MT ENTERPRISE COMMUNITY HEALTH CLINIC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: MT ENTERPRISE COMMUNITY HEALTH CLINIC (EIN 43-2016287)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-08-07
IRS object ID: 201242209349300119
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 D
Schedule J
Schedule L
Schedule M
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-08-07T09:13:21-05:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	752966974	EIN

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1329 N UNIVERSITY SUITE A3	AddressLine1
City	NACOGDOCHES	City
State	TX	State
ZIP Code	75961	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	432016287	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	MT ENTERPRISE COMMUNITY HEALTH CLINIC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	MTEN	NameControl
Phone	9033928203	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 489	AddressLine1
City	MT ENTERPRISE	City
State	TX	State
ZIP Code	75681	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	ROBIN BIRDWELL	Name
Title	CFO	Title
Phone	9033928203	Phone
Date Signed	2012-07-16	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	TERRE MCLEMORE	Name
PTIN	P00064380	PTIN
Phone	9365648186	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	JILL COOLEY	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	PO BOX 489	AddressLine1
City	MT ENTERPRISE	City
State	TX	State
ZIP Code	75681	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	2920641	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2003	YearFormation
State Legal Domicile	TX	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	36	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1033528	ContributionsGrantsPriorYear
Contributions Grants Current Year	1055867	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	489082	ProgramServiceRevenuePriorYear
Program Service Revenue CY	1144295	ProgramServiceRevenueCY
Investment Income Prior Year	95	InvestmentIncomePriorYear
Investment Income Current Year	157	InvestmentIncomeCurrentYear
Other Revenue Prior Year	206523	OtherRevenuePriorYear
Other Revenue Current Year	720322	OtherRevenueCurrentYear
Total Revenue Prior Year	1729228	TotalRevenuePriorYear
Total Revenue Current Year	2920641	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	906120	SalariesEtcPriorYear
Salaries Etc Current Year	1289390	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	853596	OtherExpensePriorYear
Other Expenses Current Year	1575778	OtherExpensesCurrentYear
Total Expenses Prior Year	1759716	TotalExpensesPriorYear
Total Expenses Current Year	2865168	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-30488	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	55473	RevenuesLessExpensesCY
Total Assets BOY	728632	TotalAssetsBOY
Total Assets EOY	991051	TotalAssetsEOY
Total Liabilities BOY	236739	TotalLiabilitiesBOY
Total Liabilities EOY	443685	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	491893	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	547366	NetAssetsOrFundBalancesEOY
Mission Description	TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	2261174	Expense
Grants	1044337	Grants
Revenue	1864617	Revenue
Description	PROVIDED PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY	Description
Total Program Service Expense	2261174	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	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	0	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	1	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	1	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	1	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	36	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
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	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	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ROBIN BIRDWELL	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	9033928203	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	PO BOX 489	AddressLine1
City	MT ENTERPRISE	City
State	TX	State
ZIP Code	75681	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer
KENNETH MILEY
PRESIDENT	5.00	X	0	0	0
RAMONA SMITH
VICE PRESIDENT	2.00	X	0	0	0
BARBARA CATES
SECRETARY	3.00	X	0	0	0
DARRELL OWENS
TREASURER	5.00	X	0	0	0
JOYCE YBARRA
BOARD MEMBER	2.00	X	0	0	0
HARVEY GRAVES
BOARD MEMBER	2.00	X	0	0	0
TOM VAUGHT
BOARD MEMBER	5.00	X	0	0	0
JOE MOORE
BOARD MEMBER	2.00	X	0	0	0
MAMIE HODGE
BOARD MEMBER	2.00	X	0	0	0
MATT GHOLSON
BOARD MEMBER	2.00	X	0	0	0
DEBRA JILL COOLEY
CEO	40.00		90846	0	0	X
ROBIN BIRDWELL
CFO	40.00		53275	0	0	X
BECKY ELDRIDGE
COO	40.00		52368	0	0	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	196489	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	0	TotalOtherCompensation
Number Individuals GT100 K	2	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	0	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
Government Grants	1044337	GovernmentGrants
All Other Contributions	11530	AllOtherContributions
Total Contributions	1055867	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAL SERVICE INCOME	624100	814434	814434
MEDICARE/MEDICAID PMTS	624100	329861	329861

Field	Value	IRS element (for citing)
Total Program Service Revenue	1144295	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	157	TotalRevenueColumn
Exclusion	$157	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
IN-KIND DONATIONS	624110	717586	717586
OTHER REVENUES	624110	2736	2736

Field	Value	IRS element (for citing)
Total Other Revenue	720322	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	2920641	TotalRevenueColumn
Related Or Exempt Function Income	1864617	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$157	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	530498	Total
Program Services	412604	ProgramServices
Management And General	117894	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	611217	Total
Program Services	473132	ProgramServices
Management And General	138085	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	147675	Total
Program Services	77187	ProgramServices
Management And General	70488	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	138	Total
Program Services	138	ProgramServices

