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UNITED NEIGHBORHOOD HEALTH SERVICES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
UNITED NEIGHBORHOOD HEALTH SERVICES INC (EIN 62-1032792)
Tax period
2012-02-01 to 2013-01-31
Filed
2013-06-13
IRS object ID
201311649349300541
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-06-13T16:17:47-05:00Timestamp
Tax Period End Date2013-01-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN621404815EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MATHENEY STEES & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line16136 SHALLOWFORD ROAD SUITE 101AddressLine1
CityCHATTANOOGACity
StateTNState
ZIP Code374217214ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-02-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN621032792EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNITED NEIGHBORHOOD HEALTH SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlUNITNameControl
Phone6156208647Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1711 MAIN STREETAddressLine1
CityNASHVILLECity
StateTNState
ZIP Code37206ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARY BUFWACKName
TitleCEOTitle
Phone6156208647Phone
Date Signed2013-06-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWILLIAM C MATHENEYName
PTINP00439757PTIN
Phone4238947400Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARY BUFWACKNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1711 MAIN STREETAddressLine1
CityNASHVILLECity
StateTNState
ZIP Code37206ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11737586GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.UNITEDNEIGHBORHOOD.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1976YearFormation
State Legal DomicileTNStateLegalDomicile
Activity Or Mission DescriptionUNITED NEIGHBORHOOD HEALTH SERVICES, INC. OPERATES HEALTH CARE CENTERS LOCATED IN THE STATE OF TENNESSEE IN THE COUNTIES OF DAVIDSON AND TROUSDALE. THE CENTER PROVIDES A BROAD RANGE OF HEALTH SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees182TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year994973ContributionsGrantsPriorYear
Contributions Grants Current Year1054938ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10732895ProgramServiceRevenuePriorYear
Program Service Revenue CY10451090ProgramServiceRevenueCY
Investment Income Prior Year1235InvestmentIncomePriorYear
Investment Income Current Year13051InvestmentIncomeCurrentYear
Other Revenue Prior Year263018OtherRevenuePriorYear
Other Revenue Current Year216551OtherRevenueCurrentYear
Total Revenue Prior Year11992121TotalRevenuePriorYear
Total Revenue Current Year11735630TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7529805SalariesEtcPriorYear
Salaries Etc Current Year7319535SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4131667OtherExpensePriorYear
Other Expenses Current Year4298170OtherExpensesCurrentYear
Total Expenses Prior Year11661472TotalExpensesPriorYear
Total Expenses Current Year11617705TotalExpensesCurrentYear
Revenues Less Expenses Prior Year330649RevenuesLessExpensesPriorYear
Revenues Less Expenses CY117925RevenuesLessExpensesCY
Total Assets BOY8885553TotalAssetsBOY
Total Assets EOY8892036TotalAssetsEOY
Total Liabilities BOY1147366TotalLiabilitiesBOY
Total Liabilities EOY1035924TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7738187NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7856112NetAssetsOrFundBalancesEOY
Mission DescriptionUNITED NEIGHBORHOOD HEALTH SERVICES, INC. OPERATES HEALTH CARE CENTERS LOCATED IN THE STATE OF TENNESSEE IN THE COUNTIES OF DAVIDSON AND TROUSDALE. THE CENTER PROVIDES A BROAD RANGE OF HEALTH SERVICES TO A LARGELY MEDICALLY UNDERSERVED POPULATION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8362591Expense
Revenue10678822Revenue
DescriptionUNITED NEIGHBORHOOD HEALTH SERVICES, INC. OPERATES A COMMUNITY BASED HEALTHCARE CLINIC PROVIDING HEALTHCARE SERVICES. DURING THE YEAR ENDED 1/31/2013, THE COMPANY PROVIDED APPROXIMATELY 73,000 CLINIC VISITS.Description
Total Program Service Expense8362591TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10965NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees182NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMARY BUFWACKNamePerson
Telephone Number6156208647TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1617 SOUTH 8TH STREETAddressLine1
CityNASHVILLECity
StateTNState
ZIP Code37206ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
SHIRLEY MCCLENDON
BOARD MEMBER2.00X000
GLENN HUNTER
BOARD PRESIDENT2.00X000X
BRENDA MARROW
BOARD VICE PRESIDENT2.00X000X
SCOTT MERTIE
BOARD MEMBER2.00X000
DENISE ALPER
BOARD MEMBER2.00X000
MARY ROBERTSON
BOARD MEMBER2.00X000
JENNIFER HAMILTON RN
BOARD MEMBER2.00X000
MARC HILL
BOARD MEMBER2.00X000
ROBERT MASON
BOARD MEMBER2.00X000
KEN MCNIGHT
BOARD TREASURER2.00X000X
MARY E OWENS
BOARD SECRETARY2.00X000X
RONNIE STEINE
BOARD MEMBER2.00X000
PAUL BENNETT
BOARD MEMBER2.00X000
KEITH JUNIOR MD
CMO35.0021599005200X
MARY BUFWACK
CEO35.00135720022500X
SMITA BAJPAI
PHYSICIAN35.00133339017000X
AFUA BOATEN
PHYSICIAN35.0015518100X
SUZETTE KELLY
PHYSICIAN35.0013572000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org775950TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation44700TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants10261GovernmentGrants
All Other Contributions1044677AllOtherContributions
Noncash Contributions382539NoncashContributions
Total Contributions1054938TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
DEPARTMENT OF HEALTH A90009965959996595999
TENNCARE MANAGED CARE90009914178951417895
MEDICAID MANAGED CARE900099661407661407
SELF-PAY900099556418556418
