P R HEALTH CORPORATION: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- P R HEALTH CORPORATION (EIN 45-0232743)
- Tax period
- 2024-01-01 to 2024-12-31
- Filed
- 2025-10-23
- IRS object ID
- 202522969349300032
- Schema version
- 2024v5.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-10-23T09:37:03-05:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4585 Coleman St Ste 200 | AddressLine1Txt |
| City | Bismarck | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58503 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450232743 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PR Health Corporation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PRHE | BusinessNameControlTxt |
| Phone | 7012847500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 Vivian St | AddressLine1Txt |
| City | Park River | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 582700708 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Marcus Lewis | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7012847500 | PhoneNum |
| Signature | 2025-10-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lisa Chaffee CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012551091 | PhoneNum |
| Preparation | 2025-10-23 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | First Care Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Marcus Lewis | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 Vivian St | AddressLine1Txt |
| City | Park River | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 582700708 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,480,469 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.firstcarehc.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1952 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Acute care hospital serving the healthcare needs of individuals residing in the Park River, ND area. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 160 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,193,851 | PYContributionsGrantsAmt |
| CY Contributions Grants | $478,475 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,440,632 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,310,390 | CYProgramServiceRevenueAmt |
| PY Investment Income | $270,859 | PYInvestmentIncomeAmt |
| CY Investment Income | $677,983 | CYInvestmentIncomeAmt |
| PY Other Revenue | $119,863 | PYOtherRevenueAmt |
| CY Other Revenue | -$33,792 | CYOtherRevenueAmt |
| PY Total Revenue | $21,025,205 | PYTotalRevenueAmt |
| CY Total Revenue | $22,433,056 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $13,313 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $12,875 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,947,375 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,170,854 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,083,079 | PYOtherExpensesAmt |
| CY Other Expenses | $12,091,965 | CYOtherExpensesAmt |
| PY Total Expenses | $19,043,767 | PYTotalExpensesAmt |
| CY Total Expenses | $22,275,694 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,981,438 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $157,362 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,767,436 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,959,687 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,399,423 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,445,350 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,368,013 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,514,337 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To continue the healing mission of Jesus in a rural setting. We are committed to: A respect for each person; A caring, Christian environment; Professional excellence; Promoting healthy communities; Personal service; and an Innovative spirit. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $19,467,022 | ExpenseAmt |
| Grant | $12,875 | GrantAmt |
| Revenue | $21,310,390 | RevenueAmt |
| Desc | First Care Health Center is dedicated to carrying out the healing mission of Jesus. In calendar year 2024, First Care Health Center provided acute care to 262 patients. This constituted 910 days of care. The swing-bed program at the health center provides skilled nursing care for the elderly. This program provided service to 138 patients, accounting for 1,921 days of care.First Care Health Center provides health care to the community in the form of outpatient services. In calendar year 2024, outpatient visits totaling 24,768 were provided to the community. In addition, there were 11,415 visits to First Care Rural Health Clinic. As part of the mission of First Care Health Center, we provide health care to persons who are unable to pay for the services that they receive. First Care Health Center will not deny care to anyone based on their ability to pay. Charity care, based on charges foregone, in the amount of $122,074, was written off for qualified individuals.Gross revenue from Medicare and Medicaid patients for calendar year 2024 was $14,262,101. Due to the limited reimbursement from these programs, the cost of these services to the hospital is not fully reimbursed. | Desc |
| Total Program Service Expenses | $19,467,022 | 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 | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| 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 | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| 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 | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 160 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 | 0 | 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 | 0 | 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 | Nina Hollingsworth CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7012844580 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 Vivian St | AddressLine1Txt |
| City | Park River | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58270 | 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Dennis Markusen | ||||||||
| Board Chair (Jan-Mar) | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Patty Dahlen | ||||||||
| Vice Chair (Jan-Mar)/Chair (Apr-Dec) | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Eugene Bossert - Director | ||||||||
| (Jan-Mar)/Vice Chair (Apr-Dec) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Ian Myrdal | ||||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Gale Beneda | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Nicholas Beneda DDS | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Mark Helgeson OD | ||||||||
| Director (Jan-Mar) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Katherine Hall | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Kirk Ham | ||||||||
| Director (Jan-Sept) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Brenda Nilson | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Diana Hahn | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Dori Carlson | ||||||||
| Director (Apr-Dec) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Casey Wollangk | ||||||||
| Director (Apr-Dec) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Marcus Lewis | ||||||||
| CEO | 40.00 | Yes (X) | $232,611 | $0 | $31,580 | |||
| Nina Hollingsworth | ||||||||
| CFO | 40.00 | Yes (X) | $115,296 | $0 | $15,454 | |||
| Lori Seim | ||||||||
| CNO | 40.00 | $159,730 | $0 | $9,256 | Yes (X) | |||
| Tamara Clemetson | ||||||||
| PA-C/Clinic Manager | 40.00 | $221,241 | $0 | $30,305 | Yes (X) | |||
| Mirza Baig | ||||||||
| Gastroenterologist | 27.00 | $424,816 | $0 | $32,105 | Yes (X) | |||
| Lindsey Gillespie | ||||||||
| RN/Care Coordinator | 40.00 | $154,682 | $0 | $19,051 | Yes (X) | |||
| Michael Bittles | ||||||||
| Surgeon | 8.00 | $188,334 | $0 | $5,650 | Yes (X) | |||
| Amy Burianek | ||||||||
| RN/Care Coordinator | 40.00 | $140,141 | $0 | $24,502 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,636,851 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $167,903 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | 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 |
|---|---|---|---|---|---|
| Triage LLC | |||||
| PO Box 773328 | Chicago | IL | 60677 | Staffing Agency | $1,882,637 |
| Joel J Johnson | |||||
| 115 Vivian St | Park River | ND | 58270 | Family Physician | $1,476,964 |
| Psychiatric Medical Care | |||||
| PO Box 734606 | Dallas | TX | 75373 | Behavioral Health | $602,788 |
| DMS Health Technologies | |||||
| PO Box 670747 | Dallas | TX | 75267 | Mobile Imaging | $381,328 |
| Independent Radiology | |||||
| PO Box 2746 | Fargo | ND | 58108 | Imaging Reads | $246,816 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $170,576 | FundraisingAmt |
| Government Grants | $249,592 | GovernmentGrantsAmt |
| All Other Contributions | $58,307 | AllOtherContributionsAmt |
| Noncash Contributions | $31,258 | NoncashContributionsAmt |
| Total Contributions | $478,475 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621110 | $21,110,402 | $21,110,402 |
| Supporting Revenue | 900099 | $186,395 | $186,395 |
| Auxiliary Revenue | 900099 | $13,593 | $13,593 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,310,390 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $671,983 | TotalRevenueColumnAmt |
| Exclusion | $671,983 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,000 | TotalRevenueColumnAmt |
| Exclusion | $6,000 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $13,621 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $170,576 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $47,413 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$33,792 | TotalRevenueColumnAmt |
| Exclusion | -$33,792 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,433,056 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,310,390 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $644,191 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,875 | TotalAmt |
| Program Services | $12,875 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $569,585 | TotalAmt |
| Program Services | $11,964 | ProgramServicesAmt |
| Management And General | $557,621 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,313,437 | TotalAmt |
| Program Services | $6,968,102 | ProgramServicesAmt |
| Management And General | $345,335 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $310,542 | TotalAmt |
| Program Services | $300,542 | ProgramServicesAmt |
| Management And General | $10,000 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,435,705 | TotalAmt |
| Program Services | $1,313,857 | ProgramServicesAmt |
| Management And General | $121,848 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $541,585 | TotalAmt |
| Program Services | $483,774 | ProgramServicesAmt |
| Management And General | $57,811 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,060 | TotalAmt |
| Management And General | $18,060 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,689 | TotalAmt |
| Management And General | $141,689 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,930,874 | TotalAmt |
| Program Services | $5,817,509 | ProgramServicesAmt |
| Management And General | $113,365 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,639 | TotalAmt |
| Program Services | $3,108 | ProgramServicesAmt |
| Management And General | $269,531 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,225,014 | TotalAmt |
| Program Services | $450,661 | ProgramServicesAmt |
| Management And General | $774,353 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $387,921 | TotalAmt |
| Program Services | $354,842 | ProgramServicesAmt |
| Management And General | $33,079 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,655 | TotalAmt |
| Program Services | $125,722 | ProgramServicesAmt |
| Management And General | $124,933 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,617 | TotalAmt |
| Program Services | $115,832 | ProgramServicesAmt |
| Management And General | $10,785 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,121,166 | TotalAmt |
| Program Services | $1,025,665 | ProgramServicesAmt |
| Management And General | $95,501 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,736 | TotalAmt |
| Program Services | $148,874 | ProgramServicesAmt |
