CLINICA CAMPESINA FAMILY HEALTH SERVICES: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- CLINICA CAMPESINA FAMILY HEALTH SERVICES (EIN 84-0743432)
- Tax period
- 2014-02-01 to 2015-01-31
- Filed
- 2015-11-12
- IRS object ID
- 201523169349304857
- Schema version
- 2014v5.0
- 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 | 2015-11-12T15:16:42-06:00 | ReturnTs |
| Tax Period End | 2015-01-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 370 INTERLOCKEN BLVD SUITE 500 | AddressLine1Txt |
| City | BROOMFIELD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-02-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 840743432 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLINICA CAMPESINA FAMILY HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLIN | BusinessNameControlTxt |
| Phone | 3036504460 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1345 PLAZA COURT NORTH NO 1A | AddressLine1Txt |
| City | LAFAYETTE | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80026 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SIMON G SMITH | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 3036504460 | PhoneNum |
| Signature | 2015-06-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 3034668822 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLINICA FAMILY HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SIMON G SMITH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1345 PLAZA COURT NORTH NO 1A | AddressLine1Txt |
| City | LAFAYETTE | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80026 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,012,759 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CLINICA.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | CO | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HIGH-QUALITY, CULTURALLY APPROPRIATE CARE TO LOW-INCOME AND OTHER UNDESERVED PEOPLE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 548 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $15,091,658 | PYContributionsGrantsAmt |
| CY Contributions Grants | $13,349,799 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $20,858,986 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,327,131 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,641 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,225 | CYInvestmentIncomeAmt |
| PY Other Revenue | $218,472 | PYOtherRevenueAmt |
| CY Other Revenue | $334,604 | CYOtherRevenueAmt |
| PY Total Revenue | $36,172,757 | PYTotalRevenueAmt |
| CY Total Revenue | $40,012,759 | 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 | $26,370,843 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $29,426,793 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $226,017 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,983,977 | PYOtherExpensesAmt |
| CY Other Expenses | $10,485,629 | CYOtherExpensesAmt |
| PY Total Expenses | $36,354,820 | PYTotalExpensesAmt |
| CY Total Expenses | $39,912,422 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$182,063 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $100,337 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $30,180,885 | TotalAssetsBOYAmt |
| Total Assets EOY | $30,514,963 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,259,380 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,493,121 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $26,921,505 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $27,021,842 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO BE THE MEDICAL, BEHAVIORAL HEALTH AND DENTAL CARE PROVIDER OF CHOICE FOR LOW-INCOME AND OTHER UNDERSERVED PEOPLE IN SOUTH BOULDER, BROOMFIELD AND WEST ADAMS COUNTIES. OUR CARE SHALL BE CULTURALLY APPROPRIATE AND PREVENTION FOCUSED. OUR VISION IS TO ASSURE THAT EVERY LOW-INCOME AND OTHER UNDERSERVED PERSON IN THESE AREAS HAVE ACCESS TO HIGH-QUALITY, PREVENTATIVE MEDICAL, BEHAVIORAL HEALTH AND DENTAL CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,725,590 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $26,327,131 | RevenueAmt |
| Desc | FOR FISCAL YEAR 2015, CLINICA PROVIDED 152,387 MEDICAL VISITS, 20,214 DENTAL VISITS, 15,514 BEHAVIORAL HEALTH VISITS, 2,158 REGISTERED DIETICIAN VISITS, AND 24,845 CASE MANAGEMENT VISITS. | Desc |
