MIDTOWN HEALTH CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MIDTOWN HEALTH CENTER INC (EIN 47-0833378)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-01-28
- IRS object ID
- 201730289349300118
- 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 | 2017-01-28T14:48:14-06:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 201430448 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Christensen Brozek Faltys PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1264 | AddressLine1Txt |
| City | Norfolk | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68702 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470833378 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Midtown Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MIDT | BusinessNameControlTxt |
| Phone | 4023718000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 302 W Phillip Ave | AddressLine1Txt |
| City | Norfolk | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kathleen Nordby | PersonNm |
| Person Title | Executive Director | PersonTitleTxt |
| Phone | 4023718000 | PhoneNum |
| Signature | 2017-01-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Danny Fuerhoff CPA | PreparerPersonNm |
| PTIN | P00026845 | PTIN |
| Phone | 4023711160 | 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) |
|---|---|---|
| Principal Officer | Kathleen Nordby | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 302 W Phillip Ave | AddressLine1Txt |
| City | Norfolk | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,255,844 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | NE | LegalDomicileStateCd |
| Activity Or Mission | Provide medical, behavioral and dental services that are affordable, accessible and patient focused. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 75 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,150,636 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,970,601 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,807,180 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,224,686 | CYProgramServiceRevenueAmt |
| PY Investment Income | $868 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,669 | CYInvestmentIncomeAmt |
| PY Other Revenue | $19,625 | PYOtherRevenueAmt |
| CY Other Revenue | $17,600 | CYOtherRevenueAmt |
| PY Total Revenue | $3,978,309 | PYTotalRevenueAmt |
| CY Total Revenue | $5,214,556 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,223,465 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,766,991 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $102,205 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,414,934 | PYOtherExpensesAmt |
| CY Other Expenses | $1,840,583 | CYOtherExpensesAmt |
| PY Total Expenses | $3,638,399 | PYTotalExpensesAmt |
| CY Total Expenses | $4,607,574 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $339,910 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $606,982 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,904,072 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,579,455 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,620,426 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,688,829 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,283,646 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,890,626 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Providing high quality medical, behavioral, and dental services that are affordable, accessible, and patient focused. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,789,756 | ExpenseAmt |
| Revenue | $2,224,084 | RevenueAmt |
| Desc | The organization provides medical, dental and behavioral health services to the poor and uninsured or under-insured of our community. Our target population is this population within Madison County but we do not deny services to anyone based on their geographic location or ability to pay. In 2015 we saw 4,899 unduplicated patients for a total of 19,070 encounters. Of this population 49% were uninsured, 26% were either Medicaid or Medicare, and the rest had private insurance. | Desc |
| Total Program Service Expenses | $3,789,756 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 9 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 75 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Organization | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4023718000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 302 W Phillip Ave | AddressLine1Txt |
| City | Norfolk | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|
| Kathy Nordby | |||||||
| Executive Director | 40.00 | Yes (X) | $103,817 | $0 | $0 | ||
| Karen Weidner | |||||||
| Board member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Joe Mtika | |||||||
| Past Chair | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Brenda Jones | |||||||
| President | 8.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Alan Ehlers | |||||||
| Board member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Pat Samuels | |||||||
| Board member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Betty Froehlich | |||||||
| Secretary | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Gretchen Forsell | |||||||
| Vice President | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Susie Lutz | |||||||
| Treasurer | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Leticia Rodriguez | |||||||
| Board member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Leonor Fuhrer | |||||||
| Board member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Lance Morrow | |||||||
| Board member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Mary Luhr | |||||||
| Board member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dr Raymond Heller | |||||||
| Medical Director/Physician | 40.00 | $169,290 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $273,107 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $20,014 | FederatedCampaignsAmt |
| Government Grants | $2,574,650 | GovernmentGrantsAmt |
| All Other Contributions | $375,937 | AllOtherContributionsAmt |
| Noncash Contributions | $52,904 | NoncashContributionsAmt |
| Total Contributions | $2,970,601 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient revenue | 621110 | $2,179,386 | $2,179,386 |
| Contract Revenue | 621110 | $45,300 | $45,300 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,224,686 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,271 | TotalRevenueColumnAmt |
| Exclusion | $2,271 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,600 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,600 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,600 | TotalRevenueColumnAmt |
| Exclusion | $17,600 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $40,686 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $41,288 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$602 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$602 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$602 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,214,556 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,224,084 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $19,871 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,040 | TotalAmt |
| Program Services | $248,095 | ProgramServicesAmt |
| Management And General | $30,903 | ManagementAndGeneralAmt |
| Fundraising | $2,042 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,137,366 | TotalAmt |
| Program Services | $1,686,630 | ProgramServicesAmt |
| Management And General | $404,410 | ManagementAndGeneralAmt |
| Fundraising | $46,326 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,066 | TotalAmt |
| Program Services | $19,253 | ProgramServicesAmt |
| Management And General | $4,332 | ManagementAndGeneralAmt |
| Fundraising | $481 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,779 | TotalAmt |
| Program Services | $111,023 | ProgramServicesAmt |
| Management And General | $24,980 | ManagementAndGeneralAmt |
| Fundraising | $2,776 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,740 | TotalAmt |
| Program Services | $148,592 | ProgramServicesAmt |
| Management And General | $33,433 | ManagementAndGeneralAmt |
| Fundraising | $3,715 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,556 | TotalAmt |
| Program Services | $3,467 | ProgramServicesAmt |
| Management And General | $8,089 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,121 | TotalAmt |
