FIVE RIVERS HEALTH CENTERS: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- FIVE RIVERS HEALTH CENTERS (EIN 45-0914398)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-07-14
- IRS object ID
- 201611969349300221
- Schema version
- 2015v2.1
- Note
- A later return for the same period supersedes this one.
- 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 | 2016-07-14T09:30:05-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 310800053 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK SCHAEFER HACKETT & CO | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 E MAIN STREET SUITE 500 | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45502 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450914398 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIVE RIVERS HEALTH CENTERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FIVE | BusinessNameControlTxt |
| Phone | 9377344141 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2261 PHILADELPHIA DR | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45406 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID MITTELKAMP | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9377344141 | PhoneNum |
| Signature | 2016-07-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DEVESH KAMAL CPA | PreparerPersonNm |
| PTIN | P00201226 | PTIN |
| Phone | 9373992000 | PhoneNum |
| Preparation | 2016-07-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID MITTELKAMP | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2261 PHILADELPHIA DR | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45406 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,973,110 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FIVERIVERSHEALTHCENTERS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | FIVE RIVER HEALTH CENTERS AIMS TO LIVE OUT OUR MISSION FOR OUR PATIENTS - "YOUR HEALTHCARE MATTERS!" | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 203 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,065,227 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,437,082 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,043,082 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,536,028 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $12,108,309 | PYTotalRevenueAmt |
| CY Total Revenue | $15,973,110 | 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 | $3,372,645 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,961,488 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,170,234 | PYOtherExpensesAmt |
| CY Other Expenses | $6,746,548 | CYOtherExpensesAmt |
| PY Total Expenses | $12,542,879 | PYTotalExpensesAmt |
| CY Total Expenses | $14,708,036 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$434,570 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,265,074 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,461,669 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,025,517 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,549,345 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,848,119 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $912,324 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,177,398 | NetAssetsOrFundBalancesEOYAmt |
| Mission | FIVE RIVERS HEALTH CENTERS ARE COMMITTED TO PROVIDING QUALITY, COST-EFFECTIVE CARE FOR OUR PATIENTS AND COMMUNITY, WITH RESPECT AND DIGNITY, AND WITHOUT REGARD TO ABILITY TO PAY, WHILE PROVIDING A SUPERIOR EDUCATIONAL EXPERIENCE FOR RESIDENTS AND OTHER LEARNERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,972,471 | ExpenseAmt |
| Revenue | $7,536,028 | RevenueAmt |
| Desc | PROVIDE QUALITY, COST-EFFECTIVE CARE FOR OUR PATIENTS AND COMMUNITY WITH RESPECT AND DIGNITY, AND WITHOUT REGARD TO ABILITY TO PAY, WHILE PROVIDING A SUPERIOR EDUCATIONAL EXPERIENCE FOR RESIDENTS AND OTHER LEARNERS. IN 2015, CARE WAS PROVIDED TO APPROXIMATELY 15,000 PATIENTS. | Desc |
| Total Program Service Expenses | $12,972,471 | 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 | Yes (1) | 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 | Yes (1) | 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 | 46 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 203 | 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| DAF Excess Business Holdings | 0 | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | 0 | TaxableDistributionsInd |
| Distribution To Donor | 0 | DistributionToDonorInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | 0 | 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 | DAVID MITTELKAMP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9377346844 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2261 PHILADELPHIA DR | AddressLine1Txt |
| City | DAYTON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45406 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| AMY WIEDEMAN | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RACHEL SELBY | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RENEE GEORGE | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DWIGHT BROWN | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR MARGARET DUNN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RONA CLARK | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD GOSHAY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TRISCHA COATES | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFF COOPER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| VERA CROWE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DIANE WELBORN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SERENE DUDLEY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NANCY SCHIFFLER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVE BRIDGE | |||||||
| CFO | 40.00 | Yes (X) | $93,670 | $0 | $16,274 | ||
| GINA MCFARLANE-EL | |||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $151,306 | $0 | $19,431 | ||