| Total Program Service Expenses | $29,725,590 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | 90 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 548 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 |
| States Where Copy Of Return Is Fld | CO | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BETSY DAVID | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3036504460 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1345 PLAZA COURT NORTH 1A | AddressLine1Txt |
| City | LAFAYETTE | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80026 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MANDY M RIGG | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GLADYS JOHNSON | ||||||||
| CHAIR-ELECT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL MORAN | ||||||||
| TREASURER & CHAIR-ELECT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH SHAFFER | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DAMON BROWN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| INEZ BUGGS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BEN GOLDSTEIN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| W DOUGLAS JONES | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARYANN KELLER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHELLE KREZEK | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LOIS LACROIX | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHERLYN MARRIOTT | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ELEANOR MONTOUR | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LIBBEY SMITH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DONOVAN TULLOCH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SIMON G SMITH | ||||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $167,762 | $0 | $34,293 | |||
| ELIZABETH A DAVID | ||||||||
| CFO | 40.00 | Yes (X) | $9,503 | $0 | $6,405 | |||
| SEAN C SAUNDERS | ||||||||
| CFO THROUGH 8/4/2014 | 40.00 | Yes (X) | $220,134 | $0 | $6,602 | |||
| KAREN FUNK | ||||||||
| VP OF CLINICAL SERVICES | 40.00 | $211,976 | $0 | $35,432 | Yes (X) | |||
| JUSTIN D WHEELER | ||||||||
| VP OF CLINICAL SERVICES | 40.00 | $206,163 | $0 | $30,613 | Yes (X) | |||
| AN T NGUYEN | ||||||||
| VP OF DENTAL SERVICES | 40.00 | $154,291 | $0 | $9,963 | Yes (X) | |||
| PHILIP J KEPPELER | ||||||||
| PHYSICIAN | 40.00 | $234,905 | $0 | $26,262 | Yes (X) | |||
| CHRISTOPHER J KEENAN | ||||||||
| PHYSICIAN | 40.00 | $225,498 | $0 | $18,201 | Yes (X) | |||
| COLLEEN KEPNER | ||||||||
| PHYSICIAN | 40.00 | $231,754 | $0 | $11,896 | Yes (X) | |||
| JESSICA KENERSON | ||||||||
| PHYSICIAN | 40.00 | $219,048 | $0 | $16,863 | Yes (X) | |||
| EDWARD L FARRELL | ||||||||
| PHYSICIAN | 40.00 | $193,102 | $0 | $21,740 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,074,136 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $218,270 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 47 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| TECHNICAL MOMENTUM LLC | |||||
| 5197 S VERSAILLES STREET | AURORA | CO | 80015 | IT SERVICES | $256,599 |
| INTEGRATED PHYSICIANS NETWORK | |||||
| 1913 S 88TH STREET | SUPERIOR | CO | 80027 | SOFTWARE LICENSE FEES | $245,413 |
| QUEST DIAGNOSTICS INC | |||||
| 695 S BROADWAY | DENVER | CO | 80209 | LABORATORY SERVICES | $229,893 |
| MOJOS CLEANING SERVICES | |||||
| 11352 E 111TH AVENUE | HENDERSON | CO | 80640 | JANITORIAL SERVICES | $203,872 |
| COLORADO PATHOLOGY CONSULTANTS | |||||
| PO BOX 840274 | DALLAS | TX | 75284 | PATHOLOGY SERVICES | $202,552 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $89,036 | FederatedCampaignsAmt |
| Government Grants | $10,514,096 | GovernmentGrantsAmt |
| All Other Contributions | $2,746,667 | AllOtherContributionsAmt |
| Noncash Contributions | $2,100,005 | NoncashContributionsAmt |
| Total Contributions | $13,349,799 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $25,111,215 | $25,111,215 |
| PHARMACY REVENUE | 621110 | $1,215,916 | $1,215,916 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,327,131 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,177 | TotalRevenueColumnAmt |
| Exclusion | $1,177 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $48 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $48 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $48 | TotalRevenueColumnAmt |
