GATEWAY COMMUNITY HEALTH CENTERS INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GATEWAY COMMUNITY HEALTH CENTERS INC (EIN 46-2385383)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-15
- IRS object ID
- 201412279349303691
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-08-15T14:14:57-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462385383 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GATEWAY COMMUNITY HEALTH CENTERS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GATE | NameControl |
| Phone | 2523844088 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1144 NORTH ROAD STREET | AddressLine1 |
| City | ELIZABETH CITY | City |
| State | NC | State |
| ZIP Code | 27909 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SIGNING OFFICER | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 2523844088 | Phone |
| Date Signed | 2014-08-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | ROSE TURNER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1144 NORTH ROAD STREET | AddressLine1 |
| City | ELIZABETH CITY | City |
| State | NC | State |
| ZIP Code | 27909 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1315301 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2010 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO OPERATE A FEDERALLY QUALIFIED HEALTH CENTER (FHQC) IN NORTHEAST NORTH CAROLINA | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 15 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1019677 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 701445 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 535656 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 605570 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 547 | OtherRevenuePriorYear |
| Other Revenue Current Year | 8286 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1555880 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1315301 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 835164 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1025123 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 384224 | OtherExpensePriorYear |
| Other Expenses Current Year | 467298 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1219388 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1492421 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 336492 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -177120 | RevenuesLessExpensesCY |
| Total Assets BOY | 547338 | TotalAssetsBOY |
| Total Assets EOY | 451604 | TotalAssetsEOY |
| Total Liabilities BOY | 222261 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 303647 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 325077 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 147957 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO OPERATE A COMMUNITY HEALTH CENTER THAT PROVIDES PREVENTIVE AND PRIMARY HEALTH CARE SERVICES, RELATED ENABLING AND ANCILLARY SERVICES, AND OTHER CRITICAL COMMUNITY AND SOCIAL SERVICES REGARDLESS OF A PATIENT'S INSURANCE STATUS OR ABILITY TO PAY TO THE COMMUNITIES OF GATES, CHOWAN, AND PERQUIMANS COUNTIES OF NORTH CAROLINA. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1126687 | Expense |
| Revenue | 605570 | Revenue |
| Description | GATEWAY COMMUNITY HEALTH CENTERS, INC.(GCHC) IS A PRIVATE, NON-PROFIT 501(C)(3) CORPORATION HEADQUARTERED IN GATESVILLE, NORTH CAROLINA CELEBRATING 35 YEARS OF PROVIDING QUALITY HEALTHCARE SERVICE TO NORTHEASTERN COUNTIES OF NORTH CAROLINA. GCHC WAS ESTABLISHED IN 1979 (AS GATES COUNTY RURAL HEALTH CLINIC) WITH A MISSION TO "ENSURE THE PROVISION OF HIGH QUALITY HEALTH SERVICES TO THE PEOPLE WE SERVE." THE PROJECT BEGAN AS A SHARED PLANNING EFFORT SPEARHEADED BY CONCERNED COMMUNITY LEADERS. THE HEALTH CENTER IS GOVERNED BY A NINE MEMBER VOLUNTEER BOARD OF DIRECTORS WHICH REPRESENTS (A) USERS/PATIENTS OF THE HEALTH CENTERS, (B) COMMUNITY ORGANIZATIONS, GOVERNMENT AND LOCAL BUSINESSES AND (C) THE HEALTH CARE PROFESSION. ACCORDING TO THE US CENSUS, THE 2010 ESTIMATED POPULATION IS 110,877 PERSONS IN TWENTY FOUR UNDUPLICATED ZIP CODES (27818, 27909, 27917, 27919, 27921, 27922, 27926, 27929, 27932, 27934, 27935, 27937, 27938, 27942, 27944, 27946, 27956, 27958, 27973, 27974, 27976, 27979, 27980, 27986) ENCOMPASSING SEVEN NORTH CAROLINA COUNTIES: (CAMDEN, CHOWAN, CURRITUCK, GATES, HERTFORD, PASQUOTANK AND PERQUIMANS). GCHC PROPOSES TO SERVE AT LEAST 2639 USERS BY THE END OF THE PROJECT.SIX OF THE SEVEN COUNTIES ARE HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) AND MEDICALLY UNDERSERVED AREAS (MUA). THESE AREAS ARE RURAL WITH MANY NEGATIVE SOCIAL AND ECONOMIC FACTORS AFFECTING THE POPULATION. IN ADDITION, THE ENTIRE COMMUNITY SUFFERS FROM SOME OF THE HIGHEST DEATH AND DISEASE RATES IN THE STATE OF NORTH CAROLINA, WHERE HEALTH DISPARITIES ARE SOME OF THE HIGHEST IN THE UNITED STATES. GCHC DESIRES TO CONTINUE PROVIDING MEDICAL SERVICES TO THE RESIDENTS AND SEASONAL AND MIGRANT HEALTH WORKERS IN THE SERVICE AREA AND REMAIN THE PRINCIPAL SOURCE OF SUPPORT FOR THIS INDIGENT MEDICALLY UNDERSERVED COMMUNITY. GIVEN THE POVERTY LEVEL, LACK OF PUBLIC TRANSPORTATION SYSTEM AND HIGH PERCENTAGE OF MIGRANT WORKERS, IT IS APPARENT THAT ACCESS TO PRIMARY HEALTH CARE SERVICES IS OF GREAT CONCERN AND A SUBSTANTIAL NEED FOR THIS TARGETED AREA. THIS POPULATION STRUGGLES WITHOUT HAVING AN ACCESSIBLE PRIMARY CARE PROVIDER THAT ACCEPTS MEDICAID OR OPERATES ON A SLIDING FEE SCHEDULE, AND IT ALSO REPRESENTS A LARGE PORTION OF FAMILIES WHO LACK INSURANCE FOR HEALTHCARE. OUR GOAL IS QUITE SIMPLE - KEEP OUR ORGANIZATION AS THE PRIMARY SAFETY NET PROVIDER OF QUALITY HEALTHCARE SERVICES FOR THOSE IN NEED THROUGH A MEDIUM OF CARE THAT IMPROVE HEALTH OUTCOMES. | Description |
