BEAR LAKE COMMUNITY HEALTH CENTER INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: BEAR LAKE COMMUNITY HEALTH CENTER INC (EIN 81-0587644)
Tax period: 2009-05-01 to 2010-04-30
Filed: 2011-04-30
IRS object ID: 201141209349300104
Schema version: 2009v1.7
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 J
Schedule L
Schedule M
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-04-30T10:27:17-05:00	Timestamp
Tax Period End Date	2010-04-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	SQUIRE & COMPANY PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1329 SOUTH 800 EAST	AddressLine1
City	OREM	City
State	UT	State
ZIP Code	840977737	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2009-05-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	810587644	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	BEAR LAKE COMMUNITY HEALTH CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	BEAR	NameControl
Phone	4359463660	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	325 W LOGAN HIGHWAY	AddressLine1
City	GARDEN CITY	City
State	UT	State
ZIP Code	84028	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	LAVAL JENSEN	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	4359463660	Phone
Date Signed	2011-04-27	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	M PAUL WINWARD CPA	Name
Phone	8012256900	Phone
Date Prepared	2011-04-30	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2009	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	CACHE VALLEY COMMUNITY HEALTH CENTE	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	LAVAL JENSEN	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	325 W LOGAN HIGHWAY	AddressLine1
City	GARDEN CITY	City
State	UT	State
ZIP Code	84028	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	4623105	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c	X	Organization501c
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	2002	YearFormation
State Legal Domicile	UT	StateLegalDomicile
Activity Or Mission Description	MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR LOW-INCOME FAMILIES.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	8	NbrIndependentVotingMembers
Total Nbr Employees	95	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	443993	ContributionsGrantsPriorYear
Contributions Grants Current Year	1625820	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	1820842	ProgramServiceRevenuePriorYear
Program Service Revenue CY	1725416	ProgramServiceRevenueCY
Investment Income Prior Year	31	InvestmentIncomePriorYear
Investment Income Current Year	44	InvestmentIncomeCurrentYear
Other Revenue Prior Year	535905	OtherRevenuePriorYear
Other Revenue Current Year	745533	OtherRevenueCurrentYear
Total Revenue Prior Year	2800771	TotalRevenuePriorYear
Total Revenue Current Year	4096813	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	1937338	SalariesEtcPriorYear
Salaries Etc Current Year	2956940	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	697953	OtherExpensePriorYear
Other Expenses Current Year	852528	OtherExpensesCurrentYear
Total Expenses Prior Year	2635291	TotalExpensesPriorYear
Total Expenses Current Year	3809468	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	165480	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	287345	RevenuesLessExpensesCY
Total Assets BOY	1933105	TotalAssetsBOY
Total Assets EOY	2487833	TotalAssetsEOY
Total Liabilities BOY	1205734	TotalLiabilitiesBOY
Total Liabilities EOY	1473117	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	727371	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	1014716	NetAssetsOrFundBalancesEOY
Mission Description	MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR LOW-INCOME FAMILIES.	MissionDescription
Significant New Program Services	true	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	1650102	Expense
Revenue	1400739	Revenue
Description	PROVIDED MEDICAL SERVICES TO LOW-INCOME FAMILIES	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	491066	Expense
Revenue	272148	Revenue
Description	PROVIDED DENTAL SERVICES TO LOW-INCOME FAMILIES.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	150877	Expense
Revenue	29821	Revenue
Description	PROVIDED MENTAL HEALTH SERVICES TO LOW-INCOME FAMILIES.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	544845	Expense
Revenue	316467	Revenue
Description	PROVIDED PHARMACY SERVICES & HEALTH AND WELLNESS SERVICES TO LOW-INCOME FAMILIES.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	544845	TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev	316467	TotalOfOtherProgramServiceRev
Total Program Service Expense	2836890	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Balance Sheet Amounts Reported	true	BalanceSheetAmountsReported
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	true	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	true	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	true	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	5	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	95	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	8	NumberIndependentVotingMembers
Family Or Business Relationship	true	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	BEAR LAKE COMMUNITY HEALTH CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	4359463660	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	325 W LOGAN HWY	AddressLine1
City	GARDEN CITY	City
State	UT	State