TENNESSEE DEPARTMENT OF HEALTH900099504506504506

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column714865TotalRevenueColumn
Related Or Exempt Function Income714865RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10451090TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1870TotalRevenueColumn
Exclusion$1,870ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other13137Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1956Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other11181Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column11181TotalRevenueColumn
Related Or Exempt Function Income11181RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OTHER REVENUE900099195720195720
MEDICAL RECORDS9000992083120831
FieldValueIRS element (for citing)
Total Other Revenue216551TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11735630TotalRevenueColumn
Related Or Exempt Function Income10678822RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,870ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5884099Total
Program Services3788961ProgramServices
Management And General2095138ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total914583Total
Program Services728734ProgramServices
Management And General185849ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total520853Total
Program Services195543ProgramServices
Management And General325310ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total208Total
Management And General208ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total209764Total
Program Services181888ProgramServices
Management And General27876ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total12725Total
Program Services12725ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total35746Total
Management And General35746ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total50828Total
Program Services-695ProgramServices
Management And General51523ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total257196Total
Program Services229557ProgramServices
Management And General27639ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total54987Total
Program Services34312ProgramServices
Management And General20675ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total94683Total
Program Services1409ProgramServices
Management And General93274ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total8739Total
Program Services8739ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total665481Total
Program Services612376ProgramServices
Management And General53105ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total37986Total
Program Services23703ProgramServices
Management And General14283ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CONTRACTUAL SERVICES895593724976170617
OTHER EXPENSE87559585631019285
PHARMACEUTICALS441460441460
CONSUMABLE SUPPLIES20710413849868606

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total450075Total
Program Services384095ProgramServices
Management And General65980ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11617705Total
Program Services8362591ProgramServices
Management And General3255114ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY164176BOY
EOY168553EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY521357BOY
EOY1687632EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY924391BOY
EOY831408EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY774939BOY
EOY276012EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY63548BOY
EOY82737EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9938453LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4156987LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6386842BOY
EOY5781466EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY50300BOY
EOY64228EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8885553BOY
EOY8892036EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY848141BOY
EOY728450EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY99253BOY
EOY199162EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY199972BOY
EOY108312EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1147366BOY
EOY1035924EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7738187BOY
EOY7856112EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7738187BOY
EOY7856112EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8885553BOY
EOY8892036EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses117925ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5705734CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7847210CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2005296CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year742380CurrentTaxYearMinus1Year
Current Tax Year594417CurrentTaxYear
Total16895037Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5056016CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6518227CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12132082CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10732895CurrentTaxYearMinus1Year
Current Tax Year10451090CurrentTaxYear
Total44890310Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years134975CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year252593CurrentTaxYearMinus1Year
Current Tax Year471702CurrentTaxYear
Total859270Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10761750CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14365437CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14272353CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11727868CurrentTaxYearMinus1Year
Current Tax Year11517209CurrentTaxYear