| Management And General | $13,862 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $2,291,980 | $2,291,980 |
| Auxiliary Expenses | $2,555 | $2,555 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,059 | TotalAmt |
| Program Services | $39,160 | ProgramServicesAmt |
| Management And General | $120,899 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,275,694 | TotalAmt |
| Program Services | $19,467,022 | ProgramServicesAmt |
| Management And General | $2,808,672 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,642,096 | BOYAmt |
| EOY | $4,741,774 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,390,023 | BOYAmt |
| EOY | $3,059,933 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $522,709 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,090 | BOYAmt |
| EOY | $24,794 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $473,190 | BOYAmt |
| EOY | $535,302 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $210,880 | BOYAmt |
| EOY | $314,599 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $22,496,764 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,853,127 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,678,749 | BOYAmt |
| EOY | $7,643,637 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,361,786 | BOYAmt |
| EOY | $13,004,283 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,003,622 | BOYAmt |
| EOY | $112,656 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,767,436 | BOYAmt |
| EOY | $29,959,687 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,269,806 | BOYAmt |
| EOY | $1,845,447 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,978,806 | BOYAmt |
| EOY | $2,755,576 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,811 | BOYAmt |
| EOY | $844,327 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,399,423 | BOYAmt |
| EOY | $5,445,350 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,512,588 | BOYAmt |
| EOY | $22,409,320 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,855,425 | BOYAmt |
| EOY | $2,105,017 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,368,013 | BOYAmt |
| EOY | $24,514,337 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,767,436 | BOYAmt |
| EOY | $29,959,687 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $157,362 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$11,038 | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $2,240 | BeginningBalanceAmt |
| Additions During Year | $13,593 | AdditionsDuringYearAmt |
| Distributions During Year | $2,555 | DistributionsDuringYearAmt |
| Ending Balance | $13,278 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $154,334 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $5,717 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,717 | OtherExpendituresAmt |
| End Year Balance | $154,334 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $154,334 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,370 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,370 | OtherExpendituresAmt |
| End Year Balance | $154,334 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $154,334 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $345 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $345 | OtherExpendituresAmt |
| End Year Balance | $154,334 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $154,334 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $347 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $347 | OtherExpendituresAmt |
| End Year Balance | $154,334 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $154,334 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $308 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $308 | OtherExpendituresAmt |
| End Year Balance | $154,334 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $62,063 | OtherCostOrOtherBasisAmt |
| Book Value | $62,063 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,558,248 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,135,956 | DepreciationAmt |
| Book Value | $3,422,292 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,045,829 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,385,498 | DepreciationAmt |
| Book Value | $3,660,331 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $830,624 | OtherCostOrOtherBasisAmt |
| Depreciation | $331,673 | DepreciationAmt |
| Book Value | $498,951 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,643,637 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Finance Lease | $117,033 |
| Estimated third-party payor settlements | $324,558 |
| Split-dollar life insurance obligations | $402,736 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $844,327 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $22,419,463 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $22,419,463 | RevenueSubtotalAmt |
| Other Revenues Not Included | $13,593 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $13,593 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $22,433,056 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,267,422 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,267,422 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $8,272 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $8,272 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $22,275,694 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | The organization holds assets on behalf of the First Care Health Center Auxiliary. |
| Part V, Line 4: | Investments are to be held in perpetuity, and the income from the investments is expendable to support various health care services. |
| Part X, Line 2: | The Health Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 4b - Other Adjustments: | Income from Auxiliary Operations 13,593. |
| Part XII, Line 4b - Other Adjustments: | Expenses from Auxiliary Operations 2,555. Endowment Expenditures Recorded in Net Assets 5,717. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Harvest Fest | Event1Nm |
