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SAPPHIRE COMMUNITY HEALTH INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SAPPHIRE COMMUNITY HEALTH INC (EIN 81-0542716)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-14
IRS object ID
201212279349302691
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-14T12:27:17-07:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CPR ACCOUNTING PLLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 4325AddressLine1
CityMISSOULACity
StateMTState
ZIP Code59806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810542716EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SAPPHIRE COMMUNITY HEALTH INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSAPPNameControl
Phone4067283710Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1303 N 3RDAddressLine1
CityHAMILTONCity
StateMTState
ZIP Code59840ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJIM MORTONName
TitleBOARD MEMBERTitle
Phone4067283710Phone
Date Signed2012-08-02DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLOREN W RANDALL CPAName
Phone4067285539Phone
Date Prepared2012-08-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJIM MORTONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1303 N THIRDAddressLine1
CityHAMILTONCity
StateMTState
ZIP Code59840ZIPCode
FieldValueIRS element (for citing)
Gross Receipts251682GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.sapphirechc.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2001YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionHEALTH CARE IMPROVE THE OVERALL HEALTH STATUS OF ADULTS AND CHILDREN IN RAVALLI COUNTY BY PROVIDING QUALITY PRIMARY AND PREVENTATIVE HEALTH SERVICES TO THE MEDICALLY UNDERSERVED POPULATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees7TotalNbrEmployees
Total Nbr Volunteers5TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year700146ContributionsGrantsPriorYear
Contributions Grants Current Year152066ContributionsGrantsCurrentYear
Program Service Revenue Prior Year91448ProgramServiceRevenuePriorYear
Program Service Revenue CY89838ProgramServiceRevenueCY
Investment Income Prior Year59InvestmentIncomePriorYear
Investment Income Current Year-47572InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year791653TotalRevenuePriorYear
Total Revenue Current Year194332TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year283790SalariesEtcPriorYear
Salaries Etc Current Year223219SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year764TotalFundrsngExpCurrentYear
Other Expense Prior Year297952OtherExpensePriorYear
Other Expenses Current Year160016OtherExpensesCurrentYear
Total Expenses Prior Year581742TotalExpensesPriorYear
Total Expenses Current Year383235TotalExpensesCurrentYear
Revenues Less Expenses Prior Year209911RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-188903RevenuesLessExpensesCY
Total Assets BOY288124TotalAssetsBOY
Total Assets EOY75237TotalAssetsEOY
Total Liabilities BOY25982TotalLiabilitiesBOY
Total Liabilities EOY1998TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY262142NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY73239NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionHEALTH CAREMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangetrueSignificantChange
Expense377971Expense
Revenue89838Revenue
DescriptionPROVIDING COMPREHENSIVE PRIMARY CARE AND PREVENTIVE HEALTH CARE SERVICES THAT WILL IMPROVE THE HEALTH STATUS AND DECREASE HEALTH DISPARITIES OF THE MEDICALLY UNDERSERVED POPULATIONS OF RAVALLI COUNTY MONTANA. THIS IS ACCOMPLISHED BY PROVIDING A PHYSICIAN, SUPPORT STAFF, AND PROVISION AND ACCESS TO LABORATORY SERVICES, REFERRALS TO SPECIALTY CARE, AND ACCESS TO PHARMACOLOGICAL SERVICES.Description
Total Program Service Expense377971TotalProgramServiceExpense
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 LiabilitiesfalseReportOtherLiabilities
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 RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees7NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
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 CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
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
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HUMAN RESOURCE COUNCIL INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4067283710TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11801 S HIGGINSAddressLine1
CityMISSOULACity
StateMTState
ZIP Code59801ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
CARLOTTA GRANDSTAFF
HAMILTON, MT1.00X000
DIXIE STARK
DARBY, MT1.00X000
EDITH WARK
STEVENSVILLE, MT1.00X000
JAMES WALKER
HAMILTON, MT1.00X000
JERI DRAKE
HAMILTON, MT1.00X000
JIM MORTON
MISSOULA, MT1.00X000
KAREN TINNEY
DARBY, MT1.00X000
MARGARET ENNES
HAMILTON, MT1.00X000
PATTI NELSON
HAMILTON, MT1.00X000
FieldValueIRS element (for citing)
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Government Grants151458GovernmentGrants
All Other Contributions608AllOtherContributions
Total Contributions152066TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionHEALTH SERVICESDescription
Business Code621498BusinessCode
Total Revenue Column89838TotalRevenueColumn
FieldValueIRS element (for citing)
Total Program Service Revenue89838TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column52TotalRevenueColumn
