Indian Stream Health Center Inc: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- Indian Stream Health Center Inc (EIN 20-0999212)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-08-07
- IRS object ID
- 201442199349301614
- Schema version
- 2013v3.0
- 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) |
|---|---|---|
| Return | 2014-08-07T15:29:08-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 020400296 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRAD BORBIDGE PA | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 197 LOUDON ROAD STE 350 | AddressLine1 |
| City | CONCORD | City |
| State | NH | State |
| ZIP Code | 03301 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200999212 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Indian Stream Health Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | INDI | BusinessNameControlTxt |
| Phone | 6032378336 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 141 Corliss Lane | AddressLine1 |
| City | Colebrook | City |
| State | NH | State |
| ZIP Code | 03756 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Shirley Powell | PersonNm |
| Person Title | Cheif Executive Officer | PersonTitleTxt |
| Phone | 6032378336 | PhoneNum |
| Signature | 2014-08-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DIMITRIOS PANACOPOULOS CPA | PreparerPersonNm |
| PTIN | P01603705 | PTIN |
| Phone | 6032240849 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Shirley Powell | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 141 Corliss Lane | AddressLine1 |
| City | Colebrook | City |
| State | NH | State |
| ZIP Code | 03756 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,368,004 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | To provide excellent preventive, acute, and wellness-focused health care to residents within the organziation's service area regardless of patient's ability to pay.We will focus our resources to maximize the quality of life of area residents in a cost-effective and efficient manner. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 43 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,454,425 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,333,298 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,775,359 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,034,706 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $4,229,784 | PYTotalRevenueAmt |
| CY Total Revenue | $4,368,004 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,825,367 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,124,198 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,581,865 | PYOtherExpensesAmt |
| CY Other Expenses | $1,717,904 | CYOtherExpensesAmt |
| PY Total Expenses | $3,407,232 | PYTotalExpensesAmt |
| CY Total Expenses | $3,842,102 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $822,552 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $525,902 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,876,624 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,307,252 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,212,717 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,118,635 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,663,907 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,188,617 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To provide excellent preventive, acute, and wellness-focused health care to residents within the organziation's service area regardless of patient's ability to pay.We will focus our resources to maximize the quality of life of area residents in a cost-effective and efficient manner. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,165,961 | ExpenseAmt |
| Revenue | $3,034,706 | RevenueAmt |
| Desc | Provided primary health care to the residents of the Colebrook, NH region. | Desc |
| Total Program Service Expenses | $3,165,961 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 43 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Shirley Powell Chief Executive Officer | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6032378336 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 141 Corliss Lane | AddressLine1 |
| City | Colebrook | City |
| State | NH | State |
| ZIP Code | 03756 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Bridget Freudenberger | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Linda Lomasney | |||||||
| Secretary | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Julie Riffon | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Steve Ellis | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Bill Freedman | |||||||
| Treasurer | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Melissa Shaw | |||||||
| Vice President | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Charlie White | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Dallas Chase | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Gail Fisher | |||||||
| President | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Errin Meenan | |||||||
| Board Member | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Shirley Powell | |||||||
| CEO | 40.00 | $111,425 | $0 | $2,021 | Yes (X) | ||
| Jonathan Brown | |||||||
| Finance Director | 40.00 | $53,484 | $0 | $4,978 | Yes (X) | ||
| Peter Moran | |||||||
| MD | 40.00 | $156,572 | $0 | $13,181 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $321,481 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $20,180 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dartmouth Hitchcock | BusinessNameLine1 |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Medical Center Drive | AddressLine1 |
| City | Hanover | City |
| State | NH | State |
| ZIP Code | 03756 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Contracted Services | ServicesDesc |
| Compensation | $247,539 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,233,298 | GovernmentGrantsAmt |
| All Other Contributions | $100,000 | AllOtherContributionsAmt |
| Total Contributions | $1,333,298 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Federally Qualified He | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $3,034,706 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,034,706 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,034,706 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,368,004 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,034,706 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,661 | TotalAmt |
| Management And General | $341,661 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,367,368 | TotalAmt |
| Program Services | $1,289,377 | ProgramServicesAmt |
| Management And General | $77,991 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,365 | TotalAmt |
| Program Services | $18,459 | ProgramServicesAmt |
| Management And General | $5,906 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $254,642 | TotalAmt |
| Program Services | $192,917 | ProgramServicesAmt |
| Management And General | $61,725 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,162 | TotalAmt |
| Program Services | $103,156 | ProgramServicesAmt |
| Management And General | $33,006 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,092 | TotalAmt |
| Management And General | $8,092 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,000 | TotalAmt |
| Management And General | $40,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,150 | TotalAmt |
| Program Services | $538,150 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,809 | TotalAmt |
| Management And General | $11,809 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,428 | TotalAmt |
| Program Services | $9,415 | ProgramServicesAmt |
| Management And General | $3,013 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,967 | TotalAmt |
| Program Services | $19,673 | ProgramServicesAmt |
| Management And General | $6,294 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,699 | TotalAmt |
| Program Services | $52,804 | ProgramServicesAmt |
