WESTERN SIERRA MEDICAL CLINIC INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: WESTERN SIERRA MEDICAL CLINIC INC (EIN 94-2279011)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-07-23
IRS object ID: 201332079349300828
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
Form 990
Schedule A
Schedule D
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-07-23T17:39:51-07:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	202707086	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	TCA Partners LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1111 E Herndon Avenue Suite 211	AddressLine1
City	Fresno	City
State	CA	State
ZIP Code	93720	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	942279011	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Western Sierra Medical Clinic	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	WEST	NameControl
Phone	5302739339	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO Box 286	AddressLine1
Address Line2	209 Nevada Street	AddressLine2
City	Downieville	City
State	CA	State
ZIP Code	95936	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Tom Morrissey	Name
Title	CFO	Title
Phone	5302739339	Phone
Date Signed	2013-06-24	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Jeremy Ware	Name
PTIN	P00642659	PTIN
Phone	5594317708	Phone
Date Prepared	2013-06-24	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Scott McFarlane	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1345 Whispering Pines Lane	AddressLine1
City	Grass Valley	City
State	CA	State
ZIP Code	95945	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	5492438	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.wsmcmed.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1975	YearFormation
State Legal Domicile	CA	StateLegalDomicile
Activity Or Mission Description	The Clinic's specific purpose is to provide quality health care and related charitable and educational opportunities to people of all ages and incomes, living in Western Sierra and Nevada Counties. This purpose includes medical and preventive health services, long-term care and education concerning health care needs and issues. During the year, the Clinic provided over 39,770 visits to 10,175 patients.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	11	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	87	TotalNbrEmployees
Total Nbr Volunteers	1	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	921229	ContributionsGrantsPriorYear
Contributions Grants Current Year	863134	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	4738621	ProgramServiceRevenuePriorYear
Program Service Revenue CY	4458466	ProgramServiceRevenueCY
Investment Income Prior Year	963	InvestmentIncomePriorYear
Investment Income Current Year	353	InvestmentIncomeCurrentYear
Other Revenue Prior Year	45329	OtherRevenuePriorYear
Other Revenue Current Year	170485	OtherRevenueCurrentYear
Total Revenue Prior Year	5706142	TotalRevenuePriorYear
Total Revenue Current Year	5492438	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	3778168	SalariesEtcPriorYear
Salaries Etc Current Year	4133547	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1817935	OtherExpensePriorYear
Other Expenses Current Year	1989825	OtherExpensesCurrentYear
Total Expenses Prior Year	5596103	TotalExpensesPriorYear
Total Expenses Current Year	6123372	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	110039	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-630934	RevenuesLessExpensesCY
Total Assets BOY	2780348	TotalAssetsBOY
Total Assets EOY	2229648	TotalAssetsEOY
Total Liabilities BOY	946281	TotalLiabilitiesBOY
Total Liabilities EOY	1026515	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	1834067	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1203133	NetAssetsOrFundBalancesEOY
Mission Description	The Clinic's specific purpose is to provide quality health care and related charitable and educational opportunities to people of all ages and incomes, living in Western Sierra and Nevada Counties. This purpose includes medical and preventive health services, long-term care and education concerning health care needs and issues.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	4737917	Expense
Grants	0	Grants
Revenue	5492438	Revenue
Description	The Clinic's specific purpose is to provide quality health care and related charitable and educational opportunities to people of all ages and incomes, living in Western Sierra and Nevada Counties. This purpose includes medical and preventive health services, long-term care and education concerning health care needs and issues. During the year, the Clinic provided over 39,770 visits to 10,175 patients.	Description
Total Of Other Program Service Exp	0	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	0	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	0	TotalOfOtherProgramServiceRev
Total Program Service Expense	4737917	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	1	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	65	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	87	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	11	NbrVotingGoverningBodyMembers
Number Independent Voting Members	11	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	CA	StatesWhereCopyOfReturnIsFiled
Other Website	X	OtherWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Tom Morrissey	BusinessNameLine1
Business Name Line2	Western Sierra Medical Clinic	BusinessNameLine2