| Total Program Service Expense | 1126687 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 15 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2523844088 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1144 NORTH ROAD STREET | AddressLine1 |
| City | ELIZABETH CITY | City |
| State | NC | State |
| ZIP Code | 27909 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JEFF SACKRISON | |||||||
| PRESIDENT (THRU MAY 2013) | 1.00 | X | X | 0 | 0 | 0 | |
| REV WESLEY BOONE | |||||||
| PRESIDENT AND VICE PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| JENNIFER GREENE | |||||||
| VICE PRESIDENT AND TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| TERRI RIDDICK | |||||||
| SECRETARY (THRU MAY 2013) | 1.00 | X | X | 0 | 0 | 0 | |
| JUDITH AGUILAR | |||||||
| TREASURER (BEGAN MAY 2013) | 1.00 | X | X | 0 | 0 | 0 | |
| KAY WIGGINS | |||||||
| SECRETARY (BEGAN MAY 2013) | 1.00 | X | X | 0 | 0 | 0 | |
| RICHARD OCHOA | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| PAT BASTEK | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| FANNIE LANGSTON | |||||||
| BOARD MEMBER (THRU MAY 2013) | 1.00 | X | 0 | 0 | 0 | ||
| GEOFF MARETT | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JUDITH AGUILAR | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ALTHEA RIDDICK | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| TIM GRAVGAARD | |||||||
| BOARD MEMBER (BEGAN SEP 2013) | 1.00 | X | 0 | 0 | 0 | ||
| CAROLYN ALLISON | |||||||
| EXECUTIVE DIRECTOR (THRU 07/2013) | 40.00 | X | 151596 | 0 | 0 | ||
| ROSE TURNER | |||||||
| EXECUTIVE DIRECTOR (BEGAN 06/2013) | 40.00 | X | 0 | 0 | 0 | ||
| RAYETTE POLLARD CASIANO | |||||||
| PHYSICIAN | 40.00 | 160316 | 0 | 19093 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 311912 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 19093 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Government Grants | 539017 | GovernmentGrants |
| All Other Contributions | 162428 | AllOtherContributions |
| Total Contributions | 701445 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 621400 | 599252 | 599252 |
| PRESCRIPTION PROCESS | 621400 | 3644 | 3644 |
| MEDICAL RECORD TRANSCR | 621400 | 2674 | 2674 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 605570 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 8286 | TotalRevenueColumn |
| Exclusion | $8,286 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 8286 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1315301 | TotalRevenueColumn |
| Related Or Exempt Function Income | 605570 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $8,286 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 151596 | Total |
| Management And General | 151596 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 760987 | Total |
| Program Services | 648710 | ProgramServices |
| Management And General | 112277 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6515 | Total |
| Program Services | 4631 | ProgramServices |
| Management And General | 1884 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51884 | Total |
| Program Services | 45044 | ProgramServices |
| Management And General | 6840 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54141 | Total |
| Program Services | 45591 | ProgramServices |
| Management And General | 8550 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4541 | Total |
| Management And General | 4541 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 343 | Total |
| Management And General | 343 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31733 | Total |
| Management And General | 31733 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73419 | Total |
| Program Services | 37318 | ProgramServices |
| Management And General | 36101 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34678 | Total |
| Program Services | 34320 | ProgramServices |
| Management And General | 358 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180 | Total |
| Management And General | 180 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72159 | Total |
| Program Services | 72159 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13547 | Total |
| Program Services | 8560 | ProgramServices |
| Management And General | 4987 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11459 | Total |
| Program Services | 11459 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17667 | Total |
| Program Services | 14067 | ProgramServices |