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	13920	Total
Program Services	13920	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	63129	Total
Program Services	4399	ProgramServices
Management And General	58730	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	32249	Total
Program Services	901	ProgramServices
Management And General	31348	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	31259	Total
Management And General	31259	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	11818	Total
Program Services	684	ProgramServices
Management And General	11134	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	16423	Total
Program Services	4941	ProgramServices
Management And General	11482	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	4226	Total
Management And General	4226	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	156186	Total
Program Services	156186	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	9056	Total
Management And General	9056	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
IN-KIND EXPENSE	717586	717586
MEDICAL SERVICES	182561	182561
BAD DEBTS	176026	176026
CONTRACTED SERVICES	78686	36233	42453

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	82515	Total
Program Services	4676	ProgramServices
Management And General	77839	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	2865168	Total
Program Services	2261174	ProgramServices
Management And General	603994	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	90034	BOY
EOY	189906	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	15983	BOY
EOY	40295	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	91958	BOY
EOY	57219	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	5707	BOY
EOY	8633	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	1119476	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	424478	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	410792	BOY
EOY	694998	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	114158	BOY
EOY	0	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	728632	BOY
EOY	991051	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	57072	BOY
EOY	66624	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	115345	BOY
EOY	112185	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	64322	BOY
EOY	264876	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	236739	BOY
EOY	443685	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	491893	BOY
EOY	547366	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	491893	BOY
EOY	547366	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	728632	BOY
EOY	991051	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	55473	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	0	FSAudited
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	200	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	15827	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1000330	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1033528	CurrentTaxYearMinus1Year
Current Tax Year	1055867	CurrentTaxYear
Total	3105752	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	200	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	15827	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1000330	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1033528	CurrentTaxYearMinus1Year
Current Tax Year	1055867	CurrentTaxYear
Total	3105752	Total

Field	Value	IRS element (for citing)
Public Support Total170	3105752	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus2 Years	34	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	95	CurrentTaxYearMinus1Year
Current Tax Year	157	CurrentTaxYear
Total	286	Total

Other Income170 OtherIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus1 Year	206523	CurrentTaxYearMinus1Year
Current Tax Year	720322	CurrentTaxYear
Total	926845	Total

Field	Value	IRS element (for citing)
Total Support	4032883	TotalSupport
Gross Receipts From Admissions Etc	2409865	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	0.77010	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.91020	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	276721	OtherCostOrOtherBasis
Book Value	276721	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	547550	OtherCostOrOtherBasis
Depreciation	242142	Depreciation
Book Value	305408	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	295205	OtherCostOrOtherBasis
Depreciation	182336	Depreciation
Book Value	112869	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	694998	TotalOfBookValueLandBuildings
Total Revenue	2920641	TotalRevenue
Total Expenses	2865168	TotalExpenses
Excess Or Deficit For Year	55473	ExcessOrDeficitForYear
Excess Or Deficit Per FS	55473	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	2920641	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	2920641	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	2920641	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	2865168	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	2865168	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	2865168	TotalExpensesPerForm990

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

Loan Table LoanTable

Field	Value	IRS element (for citing)
Name Person	RUSSELL HALL	NamePerson
Purpose Of Loan	PROVIDE FINANCING TO KEEP ENTITY OPERATING	PurposeOfLoan
Loan To Organization	X	LoanToOrganization
Original Principal	$114,500	OriginalPrincipalAmount
Balance Due	112185	BalanceDue
Default	0	Default
Approved By Board	1	ApprovedByBoard
Written Agreement	1	WrittenAgreement

Field	Value	IRS element (for citing)
Total Balance Due	112185	TotalBalanceDue

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Description	MEDICAL SUPPLIES	Description
Number Of Contributions	1	NumberOfContributions
Noncash Contribs Rptd F990	717586	NoncashContribsRptdF990
Method Of Determining Revenues	RETAIL VALUE DETERMINED BY DONOR	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 (5 entries)

Return ReferenceReturnReference	ExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11	THE 990 WAS REVIEWED BY THE CFO AND THE FINANCE COMMITTEE BEFORE BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT OF INTEREST FORMS ARE COMPLETED EVERY TWO YEARS BY BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. FORMS RECEIVED ARE REVIEWED BY THE CFO AND THE FINANCE COMMITTEE AND MONITORED AS NECESSARY.
FORM 990, PART VI, SECTION B, LINE 15A	THE COMPENSATION OF THE CEO IS DISCUSSED AT LENGTH BY THE BOARD OF DIRECTORS YEARLY. AS PART OF THEIR ANNUAL EVALUATION/REVIEW OF THE CEO, THEY REVIEW WHETHER GOALS SET WERE MET AND REVIEW COMPENSATION IN COMPARISON WITH OTHER COMMUNITY HEALTH ORGANIZATION CEO'S WITH THE HELP OF AN ANNUAL SALARY COMPARISON REPORT ISSUED BY THE NATIONAL ORGANIZATION OF COMMUNITY HEALTH ORGANIZATIONS. ALL OF THESE DISCUSSIONS ARE DOCUMENTED IN THE ORGANIZATIONS APPROPRIATE BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 18	THE ORGANIZATION MAKES FORM 1023 AND FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON WRITTEN REQUEST.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.