| DIANE CUMMINS | |||||||
| COO | 40.00 | Yes (X) | $28,247 | $0 | $4,345 | ||
| NICOLE CRASE | |||||||
| PHARMACY MANAGER | 40.00 | $115,672 | $0 | $0 | Yes (X) | ||
| MARY GORNIAK | |||||||
| CERTIFIED NURSE MIDWIFE | 40.00 | $116,478 | $0 | $0 | Yes (X) | ||
| CARL CRUTCHFIELD | |||||||
| DENTIST | 40.00 | $135,571 | $0 | $0 | Yes (X) | ||
| DONNA GAU-JATA | |||||||
| CERTIFIED NURSE MIDWIFE | 40.00 | $104,745 | $0 | $0 | Yes (X) | ||
| KATHRYN LOWRY COLLINS | |||||||
| CERTIFIED NURSE MIDWIFE | 40.00 | $100,455 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $846,144 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $40,050 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WRIGHT STATE PHYSICIANS | |||||
| 725 UNIVERSITY BOULEVARD | DAYTON | OH | 45435 | MEDICAL SERVICES | $1,103,000 |
| WSU DEPT OF MEDICINE | |||||
| ONE WYOMING STREET | DAYTON | OH | 45409 | MEDICAL SERVICES | $228,188 |
| PREMIER HEALTH SPECIALISTS INC | |||||
| 110 N MAIN ST | DAYTON | OH | 45402 | MEDICAL SERVICES | $128,750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,856,491 | GovernmentGrantsAmt |
| All Other Contributions | $5,580,591 | AllOtherContributionsAmt |
| Noncash Contributions | $222,601 | NoncashContributionsAmt |
| Total Contributions | $8,437,082 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICAID, NET | 621400 | $6,553,005 | $6,553,005 |
| PHARMACY | 621400 | $585,503 | $585,503 |
| MEDICARE, NET | 621400 | $279,311 | $279,311 |
| MISCELLANEOUS | 624100 | $97,981 | $97,981 |
| FIRST AND THIRD PARTIES, NET | 621400 | $17,658 | $17,658 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,570 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,570 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,536,028 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,973,110 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,536,028 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $273,223 | TotalAmt |
| Management And General | $273,223 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,270,427 | TotalAmt |
| Program Services | $5,723,113 | ProgramServicesAmt |
| Management And General | $547,314 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $925,923 | TotalAmt |
| Program Services | $806,059 | ProgramServicesAmt |
| Management And General | $119,864 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $491,915 | TotalAmt |
| Program Services | $430,644 | ProgramServicesAmt |
| Management And General | $61,271 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,434 | TotalAmt |
| Management And General | $12,434 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,250 | TotalAmt |
| Management And General | $26,250 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,386 | TotalAmt |
| Program Services | $102,248 | ProgramServicesAmt |
| Management And General | $6,138 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,312 | TotalAmt |
| Program Services | $12,162 | ProgramServicesAmt |
| Management And General | $48,150 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,861 | TotalAmt |
| Program Services | $110,087 | ProgramServicesAmt |
| Management And General | $27,774 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,297,111 | TotalAmt |
| Program Services | $1,249,882 | ProgramServicesAmt |
| Management And General | $47,229 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,595 | TotalAmt |
| Program Services | $25,667 | ProgramServicesAmt |
| Management And General | $12,928 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,657 | TotalAmt |
| Program Services | $77,335 | ProgramServicesAmt |
| Management And General | $10,322 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,557 | TotalAmt |
| Management And General | $7,557 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,193 | TotalAmt |
| Program Services | $102,183 | ProgramServicesAmt |
| Management And General | $65,010 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,532 | TotalAmt |
| Program Services | $143,172 | ProgramServicesAmt |
| Management And General | $2,360 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRACT SERVICES | $2,677,883 | $2,305,741 | $372,142 |
| PHARMACY COSTS | $703,626 | $703,626 | |
| MEDICAL SUPPLIES | $459,701 | $459,701 | |
| MEMBERSHIP DUES | $318,920 | $237,132 | $81,788 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $497,530 | TotalAmt |
| Program Services | $483,719 | ProgramServicesAmt |
| Management And General | $13,811 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,708,036 | TotalAmt |
| Program Services | $12,972,471 | ProgramServicesAmt |
| Management And General | $1,735,565 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,389 | BOYAmt |
| EOY | $686,003 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,049,704 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,274,266 | BOYAmt |
| EOY | $963,745 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,696 | BOYAmt |
| EOY | $9,093 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $428,316 | BOYAmt |
| EOY | $399,401 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,380,894 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $463,323 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600,002 | BOYAmt |
| EOY | $917,571 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,461,669 | BOYAmt |
| EOY | $4,025,517 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $324,458 | BOYAmt |
| EOY | $697,396 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,224,887 | BOYAmt |
| EOY | $1,150,723 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,549,345 | BOYAmt |
| EOY | $1,848,119 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $912,324 | BOYAmt |
| EOY | $2,177,398 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $912,324 | BOYAmt |
| EOY | $2,177,398 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,461,669 | BOYAmt |