| Gross Receipts Event1 | $136,847 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $129,897 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $6,950 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $28,704 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $150 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $5,500 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $1,300 | EntertainmentEvent1Amt |
| Event2 | Golf Tournament | Event2Nm |
| Gross Receipts Event2 | $47,350 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $40,679 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $6,671 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $500 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $4,588 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $3,690 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $2,484 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $497 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $184,197 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $170,576 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $13,621 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $500 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $33,292 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,840 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $7,984 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $1,300 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $497 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $47,413 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$33,792 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $84,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $84,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,038,148 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $661,555 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $376,593 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01690 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,122,148 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $661,555 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $460,593 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02070 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,422 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,500 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $28,922 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,572 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,552 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $22,020 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,275 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,275 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $76,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,052 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $68,217 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,198,417 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $669,607 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $528,810 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02380 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,277 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,277 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $189 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $189 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,786 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,786 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,204 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,204 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,456 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,456 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $146,690 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $71,715 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,065,061 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,170,567 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$105,506 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | First Care Health Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 Vivian Street PO Box I | AddressLine1Txt |
| City | Park River | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 582700708 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.firstcarehc.com | WebsiteAddressTxt |
| State License | 5042 | StateLicenseNum |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | First Care Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V, Page 8 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | firstcarehc.com/community-health-needs-assessment | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | firstcarehc.com/insurance-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | firstcarehc.com/insurance-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | firstcarehc.com/insurance-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| First Care Health Center | Part V, Section B, Line 5: Administrator of Walsh County Public Health was a member of our steering committee as well as a key informant during the interview phase. They were present at planning meetings throughout the CHNA process and assisted with the implementation of the surveys throughout the county. We also included various community members that would have knowledge and expertise related to health needs of medically underserved, low-income, and minority populations including school staff, local pastors, law enforcement, medical providers, human service center providers, social workers, and population health nurses. |
| First Care Health Center | Part V, Section B, Line 6a: Unity Medical Center located in Grafton, ND. |
| First Care Health Center | Part V, Section B, Line 6b: Walsh County Health District |