| Management And General | 3600 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 189644 | 189644 | |
| MEDICAL SUPPLIES | 12494 | 12494 | |
| OTHER EXPENSE | 5434 | 2690 | 2744 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1492421 | Total |
| Program Services | 1126687 | ProgramServices |
| Management And General | 365734 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 97290 | BOY |
| EOY | 247344 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 400 | BOY |
| EOY | 400 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 327817 | BOY |
| EOY | 117284 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5154 | BOY |
| EOY | 1929 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 79371 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 19794 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66997 | BOY |
| EOY | 59577 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49680 | BOY |
| EOY | 25070 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 547338 | BOY |
| EOY | 451604 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11260 | BOY |
| EOY | 52275 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 211001 | BOY |
| EOY | 251372 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 222261 | BOY |
| EOY | 303647 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 325077 | BOY |
| EOY | 110573 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 37384 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 325077 | BOY |
| EOY | 147957 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 547338 | BOY |
| EOY | 451604 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -177120 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 76640 | OtherCostOrOtherBasis |
| Depreciation | 19794 | Depreciation |
| Book Value | 56846 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2731 | OtherCostOrOtherBasis |
| Book Value | 2731 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 59577 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM AHA | 9110 |
| OTHER RECEIVABLES | 15960 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 25070 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO AHA | $171,339 |
| DUE TO APS | $80,033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 251372 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 1125657 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 1125657 | RevenueSubtotal |
| Other Revenues Not Included | 189644 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 189644 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1315301 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1302777 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1302777 | ExpensesSubtotal |
| Other Expenses Not Included | 189644 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 189644 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1492421 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE CENTER IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE CENTER HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. THE CENTER BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2010. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBTS NET WITH REVENUE 189,644. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBTS NET WITH REVENUE 189,644. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROLYN ALLISON | ||||||||||||||
| EXECUTIVE DIRECTOR (THRU 07/2013) | 151596 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 151596 | 0 | 0 | 0 |
| RAYETTE POLLARD CASIANO | ||||||||||||||
| PHYSICIAN | 160316 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 19093 | 0 | 179409 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITEE IS COMPRISED OF THE PRESIDENT, THE VICE PRESIDENT, THE SECRETARY, AND THE TREASURER. THE EXECUTIVE COMMITTEE IS AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH ALL THE POWERS OF THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 3 | ACCORDING TO A CO-APPLICANT AGREEMENT WITH ALBEMARLE HOSPITAL AUTHORITY TO OPERATE THE FEDERALLY QUALIFIED HEALTH CENTER, THE EXECUTIVE DIRECTOR IS AN EMPLOYEEE OF ALBEMARLE HOSPITAL AUTHORITY. THE EXECUTIVE DIRECTOR HAS THE AUTHORITY TO SELECT, SUPERVISE, AND DISCHARGE ALL GCHC PERSONNEL. THE EXECUTIVE DIRECTOR DEVOTES ALL OF HIS/HER TIME TO THE OPERATIONS OF GCHC, WHILE THE OTHER OFFICERS DEVOTE APPROXIMATELY 1% OF THEIR TIME TO GCHC. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE TAX RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT. THE COMPLETED IRS FORM 990 TAX RETURN, ALONG WITH ALL SUPPORTING SCHEDULES, WAS THEN PROVIDED TO BOARD MEMBERS. BOARD MEMBERS REVIEWED THE TAX RETURN BEFORE IT WAS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE CONFLICT OF INTEREST POLICY AND EACH MEMBER PROVIDES IN WRITING AN ACKNOWLEDGEMENT OF THEIR UNDERSTANDING OF THE POLICY AND DISCLOSURE OF ANY POTENTIAL CONFLICTS. ALL DISCLOSURES ARE PROVIDED TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE REVIEWS AND FOLLOWS UP ON ANY POTENTIAL ISSUES. IF ANY CONFLICT EXISTS, THAT MEMBER DOES NOT PARTICIPATE IN DISCUSSIONS OR VOTING REGARDING THAT MATTER. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |