BEAR LAKE COMMUNITY HEALTH CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: BEAR LAKE COMMUNITY HEALTH CENTER INC (EIN 81-0587644)
Tax period: 2011-05-01 to 2012-04-30
Filed: 2013-01-23
IRS object ID: 201320239349300517
Schema version: 2011v1.5
Source: Download XML · Original 990 at ProPublica

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

Return header
Form 990
Schedule A
Schedule D
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-01-23T12:37:28-06:00	Timestamp
Tax Period End Date	2012-04-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

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

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-05-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	810587644	EIN

Name Name

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

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

US Address USAddress

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

Officer Officer

Field	Value	IRS element (for citing)
Name	LAVAL JENSEN	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	4359463660	Phone
Date Signed	2012-12-20	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	M PAUL WINWARD CPA	Name
Phone	8012256900	Phone
Date Prepared	2013-01-23	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

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

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

Address Principal Officer US AddressPrincipalOfficerUS

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

Field	Value	IRS element (for citing)
Gross Receipts	5129233	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2002	YearFormation
State Legal Domicile	UT	StateLegalDomicile
Activity Or Mission Description	MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR LOW-INCOME FAMILIES.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	10	NbrIndependentVotingMembers
Total Nbr Employees	102	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	1109203	ContributionsGrantsPriorYear
Contributions Grants Current Year	1070297	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	2130109	ProgramServiceRevenuePriorYear
Program Service Revenue CY	2470891	ProgramServiceRevenueCY
Investment Income Prior Year	26	InvestmentIncomePriorYear
Investment Income Current Year	22	InvestmentIncomeCurrentYear
Other Revenue Prior Year	765131	OtherRevenuePriorYear
Other Revenue Current Year	1071600	OtherRevenueCurrentYear
Total Revenue Prior Year	4004469	TotalRevenuePriorYear
Total Revenue Current Year	4612810	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	3197248	SalariesEtcPriorYear
Salaries Etc Current Year	3225347	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1028415	OtherExpensePriorYear
Other Expenses Current Year	1039848	OtherExpensesCurrentYear
Total Expenses Prior Year	4225663	TotalExpensesPriorYear
Total Expenses Current Year	4265195	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-221194	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	347615	RevenuesLessExpensesCY
Total Assets BOY	4224450	TotalAssetsBOY
Total Assets EOY	4327682	TotalAssetsEOY
Total Liabilities BOY	3430178	TotalLiabilitiesBOY
Total Liabilities EOY	3185795	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	794272	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1141887	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR LOW-INCOME FAMILIES.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	1842126	Expense
Description	PROVIDED MEDICAL SERVICES TO LOW-INCOME FAMILIES	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	574928	Expense
Description	PROVIDED DENTAL SERVICES TO LOW-INCOME FAMILIES.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	124988	Expense
Description	PROVIDED MENTAL HEALTH SERVICES TO LOW-INCOME FAMILIES.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	860190	Expense
Description	PROVIDED PHARMACY SERVICES & HEALTH AND WELLNESS SERVICES TO LOW-INCOME FAMILIES.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	860190	TotalOfOtherProgramServiceExp
Total Program Service Expense	3402232	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	true	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
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	8	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	102	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
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	10	NbrVotingGoverningBodyMembers
Number Independent Voting Members	10	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	false	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

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

Field	Value	IRS element (for citing)
Telephone Number	4359463660	TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
ANGELA GLOVER
BOARD MEMBER	1.00	X	0	0	0
ANNA CHRISTENSEN
BOARD MEMBER	1.00	X	0	0	0
DAREN WALLENTINE
BOARD MEMBER	1.00	X	0	0	0
DOROTHY EVANS
SECRETARY	1.00	X	0	0	0
LARAINE SCHNETZER
CHAIR	1.00	X	0	0	0
NORMAN MECHAM
BOARD MEMBER	1.00	X	0	0	0
PAT SNELL
VICE CHAIR	1.00	X	0	0	0
SHERRIE DAVIS
TREASURER	1.00	X	0	0	0
MARC TRENERY
BOARD MEMBER	1.00	X	0	0	0
TARA MCMULLIN
BOARD MEMBER	1.00	X	0	0	0
DAVID J BALLINGHAM
CLINICAL DIR	40.00		188178	0	28456	X
LAVAL JENSEN
EXEC. DIRECT	40.00		188114	0	31041	X
GLADE CROWTHER
DENTIST	40.00		135874	0	8558		X
BEN BOYER
NURSE PRACTI	40.00		135874	0	9525		X
GREGG LUKE
PHARMACIST	40.00		123941	0	9846		X
RICHARD BALLAM
PHARMACIST	40.00		120000	0	0		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	891981	TotalReportableCompFromOrg
Total Other Compensation	87426	TotalOtherCompensation
Number Individuals GT100 K	6	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Government Grants	1058809	GovernmentGrants
All Other Contributions	11488	AllOtherContributions
Total Contributions	1070297	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PROFESSIONAL FEES	Description
Total Revenue Column	2470891	TotalRevenueColumn
Related Or Exempt Function Income	2470891	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	2470891	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	22	TotalRevenueColumn
Related Or Exempt Function Income	22	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	1579997	GrossSalesOfInventory
Cost Of Goods Sold	516423	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	1063574	TotalRevenueColumn
Related Or Exempt Function Income	1063574	RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	OTHER	Description
Total Revenue Column	8026	TotalRevenueColumn
Related Or Exempt Function Income	8026	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	8026	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4612810	TotalRevenueColumn
Related Or Exempt Function Income	3542513	RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	376292	Total
Program Services	282235	ProgramServices
Management And General	94057	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2354071	Total
Program Services	1852569	ProgramServices
Management And General	501502	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	56864	Total
Program Services	56864	ProgramServices