| Management And General | $24,121 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,821 | TotalAmt |
| Program Services | $178,273 | ProgramServicesAmt |
| Management And General | $7,529 | ManagementAndGeneralAmt |
| Fundraising | $5,019 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,317 | TotalAmt |
| Program Services | $11,195 | ProgramServicesAmt |
| Fundraising | $26,122 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $211,555 | TotalAmt |
| Program Services | $162,314 | ProgramServicesAmt |
| Management And General | $35,273 | ManagementAndGeneralAmt |
| Fundraising | $13,968 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,680 | TotalAmt |
| Program Services | $22,176 | ProgramServicesAmt |
| Management And General | $9,504 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,261 | TotalAmt |
| Program Services | $28,183 | ProgramServicesAmt |
| Management And General | $7,052 | ManagementAndGeneralAmt |
| Fundraising | $26 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,397 | TotalAmt |
| Program Services | $9,072 | ProgramServicesAmt |
| Management And General | $6,632 | ManagementAndGeneralAmt |
| Fundraising | $693 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,659 | TotalAmt |
| Program Services | $23,089 | ProgramServicesAmt |
| Management And General | $2,733 | ManagementAndGeneralAmt |
| Fundraising | $837 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,190 | TotalAmt |
| Management And General | $62,190 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,147 | TotalAmt |
| Program Services | $70,518 | ProgramServicesAmt |
| Management And General | $17,629 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,830 | TotalAmt |
| Program Services | $12,542 | ProgramServicesAmt |
| Management And General | $10,136 | ManagementAndGeneralAmt |
| Fundraising | $152 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Bad debt expense | $491,842 | $491,842 |
| Dental, Medical & Pharm | $324,900 | $324,900 |
| Recruitment/hiring | $134,447 | $134,447 |
| Lab fees | $57,000 | $57,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,860 | TotalAmt |
| Program Services | $47,145 | ProgramServicesAmt |
| Management And General | $26,667 | ManagementAndGeneralAmt |
| Fundraising | $48 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,607,574 | TotalAmt |
| Program Services | $3,789,756 | ProgramServicesAmt |
| Management And General | $715,613 | ManagementAndGeneralAmt |
| Fundraising | $102,205 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $603,257 | BOYAmt |
| EOY | $533,936 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $635,270 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,097 | BOYAmt |
| EOY | $169,542 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $234,686 | BOYAmt |
| EOY | $321,005 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,331 | BOYAmt |
| EOY | $7,120 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,177,352 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $296,206 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,948,210 | BOYAmt |
| EOY | $1,881,146 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,491 | BOYAmt |
| EOY | $31,436 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,904,072 | BOYAmt |
| EOY | $3,579,455 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $165,485 | BOYAmt |
| EOY | $268,951 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,258 | BOYAmt |
| EOY | $114,854 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,449,683 | BOYAmt |
| EOY | $1,305,024 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,620,426 | BOYAmt |
| EOY | $1,688,829 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,278,646 | BOYAmt |
| EOY | $1,885,626 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $5,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,283,646 | BOYAmt |
| EOY | $1,890,626 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,904,072 | BOYAmt |
| EOY | $3,579,455 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $606,982 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | 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 | $1,436,220 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,596,091 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,768,636 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,150,636 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,970,601 | CurrentTaxYearAmt |
| Total | $9,922,184 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,436,220 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,596,091 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,768,636 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,150,636 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,970,601 | CurrentTaxYearAmt |
| Total | $9,922,184 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $9,922,184 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,109 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,211 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,822 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $20,493 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,269 | CurrentTaxYearAmt |
| Total | $51,904 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $562 | CurrentTaxYearMinus4YearsAmt |
| Total | $562 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $9,974,650 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $7,884,828 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99470 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99570 | 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 | $88,913 | OtherCostOrOtherBasisAmt |
| Book Value | $88,913 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,782,816 | OtherCostOrOtherBasisAmt |
| Depreciation | $134,078 | DepreciationAmt |
| Book Value | $1,648,738 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $305,623 | OtherCostOrOtherBasisAmt |
| Depreciation | $162,128 | DepreciationAmt |
| Book Value | $143,495 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,881,146 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $5,214,556 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,214,556 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $5,214,556 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,607,575 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,607,574 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,607,574 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Organization files required income tax returns in the U.S. federal jurisdiction. With few exceptions, the Organization is no longer subject to U.S. federal income tax examinations by tax authorities for years before 2012. The Organization has concluded no material uncertain tax positions have been taken on any open tax returns. For the current year the Organization believes all tax positions are fully supportable by existing Federal law and related interpretations and there are no uncertain tax positions to consider. |
| Part XII, Line 2d - Other Adjustments: | Rounding 1. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dr Raymond Heller | PersonNm |
| Title | Medical Director/Physician | TitleTxt |
| Base Compensation Filing Org | $169,290 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $169,290 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | Software and supplies | Desc |
| Contribution | 0 | ContributionCnt |
| Noncash Contributions Rpt F990 | $52,904 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Cost | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | A copy of the Form 990 is provided to the board for review before it is filed. |
| Form 990, Part VI, Section B, line 12c | A new conflict of interest policy is distributed and signed annually by board members. The policy clearly states the board members responsibility to disclose existing known conflicts at that time and disclose future conflicts or potential/perceived conflicts at the time any new situation or decision may warrant such disclosure. |
| Form 990, Part VI, Section B, line 15 | There is a study to compare pay from like organizations across the nation and midwest. We also include consideration of the local market for other health care or health delivery agencies locally that we compete with for staff. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents are made available to the public upon request. |
| Form 990, Part XI, line 9: | Rounding -2. |
| Form 990, Part XI, Line 2c | This process has not changed from the prior year. |