| Exclusion | $48 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $334,604 | TotalRevenueColumnAmt |
| Exclusion | $334,604 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $334,604 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,012,759 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,327,131 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $335,829 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,030,623 | TotalAmt |
| Management And General | $1,030,623 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,601,944 | TotalAmt |
| Program Services | $20,238,273 | ProgramServicesAmt |
| Management And General | $3,224,341 | ManagementAndGeneralAmt |
| Fundraising | $139,330 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $380,350 | TotalAmt |
| Program Services | $262,361 | ProgramServicesAmt |
| Management And General | $115,291 | ManagementAndGeneralAmt |
| Fundraising | $2,698 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,588,661 | TotalAmt |
| Program Services | $1,551,123 | ProgramServicesAmt |
| Management And General | $1,022,960 | ManagementAndGeneralAmt |
| Fundraising | $14,578 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,825,215 | TotalAmt |
| Program Services | $1,219,418 | ProgramServicesAmt |
| Management And General | $595,411 | ManagementAndGeneralAmt |
| Fundraising | $10,386 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,904 | TotalAmt |
| Program Services | $932 | ProgramServicesAmt |
| Management And General | $6,599 | ManagementAndGeneralAmt |
| Fundraising | $373 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,223 | TotalAmt |
| Program Services | $5,334 | ProgramServicesAmt |
| Management And General | $37,756 | ManagementAndGeneralAmt |
| Fundraising | $2,133 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,947,191 | TotalAmt |
| Program Services | $1,332,528 | ProgramServicesAmt |
| Management And General | $599,586 | ManagementAndGeneralAmt |
| Fundraising | $15,077 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,238 | TotalAmt |
| Program Services | $14,182 | ProgramServicesAmt |
| Management And General | $84,740 | ManagementAndGeneralAmt |
| Fundraising | $1,316 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $764,232 | TotalAmt |
| Program Services | $103,566 | ProgramServicesAmt |
| Management And General | $641,919 | ManagementAndGeneralAmt |
| Fundraising | $18,747 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $320,870 | TotalAmt |
| Program Services | $47,950 | ProgramServicesAmt |
| Management And General | $272,396 | ManagementAndGeneralAmt |
| Fundraising | $524 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,174,409 | TotalAmt |
| Program Services | $105,976 | ProgramServicesAmt |
| Management And General | $1,067,136 | ManagementAndGeneralAmt |
| Fundraising | $1,297 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,379 | TotalAmt |
| Program Services | $56,743 | ProgramServicesAmt |
| Management And General | $75,465 | ManagementAndGeneralAmt |
| Fundraising | $3,171 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,433 | TotalAmt |
| Program Services | $22,396 | ProgramServicesAmt |
| Management And General | $29,785 | ManagementAndGeneralAmt |
| Fundraising | $1,252 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,934 | TotalAmt |
| Management And General | $23,934 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,179,837 | TotalAmt |
| Program Services | $760,415 | ProgramServicesAmt |
| Management And General | $419,422 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,018 | TotalAmt |
| Program Services | $6,959 | ProgramServicesAmt |
| Management And General | $65,364 | ManagementAndGeneralAmt |
| Fundraising | $695 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $3,831,088 | $3,831,088 | ||
| MISCELLANEOUS | $236,382 | $33,888 | $200,032 | $2,462 |
| EDUCATION | $221,201 | $90,244 | $125,475 | $5,482 |
| EQUIPMENT RENTAL & REPA | $189,999 | $19,253 | $170,517 | $229 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,291 | TotalAmt |
| Program Services | $22,961 | ProgramServicesAmt |
| Management And General | $152,063 | ManagementAndGeneralAmt |
| Fundraising | $6,267 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,912,422 | TotalAmt |
