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FIRST CHOICE PRIMARY CARE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
FIRST CHOICE PRIMARY CARE INC (EIN 20-4391090)
Tax period
2012-05-01 to 2013-04-30
Filed
2013-11-13
IRS object ID
201323179349301242
Schema version
2012v2.0
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

FieldValueIRS element (for citing)
Timestamp2013-11-13T06:58:16-08:00Timestamp
Tax Period End Date2013-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1TERRY HORNE CPA & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1732 WEST MAIN STREETAddressLine1
CityLEBANONCity
StateTNState
ZIP Code37087ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN204391090EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FIRST CHOICE PRIMARY CARE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFIRSNameControl
Phone4787874266Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 4363AddressLine1
CityMACONCity
StateGAState
ZIP Code312084363ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKATHERINE MCLEODName
TitleCHIEF EXECUTIVE OFFICERTitle
Phone4787874266Phone
Date Signed2013-11-13DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTERRY HORNEName
Phone6154447293Phone
Date Prepared2013-11-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKATHERINE MCLEODNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 4363AddressLine1
CityMACONCity
StateGAState
ZIP Code31208ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1823396GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2005YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION PROVIDES HEALTH CARE TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THIS IS A DIRECT FULFILLMENT OF THEIR TAX EXEMPT PURPOSE.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees38TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year849461ContributionsGrantsPriorYear
Contributions Grants Current Year1134464ContributionsGrantsCurrentYear
Program Service Revenue Prior Year791641ProgramServiceRevenuePriorYear
Program Service Revenue CY688160ProgramServiceRevenueCY
Investment Income Prior Year476InvestmentIncomePriorYear
Investment Income Current Year772InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year1641578TotalRevenuePriorYear
Total Revenue Current Year1823396TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1044054SalariesEtcPriorYear
Salaries Etc Current Year1149620SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year544856OtherExpensePriorYear
Other Expenses Current Year593792OtherExpensesCurrentYear
Total Expenses Prior Year1588910TotalExpensesPriorYear
Total Expenses Current Year1743412TotalExpensesCurrentYear
Revenues Less Expenses Prior Year52668RevenuesLessExpensesPriorYear
Revenues Less Expenses CY79984RevenuesLessExpensesCY
Total Assets BOY1016718TotalAssetsBOY
Total Assets EOY1027191TotalAssetsEOY
Total Liabilities BOY263177TotalLiabilitiesBOY
Total Liabilities EOY193666TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY753541NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY833525NetAssetsOrFundBalancesEOY
Mission DescriptionTHE ORGANIZATION PROVIDES HEALTH CAREMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1099630Expense
Revenue688160Revenue
DescriptionTHE ORGANIZATION PROVIDES HEALTH CARE REGARDLESS OF THE INDIVIDUALS ABILITY TO PAY. THESE MEDICAL SERVICES ARE PROVIDED IN AREAS THAT HAVE A SHORTAGE OF HEALTH CARE PROVIDERS. THIS IS A DIRECT FULFILLMENT OF THEIR TAX EXEMPT PURPOSE. OVER 10,100 VISITS WERE PROVIDED DURING THE YEAR.Description
Total Program Service Expense1099630TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10967NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees38NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKATHERINE MCLEODNamePerson
Telephone Number4787874266TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1770 WALNUT STREETAddressLine1
CityMACONCity
StateGAState
ZIP Code312017307ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
CAMILLE HOPE
PRESIDENT1.00X000
MARC WHITFIELD
VICE PRESIDENT1.00X000
THOMAS DUVAL
TREASURER1.00X000
DAVID PARISH
SECRETARY1.00X000
JONATHAN ALDERMAN
BOARD MEMBER1.00X000
MABLE P WHEELER
BOARD MEMBER1.00X000
LINDA HOLLAND
BOARD MEMBER1.00X000
STEVE CORKERY
BOARD MEMBER1.00X000
MARVIN RIGGINS
BOARD MEMBER1.00X000
HELEN SHELLEY WILLOUGHBY
BOARD MEMBER1.00X000
KATHERINE MCLEOD
CHIEF EXECUTIVE OFFICER40.008071804403X
TIMOTHY GRAVES
MEDICAL DIRECTOR40.0011835104513X
PAUL GROGAN
CFO-TERMINATED40.004736303302X
ROCKY DAVIDSON
CFO40.001891900X
FieldValueIRS element (for citing)
Total Reportable Comp From Org265351TotalReportableCompFromOrg
Total Other Compensation12218TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Government Grants776701GovernmentGrants
All Other Contributions357763AllOtherContributions
Total Contributions1134464TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT FEESDescription
Business Code621110BusinessCode
Total Revenue Column688160TotalRevenueColumn
FieldValueIRS element (for citing)
Total Program Service Revenue688160TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column772TotalRevenueColumn
Exclusion$772ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1823396TotalRevenueColumn
Related Or Exempt Function Income688160RelatedOrExemptFunctionIncome
Exclusion$772ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total265351Total
Program Services118351ProgramServices
