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MT OLIVE FAMILY MEDICINE CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MT OLIVE FAMILY MEDICINE CENTER INC (EIN 56-2000255)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-01-21
IRS object ID
201340219349300059
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)
Timestamp2013-01-21T10:41:14-08:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Krombach Dunn Pappalardo & Turchetti CPAsBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1326 West StreetAddressLine1
CityPittsboroCity
StateNCState
ZIP Code27312ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN562000255EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mt Olive Family Medicine Center IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMTOLNameControl
Phone9196584954Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1201 North Breazeale AvenueAddressLine1
CityMount OliveCity
StateNCState
ZIP Code28365ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCarol DildaName
TitleExecutive DirectorTitle
Date Signed2013-01-21DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCorinne W DunnName
Phone9195425228Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts3538754GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTo provide medical care for all those in need regardless of ability to pay.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees44TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year90860ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3267925ProgramServiceRevenuePriorYear
Program Service Revenue CY3512422ProgramServiceRevenueCY
Investment Income Prior Year-3003InvestmentIncomePriorYear
Investment Income Current Year-1616InvestmentIncomeCurrentYear
Other Revenue Prior Year9065OtherRevenuePriorYear
Other Revenue Current Year24078OtherRevenueCurrentYear
Total Revenue Prior Year3364847TotalRevenuePriorYear
Total Revenue Current Year3534884TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2382832SalariesEtcPriorYear
Salaries Etc Current Year2749983SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year772937OtherExpensePriorYear
Other Expenses Current Year774595OtherExpensesCurrentYear
Total Expenses Prior Year3155769TotalExpensesPriorYear
Total Expenses Current Year3524578TotalExpensesCurrentYear
Revenues Less Expenses Prior Year209078RevenuesLessExpensesPriorYear
Revenues Less Expenses CY10306RevenuesLessExpensesCY
Total Assets BOY2290240TotalAssetsBOY
Total Assets EOY2372313TotalAssetsEOY
Total Liabilities BOY1281044TotalLiabilitiesBOY
Total Liabilities EOY1352811TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1009196NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1019502NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide medical care for all those in need regardless of ability to pay.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense2975151Expense
DescriptionMt. Olive Family Medicine Center, Inc. is dedicated to the health and well-being of the residents of Wayne County and the surrounding areas. It is our goal to identify and minister to the medical needs of the family unit - not only to provide quality, comprehensive medical care, but also to institute health education, urgent care, wellness and preventative medicine. Accessible and affordable quality health care will be provided with dignity and respect, regardless of race, religion, gender, age or economic background.Description
Total Program Service Expense2975151TotalProgramServiceExpense
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 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 With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees44NumberOfEmployees
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 Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
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 CommitteesfalseMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
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
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLisa HooksNamePerson
Telephone Number9195814981TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1201 North Breazeale AvenueAddressLine1
CityMt OliveCity
StateNCState
ZIP Code28365ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Lisa Hooks
CFO40.00X7550509534
Jennifer Robbins
Board Member2.00X000
Brandi Worth
Board Member2.00X000
Roger Davis
Board Member2.00X000
Carol Dilda
Executive Direc40.00X76309012108
Chris Whitley
Treasurer.Sec2.00X000X
Kevin Kornegay
President2.00X000X
Mark Raynor
Vice President2.00X000X
Dr Tyanna Yonkers
Board Member2.00X000
Ed Cromartie Sr
Board Member2.00X000
Charlie McClenny
Board Member2.00X000
Robert K Talton
Medical Director40.00246853018728X
Thomas S Draughon
Physician40.00224231014774X
Humayun M Kadir
Physician40.00214686015168X
Stephen D Fairchild
Physician40.0012176807688X
Sufia Siddique
Physician40.00266322016974X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1225674TotalReportableCompFromOrg
Total Other Compensation94974TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Fees33083213308321
Management Fees9926299262
Contracts104839104839
FieldValueIRS element (for citing)
Total Program Service Revenue3512422TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1738TotalRevenueColumn
Related Or Exempt Function Income1738RelatedOrExemptFunctionIncome

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)
Real14100Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real299Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real13801Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column13801TotalRevenueColumn
Related Or Exempt Function Income13801RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other217Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other3571Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-3354Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-3354TotalRevenueColumn
Related Or Exempt Function Income-3354RelatedOrExemptFunctionIncome

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

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOther IncomeDescription
Total Revenue Column10277TotalRevenueColumn
Related Or Exempt Function Income10277RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue10277TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3534884TotalRevenueColumn
Related Or Exempt Function Income3534884RelatedOrExemptFunctionIncome