Exclusion$52ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other9726Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other57350Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-47624Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-47624TotalRevenueColumn
Exclusion-$47,624ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column194332TotalRevenueColumn
Related Or Exempt Function Income89838RelatedOrExemptFunctionIncome
Exclusion-$47,572ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total182909Total
Program Services182245ProgramServices
Management And General0ManagementAndGeneral
Fundraising664Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total7424Total
Program Services7391ProgramServices
Management And General0ManagementAndGeneral
Fundraising33Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total16215Total
Program Services16215ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total16671Total
Program Services16604ProgramServices
Management And General0ManagementAndGeneral
Fundraising67Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total21109Total
Program Services21109ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1005Total
Program Services1005ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total4500Total
Program Services0ProgramServices
Management And General4500ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3692Total
Program Services3692ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total13194Total
Program Services13194ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total42092Total
Program Services42092ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total513Total
Program Services513ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2606Total
Program Services2606ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total18220Total
Program Services18220ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total27126Total
Program Services27126ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
OUTREACH SERVICES1412141200
SUPPLIES AND LAB FEES222612226100
LICENSES454500
BAD DEBTS2241224100

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total383235Total
Program Services377971ProgramServices
Management And General4500ManagementAndGeneral
Fundraising764Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY104675BOY
EOY47856EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY50797BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY15475BOY
EOY471EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY9500BOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY7557BOY
EOY2359EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis40918LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16367LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY100120BOY
EOY24551EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY288124BOY
EOY75237EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY25982BOY
EOY1998EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY25982BOY
EOY1998EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY262142BOY
EOY73239EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY262142BOY
EOY73239EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY288124BOY
EOY75237EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-188903ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170
Public Support Total5090PublicSupportTotal509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis40918OtherCostOrOtherBasis
Depreciation16367Depreciation
Book Value24551BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings24551TotalOfBookValueLandBuildings
Total Revenue194332TotalRevenue
Total Expenses383235TotalExpenses
Excess Or Deficit For Year-188903ExcessOrDeficitForYear
Excess Or Deficit Per FS-188903ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt241956TotRevenueEtcAuditedFinclStmt
Other Revenues47624OtherRevenues
Revenue Not Rptd F99047624RevenueNotRptdF990
Revenue Subtotal194332RevenueSubtotal
Total Revenue Per Form990194332TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt430859TotExpensesEtcAuditedFinclStmt
Other Expenses Included47624OtherExpensesIncluded
Expenses Not Rptd F99047624ExpensesNotRptdF990
Expenses Subtotal383235ExpensesSubtotal
Total Expenses Per Form990383235TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
Pt XII Line 2dLOSS ON DISPOSAL OF ASSETS: $47,624
Pt XIII Line 2dLOSS ON DISPOSAL OF ASSETS: $47,624

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (19 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 11aTHE ORGANIZATION PROVIDES A COPY OF THE DRAFT FORM 990
TO BOARD MEMBERS FOR REVIEW PRIOR TO FILING. A DETAIL
REVIEW IS CONDUCTED BY THE AGENCY FISCAL STAFF.
Pt VI, Line 12cTHE BOARD OF DIRECTORS ANNUALLY REVIEWS ITS CONFLICT OF
INTEREST POLICIES. SHOULD A CONFLICT BE NOTED DURING
A MEETING, THE MEMBER REPORTS THE CONFLICT AND EXCUSES
THEMSELVES FROM FURTHER DISCUSSION OF THE MATTER.
Pt VI, Line 15EMPLOYEE COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS
BASED UPON PREVAILING WAGES FOR SIMILAR POSITIONS IN
THE AREA AND PERFORMANCE.
Pt III, Line 3THE AGENCY FORMALLY CLOSED OPERATIONS OF THE HEATH
CLINIC ON JUNE 30, 2011 DUE TO DELAY OF FEDERAL GRANT
APPROPRIATIONS. AS OF THAT DATE, THE AGENCY IS CONSIDERED
DORMANT UNTIL FUNDING IS SECURED TO CONTINUE OPERATIONS
OF THE CLINIC
Pt VI, Line 19THE AGENCY MAKES ITS GOVERNING DOCUMENTS, POLICIES, AND
FINANCIAL STATEMENTS AVAILABLE BY REQUEST. THE AGENCY'S
FORM 990 IS AVAILABLE AT GUIDESTAR.ORG.
Form 990, Part IX, Line 24fOTHER MISCELLANEOUS