Field	Value	IRS element (for citing)
Telephone Number	5302734984	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	135 Whispering Pines Lane	AddressLine1
City	Grass Valley	City
State	CA	State
ZIP Code	95945	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
Larry Allen
Board President	2	0	X	0	0	0
Florence Lyss
Vice President	2	0	X	0	0	0
Dick Kuwarth
Treasurer	2	0	X	0	0	0
Scotte Browne
Secretary	2	0	X	0	0	0
Tim Beals
Director	2	0	X	0	0	0
Anita Daniels
Director	2	0	X	0	0	0
Katherine Madeiros
Director	2	0	X	0	0	0
Jeannie Medley
Director	2	0	X	0	0	0
Brandon Pangman
Director	2	0	X	0	0	0
Jon Peek
Director	2	0	X	0	0	0
Lupe Peterson
Director	2	0	X	0	0	0
Don Russell
Director	2	0	X	0	0	0
Derek Williams
Director	2	0	X	0	0	0
Tom Morrissey
CFO	40	0		115437	0	0	X
Scott McFarland
CEO	40	0		195589	0	0	X
Frank Lang Jr
CMO	40	0		215879	0	0	X
Leann Watson
Physician	40	0		162422	0	0		X
Heather Lucas Ross
Physician	40	0		185821	0	0		X
Allen Kellerman
Physician	24	0		134680	0	0		X
Frank Lang Sr
FNP	40	0		175069	0	0		X
Galen Martin
Physician	24	0		109000	0	0		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1293897	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	0	TotalOtherCompensation
Number Individuals GT100 K	8	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Sierra Nevada Memorial Hospital
1500 Glasson Way	Grass Valley	CA	95945	Purchased Services	272739
Cardinal Health
7000 Cardinal Place	Dublin	OH	43017	Pharmaceutical Supplies	163638
Sierra Care Physicians
PO Box 459001	Grass Valley	CA	95945	Pediatric and OnCall Services	132197

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	3	NumberOfContractorsGT100K
Federated Campaigns	0	FederatedCampaigns
Membership Dues	0	MembershipDues
Fundraising Events	0	FundraisingEvents
Related Organizations	0	RelatedOrganizations
Government Grants	817004	GovernmentGrants
All Other Contributions	46130	AllOtherContributions
Noncash Contributions	0	NoncashContributions
Total Contributions	863134	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	Net Patient Service Revenue	Description
Business Code	621400	BusinessCode
Total Revenue Column	5265712	TotalRevenueColumn
Related Or Exempt Function Income	5265712	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	-807246	TotalRevenueColumn
Related Or Exempt Function Income	-807246	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	4458466	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	353	TotalRevenueColumn
Related Or Exempt Function Income	353	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	12731	Real
Personal	0	Personal

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	12731	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	12731	TotalRevenueColumn
Related Or Exempt Function Income	12731	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	0	Other

Field	Value	IRS element (for citing)
Cntrbtns Rprtd Fundraising Events	0	CntrbtnsRprtdFundraisingEvents

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	Meaningful Use Revenue	Description
Business Code	621400	BusinessCode
Total Revenue Column	127500	TotalRevenueColumn
Related Or Exempt Function Income	127500	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	30254	TotalRevenueColumn
Related Or Exempt Function Income	30254	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	157754	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	5492438	TotalRevenueColumn
Related Or Exempt Function Income	4629304	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	526905	Total
Program Services	86352	ProgramServices
Management And General	440553	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2879172	Total
Program Services	2618588	ProgramServices
Management And General	260584	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	86116	Total
Program Services	65692	ProgramServices
Management And General	20424	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	372841	Total
Program Services	295634	ProgramServices
Management And General	77207	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	268513	Total
Program Services	221659	ProgramServices
Management And General	46854	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	303717	Total
Program Services	239625	ProgramServices
Management And General	64092	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	7319	Total
Program Services	2951	ProgramServices
Management And General	4368	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	25062	Total
Management And General	25062	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	424709	Total
Program Services	424709	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	8118	Total
Program Services	1815	ProgramServices
Management And General	6303	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	147864	Total
Program Services	12010	ProgramServices
Management And General	135854	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	393046	Total
Program Services	231073	ProgramServices
Management And General	161973	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	57076	Total
Program Services	19668	ProgramServices
Management And General	37408	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	41687	Total
Program Services	6808	ProgramServices
Management And General	34879	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	115199	Total
Program Services	88660	ProgramServices
Management And General	26539	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	29649	Total
Program Services	17932	ProgramServices
Management And General	11717	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Medical Supplies	359165	352534	6631
Postage and Shipping	6657	1389	5268
Equipment Rental and Maitenance	27490	7751	19739