| First Care Health Center | Part V, Section B, Line 11: The needs identified in the latest CHNA were, in descending order, the availability of mental health and disorder treatment services, the availability of resources to help the elderly stay in their homes, the availability of transportation resources, and having enough child daycare services. The actions taken in the current year to address the needs identified are as follows:1. Hired a full time Psychologist to provide behavioral health services both virtually and in person. Continued to provide Senior Life Solutions, telepsychiatry, and an e-emergency solution to coordinate behavioral health care in the ED to support behavioral health within the community. Continued to provide space for UND Psychology students to provide services free of charge.2. Continued to provide transportation for patients free of charge.3. Continued to participate in the Walsh County Substance Abuse Coalition.4. Attended quarterly Walsh County Behavioral Health meetings to collaborate with other resources within the community.5. Continued to employ an outpatient care coordinator to assist high risk patients.6. Continued to provide Powerful Tools for Caregivers course throughout the year.7. Started a daycare to address the severe daycare shortage within the area. |
| First Care Health Center | Part V, Section B, Line 13b: The Hospital provides free care and discounted care up to 300% of the Federal Poverty Income guidelines. In addition to the FPGs, the hospital requires proof of Medicaid/Medicaid expansion denial, most recent tax return copy, current wage verification, and a completed financial assistance application. |
| Schedule H, Part V, Line 7a: | firstcarehc.com/community-health-needs-assessment |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - First Care Rural Health Clinic | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 115 Vivian Street | AddressLine1Txt |
| City | Park River | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58270 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Rural Health Clinic | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | The Hospital provides free care and discounted care up to 300% of the Federal Poverty Income guidelines. In addition to the FPGs, the hospital requires proof of Medicaid/Medicaid expansion denial, most recent tax return copy, current wage verification, and a completed financial assistance application. |
| Part I, Line 7: | The Organization calculated the cost for providing financial assistance reported in Part I, line 7a by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Medicaidon line 7b and subsidized health services on line 7g are reported according to costs allocated to the relevant costs centers on the Medicare Cost Report. The Organization used actual expenses to determine the cost for Community Health Improvement Services and Caontributions, lines 7e and 7i. |
| Part II, Community Building Activities: | Employees participate in meetings, events, and committees to assist new businesses, develop housing projects, improve access to care, and address other concerns to help the community. |
| Part III, Line 2: | The amount reported on line 2 represents implicit price concessions. The hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. |
| Part III, Line 3: | The estimated amount of implicit price concessions attributable to patients eligible for charity care of is determined by taking the percentage of applications that were denied due to lack of information or unwillingness to complete the applications. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on pages 13 and 14 of the attached audited financial statements. |
| Part III, Line 8: | One hundred percent of any shortfall should be treated as community benefit. A facility must be able to recover its costs in order to continue to provide quality care to Medicare patients and the community as a whole. Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall, if any, is considered a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the Hospital would have had a greater loss from Medicare services of $189,867.Medicare fee schedule revenue $207,201Medicare estimated costs of care relating to payments $(397,068)Net Surplus (Shortage) $(189,867) |
| Part III, Line 9b: | If a patient hasn't made a payment on their bill 30 days after they receive it, they receive a letter reminding them to pay it. A patient continues to receive letters up to 120 days after they receive their bill if they haven't made any payments, stating that their account could be turned over to bad debt or turn in a financial assistance application. The patient has up to 240 days to turn in their financial assistance application from the time of their first bill. If a patient applies for financial assistance within 240 days of the date of the first invoice the patient charges are pulled from collections as the Hospital works with the patient to complete the application. |
| Part VI, Line 2: | First Care Health Center utilizes patient satisfaction surveys and assessment surveys to get feedback on the services offered and to find out what services are desired by the people we serve. Most recently, the surveys focused on wellness and outreach to the surrounding communities. |
| Part VI, Line 3: | First Care Health Center posts its charity care policy, or a summary thereof, and financial assistance contact information (1) in admissions areas, emergency rooms, and other areas of the Organization's facilities in which eligible patients are likely to be present;(2) provides a copy of the policy, or a verbal summary thereof, and financial assistance contact information to patients as part of the intake process; (3) provides a copy of the policy, or a verbal summary thereof, and financial assistance contact information to patients with discharge materials; (4) may include the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (5) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. In addition, the charity care policy, application and plain language summary are posted on the facility web site. |
| Part VI, Line 4: | First Care Health Center (FCHC) serves a rural geographical area in NE North Dakota which includes portions of six counties. The total population served is estimated at 19,500. The median household income of the service area is $51,181 with 11.0% of the population below the federal poverty level. Almost 15 percent of the communities' patients are uninsured or on Medicaid. The main county, in which the Health Center is located, is a federally-designated primary care HPSA due to low income. FCHC is located in Park River, which is a federally-designated medically underserved area. The unemployment rate of the service area is 6.1%. Nearly 21.0% of the area population is over 65 years of age and just over 22.7% of the area population are children zero to seventeen years of age. |