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	226634	Total
Program Services	118666	ProgramServices
Management And General	107968	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	211486	Total
Program Services	211486	ProgramServices

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	6065	Total
Program Services	6065	ProgramServices

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	20930	Total
Program Services	12853	ProgramServices
Management And General	8077	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	33283	Total
Program Services	33283	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	302662	Total
Program Services	262974	ProgramServices
Management And General	39688	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	72855	Total
Program Services	72855	ProgramServices

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	143131	Total
Program Services	129182	ProgramServices
Management And General	13949	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	81770	Total
Program Services	19765	ProgramServices
Management And General	62005	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	113702	Total
Program Services	102622	ProgramServices
Management And General	11080	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	172442	Total
Program Services	155637	ProgramServices
Management And General	16805	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	36414	Total
Program Services	32866	ProgramServices
Management And General	3548	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BANK FEES	25626	25626
OTHER	18107	13823	4284
DUES AND SUBSCRIPTIONS	6885	6885
PATIENT EDUCATION	3809	3809

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	2167	Total
Program Services	2167	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	4265195	Total
Program Services	3402232	ProgramServices
Management And General	862963	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	54768	BOY
EOY	78703	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	17649	BOY
EOY	22421	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	412302	BOY
EOY	528862	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	192885	BOY
EOY	218998	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	4071032	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	594834	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	3544346	BOY
EOY	3476198	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4224450	BOY
EOY	4327682	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	610445	BOY
EOY	465510	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	10000	BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	2712485	BOY
EOY	2657209	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	97248	BOY
EOY	63076	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3430178	BOY
EOY	3185795	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	794272	BOY
EOY	1141887	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	794272	BOY
EOY	1141887	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4224450	BOY
EOY	4327682	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	347615	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year	1070297	CurrentTaxYear
Total	1070297	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year	1070297	CurrentTaxYear
Total	1070297	Total

Field	Value	IRS element (for citing)
Public Support Total170	1070297	PublicSupportTotal170
Total Support	1070297	TotalSupport
Gross Receipts From Admissions Etc	4058936	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	1.00000	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.99940	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Disclosed Orgs Legal Control	false	DisclosedOrgsLegalControl
Disclosed For Charitable Purposes	false	DisclosedForCharitablePurposes
Written Policy Monitoring	false	WrittenPolicyMonitoring
Sect170h Requirements Satisfied	false	Sect170hRequirementsSatisfied
Solicited Assets For Sale	false	SolicitedAssetsForSale
Agent Trustee Etc	false	AgentTrusteeEtc
Included On FS	false	IncludedOnFS
Endowments Held By Unrelated Orgs	false	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	false	AreRelatedOrgsListedScheduleR

Land Land

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

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3012706	OtherCostOrOtherBasis
Depreciation	173337	Depreciation
Book Value	2839369	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	199147	OtherCostOrOtherBasis
Depreciation	68127	Depreciation
Book Value	131020	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	756179	OtherCostOrOtherBasis
Depreciation	353370	Depreciation
Book Value	402809	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3476198	TotalOfBookValueLandBuildings
Total Revenue	4612810	TotalRevenue
Total Expenses	4265195	TotalExpenses
Excess Or Deficit For Year	347615	ExcessOrDeficitForYear
Excess Or Deficit Per FS	347615	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	5129233	TotRevenueEtcAuditedFinclStmt
Other Revenues	516423	OtherRevenues
Revenue Not Rptd F990	516423	RevenueNotRptdF990
Revenue Subtotal	4612810	RevenueSubtotal
Total Revenue Per Form990	4612810	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	4781618	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	516423	OtherExpensesIncluded
Expenses Not Rptd F990	516423	ExpensesNotRptdF990
Expenses Subtotal	4265195	ExpensesSubtotal
Total Expenses Per Form990	4265195	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
RECONCILIATION OF CHANGES - OTHER	SCHEDULE D, PAGE 4, PART XI, LINE 8	PHARMACY COST OF GOODS SOLD 516,423 PHARMACY COST OF GOODS SOLD -516,423
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XII, LINE 2D	PHARMACY COST OF GOODS SOLD 516,423
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XIII, LINE 2D	PHARMACY COST OF GOODS SOLD 516,423

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Bonus Filing OrgBonusFilingOrg	Deferred Comp Filing OrgDeferredCompFilingOrg	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
DAVID J BALLINGHAM
159080	29098	7527	20929	216634
LAVAL JENSEN
159016	29098	7579	23462	219155

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	LAVAL JENSEN	NamePerson

Field	Value	IRS element (for citing)
Relationship	EXEC. DIRECTOR	Relationship
Amount Of Transaction	62000	AmountOfTransaction
Description Of Transaction	LOAN REPAID BY YEAR	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

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