| Program Services | $29,725,590 | ProgramServicesAmt |
| Management And General | $9,960,815 | ManagementAndGeneralAmt |
| Fundraising | $226,017 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,171,318 | BOYAmt |
| EOY | $6,528,762 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $596,266 | BOYAmt |
| EOY | $632,025 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $542,036 | BOYAmt |
| EOY | $522,642 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,287,941 | BOYAmt |
| EOY | $2,843,733 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,218 | BOYAmt |
| EOY | $39,344 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,048 | BOYAmt |
| EOY | $107,752 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,124,661 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,294,606 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,459,408 | BOYAmt |
| EOY | $19,830,055 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,650 | BOYAmt |
| EOY | $10,650 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,180,885 | BOYAmt |
| EOY | $30,514,963 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,369,881 | BOYAmt |
| EOY | $2,702,686 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,245 | BOYAmt |
| EOY | $51,157 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $843,254 | BOYAmt |
| EOY | $739,278 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,259,380 | BOYAmt |
| EOY | $3,493,121 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,468,434 | BOYAmt |
| EOY | $26,677,381 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,071 | BOYAmt |
| EOY | $344,461 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,921,505 | BOYAmt |
| EOY | $27,021,842 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,180,885 | BOYAmt |
| EOY | $30,514,963 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $100,337 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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 | $16,287,462 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,868,113 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,328,812 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,091,658 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,349,799 | CurrentTaxYearAmt |
| Total | $75,925,844 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,287,462 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,868,113 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,328,812 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,091,658 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,349,799 | CurrentTaxYearAmt |
| Total | $75,925,844 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $75,925,844 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,127 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,831 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,954 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,641 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,177 | CurrentTaxYearAmt |
| Total | $35,730 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,190 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,798 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $35,927 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $218,472 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $334,604 | CurrentTaxYearAmt |
| Total | $604,991 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $76,566,565 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $95,498,251 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99160 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99570 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME HONORARIUM MEDICAL RECORDS MEDICAID APPLICATIONS | 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 C IRS990ScheduleC
Total Grassroots Lobbying TotalGrassrootsLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $0 | FilingOrganizationsTotalAmt |
Total Direct Lobbying TotalDirectLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $22,357 | FilingOrganizationsTotalAmt |
Total Lobbying Expend TotalLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $22,357 | FilingOrganizationsTotalAmt |
Other Exempt Purpose Expend OtherExemptPurposeExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $39,664,048 | FilingOrganizationsTotalAmt |
