2015-05-13T09:18:21-05:00 2014-06-30 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2013-07-01 453023360 WABASH VALLEY HEALTH CENTER INC WABA 8122327447 1436 LOCUST STREET TERRE HAUTE IN 47807 TINA ELLIOTT SECRETARY/TREASURER 8122327447 2015-05-13 1 ANGELA CRAWFORD CPA P00573197 3176334705 2013 2016-02-25 16:41:14Z TINA ELLIOTT 1436 LOCUST STREET TERRE HAUTE IN 47807 711191 0 X N/A X 2011 IN TO PROVIDE PRIMARY HEALTH CARE, DENTAL CARE AND RELATED SERVICES TO THOSE IN NEED OF MEDICAL CARE, INCLUDING THE MEDICALLY UNDERSERVED, UNINSURED AND VULNERABLE POPULATION IN THE WABASH VALLEY WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. 10 10 10 220 0 0 565784 596753 127288 114036 3876 402 0 0 696948 711191 0 0 0 0 159621 377989 0 0 0 187777 295824 347398 673813 349550 37378 742135 828541 37868 86896 704267 741645 TO PROVIDE PRIMARY HEALTH CARE, DENTAL CARE AND RELATED SERVICES TO THOSE IN NEED OF MEDICAL CARE, INCLUDING THE MEDICALLY UNDERSERVED, UNINSURED AND VULNERABLE POPULATION IN THE WABASH VALLEY WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. 0 0 332506 114036 THE ORGANIZATION PROVIDED PRIMARY HEALTH CARE, DENTAL CARE AND RELATED SERVICES TO A LARGE NUMBER OF THOSE IN NEED OF MEDICAL CARE, INCLUDING THE MEDICALLY UNDERSERVED AND UNINSURED INDIVIDUALS IN THE WABASH VALLEY. 332506 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 10 1 0 0 0 0 0 0 0 0 0 0 X 10 10 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 IN X BROOKE LOCKHART 8122327447 1436 LOCUST STREET TERRE HAUTE IN 47807 PETER CIANCONE PRESIDENT 3.00 X X 0 0 0 JUDGE MIKE ELDRED VICE PRESIDENT 3.00 X X 0 0 0 TINA ELLIOTT SECRETARY/TREASURER 3.00 X X 0 0 0 GARY BROYLES MEMBER 3.00 X 0 0 0 TIM CULLEN MEMBER 3.00 X 0 0 0 ROBERT FROST MEMBER 3.00 X 0 0 0 CATHY HALL MEMBER 3.00 X 0 0 0 TERRY HIGGINS MEMBER 3.00 X 0 0 0 TAMARA SEELEY MEMBER 3.00 X 0 0 0 TELISSA L TRUE MEMBER 3.00 X 0 0 0 ANNETTA SWEATT MEMBER 3.00 X 0 0 0 CHARLES WELKER CHIEF EXECUTIVE OFFICER 40.00 X 48654 0 0 EARL ELLIOTT CHIEF FINANCIAL OFFICER 40.00 X 0 0 0 SR LAWRENCE ANN LISTON CHIEF OPERATING OFFICER 40.00 X 22074 0 0 70728 0 0 0 0 0 0 0 332136 264617 596753 HARRISON TOWNSHIP SUBS 624110 113832 113832 MEDICAL RECORDS INCOME 624110 204 204 114036 402 402 711191 114036 0 402 70728 70728 275565 201157 74408 31696 20223 11473 41854 41854 14391 14391 5327 5327 34744 34744 34614 34614 9592 9592 31319 25193 6126 43154 10969 32185 SUPPLIES 71259 71259 OTHER EXP 5865 5865 BIOHAZARD WASTE DISPOSA 3705 3705 673813 332506 341307 0 315844 199732 105037 156240 25995 72334 4000 4895 13341 14143 435698 54501 277918 381197 742135 828541 15368 86896 22500 37868 86896 X 698110 726694 6157 14951 0 704267 741645 742135 828541 37378 0 X X 0 1 X 1 0 X 47625 184878 596753 829256 16357 127288 114036 257681 63982 312166 710789 1086937 0 0 0 1086937 298 3876 402 4576 298 3876 402 4576 64280 316042 711191 1091513 X SCHEDULE A, PART IV, LIST OF UNUSUAL GRANTS: DESCRIPTION: DEBT FORGIVENESS DATE: 06/30/14 AMOUNT: 22500. DESCRIPTION: DEBT FORGIVENESS DATE: 06/30/13 AMOUNT: 30000. DESCRIPTION: DEBT FORGIVENESS DATE: 06/30/12 AMOUNT: 30000. DESCRIPTION: CASH & EQUIPMENT DATE: 06/30/12 AMOUNT: 409035. DESCRIPTION: CASH & EQUIPMENT DATE: 12/20/12 AMOUNT: 230906. DESCRIPTION: BUILDING & LAND DATE: 03/15/13 AMOUNT: 120000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3512 3512 120000 6208 113792 312186 48293 263893 381197 X 1269870 558679 558679 711191 0 711191 1232492 558679 558679 673813 0 673813 PART X, LINE 2: THE CENTER IS ORGANIZED AS A NOT-FOR-PROFIT UNDER SECTION 501(C)(3) OF THE UNITED STATES INTERNAL REVENUE CODE. THE EXEMPTION IS ON ALL INCOME EXCEPT UNRELATED BUSINESS INCOME AS NOTED UNDER SECTION 511 OF THE INTERNAL REVENUE CODE. INTERNAL REVENUE CODE SECTION 513(A) DEFINES AN UNRELATED TRADE OR BUSINESS OF AN EXEMPT ORGANIZATION AS ANY TRADE OR BUSINESS WHICH IS NOT SUBSTANTIALLY RELATED TO THE EXERCISE OR PERFORMANCE OF ITS EXEMPT PURPOSE. AS SUCH, THE CENTER IS GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, THE CENTER IS REQUIRED TO FILE FEDERAL FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX WHICH IS AN INFORMATIONAL RETURN ONLY. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CENTER AND HAS CONCLUDED THAT AS OF JUNE 30, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE CENTER FILED THEIR FEDERAL AND STATE INCOME TAX RETURNS FOR PERIODS THROUGH JUNE 30, 2013. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). FORM 990, PART VI, SECTION A, LINE 2 TINA ELLIOTT (SECRETARY/TREASURER) AND EARL ELLIOTT (CFO) ARE MARRIED. FORM 990, PART VI, SECTION A, LINE 3 THE WABASH VALLEY HEALTH CENTER'S ACCOUNTING AND CFO DUTIES ARE OUTSOURCED TO A LOCAL CPA FIRM, SACKRIDER & COMPANY, THROUGH A CONTRACTUAL AGREEMENT. THESE DUTIES ARE UNDER THE SUPERVISION OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 FORM 990, PART VI, SECTION B, LINE 11: COPIES OF THE FORM 990 ARE PROVIDED TO MEMBERS OF THE EXECUTIVE AND FINANCE COMMITTEES. THEY ARE ASKED TO REVIEW, QUESTIONS AND/OR COMMENT, AND APPROVE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY REVIEWS COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR.