WAYNE MEMORIAL COMMUNITY HEALTH CENTERS: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (EIN 23-2180889)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-12
- IRS object ID
- 201441329349302214
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-12T12:02:46-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E ST LOUIS 200/PO BOX 1190 | AddressLine1 |
| City | SPRINGFIELD | City |
| State | MO | State |
| ZIP Code | 658062523 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232180889 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % FREDERICK JACKSON | InCareOfName |
| Name Control | WAYN | NameControl |
| Phone | 5702516676 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 PARK STREET | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | HONESDALE | City |
| State | PA | State |
| ZIP Code | 18431 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | FREDERICK JACKSON | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 5702538100 | Phone |
| Date Signed | 2014-05-09 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Brian D Todd | Name |
| Phone | 4178658701 | 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 | FREDERICK JACKSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 PARK STREET | AddressLine1 |
| City | HONESDALE | City |
| State | PA | State |
| ZIP Code | 18431 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12884125 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.WMH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1981 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO THE RESIDENTS OF THE WAYNE, PIKE AND PART OF LACKAWANNA COUNTIES OF PA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 144 | TotalNbrEmployees |
| Total Nbr Volunteers | 14 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2549782 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 3641522 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7565970 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9197490 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2389 | InvestmentIncomePriorYear |
| Investment Income Current Year | 523 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 40004 | OtherRevenuePriorYear |
| Other Revenue Current Year | 12871 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10158145 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12852406 | 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 | 7567793 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8900327 | 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 | 2533422 | OtherExpensePriorYear |
| Other Expenses Current Year | 3048036 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 10101215 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11948363 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 56930 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 904043 | RevenuesLessExpensesCY |
| Total Assets BOY | 3634594 | TotalAssetsBOY |
| Total Assets EOY | 4974025 | TotalAssetsEOY |
| Total Liabilities BOY | 2884710 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3320098 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 749884 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1653927 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION IS TO PROVIDE MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO ALL THE RESIDENTS OF WAYNE & PIKE COUNTIES, PENNSYLVANIA WITH A SPECIFIC EMPHASIS ON THE UNDERSERVED, LOW INCOME AND UNINSURED. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 3050884 | Expense |
| Revenue | 2883969 | Revenue |
| Description | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS PROVIDES HIGH QUALITY PRIMARY CARE SERVICES THROUGH ITS FAMILY HEALTH CLINICS TO THE RESIDENTS OF WAYNE AND PIKE COUNTIES. THE FAMILY HEALTH CLINICS ARE LOCATED IN HONESDALE, LAKE COMO, WAYMART, LORDS VALLEY, VANDLING AND CARBONDALE, PROVIDING OUTPATIENT PRIMARY CARE SERVICES FOR CHILDREN AND ADULTS. SEE SCHEDULE O FOR MORE INFORMATION. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2369458 | Expense |
| Revenue | 2332146 | Revenue |
| Description | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS PROVIDES WOMEN'S HEALTH SERVICES THROUGH ITS WOMEN'S HEALTH CLINIC. THESE SERVICES INCLUDE OBSTETRICAL AND GYNECOLOGICAL SERVICES WITH BOARD-CERTIFIED AND BOARD-ELIGIBLE PHYSICIANS, CERTIFIED NURSE-MIDWIVES, ULTRASOUND TECHNOLOGISTS AND REGISTERED NURSES IN HONESDALE, HAMLIN, LORDS VALLEY, WAYMART AND VANDLING. SEE SCHEDULE O FOR MORE INFORMATION. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1895835 | Expense |
| Revenue | 1804096 | Revenue |
| Description | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS PROVIDES COMPREHENSIVE DENTAL CARE THROUGH ITS DENTAL CLINIC FOR CHILDREN AND ADULTS AT THE TOGETHER FOR HEALTH DENTAL CENTER IN HONESDALE AND THE PIKE DENTAL CENTER IN LORDS VALLEY. BOTH SITES ARE FULLY DIGITAL ALLOWING X-RAY IMAGES TO BE VIEWED BY THE DENTAL TEAM INSTANTLY. ADVANCED EQUIPMENT CALLED PANORAMIC RADIOLOGY PERFORMS TWO-DIMENSIONAL EXAMINATIONS OF THE ENTIRE MOUTH WITH ONLY A SINGLE IMAGE. SEE SCHEDULE O FOR MORE INFORMATION. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 3168416 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 2177279 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 10484593 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | 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 | true | ReportOtherAssets |
| Report Other Liabilities | true | 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 | false | 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 | 32 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 144 | 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 | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | 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 |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | FREDERICK JACKSON | NamePerson |
| Telephone Number | 5702516676 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 PARK STREET | AddressLine1 |
| City | HONESDALE | City |
| State | PA | State |
| ZIP Code | 18431 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| PETER RODGERS | ||||||||
| CHAIRMAN | 1.0 | X | X | 0 | 0 | |||
| MICHAEL CLIFFORD | ||||||||
| TREASURER | 1.0 | X | X | 0 | 0 | |||
| SUSAN GABRIELSON | ||||||||
| SECRETARY | 1.0 | X | X | 0 | 0 | |||
| STEVE BURLEIN | ||||||||
| VICE CHAIRMAN | 1.0 | X | X | 0 | 0 | |||
| DOREEN FITZGERALD | ||||||||
| BOARD MEMBER | 1.0 | X | 0 | 0 | ||||
| ANN FOSTER | ||||||||
| BOARD MEMBER | 1.0 | X | 0 | 0 | ||||
| WILLIAM KERL | ||||||||
| BOARD MEMBER | 1.0 | X | 0 | 0 | ||||
| DAVID HOFF | ||||||||
| BOARD MEMBER | 1.0 | X | 0 | 0 | ||||
| MORRIS BROOKE | ||||||||
| BOARD MEMBER | 1.0 | X | 0 | 0 | ||||
| WILLIAM SCHWEIGHOFER | ||||||||
| BOARD MEMBER | 1.0 | X | 0 | 0 | ||||
| STEVE TOURJE | ||||||||
| BOARD MEMBER | 1.0 | X | 0 | 0 | ||||
| JUSTIN O'DONNELL | ||||||||
| BOARD MEMBER ENDING 10/2012 | 1.0 | X | 0 | 0 | ||||
| FREDERICK JACKSON | ||||||||
| CEO | 40.0 | X | 139653 | 0 | 23108 | |||
| ROBERT DOHNOR | ||||||||
| MEDICAL DIRECTOR ENDING 3/2013 | 40.0 | 155540 | 0 | 22171 | X | |||
| BRIAN BROWN | ||||||||
| DENTAL DIRECTOR | 40.0 | 171324 | 0 | 19956 | X | |||
| MICHAEL CAMPBELL | ||||||||
| BEHAVIORAL DIRECTOR | 40.0 | 162722 | 0 | 22925 | X | |||
| SEAN MCVEIGH | ||||||||
| PHYSICIAN | 40.0 | 269108 | 0 | 26874 | X | |||
| BRIAN LENCZEWSKI | ||||||||
| PHYSICIAN | 40.0 | 266215 | 0 | 22089 | X | |||
| HONN YOO | ||||||||
| PHYSICIAN | 40.0 | 259328 | 0 | 27672 | X | |||
| DENISE VIOLA | ||||||||
| PHYSICIAN | 40.0 | 169667 | 0 | 15540 | X | |||
| JOHN ZIMMERLY | ||||||||
| PHYSICIAN | 40.0 | 167656 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1761213 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 180335 | TotalOtherCompensation |
| Number Individuals GT100 K | 20 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| CHARLES GRIMM CONSTRUCTION | |
| CONSTRUCTION | 538458 |