| Part VI, Line 5: | The Organization's governing body is comprised of persons who reside in the Organization's primary service area. The Organization applies any surplus funds to improve the Facility and equipment to improve patient care. The Organization also extends medical staff privileges to other qualified physicians in the community.Educational pamphlets and brochures are available at no cost to patients. FCHC staff assist patients with understanding their Medicare and Medicaid benefits, applying for said benefits, and assist with completing Advanced Medical Directives and Living Wills. The Facility participates in the annual county fair by renting booth space to educate the public on various health issues. First Care Health Center sponsors drives to collect school supplies for the area schools and food donations to the local food pantry. FCHC participates in mentoring medical, pharmacy, nursing, and health careers students. First Care Health Center also provides nail care at a nominal fee by licensed staff. This service serves as a first step in checking for issues in diabetic patients. The fee does not cover the cost of space, salaries, or supplies, but is done more as a service to patients.First Care Health Center provides many other services that benefit the community for which there is little or no reimbursement. The following list provides examples of some of the services and programs offered:*Tours of the hospital to children.*Provide rooms for overnight stay for families of patients.*Training to area vocational high school students.*Provide preceptorships for nurses training.*Provide educational pamphlets and brochures to the community.*Provide free medical advice from registered nurses via telephone.*Provide meals to parents of pediatric patients.*Personnel run errands for patients.*Provide supplies and movies for activities and crafts for swing-bed patients.*Pay for local travel for swing-bed patients. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mirza Baig | ||||||||||||||
| Gastroenterologist | $424,816 | $0 | $0 | $0 | $0 | $0 | $17,250 | $0 | $14,855 | $0 | $456,921 | $0 | $0 | $0 |
| Marcus Lewis | ||||||||||||||
| CEO | $232,611 | $0 | $0 | $0 | $0 | $0 | $12,174 | $0 | $21,333 | $0 | $266,118 | $0 | $0 | $0 |
| Tamara Clemetson | ||||||||||||||
| PA-C/Clinic Manager | $221,241 | $0 | $0 | $0 | $0 | $0 | $19,175 | $0 | $13,056 | $0 | $253,472 | $0 | $0 | $0 |
| Michael Bittles | ||||||||||||||
| Surgeon | $188,334 | $0 | $0 | $0 | $0 | $0 | $5,650 | $0 | $0 | $0 | $193,984 | $0 | $0 | $0 |
| Lindsey Gillespie | ||||||||||||||
| RN/Care Coordinator | $154,682 | $0 | $0 | $0 | $0 | $0 | $7,922 | $0 | $12,361 | $0 | $174,965 | $0 | $0 | $0 |
| Lori Seim | ||||||||||||||
| CNO | $159,730 | $0 | $0 | $0 | $0 | $0 | $8,056 | $0 | $3,126 | $0 | $170,912 | $0 | $0 | $0 |
| Amy Burianek | ||||||||||||||
| RN/Care Coordinator | $140,141 | $0 | $0 | $0 | $0 | $0 | $7,426 | $0 | $18,468 | $0 | $166,035 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Marcus Lewis | PersonNm |
| Relationship With Org | CEO | RelationshipWithOrgTxt |
| Loan Purpose | CASD Plan loan | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $503,420 | OriginalPrincipalAmt |
| Balance Due | $522,709 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $522,709 | TotalBalanceDueAmt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | Auction Items | 32 | $21,735 | FMV |
| Yes (X) | Event Prizes | 70 | $9,523 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Column (b): | FormAndLineReferenceDesc |
| Explanation | Number of items contributed | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 8b | There are no committees that exist that can act on behalf of the governing board. All decisions are made by the governing board. |
| Form 990, Part VI, Section B, line 11b | The CFO and Administrator review the Form 990 together. The Form 990 is also provided to the Board of Directors electronically for their review prior to filing the Form 990 with the IRS. |
| Form 990, Part VI, Section B, line 12c | The conflict of interst policy covers the Board of Directors and all employees. Annual disclosures by the board members and officers of the organization are reviewed by the CFO after signature. The Board would review any potential conflicts of the CFO. If a board member has a conflict on a particular issue he/she will identify the conflict and he/she must abstain from voting on that issue. |
| Form 990, Part VI, Section B, line 15a | The independent Board determines and approves the Administrator's compensation. The board compares the salary with similar organizations, all of which is recorded in the board meeting minutes. The CFO's salary is determined by the Administrator, which is typically a small percentage increase from the prior year. The process for determining compensation for both positions is performed on an annual basis. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy, and financial statements are available upon request. |
| Form 990, Part IX, line 11g | Medical Professional Fees: Program service expenses 5,775,065. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,775,065. Adm Collection Expense: Program service expenses 0. Management and general expenses 72,634. Fundraising expenses 0. Total expenses 72,634. Admin Professional Fees: Program service expenses 0. Management and general expenses 34,076. Fundraising expenses 0. Total expenses 34,076. Maintenance and housekeeping professional fees: Program service expenses 42,444. Management and general expenses 0. Fundraising expenses 0. Total expenses 42,444. Consulting: Program service expenses 0. Management and general expenses 6,655. Fundraising expenses 0. Total expenses 6,655. |
| Form 990, Part XI, line 9: | Net Income From Auxiliary Operations -11,038. |