GRACEMED HEALTH CLINIC INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GRACEMED HEALTH CLINIC INC (EIN 48-1159633)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-02
- IRS object ID
- 201202159349300755
- Schema version
- 2011v1.2
- 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 B
- Schedule D
- Schedule G
- Schedule J
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-02T13:53:17-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481040139 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADAMS BROWN BERAN & BALL CHTD | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1701 LANDON | AddressLine1 |
| City | HUTCHINSON | City |
| State | KS | State |
| ZIP Code | 67502 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481159633 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRACEMED HEALTH CLINICS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GRAC | NameControl |
| Phone | 3168662001 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1122 N TOPEKA | AddressLine1 |
| City | WICHITA | City |
| State | KS | State |
| ZIP Code | 67214 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID SANFORD | Name |
| Title | CEO | Title |
| Phone | 3168662000 | Phone |
| Date Signed | 2012-07-30 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JUSTIN MITCHELL | Name |
| PTIN | P00290661 | PTIN |
| Phone | 6206635659 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID SANFORD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1122 N TOPEKA | AddressLine1 |
| City | WICHITA | City |
| State | KS | State |
| ZIP Code | 67214 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 7529416 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GRACEMED.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1979 | YearFormation |
| State Legal Domicile | KS | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE PRIMARY HEALTH AND DENTAL CARE SERVICES TO KANSAS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 173 | TotalNbrEmployees |
| Total Nbr Volunteers | 150 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2632855 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2271684 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 3590937 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5197983 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 36801 | InvestmentIncomePriorYear |
| Investment Income Current Year | 30806 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4231 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6260593 | TotalRevenuePriorYear |
| Total Revenue Current Year | 7504704 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3998384 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5045156 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 29266 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2022165 | OtherExpensePriorYear |
| Other Expenses Current Year | 2169537 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6020549 | TotalExpensesPriorYear |
| Total Expenses Current Year | 7214693 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 240044 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 290011 | RevenuesLessExpensesCY |
| Total Assets BOY | 4312797 | TotalAssetsBOY |
| Total Assets EOY | 4716685 | TotalAssetsEOY |
| Total Liabilities BOY | 502466 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 654625 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3810331 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4062060 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS OF SOUTH CENTRAL KANSAS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 6131753 | Expense |
| Revenue | 5181866 | Revenue |
| Description | PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSAS WITHOUT HEALTH INSURANCE OF ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES | Description |
| Total Program Service Expense | 6131753 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 0 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | 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 | 1 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 8 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 173 | 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 |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | 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 | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 0 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | KS | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHAROL SULLIVAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3168662001 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1122 N TOPEKA | AddressLine1 |
| City | WICHITA | City |
| State | KS | State |
| ZIP Code | 67214 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CARMEN BAKER | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| TOM BORREGO | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| TERRY BOURLARD | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| SALLY CHESSER | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| LOU ANN EWERTT | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| MICHAEL GOOD | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| LAURIE LABARCA | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| GAROLD MINNS | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| BRENDA MOORE | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| BARTON PRINCE | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| KERIN SMITH | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| GARY BROOKS | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| MARC MINNIS | |||||||
| BOARD MEMBER | 4.00 | X | 0 | 0 | 0 | ||
| DAVID SANFORD | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 103941 | 0 | 7325 | X | ||
| SHAROL SULLIVAN | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 79909 | 0 | 2397 | X | ||
| VENUS LEE | |||||||
| CHIEF OPERATIONS OFFICER | 40.00 | 82057 | 0 | 673 | X | ||
| DR ROGER NOLTE | |||||||
| CHIEF DENTAL DIRECTOR | 40.00 | 119529 | 0 | 4207 | X | ||
| DR ROBIN WALKER | |||||||
| CHIEF MEDICAL DIRECTOR | 40.00 | 57031 | 0 | 2104 | X | ||
| DR DEE STULTS | |||||||
| PHYSICIAN | 40.00 | 100857 | 0 | 7233 | X | ||
| DR ANDREA BOOTHE | |||||||
| DENTIST | 40.00 | 101474 | 0 | 5729 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 644798 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 29668 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | 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 |