| RIVIERA FINANCE | |
| STAFFING AGENCY | 259165 |
| WAYNE MEMORIAL HEALTH SYSTEM | |
| ADMINISTRATIVE SVCS | 148188 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Government Grants | 1385475 | GovernmentGrants |
| All Other Contributions | 2256047 | AllOtherContributions |
| Total Contributions | 3641522 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 624100 | 9072526 | 9072526 |
| OTHER INCOME | 900099 | 124964 | 124964 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9197490 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2357 | TotalRevenueColumn |
| Exclusion | $2,357 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 42756 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 29885 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 12871 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12871 | TotalRevenueColumn |
| Exclusion | $12,871 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1834 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -1834 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1834 | TotalRevenueColumn |
| Exclusion | -$1,834 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12852406 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9197490 | RelatedOrExemptFunctionIncome |
| Exclusion | $13,394 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 725917 | Total |
| Program Services | 558793 | ProgramServices |
| Management And General | 167124 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6579374 | Total |
| Program Services | 5891083 | ProgramServices |
| Management And General | 688291 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 217348 | Total |
| Program Services | 196499 | ProgramServices |
| Management And General | 20849 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 910468 | Total |
| Program Services | 814776 | ProgramServices |
| Management And General | 95692 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 467220 | Total |
| Program Services | 413371 | ProgramServices |
| Management And General | 53849 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 148188 | Total |
| Management And General | 148188 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18082 | Total |
| Program Services | 15998 | ProgramServices |
| Management And General | 2084 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27791 | Total |
| Program Services | 24588 | ProgramServices |
| Management And General | 3203 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 614733 | Total |
| Program Services | 543882 | ProgramServices |
| Management And General | 70851 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26852 | Total |
| Program Services | 23757 | ProgramServices |
| Management And General | 3095 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 647167 | Total |
| Program Services | 572578 | ProgramServices |
| Management And General | 74589 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 554090 | Total |
| Program Services | 490228 | ProgramServices |
| Management And General | 63862 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6359 | Total |
| Program Services | 5626 | ProgramServices |
| Management And General | 733 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58054 | Total |
| Program Services | 51363 | ProgramServices |
| Management And General | 6691 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44461 | Total |
| Program Services | 39337 | ProgramServices |
| Management And General | 5124 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 285576 | Total |
| Program Services | 252662 | ProgramServices |
| Management And General | 32914 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145982 | Total |
| Program Services | 129157 | ProgramServices |
| Management And General | 16825 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 385623 | 385623 | |
| REPAIRS & MAINTENANCE | 42953 | 38002 | 4951 |
| LICENSES, DUES, SUBSCRIPTIONS | 42125 | 37270 | 4855 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11948363 | Total |
| Program Services | 10484593 | ProgramServices |
| Management And General | 1463770 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 2341 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 141355 | BOY |
| EOY | 180751 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 605312 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 782991 | BOY |
| EOY | 879580 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61109 | BOY |
| EOY | 103531 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2555356 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 834555 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 938852 | BOY |
| EOY | 1720801 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1710287 | BOY |
| EOY | 1481709 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3634594 | BOY |
| EOY | 4974025 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1109151 | BOY |
| EOY | 1400870 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1449922 | BOY |
| EOY | 1296753 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 325637 | BOY |
| EOY | 622475 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2884710 | BOY |
| EOY | 3320098 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 749884 | BOY |
| EOY | 1374494 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 279433 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 749884 | BOY |
| EOY | 1653927 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3634594 | BOY |
| EOY | 4974025 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 904043 | 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) |
|---|---|---|
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $1,250 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1250 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE C, PART II-B, LINE I | Identifier |
| Return Reference | OTHER LOBBYING ACTIVITIES | ReturnReference |
| Explanation | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS PAYS ANNUAL MEMBERSHIP DUES TO PENNSYLVANIA ASSOCIATION OF COMMUNITY HEALTH CENTERS (PACHC). THE ORGANIZATION IS NOTIFIED EACH YEAR THAT A PORTION OF THE MEMBERSHIP DUES IS USED FOR LOBBYING ACTIVITIES. FOR THE FISCAL YEAR ENDED JUNE 30, 2013, THE PORTION OF DUES PAID REPRESENTING LOBBYING EXPENDITURES WAS $1,250. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years | |
| Land | Land | |
| Buildings | Buildings |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1016996 | OtherCostOrOtherBasis |
| Depreciation | 110202 | Depreciation |
| Book Value | 906794 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1410177 | OtherCostOrOtherBasis |
| Depreciation | 724353 | Depreciation |
| Book Value | 685824 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 128183 | OtherCostOrOtherBasis |
| Book Value | 128183 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1720801 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| EST AMT DUE FROM 3RD PARTIES | 1477225 |
| OTHER RECEIVABLES | 4484 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1481709 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO WAYNE MEMORIAL HOSPITAL | Description |
| Amount | $622,475 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 622475 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 12498502 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -385623 | OtherRevenues |
| Revenue Not Rptd F990 | -385623 | RevenueNotRptdF990 |
| Revenue Subtotal | 12884125 | RevenueSubtotal |
| Other Revenues Not Included | -31719 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -31719 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12852406 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11594459 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 31719 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 31719 | ExpensesNotRptdF990 |
| Expenses Subtotal | 11562740 | ExpensesSubtotal |
| Other Expenses Not Included | 385623 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 385623 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 11948363 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| UNCERTAIN TAX POSITIONS | SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. FINANCIAL STATEMENTS. |
| AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 | SCHEDULE D, PART XI, LINE 2D | $( 385,623) BAD DEBT EXPENSE |
| AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 | SCHEDULE D, PART XI, LINE 4B | $( 1,834) LOSS ON SALE OF ASSETS ( 29,885) RENTAL EXPENSES ----------- $( 31,719) |
| AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25 | SCHEDULE D, PART XII, LINE 2D | $ 1,834 LOSS ON SALE OF ASSETS 29,885 RENTAL EXPENSES ----------- $ 31,719 |
| AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 | SCHEDULE D, PART XII, LINE 4B | $ 385,623 BAD DEBT EXPENSE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FREDERICK JACKSON | ||||||||||||||
| CEO | 139653 | 0 | 0 | 0 | 0 | 0 | 8519 | 0 | 14589 | 0 | 162761 | 0 | 0 | 0 |
| ROBERT DOHNOR | ||||||||||||||
| MEDICAL DIRECTOR ENDING 3/2013 | 137540 | 0 | 18000 | 0 | 0 | 0 | 9499 | 0 | 12672 | 0 | 177711 | 0 | 0 | 0 |
| BRIAN BROWN | ||||||||||||||
| DENTAL DIRECTOR | 127902 | 0 | 43422 | 0 | 0 | 0 | 10345 | 0 | 9611 | 0 | 191280 | 0 | 0 | 0 |
| MICHAEL CAMPBELL | ||||||||||||||
| BEHAVIORAL DIRECTOR | 162722 | 0 | 0 | 0 | 0 | 0 | 9552 | 0 | 13373 | 0 | 185647 | 0 | 0 | 0 |
| SEAN MCVEIGH | ||||||||||||||
| PHYSICIAN | 269108 | 0 | 0 | 0 | 0 | 0 | 15000 | 0 | 11874 | 0 | 295982 | 0 | 0 | 0 |
| BRIAN LENCZEWSKI | ||||||||||||||
| PHYSICIAN | 266215 | 0 | 0 | 0 | 0 | 0 | 7500 | 0 | 14589 | 0 | 288304 | 0 | 0 | 0 |
| HONN YOO | ||||||||||||||
| PHYSICIAN | 159328 | 0 | 100000 | 0 | 0 | 0 | 15000 | 0 | 12672 | 0 | 287000 | 0 | 0 | 0 |
| DENISE VIOLA | ||||||||||||||
| PHYSICIAN | 169667 | 0 | 0 | 0 | 0 | 0 | 10216 | 0 | 5324 | 0 | 185207 | 0 | 0 | 0 |
| JOHN ZIMMERLY | ||||||||||||||
| PHYSICIAN | 167656 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 167656 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICE ACTIVITY #1 | FORM 990, PART III, LINE 4A | THE FULL RANGE OF OUTPATIENT PRIMARY CARE SERVICES PROVIDED BY THE WAYNE MEMORIAL COMMUNITY HEALTH CENTERS FAMILY CARE CLINICS FOR CHILDREN AND ADULTS INCLUDE: -EXAMS -DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC CONDITIONS -EKG -SUTURING OF MINOR LACERATIONS -MINOR SURGERY -DIABETES AND NUTRITION COUNSELING -ADULT AND CHILDHOOD IMMUNIZATIONS -WELL-CHILD VISITS -SPORTS PHYSICALS -SCHOOL PHYSICALS -CDL EXAMS -WELL-WOMAN EXAMS -PREVENTATIVE CARE -SMOKING CESSATION THESE SERVICES ARE PROVIDED BY BOARD-CERTIFIED INTERNISTS, FAMILY MEDICINE PHYSICIANS, BOARD-CERTIFIED PEDIATRICIANS, CERTIFIED REGISTERED NURSE PRACTITIONERS AND CERTIFIED PHYSICIAN ASSISTANTS. |
| PROGRAM SERVICE ACTIVITY #2 | FORM 990, PART III, LINE 4B | THE FULL RANGE OF SERVICES PROVIDED BY THE WAYNE MEMORIAL COMMUNITY HEALTH CENTERS WOMEN'S CLINIC INCLUDES: -WELL-TEEN AND WELL-WOMAN CARE -UTERINE ABLATION -URODYNAMIC TESTING -HORMONE REPLACEMENT THERAPY COUNSELING -PERIMENOPAUSAL COUNSELING -NONINVASIVE HEREDITARY CANCER TESTING -PRENATAL CARE -ULTRASOUND -PRECONCEPTION COUNSELING -PRENATAL FITNESS -CHILDBIRTH EDUCATION -LACTATION COUNSELING THE WOMEN'S HEALTH CLINIC PARTICIPATES IN STATE-FUNDED PROGRAMS SUCH AS HEALTHY BEGINNINGS PLUS AND OFFERS SERVICES TO ALL, INCLUDING THOSE WITH PRIVATE INSURANCE OR ON PUBLIC ASSISTANCE. A SLIDING FEE SCALE IS ALSO OFFERED BASED ON INCOME. |
| PROGRAM SERVICE ACTIVITY #3 | FORM 990, PART III, LINE 4C | THE FULL RANGE OF SERVICES PROVIDED BY THE WAYNE MEMORIAL COMMUNITY HEALTH CENTERS DENTAL CLINICS INCLUDE: -DENTAL EXAMS -PREVENTATIVE TREATMENT -PERIODONTAL TREATMENT -RESTORATIVE PROCEDURES -DENTURES, PARTIALS AND FIXED BRIDGES -DENTAL EDUCATION PREVENTATIVE MOBILE DENTAL SERVICES ARE OFFERED TO COMMUNITIES WITH EITHER LIMITED OR NO ACCESS TO DENTAL CARE. A PUBLIC HEALTH DENTAL HYGIENE PRACTITIONER/COMMUNITY DENTAL HEALTH COORDINATOR, A DENTAL HEALTH PROFESSIONAL WHO HAS COMPLETED A PROGRAM SPONSORED BY THE AMERICAN DENTAL ASSOCIATION, PERFORMS DENTAL SERVICES INCLUDING CLEANINGS, FLUORIDE TREATMENTS, SEALANTS AND X-RAYS FOR CHILDREN AND ADULTS WHILE VISITING AREA PHYSICIAN OFFICES, SCHOOLS AND HEAD START PROGRAMS. |
| OTHER PROGRAM SERVICES | FORM 990, PART III, LINE 4D | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS PROVIDES A VARIETY OF OTHER SERVICES, INCLUDING GENERAL SURGERY, PULMONARY AND SLEEP MEDICINE, PEDIATRIC CARE IN HONESDALE AND CARBONDALE, AND BEHAVIORAL HEALTH, INCLUDING MENTAL HEALTH AND COUNSELING SERVICES, AT THE BEHAVIORAL HEALTH CENTER IN HONESDALE. GENERAL SURGERY SERVICES ARE PROVIDED BY A BOARD-ELIGIBLE GENERAL SURGEON AND A BOARD CERTIFIED GENERAL SURGEON/BOARD-ELIGIBLE VASCULAR SURGEON IN HONESDALE AND THE PIKE COUNTY FAMILY HEALTH CENTER. PULMONARY AND SLEEP MEDICINE ARE PROVIDED THROUGH THE SLEEP DISORDERS CENTERS. POLYSOMNOGRAMS ARE PAINLESS, NON-INVASIVE TESTS DURING WHICH HIGHLY TRAINED TECHNOLOGISTS MONITOR BREATHING, HEART RATE, BLOOD OXYGEN LEVELS, EYE MOVEMENT, MUSCLE TONE AND OTHER FACTORS THROUGHOUT ONE FULL NIGHT OF SLEEP. THE SLEEP CENTER SIMULATES A COMFORTABLE HOME ENVIRONMENT WHICH GENERALLY MAKE IT EASIER TO FALL ASLEEP SO THAT SLEEP PATTERN INFORMATION CAN BE COLLECTED AND INTERPRETED. THE INFORMATION COLLECTED IS THEN SENT TO THE PATIENT'S DOCTOR. BEHAVIORAL HEALTH SERVICES ARE OFFERED AT TWO OUTPATIENT TREATMENT FACILITIES PROVIDING A FULL-RANGE OF BEHAVIORAL AND MENTAL HEALTH SERVICES TO ADULTS, ADOLESCENTS AND CHILDREN. TREATMENT SERVICES ARE AVAILABLE FOR THE FOLLOWING ISSUES: -BIPOLAR DISORDER -DEPRESSION -SCHIZOPHRENIA -PERSONALITY DISORDERS -ANXIETY -MENTAL ILLNESS -ADHD -AUTISM SPECTRUM -ANGER MANAGEMENT -SCHOOL DIFFICULTIES -GRIEF/DEATH -EATING DISORDERS -PHOBIAS -DIVORCE -SMOKING CESSATION -POST-TRAUMATIC STRESS DISORDER -OBSESSIVE COMPULSIVE DISORDER -STRESS MANAGEMENT -PREMENSTRUAL DYSPHORIC DISORDER |
| BUSINESS RELATIONSHIP | FORM 990, PART VI, SECTION A, LINE 2 | MICHAEL CLIFFORD AND DAVID HOFF SHARE A BUSINESS RELATIONSHIP. |
| DELEGATE MANAGEMENT DUTIES | FORM 990, PART VI, SECTION A, LINE 3 | WAYNE MEMORIAL HEALTH SYSTEM, INC., PROVIDES SOME MANAGERIAL AND SUPPORT SERVICES TO THE ORGANIZATION. THE SERVICES PROVIDED ARE REIMBURSED TO WAYNE MEMORIAL HEALTH SYSTEM THROUGH A MANAGEMENT FEE AND ARE REPORTED ON FORM 990, PART IX, LINE 11A. |
| 990 REVIEW POLICY | FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A COPY OF THE 990 WILL BE DISTRIBUTED VIA E-MAIL TO EACH BOARD MEMBER BEFORE THE RETURN IS SUBMITTED TO THE IRS. MANAGEMENT WILL DISCUSS ANY QUESTIONS THAT ANY BOARD MEMBER MAY HAVE AT THE NEXT FULL BOARD MEETING. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL IS REQUIRED TO SIGN AND RETURN THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE BOARD IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER. |
| COMPENSATION REVIEW | FORM 990, SECTION VI, SECTION B, LINES 15A & 15B | WAYNE MEMORIAL COMMUNITY HEALTH CENTERS UTILIZE A COMMITTEE OF THE BOARD CALLED THE EXECUTIVE COMMITTEE TO SET COMPENSATION FOR ITS CEO. FOR OTHER KEY EMPLOYEES (DOCTORS), WAYNE MEMORIAL COMMUNITY HEALTH CENTERS USES WRITTEN EMPLOYMENT AGREEMENTS FOR THEIR COMPENSATION. THESE AGREEMENTS ARE APPROVED BY THE BOARD OR EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE IS MADE UP OF INDEPENDENT DIRECTORS WHO USE DATA FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS FOR COMPARATIVE PURPOSES. THE COMMITTEE USES THE SALARY DATA AND COMPARATIVE REVENUE, COMPLEXITY, SIZE OF FQHC, AND THE GEOGRAPHIC REGION TO DETERMINE A REASONABLE SALARY FOR THE CEO. THE EXECUTIVE COMMITTEE KEEPS MINUTES TO DOCUMENT THE DELIBERATION AND DECISION-MAKING PROCESS. THE PROCESS NORMALLY OCCURS IN OCTOBER OF THE YEAR THE COMPENSATION CHANGE IS GRANTED. |
| DOCUMENT DISCLOSURE | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS AVAILABLE TO PUBLIC UPON REQUEST. |