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	43067	Total
Program Services	43067	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	6123372	Total
Program Services	4737917	ProgramServices
Management And General	1385455	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	345042	BOY
EOY	242598	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	0	BOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	26490	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	246222	BOY
EOY	254645	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	87394	BOY
EOY	84616	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	125221	BOY
EOY	72759	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	2115622	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	972766	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	896455	BOY
EOY	1142856	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1053524	BOY
EOY	432174	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	2780348	BOY
EOY	2229648	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	402600	BOY
EOY	445946	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	60306	BOY
EOY	18435	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	483375	BOY
EOY	562134	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	946281	BOY
EOY	1026515	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1834067	BOY
EOY	1203133	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1834067	BOY
EOY	1203133	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2780348	BOY
EOY	2229648	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-630934	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	0	ReconciliationUnrealizedInvest
Reconcilation Donated Services	0	ReconcilationDonatedServices
Reconcilation Invest Expenses	0	ReconcilationInvestExpenses
Reconcilation Prior Adjustment	0	ReconcilationPriorAdjustment
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	275721	OtherCostOrOtherBasis
Book Value	275721	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	855870	OtherCostOrOtherBasis
Depreciation	221457	Depreciation
Book Value	634413	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	0	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	889429	OtherCostOrOtherBasis
Depreciation	751309	Depreciation
Book Value	138120	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	94602	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	94602	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	1142856	TotalOfBookValueLandBuildings

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	Third Party Settlements	Description
Book Value	432174	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	432174	TotalBookValueOtherAssets
Tot Revenue Etc Audited Fincl Stmt	5492438	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	0	NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities	0	DonatedSrvcAndUseOfFacilities
Recoveries Of Prior Year Grants	0	RecoveriesOfPriorYearGrants
Other Revenues	0	OtherRevenues
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	5492438	RevenueSubtotal
Investment Expenses Not Included	0	InvestmentExpensesNotIncluded
Other Revenues Not Included	0	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	5492438	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	6123372	TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities	0	DonatedServicesUseOfFacilities
Prior Year Adjustments	0	PriorYearAdjustments
Losses Reported	0	LossesReported
Other Expenses Included	0	OtherExpensesIncluded
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	6123372	ExpensesSubtotal
Investment Expenses Not Included2	0	InvestmentExpensesNotIncluded2
Other Expenses Not Included	0	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	6123372	TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Frank Lang Jr
CMO	204201	0	7603	0	4075	0	-3200	0	-10903	0	201776	0	0	0
Scott McFarland
CEO	186649	0	2940	0	6000	0	-16979	0	-2336	0	176274	0	0	0
Heather Lucas Ross
Physician	178000	0	7821	0	0	0	-6000	0	-6932	0	172889	0	0	0

Schedule L IRS990ScheduleL

Loan Table LoanTable

Field	Value	IRS element (for citing)
Name Person	Frank Lang Sr	NamePerson
Relationship With Organization	Operating advance	RelationshipWithOrganization
Purpose Of Loan	Operating advance	PurposeOfLoan
Loan To Organization	X	LoanToOrganization
Original Principal	$22,817	OriginalPrincipalAmount
Balance Due	2139	BalanceDue
Default	0	Default
Approved By Board	1	ApprovedByBoard
Written Agreement	1	WrittenAgreement

Field	Value	IRS element (for citing)
Total Balance Due	2139	TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
F990_P06_S0A_L02	Form 990, Part VI, Section A, Line 2	Anita Daniels, Board Member, relationship with Tri-Counties Bank. Katherine Madeiros, Board Member, indirect rent for SNMH.
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	The Finance Committee of the board of directors reviews the Form 990 for accuracy and completeness. The Chairman of the committee presents it to the board of directors and makes a copy available to all members of the full board. Typically, this is done prior to filing but can be done after, if time does not allow prior to Form 990 being filed.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	The conflict of interest policy is reviewed by the board with an updated conflict of interest form completed annually. Periodically throughout the year as business is conducted and conflicts noted, the Policy is revisited and conflicting parties are asked to abstain from vote.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	The annual CPCA Salary Survey is compared to all employees compensation annually to confirm base salary ranges. All officers and key employees are evaluated annually by a supervisor and any increases are based on evaluations.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	Available upon request.