BEAR LAKE COMMUNITY HEALTH CENTER INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: BEAR LAKE COMMUNITY HEALTH CENTER INC (EIN 81-0587644)
Tax period: 2012-05-01 to 2013-04-30
Filed: 2014-02-27
IRS object ID: 201430589349300008
Schema version: 2012v2.3
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 J
Schedule M
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-02-27T09:24:45-06:00	Timestamp
Tax Period End Date	2013-04-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SQUIRE & COMPANY PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1329 SOUTH 800 EAST	AddressLine1
City	OREM	City
State	UT	State
ZIP Code	840977737	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-05-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	810587644	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	BEAR LAKE COMMUNITY HEALTH CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	BEAR	NameControl
Phone	4359463660	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	325 W LOGAN HIGHWAY	AddressLine1
City	GARDEN CITY	City
State	UT	State
ZIP Code	84028	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	LAVAL JENSEN	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	4359463660	Phone
Date Signed	2014-01-31	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	M PAUL WINWARD CPA	Name
Phone	8012256900	Phone
Date Prepared	2014-02-27	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	CACHE VALLEY COMMUNITY	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	LAVAL JENSEN	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	325 W LOGAN HIGHWAY	AddressLine1
City	GARDEN CITY	City
State	UT	State
ZIP Code	84028	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	6111478	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2002	YearFormation
State Legal Domicile	UT	StateLegalDomicile
Activity Or Mission Description	MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR LOW-INCOME FAMILIES.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	10	NbrIndependentVotingMembers
Total Nbr Employees	115	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	1070297	ContributionsGrantsPriorYear
Contributions Grants Current Year	1265697	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	2470891	ProgramServiceRevenuePriorYear
Program Service Revenue CY	2790125	ProgramServiceRevenueCY
Investment Income Prior Year	22	InvestmentIncomePriorYear
Investment Income Current Year	56	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1071600	OtherRevenuePriorYear
Other Revenue Current Year	1225604	OtherRevenueCurrentYear
Total Revenue Prior Year	4612810	TotalRevenuePriorYear
Total Revenue Current Year	5281482	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	3225347	SalariesEtcPriorYear
Salaries Etc Current Year	3920206	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1039848	OtherExpensePriorYear
Other Expenses Current Year	1439261	OtherExpensesCurrentYear
Total Expenses Prior Year	4265195	TotalExpensesPriorYear
Total Expenses Current Year	5359467	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	347615	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-77985	RevenuesLessExpensesCY
Total Assets BOY	4327682	TotalAssetsBOY
Total Assets EOY	4418787	TotalAssetsEOY
Total Liabilities BOY	3185797	TotalLiabilitiesBOY
Total Liabilities EOY	3354887	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1141885	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1063900	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR LOW-INCOME FAMILIES.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	2292316	Expense
Revenue	2355699	Revenue
Description	PROVIDED MEDICAL SERVICES TO LOW-INCOME FAMILIES.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	684327	Expense
Revenue	384368	Revenue
Description	PROVIDED DENTAL SERVICES TO LOW-INCOME FAMILIES.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	123236	Expense
Revenue	45743	Revenue
Description	PROVIDED MENTAL HEALTH SERVICES TO LOW-INCOME FAMILIES.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	991088	Expense
Revenue	4315	Revenue
Description	PROVIDED PHARMACY SERVICES & HEALTH AND WELLNESS SERVICES TO LOW-INCOME FAMILIES.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	991088	TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev	4315	TotalOfOtherProgramServiceRev
Total Program Service Expense	4090967	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	true	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	115	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	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	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	REBECCA LOWE	NamePerson
Telephone Number	4359463660	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	325 W LOGAN HWY	AddressLine1
City	GARDEN CITY	City
State	UT	State
ZIP Code	84028	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
ANGELA GLOVER
BOARD MEMBER	1.00	X	0	0	0
ANNA CHRISTENSEN
BOARD MEMBER	1.00	X	0	0	0
DAREN WALLENTINE
BOARD MEMBER	1.00	X	0	0	0
DOROTHY EVANS
SECRETARY	1.00	X	0	0	0
LARAINE SCHNETZER
CHAIR	1.00	X	0	0	0
NORMAN MECHAM
BOARD MEMBER	1.00	X	0	0	0
PAT SNELL
VICE CHAIR	1.00	X	0	0	0
SHERRIE DAVIS
TREASURER	1.00	X	0	0	0
MARC TRENERY
BOARD MEMBER	1.00	X	0	0	0
TARA MCMULLIN
BOARD MEMBER	1.00	X	0	0	0
DAVID J BALLINGHAM
CLINICAL DIR	40.00		203509	0	27219	X
LAVAL JENSEN
EXEC. DIRECT	40.00		202642	0	29393	X
GLADE CROWTHER
DENTIST	40.00		132640	0	14588		X
GREGG LUKE
PHARMACIST	40.00		122170	0	13403		X
RICHARD BALLAM
PHARMACIST	40.00		121042	0	2960		X
MICHAEL ADAMS
PHYSICIAN	40.00		117318	0	6678		X
JEFF MADSEN
PHARMACIST	40.00		114776	0	3810		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1014097	TotalReportableCompFromOrg
Total Other Compensation	98051	TotalOtherCompensation
Number Individuals GT100 K	7	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Government Grants	1170975	GovernmentGrants
All Other Contributions	94722	AllOtherContributions
Noncash Contributions	84642	NoncashContributions
Total Contributions	1265697	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PROFESSIONAL FEES	Description
Total Revenue Column	2790125	TotalRevenueColumn
Related Or Exempt Function Income	2790125	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	2790125	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	56	TotalRevenueColumn
Related Or Exempt Function Income	56	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	2048591	GrossSalesOfInventory
Cost Of Goods Sold	829996	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	1218595	TotalRevenueColumn
Related Or Exempt Function Income	1218595	RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	OTHER	Description
Total Revenue Column	7009	TotalRevenueColumn
Related Or Exempt Function Income	7009	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	7009	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	5281482	TotalRevenueColumn
Related Or Exempt Function Income	4015785	RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	406151	Total
Program Services	304830	ProgramServices
Management And General	101321	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2984074	Total
Program Services	2199952	ProgramServices
Management And General	784122	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	78782	Total
Program Services	52784	ProgramServices
Management And General	25998	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	178367	Total
Program Services	124857	ProgramServices
Management And General	53510	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	272832	Total
Program Services	190982	ProgramServices
Management And General	81850	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	18235	Total
Program Services	18235	ProgramServices

