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EAST TEXAS COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
EAST TEXAS COMMUNITY HEALTH SERVICES INC (EIN 75-2184369)
Tax period
2011-06-01 to 2012-05-31
Filed
2013-04-12
IRS object ID
201331039349300408
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-04-12T14:37:21-07:00Timestamp
Tax Period End Date2012-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Goff & Herrington PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 153320AddressLine1
CityLufkinCity
StateTXState
ZIP Code75915ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN752184369EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1East Texas Community Health Services IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlEASTNameControl
Phone9365605413Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 632040AddressLine1
CityNacogdochesCity
StateTXState
ZIP Code75963ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRobin MooreName
TitleExecutive DirectorTitle
Date Signed2013-04-12DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRonnie Herrington CPAName
Phone9368753317Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts4473282GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.tachc.org/etchsWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1987YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionOPERATE A PRIMARY HEALTH CARE CLINIC FOR THE CARE AND TREATMENT OF SICK, INJURED, AFFLICTED, INFIRM, DISABLED OR DESTITUTE.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees68TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year3409117ContributionsGrantsPriorYear
Contributions Grants Current Year2744364ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1535195ProgramServiceRevenuePriorYear
Program Service Revenue CY1719893ProgramServiceRevenueCY
Investment Income Prior Year1985InvestmentIncomePriorYear
Investment Income Current Year1401InvestmentIncomeCurrentYear
Other Revenue Prior Year15809OtherRevenuePriorYear
Other Revenue Current Year7624OtherRevenueCurrentYear
Total Revenue Prior Year4962106TotalRevenuePriorYear
Total Revenue Current Year4473282TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3105580SalariesEtcPriorYear
Salaries Etc Current Year3253737SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1454714OtherExpensePriorYear
Other Expenses Current Year1350214OtherExpensesCurrentYear
Total Expenses Prior Year4560294TotalExpensesPriorYear
Total Expenses Current Year4603951TotalExpensesCurrentYear
Revenues Less Expenses Prior Year401812RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-130669RevenuesLessExpensesCY
Total Assets BOY3075198TotalAssetsBOY
Total Assets EOY2834105TotalAssetsEOY
Total Liabilities BOY1308500TotalLiabilitiesBOY
Total Liabilities EOY1198076TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1766698NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1636029NetAssetsOrFundBalancesEOY
Mission DescriptionOPERATE A PRIMARY HEALTH CARE CLINIC FOR THE CARE AND TREATMENT OF SICK, INJURED, AFFLICTED, INFIRM, DISABLED OR DESTITUTE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense2987129Expense
Revenue1154523Revenue
DescriptionOPERATION OF CLINICS TO PROVIDE PRIMARY HEALTH CARE SERVICESDescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense399433Expense
Revenue154381Revenue
DescriptionOPERATION OF A PHARMACY FOR CLINIC PATIENTSDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense146866Expense
Revenue56764Revenue
DescriptionOPERATION OF DENTAL CLINICS TO PROVIDE DENTAL SERVICESDescription
FieldValueIRS element (for citing)
Total Program Service Expense3533428TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
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 LiabilitiestrueReportOtherLiabilities
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 RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
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
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109616NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees68NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
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
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
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
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonAnita HumphreysNamePerson
Telephone Number9365605413TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11401 South University DriveAddressLine1
CityNacogdochesCity
StateTXState
ZIP Code75961ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Henry Summers
Treasurer0.50X000
Michael Svenson
Past Chair0.50X000
Velta Page
Secretary0.50X000
Larry Nieto
Board Member0.50X000
Yolanda King
Board Member0.50X000
Shelia Hopkins
Board Member0.50X000
Bill Harrison
Board Member0.50X000
Tim Garrigan
Board Member0.50X000
Clay Farell
Board Member0.50X000
Walter Deptula
Board Member0.50X000
Billy Cordova Jr
Chairman0.50X000
Sharon Coleman
Board Member0.50X000
Dr Chris Bray
Vice Chair0.50X000
Anita Humphreys
CFO40.008390300X
Robin Moore
Executive Dir.40.0010262500X
Brice Houston
Dentis/Dental Director40.008055000X
Carolyn Patton
Mid-level Provider40.008720300X
Dr Penny Jeffery
Medical Director40.009230300X
Janice Henson
Director of Operations40.007568300X
Tina Cohen
Chief Nursing Officer40.004233400X
James Koerner MD
Physician40.0022560200X
Marilynn J Denson MD
Physician40.0014574100X
Le Huan Cua Diane
Dentist40.0010407600X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1040020TotalReportableCompFromOrg
Number Individuals GT100 K4NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Staff Care
PO Box 281923AtlantaGA303841923Temporary Services114747
Laboratory Corp of America
PO Box 12140BurlingtonNC272162140Med/dental lab svs124568
Blue Cross Blue Shield
PO Box 731428DallasTX753731428Healthcare Provider331099
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants2664939GovernmentGrants
All Other Contributions79425AllOtherContributions
Total Contributions2744364TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Primary Medical Care581202581202
Medicare/Medicaid11386911138691
FieldValueIRS element (for citing)
Total Program Service Revenue1719893TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1401TotalRevenueColumn
Related Or Exempt Function Income1401RelatedOrExemptFunctionIncome