|---|---|---|---|---|---|
| HENRY SCHEIN INC | |||||
| DEPT CH 10241 | PALATINE | IL | 60055 | MEDICAL EQUIPMENT | 326121 |
| PEARCE TURK DENTAL LABORATORY | |||||
| PO BOX 760 | WICHITA | KS | 67201 | DENTAL LAB | 225509 |
| ECLINICALWORKS LLC | |||||
| 110 TURNPIKE ROADE SUITE 308 | WESTBOROUGH | MA | 01581 | PRACTICE MANAGEMENT SERVICE | 104174 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Fundraising Events | 10005 | FundraisingEvents |
| Government Grants | 1795903 | GovernmentGrants |
| All Other Contributions | 465776 | AllOtherContributions |
| Noncash Contributions | 8072 | NoncashContributions |
| Total Contributions | 2271684 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICAL AND DENTAL SER | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 5197983 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5197983 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5197983 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31644 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31644 | RelatedOrExemptFunctionIncome |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 838 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -838 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -838 | TotalRevenueColumn |
| Related Or Exempt Function Income | -838 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 28105 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 10005 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 23874 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4231 | TotalRevenueColumn |
| Exclusion | $4,231 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7504704 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5228789 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $4,231 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4263730 | Total |
| Program Services | 3585483 | ProgramServices |
| Management And General | 655704 | ManagementAndGeneral |
| Fundraising | 22543 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33688 | Total |
| Program Services | 33856 | ProgramServices |
| Management And General | -660 | ManagementAndGeneral |
| Fundraising | 492 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 328446 | Total |
| Program Services | 290163 | ProgramServices |
| Management And General | 37458 | ManagementAndGeneral |
| Fundraising | 825 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 419292 | Total |
| Program Services | 356280 | ProgramServices |
| Management And General | 61122 | ManagementAndGeneral |
| Fundraising | 1890 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71345 | Total |
| Program Services | 2612 | ProgramServices |
| Management And General | 68733 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190141 | Total |
| Program Services | 179890 | ProgramServices |
| Management And General | 10251 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22505 | Total |
| Management And General | 19489 | ManagementAndGeneral |
| Fundraising | 3016 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80719 | Total |
| Program Services | 59690 | ProgramServices |
| Management And General | 20529 | ManagementAndGeneral |
| Fundraising | 500 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193044 | Total |
| Program Services | 142747 | ProgramServices |
| Management And General | 50297 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 301339 | Total |
| Program Services | 255291 | ProgramServices |
| Management And General | 46048 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15072 | Total |
| Program Services | 2323 | ProgramServices |
| Management And General | 12749 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 242663 | Total |
| Program Services | 224356 | ProgramServices |
| Management And General | 18307 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18593 | Total |
| Program Services | 4314 | ProgramServices |
| Management And General | 14279 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 809458 | 807309 | 2149 |
| REPAIRS | 122437 | 118376 | 4061 |
| CONTINUING EDUCATION | 38347 | 29412 | 8935 |
| MISCELLANEOUS | 34793 | 16237 | 18556 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29081 | Total |
| Program Services | 23414 | ProgramServices |
| Management And General | 5667 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7214693 | Total |
| Program Services | 6131753 | ProgramServices |
| Management And General | 1053674 | ManagementAndGeneral |
| Fundraising | 29266 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94664 | BOY |
| EOY | 460831 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 395884 | BOY |
| EOY | 341063 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 17282 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 674988 | BOY |
| EOY | 561930 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5168 | BOY |
| EOY | 5133 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19177 | BOY |
| EOY | 15365 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 3128770 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 826649 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2400591 | BOY |
| EOY | 2302121 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 722325 | BOY |
| EOY | 1012960 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4312797 | BOY |
| EOY | 4716685 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 314895 | BOY |
| EOY | 400899 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 187571 | BOY |
| EOY | 253726 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 502466 | BOY |
| EOY | 654625 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3798721 | BOY |
| EOY | 3799567 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11610 | BOY |
| EOY | 262493 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3810331 | BOY |
| EOY | 4062060 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4312797 | BOY |
| EOY | 4716685 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 290011 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -38282 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 1 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2029141 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1758560 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2644753 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2178498 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2025778 | CurrentTaxYear |