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)
Total162075Total
Program Services135475ProgramServices
Management And General26600ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1853555Total
Program Services1549263ProgramServices
Management And General304292ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total600536Total
Program Services502048ProgramServices
Management And General98488ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total133817Total
Program Services111871ProgramServices
Management And General21946ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total250Total
Management And General250ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total22779Total
Management And General22779ManagementAndGeneral

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)
Total137151Total
Program Services135429ProgramServices
Management And General1722ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total27048Total
Program Services21638ProgramServices
Management And General5410ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total2649Total
Program Services2649ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total44266Total
Program Services39839ProgramServices
Management And General4427ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total104445Total
Program Services94178ProgramServices
Management And General10267ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total35356Total
Program Services31423ProgramServices
Management And General3933ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Telephone25661219403721
Utilities28793230775716
Equipment Rental & Maint517234137910344
Medical Supplies & Lab Expense197843197843

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total96631Total
Program Services67099ProgramServices
Management And General29532ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3524578Total
Program Services2975151ProgramServices
Management And General549427ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY352627BOY
EOY366613EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY172250EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1271BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY173765BOY
EOY158050EOY

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)
BOY34642BOY
EOY32448EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2598753LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1028846LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1649573BOY
EOY1569907EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY68516BOY
EOY63772EOY

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)
BOY9846BOY
EOY9273EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2290240BOY
EOY2372313EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY270876BOY
EOY362560EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY994160BOY
EOY966297EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY16008BOY
EOY23954EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1281044BOY
EOY1352811EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1007925BOY
EOY1019502EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1271BOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1009196BOY
EOY1019502EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2290240BOY
EOY2372313EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses10306ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years250CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years118260CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years127775CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year90860CurrentTaxYearMinus1Year
Total337145Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2796625CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3525791CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3156926CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3267925CurrentTaxYearMinus1Year
Current Tax Year3512422CurrentTaxYear
Total16259689Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2796875CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3644051CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3284701CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3358785CurrentTaxYearMinus1Year
Current Tax Year3512422CurrentTaxYear
Total16596834Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50916596834PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2217CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2188CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1282CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year283CurrentTaxYearMinus1Year
Current Tax Year1738CurrentTaxYear
Total7708Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2217CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2188CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1282CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year283CurrentTaxYearMinus1Year
Current Tax Year1738CurrentTaxYear
Total7708Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4332CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11725CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9287CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9065CurrentTaxYearMinus1Year
Current Tax Year24377CurrentTaxYear
Total58786Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2803424CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3657964CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3295270CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3368133CurrentTaxYearMinus1Year
Current Tax Year3538537CurrentTaxYear
Total16663328Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99600PublicSupportPercentage509
Prior Year Support Percentage0.99680PriorYearSupportPercentage
Investment Income Percentage0.00050InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00040PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis185000OtherCostOrOtherBasis
Book Value185000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1653793OtherCostOrOtherBasis
Depreciation397541Depreciation
Book Value1256252BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis58875OtherCostOrOtherBasis
Depreciation33297Depreciation
Book Value25578BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis572005OtherCostOrOtherBasis
Depreciation469365Depreciation
Book Value102640BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis129080OtherCostOrOtherBasis
Depreciation128643Depreciation
Book Value437BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1569907TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionPatient Refunds PayableDescription
Amount$23,954Amount
FieldValueIRS element (for citing)
Total Of Amounts23954TotalOfAmounts
Total Revenue3534884TotalRevenue
Total Expenses3524578TotalExpenses
Excess Or Deficit For Year10306ExcessOrDeficitForYear
Excess Or Deficit Per FS10306ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3538537TotRevenueEtcAuditedFinclStmt
Other Revenues299OtherRevenues
Revenue Not Rptd F990299RevenueNotRptdF990
Revenue Subtotal3538238RevenueSubtotal
Other Revenues Not Included-3354OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-3354RevenueNotRptdOnFinStmt
Total Revenue Per Form9903534884TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3524877TotExpensesEtcAuditedFinclStmt
Other Expenses Included299OtherExpensesIncluded
Expenses Not Rptd F990299ExpensesNotRptdF990
Expenses Subtotal3524578ExpensesSubtotal
Total Expenses Per Form9903524578TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part XIII, Line 2dPart XIII, Line 2d: Other expenses and losses per audited F/SRental Expenses $299
Part XII, Line 2dPart XII, Line 2d: Other revenue amounts included in F/S but not included on form 990Rental Expenses $299

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 (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Thomas S Draughon
22423114774239005
Sufia Siddique
26632216974283296
Robert K Talton
24685318728265581
Humayun M Kadir
21468615168229854

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableUpon Request
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesEvaluation of performance by doctors. Evalution of performance by Executive and personnel committees and Doctor input. Review of salary and benefits as well as comparable compensation at similar facilities, MGMA annual salary and benefit review.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review Process990 is reviewed by Chief Financial Officer and Executive Director before filing.