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real7624Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real7624Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column7624TotalRevenueColumn
Related Or Exempt Function Income7624RelatedOrExemptFunctionIncome

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4473282TotalRevenueColumn
Related Or Exempt Function Income1728918RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total667438Total
Program Services262999ProgramServices
Management And General404439ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2148404Total
Program Services1839969ProgramServices
Management And General308435ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total246756Total
Program Services194323ProgramServices
Management And General52433ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total191139Total
Program Services145566ProgramServices
Management And General45573ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total107836Total
Program Services60846ProgramServices
Management And General46990ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total146925Total
Program Services141823ProgramServices
Management And General5102ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total19215Total
Program Services8926ProgramServices
Management And General10289ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total61557Total
Management And General61557ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total135538Total
Program Services124864ProgramServices
Management And General10674ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total25043Total
Program Services2358ProgramServices
Management And General22685ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Other Expenses389352557313362
Maintenance1128099819714612
Consumable Supplies2261992189977202
CONTRACT SERVICES40400838748816520

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total72149Total
Program Services21499ProgramServices
Management And General50650ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total4603951Total
Program Services3533428ProgramServices
Management And General1070523ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY379590BOY
EOY409200EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY51458BOY
EOY52172EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY549767BOY
EOY357860EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY10186BOY
EOY5917EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY440BOY
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3516405LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1507449LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2083757BOY
EOY2008956EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3075198BOY
EOY2834105EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY165747BOY
EOY167971EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY998908BOY
EOY944657EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY143845BOY
EOY85448EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1308500BOY
EOY1198076EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1766698BOY
EOY1636029EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1766698BOY
EOY1636029EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3075198BOY
EOY2834105EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-130669ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 Years1906474CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2332638CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2308974CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2646147CurrentTaxYearMinus1Year
Current Tax Year2744364CurrentTaxYear
Total11938597Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1906474CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2332638CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2308974CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2646147CurrentTaxYearMinus1Year
Current Tax Year2744364CurrentTaxYear
Total11938597Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total17011938597PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14136CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13755CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7933CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4843CurrentTaxYearMinus1Year
Current Tax Year9025CurrentTaxYear
Total49692Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support11988289TotalSupport
Public Support Pertcentage1700.99590PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99520PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

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

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis129059InvestmentCostOrOtherBasis
Book Value129059BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis2451992InvestmentCostOrOtherBasis
Depreciation699813Depreciation
Book Value1752179BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis7500InvestmentCostOrOtherBasis
Depreciation1500Depreciation
Book Value6000BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis927854InvestmentCostOrOtherBasis
Depreciation806136Depreciation
Book Value121718BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2008956TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionAccrued LiabilitiesDescription
Amount$85,448Amount
FieldValueIRS element (for citing)
Total Of Amounts85448TotalOfAmounts
Total Revenue4473282TotalRevenue
Total Expenses4603951TotalExpenses
Excess Or Deficit For Year-130669ExcessOrDeficitForYear
Excess Or Deficit Per FS-130669ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt4473282TotRevenueEtcAuditedFinclStmt
Revenue Subtotal4473282RevenueSubtotal
Total Revenue Per Form9904473282TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt4603951TotExpensesEtcAuditedFinclStmt
Expenses Subtotal4603951ExpensesSubtotal
Total Expenses Per Form9904603951TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJames Koerner MDNamePerson
Base Compensation Filing Org209364BaseCompensationFilingOrg
Other Compensation Filing Org16238OtherCompensationFilingOrg
Total Compensation Filing Org225602TotalCompensationFilingOrg

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableAVAILABLE UPON REQUEST.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesFOR THE EXECUTIVE DIRECTOR, ANNUAL REVIEW DOCUMENTS ARE COMPLETED BY THE EXECUTIVE COMMITTEE MEMBERS. EACH MEMBER PREPARES A RATING AND REVIEWS WITH THE ENTIRE BOARD IN EXECUTIVE SESSION. A RECOMMENDATION IS PREPARED BY THE EXECUTIVE COMMITTEE ANDPRESENTED TO THE ENTIRE BOARD FOR APPROVAL. FOR OTHER KEY EMPLOYEES COMPENSATION, COMPARABILITY DATA IS REVIEWED.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflictsannual assurances in grant application and conflict of interest statements signed annually.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessForm 990 is reviewed by the executive director and compared to the audited financial statements. In the rare instance of any differences, the executive director reviews with the board.