Total62644617Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50962644617PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10085CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5519CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2043CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1235CurrentTaxYearMinus1Year
Current Tax Year1870CurrentTaxYear
Total20752Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10085CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5519CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2043CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1235CurrentTaxYearMinus1Year
Current Tax Year1870CurrentTaxYear
Total20752Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7407CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13582CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years28559CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year263018CurrentTaxYearMinus1Year
Current Tax Year216551CurrentTaxYear
Total529117Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10779242CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14384538CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14302955CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11992121CurrentTaxYearMinus1Year
Current Tax Year11735630CurrentTaxYear
Total63194486Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99130PublicSupportPercentage509
Prior Year Support Percentage0.99340PriorYearSupportPercentage
Investment Income Percentage0.00030InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00100PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance10487BeginningOfYearBalance
End Of Year Balance10487EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance10487BeginningOfYearBalance
End Of Year Balance10487EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance9161BeginningOfYearBalance
Contributions200Contributions
Investment Earnings Or Losses1190InvestmentEarningsOrLosses
Administrative Expenses64AdministrativeExpenses
End Of Year Balance10487EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis749417OtherCostOrOtherBasis
Book Value749417BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5993079OtherCostOrOtherBasis
Depreciation1744779Depreciation
Book Value4248300BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis716003OtherCostOrOtherBasis
Depreciation259984Depreciation
Book Value456019BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1107784OtherCostOrOtherBasis
Depreciation952814Depreciation
Book Value154970BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1372170OtherCostOrOtherBasis
Depreciation1199410Depreciation
Book Value172760BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5781466TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt11824793TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities89163DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F99089163RevenueNotRptdF990
Revenue Subtotal11735630RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99011735630TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11706868TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities89163DonatedServicesUseOfFacilities
Expenses Not Rptd F99089163ExpensesNotRptdF990
Expenses Subtotal11617705ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011617705TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:BOARD DESIGNATED FUNDS.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:ON JANUARY 1, 2009, THE CENTER ADOPTED FASB ASC 740-10 ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES (FASB ASC 740-1), WHICH PROVIDES A FRAMEWORK FOR HOW COMPANIES SHOULD RECOGNIZE, MEASURE, PRESENT AND DISCLOSE UNCERTAIN TAX POSITIONS WITHIN THE FINANCIAL STATEMENTS. WITH THESE CHANGES, THE CENTER MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE CENTER DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS AS OF JANUARY 31, 2013 AND 2012 AS OF JANUARY 31, 2013 AND 2012, THE CENTER DID NOT RECORD ANY PENALTIES OR INTEREST ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE FEDERAL AND STATE INCOME TAX RETURNS OF THE CENTER FOR THE YEARS PRIOR TO 2009 ARE NOT SUBJECT TO EXAMINATION BY THE TAXING AUTHORITY.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KEITH JUNIOR MD
CMO215990000005200000221190000
MARY BUFWACK
CEO1357200000022500000158220000
SMITA BAJPAI
PHYSICIAN1333390000017000000150339000
AFUA BOATEN
PHYSICIAN155181000000000155181000

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990382539NoncashContribsRptdF990
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11BEFORE FORM 990 IS FILED, IT IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER. IF ERRORS OR QUESTIONS ARISE, THESE ARE RESOLVED BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATIONS CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY FOR ALL STAFF. FORMS ARE COMPLETED ANNUALLY BY BOARD MEMBERS. PROVIDERS HAVE CLAUSES IN CONTRACT THAT REQUIRE REPORTING. ALL CONTRACTS ARE REVIEWED FOR ANY CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION FOR THE CEO AND TOP MANAGEMENT STAFF IS DETERMINED THROUGH COMPARISON WITH NATIONAL INFORMATION ON COMPENSATION FOR OTHER COMMUNITY HEALTH CENTERS. EFFORTS ARE MADE TO HAVE THIS LEVEL AT THE MEDIAN LEVEL. THE CEO AND MANAGEMENT OFFICIALS SALARIES ARE REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS AND REVISED IF NEEDED, DEPENDING UPON THE FINANCIAL POSITION OF THE ORGANIZATION. BENEFITS FOR THE CEO AND TOP MANAGEMENT OFFICIALS ARE DONE EXACTLY LIKE THOSE OF OTHER EXEMPT STAFF.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE IN TWO WAYS. THESE DOCUMENTS MAY BE REQUESTED FROM THE ORGANIZATION'S BUSINESS OFFICE AND CAN BE OBTAINED WITHIN 5 BUSINESS DAYS. INFORMATION IS ALSO AVAILABLE ON A WEBSITE FOR NON-PROFITS: GIVINGMATTERS.COM