| EOY | $4,025,517 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,265,074 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,700,300 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,565,250 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,201,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,065,227 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,437,082 | CurrentTaxYearAmt |
| Total | $33,968,859 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $996,783 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,066,404 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,299,695 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,043,082 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,536,028 | CurrentTaxYearAmt |
| Total | $20,941,992 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,697,083 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,631,654 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,500,695 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,108,309 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,973,110 | CurrentTaxYearAmt |
| Total | $54,910,851 | 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 |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $54,910,851 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,697,083 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,631,654 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,500,695 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,108,309 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,973,110 | CurrentTaxYearAmt |
| Total | $54,910,851 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | Yes (X) | First5Years509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, SECTION A | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION WAS FORMED ON MAY 23, 2011 THUS CREATING A SHORT-YEAR TAX RETURN FOR 2011. | ExplanationTxt |
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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $355,418 | OtherCostOrOtherBasisAmt |
| Depreciation | $104,964 | DepreciationAmt |
| Book Value | $250,454 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,025,476 | OtherCostOrOtherBasisAmt |
| Depreciation | $358,359 | DepreciationAmt |
| Book Value | $667,117 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $917,571 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PAYROLL AND WITHHOLDING | $664,885 |
| ACCRUED LEASED PAYROLL AND BENEFITS | $1,710 |
| OTHER ACCRUED LIABILITIES | $89,512 |
| CAPITAL LEASE | $394,616 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,150,723 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $16,974,675 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $1,001,565 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $1,001,565 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,973,110 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,973,110 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,709,601 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $1,001,565 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $1,001,565 | ExpensesNotReportedAmt |
| Expenses Subtotal | $14,708,036 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,708,036 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | FIVE RIVERS HEALTH CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE CENTER'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE CENTER'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. NO INCOME TAX PROVISION HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS AS THE CENTER HAS DETERMINED IT DOES NOT HAVE UNRELATED BUSINESS INCOME SUBJECT TO TAXATION. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 | GINA MCFARLANE-EL | PersonNm |
| Title | EXECUTIVE DIRECTOR | TitleTxt |
| Base Compensation Filing Org | $151,306 | 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 | $6,411 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $13,020 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $170,737 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE COMPENSATION COMMITTEE USES MARKET DATA TO DETERMINE SALARIES. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR MARGARET DUNN | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER AND CEO OF WRIGHT STATE PHYSICIANS | RelationshipDescriptionTxt |
| Transaction | $1,103,000 | TransactionAmt |
| Transaction | MEDICAL SERVICES PROVIDED BY WRIGHT STATE PHYSICIANS | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | VACCINES | Desc |
| Contribution | 0 | ContributionCnt |
| Noncash Contributions Rpt F990 | $222,601 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST OF MATERIALS | 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 (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DR. MARGARET DUNN, A BOARD MEMBER IS THE CEO OF WRIGHT STATE PHYSICIANS, AN ORGANIZATION THAT PROVIDED MEDICAL SERIVCES DURING 2015. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FINANCE COMMITTEE WILL REVIEW THE 990 AND APPROVE THE REPORT. AFTER APPROVING THE 990, THE FINANCE COMMITTEE WILL TAKE THE 990 TO THE BOARD FOR BOARD APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. OPERATING POLICIES HAVE BEEN IMPLEMENTED TO DETECT POTENTIAL CONFLICTS OF INTEREST. CONTRACTS OR EXPENDITURES THAT ARE GREATER THAN $50,000 MUST HAVE BOARD APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE USES MARKET DATA TO DETERMINE SALARIES. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATIONS 990 IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XII, LINE 2C: | THE FINANCE COMMITTEE FOR THE ORGANIZATION SELECTS AN INDEPENDENT ACCOUNTING FIRM TO CONDUCT THE AUDIT OF THE FINANCIAL STATEMENTS AND PROVIDES OVERSIGHT FOR THE WORK THAT IS CONDUCTED. THIS REPRESENTS NO CHANGE IN THE PROCESS FROM PROCEDURES CONDUCTED IN PRIOR PERIODS. |