CEO

2012-08-02T13:53:17-05:00 2011-12-31 481040139 ADAMS BROWN BERAN & BALL CHTD 1701 LANDON HUTCHINSON KS 67502 990 2011-01-01 481159633 GRACEMED HEALTH CLINICS INC GRAC 3168662001 1122 N TOPEKA WICHITA KS 67214 DAVID SANFORD CEO 3168662000 2012-07-30 1 JUSTIN MITCHELL P00290661 6206635659 2011 2016-02-24 21:20:13Z DAVID SANFORD 1122 N TOPEKA WICHITA KS 67214 7529416 0 X WWW.GRACEMED.ORG X 1979 KS TO PROVIDE PRIMARY HEALTH AND DENTAL CARE SERVICES TO KANSAS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 13 13 173 150 0 0 2632855 2271684 3590937 5197983 36801 30806 0 4231 6260593 7504704 0 0 0 0 3998384 5045156 0 0 29266 2022165 2169537 6020549 7214693 240044 290011 4312797 4716685 502466 654625 3810331 4062060 TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS OF SOUTH CENTRAL KANSAS. 0 0 6131753 5181866 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSAS WITHOUT HEALTH INSURANCE OF ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 6131753 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 8 0 1 173 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 KS X SHAROL SULLIVAN 3168662001 1122 N TOPEKA WICHITA KS 67214 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 X 103941 0 7325 SHAROL SULLIVAN CHIEF FINANCIAL OFFICER 40.00 X 79909 0 2397 VENUS LEE CHIEF OPERATIONS OFFICER 40.00 X 82057 0 673 DR ROGER NOLTE CHIEF DENTAL DIRECTOR 40.00 X 119529 0 4207 DR ROBIN WALKER CHIEF MEDICAL DIRECTOR 40.00 X 57031 0 2104 DR DEE STULTS PHYSICIAN 40.00 X 100857 0 7233 DR ANDREA BOOTHE DENTIST 40.00 X 101474 0 5729 644798 0 29668 4 0 0 0 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 3 10005 1795903 465776 8072 2271684 MEDICAL AND DENTAL SER 621110 5197983 5197983 5197983 31644 31644 838 -838 -838 -838 28105 10005 23874 4231 4231 7504704 5228789 0 4231 4263730 3585483 655704 22543 33688 33856 -660 492 328446 290163 37458 825 419292 356280 61122 1890 71345 2612 68733 190141 179890 10251 22505 19489 3016 80719 59690 20529 500 193044 142747 50297 301339 255291 46048 15072 2323 12749 242663 224356 18307 18593 4314 14279 MEDICAL SUPPLIES 809458 807309 2149 REPAIRS 122437 118376 4061 CONTINUING EDUCATION 38347 29412 8935 MISCELLANEOUS 34793 16237 18556 29081 23414 5667 7214693 6131753 1053674 29266 94664 460831 395884 341063 17282 674988 561930 5168 5133 19177 15365 3128770 826649 2400591 2302121 722325 1012960 4312797 4716685 314895 400899 187571 253726 502466 654625 X 3798721 3799567 11610 262493 3810331 4062060 4312797 4716685 X 290011 -38282 X 1 1 0 1 1 X 2029141 1758560 2644753 2178498 2025778 10636730 2491442 4099665 3684944 3839861 5181866 19297778 4520583 5858225 6329697 6018359 7207644 29934508 0 0 0 29934508 9918 8277 12237 16939 31644 79015 9918 8277 12237 16939 31644 79015 4530501 5866502 6341934 6035298 7239288 30013523 0.99740 0.99800 0.00260 0.00200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1894055 268401 1625654 1170474 533637 636837 64241 24611 39630 2302121 7504704 7214693 290011 -38282 -38282 251729 7224357 -38282 23874 -14408 7238765 265939 265939 7504704 7238568 23875 23875 7214693 0 7214693 TEMPORARILY RESTRICTED NET ASSETS - CONTRIBUTIONS $265,939 5K - SAY GRACE RACE 38110 10005 28105 12297 1375 1735 510 7957 38110 10005 28105 12297 1375 1735 510 7957 23874 4231 X X 0 0 0 0 0 0 0 0 0 SALLY CHESSER BOARD MEMBER 0 GRACEMED HEALTH CLINIC, INC HOLDS AN INVESTMENT ACCOUNTS WITH SALLY CHESSER AT TD AMERITRADE. SALLY DOES NOT CHARGE A FEE FOR HER SERVICES. 0 X PROFESSIONAL VOLUNTEERS 2 8072 WAGES OF COMPARABLE DOCTORS 0 0 0 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -38,282.