Total Exempt Purpose Expend TotalExemptPurposeExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $39,686,405 | FilingOrganizationsTotalAmt |
Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $1,000,000 | FilingOrganizationsTotalAmt |
Grassroots Nontaxable GrassrootsNontaxableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $250,000 | FilingOrganizationsTotalAmt |
Tot Lbbyng Grassroot Mns Non Tx TotLbbyngGrassrootMnsNonTxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $0 | FilingOrganizationsTotalAmt |
Tot Lbby Expend Mns Lbbyng Non Tx TotLbbyExpendMnsLbbyngNonTxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $0 | FilingOrganizationsTotalAmt |
Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $1,000,000 | CurrentYearMinus3Amt |
| Current Year Minus2 | $1,000,000 | CurrentYearMinus2Amt |
| Current Year Minus1 | $1,000,000 | CurrentYearMinus1Amt |
| Current Year | $1,000,000 | CurrentYearAmt |
| Total | $4,000,000 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Lobbying Ceiling | $6,000,000 | LobbyingCeilingAmt |
Avg Total Lobbying Expend AvgTotalLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $10,292 | CurrentYearMinus3Amt |
| Current Year Minus2 | $10,658 | CurrentYearMinus2Amt |
| Current Year Minus1 | $18,808 | CurrentYearMinus1Amt |
| Current Year | $22,357 | CurrentYearAmt |
| Total | $62,115 | TotalAmt |
Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $250,000 | CurrentYearMinus3Amt |
| Current Year Minus2 | $250,000 | CurrentYearMinus2Amt |
| Current Year Minus1 | $250,000 | CurrentYearMinus1Amt |
| Current Year | $250,000 | CurrentYearAmt |
| Total | $1,000,000 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grassroots Ceiling | $1,500,000 | GrassrootsCeilingAmt |
Avg Grassroots Lobbying Expend AvgGrassrootsLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $0 | CurrentYearMinus3Amt |
| Current Year Minus2 | $0 | CurrentYearMinus2Amt |
| Current Year Minus1 | $0 | CurrentYearMinus1Amt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,300,781 | OtherCostOrOtherBasisAmt |
| Book Value | $4,300,781 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,913,905 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,836,238 | DepreciationAmt |
| Book Value | $14,077,667 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,909,975 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,458,368 | DepreciationAmt |
| Book Value | $1,451,607 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,830,055 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $40,439,664 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $318,296 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $542,928 | OtherRevenueAmt |
| Revenue Not Reported | $861,224 | RevenueNotReportedAmt |
| Revenue Subtotal | $39,578,440 | RevenueSubtotalAmt |
| Other Revenues Not Included | $434,319 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $434,319 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $40,012,759 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $40,230,718 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $318,296 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $318,296 | ExpensesNotReportedAmt |
| Expenses Subtotal | $39,912,422 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $39,912,422 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE YEARS 2012, 2013 AND 2014 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | NET ASSETS RELEASED FROM RESTRICTION 542,928. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | TEMPORARILY RESTRICTED CONTRIBUTIONS 434,319. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | 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 (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SIMON G SMITH | ||||||||||||||
| PRESIDENT & CEO | $157,762 | $0 | $10,000 | $0 | $0 | $0 | $3,388 | $0 | $30,905 | $0 | $202,055 | $0 | $0 | $0 |
| SEAN C SAUNDERS | ||||||||||||||
| CFO THROUGH 8/4/2014 | $158,379 | $0 | $0 | $0 | $61,755 | $0 | $1,808 | $0 | $4,794 | $0 | $226,736 | $0 | $0 | $0 |
| KAREN FUNK | ||||||||||||||
| VP OF CLINICAL SERVICES | $211,976 | $0 | $0 | $0 | $0 | $0 | $4,473 | $0 | $30,959 | $0 | $247,408 | $0 | $0 | $0 |
| JUSTIN D WHEELER | ||||||||||||||