Management And General147000ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total723079Total
Program Services539831ProgramServices
Management And General183248ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total97190Total
Program Services66089ProgramServices
Management And General31101ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total64000Total
Program Services43520ProgramServices
Management And General20480ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total42406Total
Program Services0ProgramServices
Management And General42406ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total156560Total
Program Services79095ProgramServices
Management And General77465ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total223787Total
Program Services144210ProgramServices
Management And General79577ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total107869Total
Program Services97082ProgramServices
Management And General10787ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total14488Total
Program Services1020ProgramServices
Management And General13468ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total44577Total
Program Services6737ProgramServices
Management And General37840ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total4105Total
Program Services3695ProgramServices
Management And General410ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1743412Total
Program Services1099630ProgramServices
Management And General643782ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY69499BOY
EOY156987EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY223900BOY
EOY108997EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY66660BOY
EOY72948EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY11039BOY
EOY68929EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis794514LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec175184LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY645620BOY
EOY619330EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1016718BOY
EOY1027191EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY115980BOY
EOY137851EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY147197BOY
EOY55815EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY263177BOY
EOY193666EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY753541BOY
EOY833525EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY753541BOY
EOY833525EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1016718BOY
EOY1027191EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses79984ReconcilationRevenueExpenses
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years915087CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years913344CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1425001CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year849461CurrentTaxYearMinus1Year
Current Tax Year1134464CurrentTaxYear
Total5237357Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years915087CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years913344CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1425001CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year849461CurrentTaxYearMinus1Year
Current Tax Year1134464CurrentTaxYear
Total5237357Total
FieldValueIRS element (for citing)
Public Support Total1705237357PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years20CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years153CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years49CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year476CurrentTaxYearMinus1Year
Current Tax Year772CurrentTaxYear
Total1470Total
FieldValueIRS element (for citing)
Total Support5238827TotalSupport
Gross Receipts From Admissions Etc2787308GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.99970PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99990PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
Public Support Total5090PublicSupportTotal509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis560825InvestmentCostOrOtherBasis
Depreciation50850Depreciation
Book Value509975BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis233689InvestmentCostOrOtherBasis
Depreciation124334Depreciation
Book Value109355BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings619330TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt1823396TotRevenueEtcAuditedFinclStmt
Revenue Subtotal1823396RevenueSubtotal
Total Revenue Per Form9901823396TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt1743412TotExpensesEtcAuditedFinclStmt
Expenses Subtotal1743412ExpensesSubtotal
Total Expenses Per Form9901743412TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST
POLICY AND FORM 990 AVAILABLE UPON WRITTEN REQUEST.
Pt VI, Line 11bTHE FORM 990 WILL BE GIVEN TO THE BOARD OF DIRECTORS FOR
REVIEW AT A REGULARLY SCHEDULED MEETING PRIOR TO FILING.
Pt VI, Line 12cWHEN OR IF A TRANSACTION OF MATERIAL NATURE WITH A POTENTIAL CONFLICT
OF INTEREST SHOULD ARRISE, THE TRANSACTION WOULD BE PRESENTED
TO THE FULL BOARD FOR DISCUSSION AND THE BOARD WOULD VOTE (BY ELECTRONIC BALLOT).
Pt VI, Line 15aSTATE AND NATIONAL SALARY COMPARISONS ARE USED TO ESTABLISH SALARY LIMITS
Pt VI, Line 15bFOR TOP MANAGEMENT OFFICIALS. PERFORMANCE EVALUATION ARE PERFORMED ANNUALLY
AND SALARY INCREASES ARE BOARD APPROVED.
Pt XII, Line 2cTHE CEO, CFO AND FINANCE COMMITTEE OVERSEE FINANCIAL STATEMENT PREPARATION
AND AUDIT ENGAGEMENT.