| Total | 10636730 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2491442 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 4099665 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3684944 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3839861 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5181866 | CurrentTaxYear |
| Total | 19297778 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4520583 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5858225 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6329697 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6018359 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7207644 | CurrentTaxYear |
| Total | 29934508 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 29934508 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9918 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8277 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 12237 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 16939 | CurrentTaxYearMinus1Year |
| Current Tax Year | 31644 | CurrentTaxYear |
| Total | 79015 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9918 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8277 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 12237 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 16939 | CurrentTaxYearMinus1Year |
| Current Tax Year | 31644 | CurrentTaxYear |
| Total | 79015 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4530501 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5866502 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6341934 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6035298 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7239288 | CurrentTaxYear |
| Total | 30013523 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99740 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.99800 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00260 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00200 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1894055 | OtherCostOrOtherBasis |
| Depreciation | 268401 | Depreciation |
| Book Value | 1625654 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1170474 | OtherCostOrOtherBasis |
| Depreciation | 533637 | Depreciation |
| Book Value | 636837 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 64241 | OtherCostOrOtherBasis |
| Depreciation | 24611 | Depreciation |
| Book Value | 39630 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2302121 | TotalOfBookValueLandBuildings |
| Total Revenue | 7504704 | TotalRevenue |
| Total Expenses | 7214693 | TotalExpenses |
| Excess Or Deficit For Year | 290011 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -38282 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -38282 | TotalAdjustments |
| Excess Or Deficit Per FS | 251729 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 7224357 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -38282 | NetUnrealizedGainsInvestments |
| Other Revenues | 23874 | OtherRevenues |
| Revenue Not Rptd F990 | -14408 | RevenueNotRptdF990 |
| Revenue Subtotal | 7238765 | RevenueSubtotal |
| Other Revenues Not Included | 265939 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 265939 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 7504704 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 7238568 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 23875 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 23875 | ExpensesNotRptdF990 |
| Expenses Subtotal | 7214693 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 7214693 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | TEMPORARILY RESTRICTED NET ASSETS - CONTRIBUTIONS $265,939 | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | 5K - SAY GRACE RACE | NameOfEvent1 |
| Gross Receipts Event1 | 38110 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 10005 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 28105 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 12297 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1375 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 1735 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 510 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 7957 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 38110 | GrossReceiptsTotal |
| Charitable Contributions Total | 10005 | CharitableContributionsTotal |
| Gross Revenue Total Events | 28105 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 12297 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1375 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 1735 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 510 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 7957 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 23874 | DirectExpenseSummaryEvents |
| Net Income Summary | 4231 | NetIncomeSummary |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SALLY CHESSER | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD MEMBER | Relationship |
| Amount Of Transaction | 0 | AmountOfTransaction |
| Description Of Transaction | GRACEMED HEALTH CLINIC, INC HOLDS AN INVESTMENT ACCOUNTS WITH SALLY CHESSER AT TD AMERITRADE. SALLY DOES NOT CHARGE A FEE FOR HER SERVICES. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule M IRS990ScheduleM
Other Non Cash Contributions Table OtherNonCashContributionsTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Description | PROFESSIONAL VOLUNTEERS | Description |
| Number Of Contributions | 2 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 8072 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | WAGES OF COMPARABLE DOCTORS | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION HIRES AN OUTSIDE CPA TO PREPARE THE FINANCIAL STATEMENT AUDIT AND THE FORM 990 EACH YEAR. AFTER THE CPA HAS COMPLETED BOTH THE AUDIT AND FORM 990, THE CFO FOR THE ORGANIZATION AND THE CPA REVIEW THE INITIAL DRAFT OF THE RETURN TO ENSURE ITS COMPLETENESS AND ACCURACY. FOLLOWING THE REVIEW, THE FORM 990 IS COMPLETED AND THE ORGANIZATION FILES THE RETURN. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -38,282. | CHANGES IN NET ASSETS OR FUND BALANCES: |