| VP OF CLINICAL SERVICES | $206,163 | $0 | $0 | $0 | $0 | $0 | $2,190 | $0 | $28,423 | $0 | $236,776 | $0 | $0 | $0 |
| AN T NGUYEN | ||||||||||||||
| VP OF DENTAL SERVICES | $154,291 | $0 | $0 | $0 | $0 | $0 | $3,090 | $0 | $6,873 | $0 | $164,254 | $0 | $0 | $0 |
| PHILIP J KEPPELER | ||||||||||||||
| PHYSICIAN | $234,905 | $0 | $0 | $0 | $0 | $0 | $1,116 | $0 | $25,146 | $0 | $261,167 | $0 | $0 | $0 |
| CHRISTOPHER J KEENAN | ||||||||||||||
| PHYSICIAN | $225,498 | $0 | $0 | $0 | $0 | $0 | $4,597 | $0 | $13,604 | $0 | $243,699 | $0 | $0 | $0 |
| COLLEEN KEPNER | ||||||||||||||
| PHYSICIAN | $231,754 | $0 | $0 | $0 | $0 | $0 | $5,158 | $0 | $6,738 | $0 | $243,650 | $0 | $0 | $0 |
| JESSICA KENERSON | ||||||||||||||
| PHYSICIAN | $219,048 | $0 | $0 | $0 | $0 | $0 | $4,665 | $0 | $12,198 | $0 | $235,911 | $0 | $0 | $0 |
| EDWARD L FARRELL | ||||||||||||||
| PHYSICIAN | $193,102 | $0 | $0 | $0 | $0 | $0 | $3,973 | $0 | $17,767 | $0 | $214,842 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4A | FormAndLineReferenceDesc |
| Explanation | SEAN C. SAUNDERS - SEVERANCE PAYMENT - $61,755 | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $1,936,951 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | SOFTWARE | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $163,054 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD OF DIRECTORS REVIEWED THE FORM 990 PRIOR TO IT BEING FILED WITH THE IRS. THE CFO REVIEWED THE FORM 990 AND PRESENTED IT TO THE BOARD'S FINANCE COMMITTEE BEFORE IT WAS PRESENTED TO THE FULL BOARD. THE REVIEW INCLUDED A RECONCILIATION OF THE FORM 990 INFORMATION TO THE DATA IN THE AUDITED FINANCIAL STATEMENTS AND A COMPARISON OF THE DATA TO PRIOR YEAR FINANCIAL STATEMENTS TO CONFIRM REASONABLENESS. |
| FORM 990, PART VI, SECTION B, LINE 12C | NEW EMPLOYEES AND BOARD MEMBERS RECEIVE TRAINING AND ARE ASKED TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ON THE FIRST DAY OF EMPLOYMENT OR SERVICE, AND THEN ANNUALLY. ALL EMPLOYEES AND BOARD MEMBERS ARE INFORMED OF THEIR OBLIGATION TO IMMEDIATELY REPORT ANY CONFLICTS WHEN THEY OCCUR OUTSIDE OF THE ANNUAL PROCESS. THE COMPLIANCE OFFICER, CFO, AND/OR CEO REVIEWS ANY CONFLICTS IDENTIFIED AND A WRITTEN MANAGEMENT PLAN IS DEVELOPED, SIGNED BY THE EMPLOYEE AND HIS/HER MANAGER, AND REMAINS A PART OF THE EMPLOYEE'S HR FILE. ANY VIOLATIONS OF THE WRITTEN MANAGEMENT PLAN WILL RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION. NO EMPLOYEE, OFFICER, DIRECTOR OR AGENT OF THE ORGANIZATION CAN PARTICIPATE IN THE SELECTION OF A CONTRACT, INCLUDING PURCHASE ORDERS, OR IN THE ADMINISTRATION OF A CONTRACT, IF A REAL OR APPARENT CONFLICT OF INTEREST EXISTS. ALL SUPPLIERS COMPLETE A SUPPLIER CONFLICT OF INTEREST DISCLOSURE. EXCEPTIONS MAY BE APPROVED BY THE CEO OR CFO. THE EXCEPTION IS DOCUMENTED AND APPROPRIATELY DISCLOSED. MONITORING OF THE CONFLICTS OF INTEREST POLICY IS A STANDARD BOARD OF DIRECTORS MEETING AGENDA ITEM. BOARD MEMBERS IDENTIFY POTENTIAL CONFLICTS OF INTEREST BEFORE THE BOARD MEETING COMMENCES SO THAT THEY CAN BE ADDED TO THE AGENDA. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS' COMPENSATION COMMITTEE DETERMINED THE COMPENSATION OF THE CEO BY ANALYSIS OF MARKET SALARY INFORMATION PROVIDED BY MOUNTAIN STATES EMPLOYERS COUNCIL, MEDICAL GROUP MANAGEMENT ASSOCIATION, THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND CCHN. THE DISCUSSION/DELIBERATION WAS DOCUMENTED IN THE BOD COMPENSATION COMMITTEE NOTES AND BOD MINUTES AND A PAYROLL NOTE WITH BOD APPROVAL. THE ORGANIZATION USED A COMPENSATION CONSULTANT REFERRED BY MOUNTAIN STATES EMPLOYERS COUNCIL TO DETERMINE COMPENSATION OF OTHER OFFICERS, KEY EMPLOYEES, AND CERTAIN OTHER EMPLOYEES OF THE ORGANIZATION. THE CONSULTANT REVIEWED THE ORGANIZATION'S STRATEGIC OBJECTIVES, RELEVANT POLICIES AND PROCEDURES AND CURRENT COMPENSATION DOCUMENTATION. THE CONSULTANT USED SURVEYS AND OTHER INFORMATION TO DEVELOP UP-TO-DATE MARKET INFORMATION BASED ON THE DETAILED JOB DESCRIPTIONS PROVIDED BY THE ORGANIZATION. THE CONSULTANT DEVELOPED BASE COMPENSATION SALARY RANGES, INCLUDING COST ANALYSIS FOR PAY ADJUSTMENTS TO THOSE SALARIES FALLING OUTSIDE THE RANGE. THE LAST COMPENSATION ANALYSIS WAS PERFORMED IN 2013. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. |