Income | Desc |
| Total Revenue Column | $1,296 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,296 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,296 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,224,483 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,038,586 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $2,727 | 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 | $220,581 | TotalAmt |
| Program Services | $187,494 | ProgramServicesAmt |
| Management And General | $33,087 | 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 | $2,430,830 | TotalAmt |
| Program Services | $2,034,234 | ProgramServicesAmt |
| Management And General | $396,596 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,284 | TotalAmt |
| Program Services | $50,391 | ProgramServicesAmt |
| Management And General | $8,893 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274,561 | TotalAmt |
| Program Services | $233,377 | ProgramServicesAmt |
| Management And General | $41,184 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,291 | TotalAmt |
| Program Services | $132,847 | ProgramServicesAmt |
| Management And General | $23,444 | 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 | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
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 | $165,741 | TotalAmt |
| Program Services | $139,848 | ProgramServicesAmt |
| Management And General | $25,893 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,124 | TotalAmt |
| Program Services | $899 | ProgramServicesAmt |
| Management And General | $225 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,004 | TotalAmt |
| Program Services | $24,003 | ProgramServicesAmt |
| Management And General | $6,001 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,896 | TotalAmt |
| Program Services | $4,896 | ProgramServicesAmt |
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 | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,785 | TotalAmt |
| Program Services | $34,006 | ProgramServicesAmt |
| Management And General | $3,779 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,115 | TotalAmt |
| Program Services | $80,186 | ProgramServicesAmt |
| Management And General | $8,929 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,582 | TotalAmt |
| Program Services | $26,475 | ProgramServicesAmt |
| Management And General | $3,107 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies & Lab Expense | $268,264 | $268,264 | |
| Equipment Rental & Main | $91,299 | $73,039 | $18,260 |
| Miscellaneous | $45,307 | $26,982 | $18,325 |
| Utilities | $32,466 | $25,960 | $6,506 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,763 | TotalAmt |
| Program Services | $105,662 | ProgramServicesAmt |
| Management And General | $14,101 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,056,893 | TotalAmt |
| Program Services | $3,448,563 | ProgramServicesAmt |
| Management And General | $608,330 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $699,291 | BOYAmt |
| EOY | $762,149 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243,520 | BOYAmt |
| EOY | $243,520 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,481 | BOYAmt |
| EOY | $215,882 | 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) |
|---|---|---|
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,727,493 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,268,788 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,519,545 | BOYAmt |
| EOY | $1,458,705 | 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) |
|---|---|---|
| BOY | $6,873 | BOYAmt |
| EOY | $4,051 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,611,710 | BOYAmt |
| EOY | $2,684,307 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $411,375 | BOYAmt |
| EOY | $352,416 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $866,929 | BOYAmt |
| EOY | $830,895 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,278,304 | BOYAmt |
| EOY | $1,183,311 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,333,406 | BOYAmt |
| EOY | $1,500,996 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,333,406 | BOYAmt |
| EOY | $1,500,996 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,611,710 | BOYAmt |
| EOY | $2,684,307 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $167,590 | 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 | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $77,467 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $159,968 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $226,775 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $183,170 | CurrentTaxYearAmt |
| Total | $647,380 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,512,422 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,684,092 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,654,277 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,825,315 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,024,829 | CurrentTaxYearAmt |
| Total | $18,700,935 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,512,422 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,761,559 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,814,245 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,052,090 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,207,999 | CurrentTaxYearAmt |
| Total | $19,348,315 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $19,348,315 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,738 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,087 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,267 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,247 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,727 | CurrentTaxYearAmt |
| Total | $11,066 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,738 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,087 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,267 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,247 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,727 | CurrentTaxYearAmt |
| Total | $11,066 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,377 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $40,912 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,141 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,446 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,296 | CurrentTaxYearAmt |
| Total | $104,172 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,538,537 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,804,558 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,832,653 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,075,783 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,212,022 | CurrentTaxYearAmt |
| Total | $19,463,553 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99410 | PublicSupportCY509Pct |
| Investment Income CY | 0.00060 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $185,000 | OtherCostOrOtherBasisAmt |
| Book Value | $185,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,686,427 | OtherCostOrOtherBasisAmt |
| Depreciation | $561,935 | DepreciationAmt |
| Book Value | $1,124,492 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $95,702 | OtherCostOrOtherBasisAmt |
| Depreciation | $46,118 | DepreciationAmt |
| Book Value | $49,584 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $618,355 | OtherCostOrOtherBasisAmt |
| Depreciation | $527,277 | DepreciationAmt |
| Book Value | $91,078 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $142,009 | OtherCostOrOtherBasisAmt |
| Depreciation | $133,458 | DepreciationAmt |
| Book Value | $8,551 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,458,705 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $4,224,727 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $244 | OtherRevenueAmt |
| Revenue Not Reported | $244 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,224,483 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $4,224,483 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,057,137 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $244 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $244 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,056,893 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $4,056,893 | 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 | Rental Expenses $244 |
| Part XII, Line 2d: Other expenses and losses per audited F/S | Rental Expenses $244 |
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 (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| Humayun M Kadir | ||||
| Physician | $294,936 | $7,200 | $19,709 | $321,845 |
| Robert K Talton | ||||
| Medical Director | $308,210 | $6,510 | $22,012 | $336,732 |
| Sufia Siddique | ||||
| Physician | $316,852 | $8,177 | $20,538 | $345,567 |
| Thomas S Draughon | ||||
| Physician | $276,295 | $3,299 | $22,298 | $301,892 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 11b: Form 990 Review Process | 990 is reviewed by Chief Financial Officer and Executive Director before filing. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | Evaluation of performance by doctors. Evalution of performance by Executive and personnel committees and Doctor input. Review of salary and benefits as well as comparable compensation at similar facilities, MGMA annual salary and benefit review. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Upon Request |