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	16033	Total
Program Services	11223	ProgramServices
Management And General	4810	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	46373	Total
Program Services	46373	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	435649	Total
Program Services	304954	ProgramServices
Management And General	130695	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	97525	Total
Program Services	97525	ProgramServices

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	266395	Total
Program Services	239755	ProgramServices
Management And General	26640	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	84117	Total
Program Services	75705	ProgramServices
Management And General	8412	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	109677	Total
Program Services	98709	ProgramServices
Management And General	10968	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	167049	Total
Program Services	167049	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	30773	Total
Program Services	28834	ProgramServices
Management And General	1939	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
OTHER	81494	69034	12460
BANK FEES	31548	22084	9464
RECRUITIN	26228	18360	7868
DUES AND SUBSCRIPTIONS	24359	17051	7308

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	3806	Total
Program Services	2671	ProgramServices
Management And General	1135	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	5359467	Total
Program Services	4090967	ProgramServices
Management And General	1268500	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	78703	BOY
EOY	55083	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	22421	BOY
EOY	66977	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	528862	BOY
EOY	475526	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	218998	BOY
EOY	394760	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	2500	BOY
EOY	2500	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	4162732	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	738791	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	3476198	BOY
EOY	3423941	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4327682	BOY
EOY	4418787	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	465512	BOY
EOY	633019	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	2657209	BOY
EOY	2681483	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	63076	BOY
EOY	40385	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3185797	BOY
EOY	3354887	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1141885	BOY
EOY	1063900	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1141885	BOY
EOY	1063900	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4327682	BOY
EOY	4418787	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-77985	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	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	443993	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1625820	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1109203	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1070297	CurrentTaxYearMinus1Year
Current Tax Year	1265697	CurrentTaxYear
Total	5515010	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	443993	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1625820	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1109203	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1070297	CurrentTaxYearMinus1Year
Current Tax Year	1265697	CurrentTaxYear
Total	5515010	Total

