MIDTOWN HEALTH CENTER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MIDTOWN HEALTH CENTER INC (EIN 47-0833378)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-05-13
- IRS object ID
- 201421339349305242
- 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 | 2014-05-13T16:31:12-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201430448 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Christensen Brozek Faltys PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1264 | AddressLine1 |
| City | Norfolk | City |
| State | NE | State |
| ZIP Code | 68702 | 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 | 470833378 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Norfolk Community Health Care Clinic In | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORF | NameControl |
| Phone | 4026447314 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N 16th Street Suite 16 | AddressLine1 |
| City | Norfolk | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kathleen Nordby | Name |
| Title | Executive Director | Title |
| Phone | 4026447314 | Phone |
| Date Signed | 2014-04-03 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Danny Fuerhoff CPA | Name |
| PTIN | P00026845 | PTIN |
| Phone | 4023711160 | 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) |
|---|---|---|
| Name Of Principal Officer Person | Kathleen Nordby | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N 16th Street Suite 16 | AddressLine1 |
| City | Norfolk | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2752534 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1999 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | Provide medical, behavioral and dental services that are affordable, accessible and patient focused. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 50 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1436220 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1596091 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1374542 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1154232 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2109 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2211 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 562 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2813433 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2752534 | 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 | 1528212 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1675415 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 188273 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 968359 | OtherExpensePriorYear |
| Other Expenses Current Year | 1010255 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2496571 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2685670 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 316862 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 66864 | RevenuesLessExpensesCY |
| Total Assets BOY | 1073509 | TotalAssetsBOY |
| Total Assets EOY | 1337920 | TotalAssetsEOY |
| Total Liabilities BOY | 130294 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 327840 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 943215 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1010080 | NetAssetsOrFundBalancesEOY |
| Mission Description | Providing high quality medical, behavioral, and dental services that are affordable, accessible, and patient focused. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1873078 | Expense |
| Revenue | 1154232 | Revenue |
| Description | The organization provides medical, dental and behavioral health services to the poor and uninsured or under-insured of our community. Our target population is this population within Madison County but we do not deny services to anyone based on their geographic location or ability to pay. In 2012 we saw 4,442 unduplicated patients for a total of 18,448 encounters. Of this population 51% were uninsured, 25% were either Medicaid or Medicare and the rest had private insurance. | Description |
| Total Program Service Expense | 1873078 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 0 | 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 | 0 | 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 | 1 | 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 | 50 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | 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 | 4026447314 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 N 16th Street Suite 16 | AddressLine1 |
| City | Norfolk | City |
| State | NE | State |
| ZIP Code | 68701 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| Kathy Nordby | ||||||
| Executive Director | 40.00 | X | 92637 | 0 | 0 | |
| Karen Weidner | ||||||
| Past Chair | 4.00 | X | 0 | 0 | 0 | |
| Joe Mtika | ||||||
| President | 8.00 | X | 0 | 0 | 0 | X |
| Brenda Jones | ||||||
| Vice President | 4.00 | X | 0 | 0 | 0 | X |
| Doug Witte | ||||||
| Treasurer | 4.00 | X | 0 | 0 | 0 | X |
| Pat Samuels | ||||||
| Board member | 1.00 | X | 0 | 0 | 0 | |
| Betty Froehlich | ||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | X |
| Gretchen Forsell | ||||||
| Board member | 1.00 | X | 0 | 0 | 0 | |
| Josh Moenning | ||||||
| Board member | 1.00 | X | 0 | 0 | 0 | |
| Linda Haack | ||||||
| Board member | 1.00 | X | 0 | 0 | 0 | |
| Mavis Hatcliff | ||||||
| Board member | 1.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 92637 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 58000 | FederatedCampaigns |
| Government Grants | 1536150 | GovernmentGrants |
| All Other Contributions | 1941 | AllOtherContributions |
| Total Contributions | 1596091 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient revenue | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 1154232 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1154232 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1154232 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2211 | TotalRevenueColumn |
| Exclusion | $2,211 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2752534 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1154232 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $2,211 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92500 | Total |
| Program Services | 55500 | ProgramServices |
| Management And General | 27750 | ManagementAndGeneral |
| Fundraising | 9250 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1320450 | Total |
| Program Services | 792270 | ProgramServices |
| Management And General | 396135 | ManagementAndGeneral |
| Fundraising | 132045 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21521 | Total |
| Program Services | 12913 | ProgramServices |
| Management And General | 6456 | ManagementAndGeneral |
| Fundraising | 2152 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125536 | Total |
| Program Services | 75321 | ProgramServices |
| Management And General | 37661 | ManagementAndGeneral |
| Fundraising | 12554 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115408 | Total |
| Program Services | 69245 | ProgramServices |
| Management And General | 34622 | ManagementAndGeneral |
| Fundraising | 11541 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 380 | Total |
| Program Services | 190 | ProgramServices |
| Management And General | 152 | ManagementAndGeneral |
| Fundraising | 38 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20523 | Total |
| Management And General | 20523 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222898 | Total |
| Program Services | 197491 | ProgramServices |
| Management And General | 22500 | ManagementAndGeneral |
| Fundraising | 2907 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15756 | Total |
| Program Services | 3151 | ProgramServices |
| Management And General | 788 | ManagementAndGeneral |
| Fundraising | 11817 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78786 | Total |
| Program Services | 68023 | ProgramServices |