| Management And General | $16,895 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,501 | TotalAmt |
| Program Services | $8,713 | ProgramServicesAmt |
| Management And General | $2,788 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,935 | TotalAmt |
| Management And General | $7,935 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,931 | TotalAmt |
| Program Services | $32,525 | ProgramServicesAmt |
| Management And General | $10,406 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,105 | TotalAmt |
| Program Services | $48,566 | ProgramServicesAmt |
| Management And General | $15,539 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,720 | TotalAmt |
| Program Services | $11,909 | ProgramServicesAmt |
| Management And General | $3,811 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Program Supplies | $748,813 | $748,813 | |
| Other Expenses | $66,448 | $50,341 | $16,107 |
| Telephone | $21,091 | $15,979 | $5,112 |
| Printing and Publicatio | $19,766 | $14,975 | $4,791 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,449 | TotalAmt |
| Program Services | $10,189 | ProgramServicesAmt |
| Management And General | $3,260 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,842,102 | TotalAmt |
| Program Services | $3,165,961 | ProgramServicesAmt |
| Management And General | $676,141 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $594,500 | BOYAmt |
| EOY | $425,098 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $480,893 | BOYAmt |
| EOY | $667,976 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $154,584 | BOYAmt |
| EOY | $341,567 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $78,035 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,211 | BOYAmt |
| EOY | $26,216 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,973,732 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $275,888 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,333,786 | BOYAmt |
| EOY | $1,697,844 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,650 | BOYAmt |
| EOY | $70,516 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,876,624 | BOYAmt |
| EOY | $3,307,252 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $140,942 | BOYAmt |
| EOY | $125,388 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $371,269 | BOYAmt |
| EOY | $567,919 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $700,506 | BOYAmt |
| EOY | $425,328 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,212,717 | BOYAmt |
| EOY | $1,118,635 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,513,978 | BOYAmt |
| EOY | $2,188,617 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,929 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,663,907 | BOYAmt |
| EOY | $2,188,617 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,876,624 | BOYAmt |
| EOY | $3,307,252 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $525,902 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$1,192 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,123,940 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,597,042 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,290,772 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,454,425 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,333,298 | CurrentTaxYearAmt |
| Total | $6,799,477 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,061,977 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,059,844 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,716,227 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,775,359 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,034,706 | CurrentTaxYearAmt |
| Total | $11,648,113 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,185,917 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,656,886 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,006,999 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,229,784 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,368,004 | CurrentTaxYearAmt |
| Total | $18,447,590 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $29,500 | CurrentTaxYearMinus2YearsAmt |
| Total | $29,500 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $29,500 | CurrentTaxYearMinus2YearsAmt |
| Total | $29,500 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $18,418,090 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,185,917 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,656,886 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,006,999 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,229,784 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,368,004 | CurrentTaxYearAmt |
| Total | $18,447,590 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99840 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99820 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,000 | OtherCostOrOtherBasisAmt |
| Book Value | $30,000 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,943,732 | OtherCostOrOtherBasisAmt |
| Depreciation | $275,888 | DepreciationAmt |
| Book Value | $1,667,844 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,697,844 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $4,368,004 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,368,004 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,368,004 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,842,102 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $3,842,102 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $3,842,102 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part IV, Line 11f | FormAndLineReferenceDesc |
| Explanation | Part IV, Line 11F - The Organization is a public charity under Section 501(c)(3) of the Internal Revenue Code. As a public charity, the Organization is exempt from state and federal income taxes on income earned in accordance with its tax exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Organizations tax positions and concluded that the Organization has no unrelated business income or uncertain tax positions that require adjustment to the financial statements. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Peter Moran | PersonNm |
| Title | MD | TitleTxt |
| Base Compensation Filing Org | $156,572 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $13,181 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $169,753 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1b | FormAndLineReferenceDesc |
| Explanation | Indian Stream Health Center, Inc. rents an apartment that Shirley Powell, The CEO, is allowed to use when she is in town on business. The value of this Benefit is included in her taxable compensation on her form W-2. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Charles White | |||
| Board Member | $50,000 | Community benefit grant from UCVH to Indian Stream Health Center | 0 |
| Bruce Powell | |||
| Spouse to CEO | $12,746 | Financial Consultant reporting to the Finance Director and Board Treasurer | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | Indian Stream began in-house pharmacy services. |
| Form 990, Part VI, Section B, line 11 | Indian Stream Health Center Inc.'s Finance Committee Reviews the Form 990. |
| Form 990, Part VI, Section B, line 12c | Indian Stream Health Center Inc. Requires their board members to sign a from stating what other organizations they are involved in. The board members are not allowed to vote on issues if they pertain to another organization the board member is involved with. |
| Form 990, Part VI, Section B, line 15 | The Board of Directors of Indian Stream Health Center, Inc. checked salary information from other FQHC's and reviewed the form 990's of the other non-profits to obtain comparability information for the officers' salaries. |
| Form 990, Part VI, Section C, line 19 | Indian Stream Health Center, Inc. Makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
| Form 990, Part IX, line 11g | Other Contracted Services: Program service expenses 538,150. Management and general expenses 0. Fundraising expenses 0. Total expenses 538,150. |
| Form 990, Part XI, line 9: | Pledges uncollectible -1,192. |