Field	Value	IRS element (for citing)
Public Support Total170	5515010	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	31	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	44	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	26	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	22	CurrentTaxYearMinus1Year
Current Tax Year	56	CurrentTaxYear
Total	179	Total

Field	Value	IRS element (for citing)
Total Support	5515189	TotalSupport
Gross Receipts From Admissions Etc	4845781	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	1.00000	PublicSupportPertcentage170
Public Support Pertcent Prior Year	1.00000	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

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	103000	OtherCostOrOtherBasis
Book Value	103000	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3012706	OtherCostOrOtherBasis
Depreciation	248655	Depreciation
Book Value	2764051	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	198329	OtherCostOrOtherBasis
Depreciation	79840	Depreciation
Book Value	118489	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	848697	OtherCostOrOtherBasis
Depreciation	410296	Depreciation
Book Value	438401	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3423941	TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt	6111478	TotRevenueEtcAuditedFinclStmt
Other Revenues	829996	OtherRevenues
Revenue Not Rptd F990	829996	RevenueNotRptdF990
Revenue Subtotal	5281482	RevenueSubtotal
Total Revenue Per Form990	5281482	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	6189463	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	829996	OtherExpensesIncluded
Expenses Not Rptd F990	829996	ExpensesNotRptdF990
Expenses Subtotal	5359467	ExpensesSubtotal
Total Expenses Per Form990	5359467	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XI, LINE 2D	PHARMACY COST OF GOODS SOLD 829,996
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XII, LINE 2D	PHARMACY COST OF GOODS SOLD 829,996

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Bonus Filing OrgBonusFilingOrg	Deferred Comp Filing OrgDeferredCompFilingOrg	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
DAVID J BALLINGHAM
CLINICAL DIRECTOR	187259	16250	8140	19079	230728
LAVAL JENSEN
EXEC DIRECTOR	186392	16250	8106	21287	232035

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Number Of Contributions	1	NumberOfContributions
Noncash Contribs Rptd F990	73190	NoncashContribsRptdF990
Method Of Determining Revenues	ESTIMATED MARKET VALUE	MethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Description	VARIOUS ITEMS	Description
Number Of Contributions	1	NumberOfContributions
Noncash Contribs Rptd F990	11452	NoncashContribsRptdF990
Method Of Determining Revenues	ESTIMATED MARKET VALUE	MethodOfDeterminingRevenues

Field	Value	IRS element (for citing)
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts	false	ReviewProcessUnusualNCGifts
Third Parties Used	false	ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DOING BUSINESS AS	FORM 990, PAGE 1, ITEM C	HEALTH CENTER, CACHE VALLEY COMMUNITY HEALTH CENTER - SOUTH, AND EVANSTON COMMUNITY HEALTH CENTER
ALL OTHER ACCOMPLISHMENT DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4D	PROVIDED PHARMACY SERVICES & HEALTH AND WELLNESS SERVICES TO LOW-INCOME FAMILIES.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	FORM 990 IS PREPARED BY OUTSIDE ACCOUNTANT AND PROVIDED TO EXECUTIVE DIRECTOR FOR APPROVAL PRIOR TO SUBMISSION. FORM 990 IS THEN PROVIDED TO BOARD FOR REVIEW AND APPROVAL PRIOR TO SUBMISSION.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	THE CONFLICTS OF INTEREST POLICY IS REVIEWED AND DISCUSSED ANNUALLY AT THE BOARD RETREAT.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) SALARY SURVEY INFORMATION IS USED TO IDENTIFY WAGE RANGES FOR SIMILAR POSITIONS.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) SALARY SURVEY INFORMATION IS USED TO IDENTIFY WAGE RANGES FOR SIMILAR POSITIONS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST JUST AS FORMS 990.
RECONCILIATION OF CHANGES - OTHER	FORM 990, PART XI, LINE 9	PHARMACY COST OF GOODS SOLD 829,996 PHARMACY COST OF GOODS SOLD -829,996