| Management And General | 8503 | ManagementAndGeneral |
| Fundraising | 2260 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16827 | Total |
| Program Services | 15144 | ProgramServices |
| Management And General | 1683 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63072 | Total |
| Program Services | 56668 | ProgramServices |
| Management And General | 6404 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14007 | Total |
| Program Services | 5603 | ProgramServices |
| Management And General | 7003 | ManagementAndGeneral |
| Fundraising | 1401 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29556 | Total |
| Program Services | 14778 | ProgramServices |
| Management And General | 13300 | ManagementAndGeneral |
| Fundraising | 1478 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58 | Total |
| Management And General | 58 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63850 | Total |
| Program Services | 31925 | ProgramServices |
| Management And General | 31925 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25935 | Total |
| Program Services | 21089 | ProgramServices |
| Management And General | 4095 | ManagementAndGeneral |
| Fundraising | 751 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Dental, Medical & Pharm | 172462 | 172462 |
| Bad debt expense | 157596 | 157596 |
| Lab fees | 105478 | 105478 |
| Repairs & maintenance | 14015 | 14015 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9056 | Total |
| Program Services | 4216 | ProgramServices |
| Management And General | 4761 | ManagementAndGeneral |
| Fundraising | 79 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2685670 | Total |
| Program Services | 1873078 | ProgramServices |
| Management And General | 624319 | ManagementAndGeneral |
| Fundraising | 188273 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 652986 | BOY |
| EOY | 422034 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25311 | BOY |
| EOY | 94087 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 149732 | BOY |
| EOY | 188477 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2074 | BOY |
| EOY | 3415 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 236429 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 93890 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 146973 | BOY |
| EOY | 142539 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 96433 | BOY |
| EOY | 60490 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 426878 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1073509 | BOY |
| EOY | 1337920 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130294 | BOY |
| EOY | 165078 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 31667 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 131095 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130294 | BOY |
| EOY | 327840 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 943215 | BOY |
| EOY | 999880 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 10200 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 943215 | BOY |
| EOY | 1010080 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1073509 | BOY |
| EOY | 1337920 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 66864 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1 | 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) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1194995 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1289989 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1339916 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1436220 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1596091 | CurrentTaxYear |
| Total | 6857211 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1194995 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1289989 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1339916 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1436220 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1596091 | CurrentTaxYear |
| Total | 6857211 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 6857211 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3578 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2957 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2785 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2109 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2211 | CurrentTaxYear |
| Total | 13640 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 144 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 562 | CurrentTaxYearMinus1Year |
| Total | 706 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 6871557 | TotalSupport |
| Gross Receipts From Admissions Etc | 4934569 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.99790 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.99670 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 122712 | OtherCostOrOtherBasis |
| Depreciation | 27385 | Depreciation |
| Book Value | 95327 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 113717 | OtherCostOrOtherBasis |
| Depreciation | 66505 | Depreciation |
| Book Value | 47212 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 142539 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Construction in progress | Description |
| Book Value | 426878 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 426878 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 2799664 | TotRevenueEtcAuditedFinclStmt |
| Donated Srvc And Use Of Facilities | 47130 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 47130 | RevenueNotRptdF990 |
| Revenue Subtotal | 2752534 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2752534 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2732800 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 47130 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 47130 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2685670 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 2685670 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X, Line 2: | ReturnReference |
| Explanation | The Organization files required income tax returns in the U.S. federal jurisdiction. With few exceptions, the Organization is no longer subject to U.S. federal income tax examinations by tax authorities for years before 2008. The Organization has concluded no material uncertain tax positions have been taken on any open tax returns. For the current year the Organization believes all tax positions are fully supportable by existing Federal law and related interpretations and there are no uncertain tax positions to consider. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Kathy Nordby | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Executive Director | Relationship |
| Amount Of Transaction | 131095 | AmountOfTransaction |
| Description Of Transaction | Executive Director Kathy Nordby's spouse is an officer with Bank of the West. Norfolk Community Health Care Clinic has a loan agreement with the bank. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | A copy of the Form 990 is provided to the board for review before it is filed. | |
| Form 990, Part VI, Section B, line 12c | A new conflict of interest policy is distributed and signed annually by board members. The policy clearly states the board members responsibility to disclose existing known conflicts at that time and disclose future conflicts or potential/perceived conflicts at the time any new situation or decision may warrant such disclosure. | |
| Form 990, Part VI, Section B, line 15 | There is a study to compare pay from like organizations across the nation and midwest. We also include consideration of the local market for other health care or health delivery agencies locally that we compete with for staff. | |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents are made available to the public upon request. | |
| Form 990, Part XI, line 9: | Rounding 1. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XI, Line 2c | This process has not changed from the prior year. |