ZIP Code	84028	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 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
LYNNE PETTIT
BOARD MEMBER	1.00	X	0	0	0
CRAIG HOFFMAN
CHAIR	1.00	X	0	0	0
DAREN WALLENTINE
BOARD MEMBER	1.00	X	0	0	0
DOROTHY EVANS
SECRETARY	1.00	X	0	0	0
LARAINE SCHNETZER
TREASURER	1.00	X	0	0	0
NORMAN MECHAM
BOARD MEMBER	1.00	X	0	0	0
PAT SNELL
VICE CHAIR	1.00	X	0	0	0
SHERRIE DAVIS
BOARD MEMBER	1.00	X	0	0	0
MARC TRENERY
BOARD MEMBER	1.00	X	0	0	0
LAVAL JENSEN
EXEC. DIRECT	40.00		149768	0	17622	X
DAVID J BALLINGHAM
MEDICAL DIRE	40.00		156303	0	17820		X
GREGG LUKE
PHARMACIST	40.00		122133	0	11366		X
AARON JONES
PHYSICIAN	40.00		120200	0	4070		X
RICHARD BALLAM
PHARMACIST	40.00		120078	0	657		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	668482	TotalReportableCompFromOrg
Total Other Compensation	51535	TotalOtherCompensation
Number Individuals GT100 K	5	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Government Grants	1578925	GovernmentGrants
All Other Contributions	46895	AllOtherContributions
Noncash Contributions	45564	NoncashContributions
Total Contributions	1625820	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PROFESSIONAL FEES	Description
Total Revenue Column	1725416	TotalRevenueColumn
Related Or Exempt Function Income	1725416	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	1725416	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	44	TotalRevenueColumn
Related Or Exempt Function Income	44	RelatedOrExemptFunctionIncome

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	2250	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	2250	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	2250	TotalRevenueColumn
Related Or Exempt Function Income	2250	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	1265327	GrossSalesOfInventory
Cost Of Goods Sold	526292	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	739035	TotalRevenueColumn
Related Or Exempt Function Income	739035	RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	OTHER REVENUE	Description
Total Revenue Column	4248	TotalRevenueColumn
Related Or Exempt Function Income	4248	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	4248	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4096813	TotalRevenueColumn
Related Or Exempt Function Income	2470993	RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	149768	Total
Program Services	74884	ProgramServices
Management And General	74884	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2301238	Total
Program Services	1672593	ProgramServices
Management And General	628645	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	47573	Total
Program Services	31874	ProgramServices
Management And General	15699	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	278751	Total
Program Services	203111	ProgramServices
Management And General	75640	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	179610	Total
Program Services	125727	ProgramServices
Management And General	53883	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	3104	Total
Management And General	3104	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	8822	Total
Program Services	8102	ProgramServices
Management And General	720	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	93139	Total
Program Services	93139	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	83935	Total
Program Services	75575	ProgramServices
Management And General	8360	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	215989	Total
Program Services	194476	ProgramServices
Management And General	21513	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	21832	Total
Management And General	21832	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	8471	Total
Program Services	8471	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	40650	Total
Program Services	36601	ProgramServices
Management And General	4049	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	94982	Total
Program Services	85522	ProgramServices
Management And General	9460	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	13554	Total
Program Services	12204	ProgramServices
Management And General	1350	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
SUPPLIES	211793	162839	48954
COMMUNICATIONS	36739	33080	3659
OTHER	19518	18692	826

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	3809468	Total
Program Services	2836890	ProgramServices
Management And General	972578	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	4921	BOY
EOY	52013	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	10278	BOY
EOY	14573	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	804609	BOY
EOY	726657	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	195413	BOY
EOY	243301	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	10079	BOY
EOY	4925	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	1703750	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	257386	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	907805	BOY
EOY	1446364	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	1933105	BOY
EOY	2487833	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	383426	BOY
EOY	685942	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	10000	BOY
EOY	10000	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	662366	BOY
EOY	649699	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	149942	BOY
EOY	127476	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1205734	BOY
EOY	1473117	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	727371	BOY
EOY	1014716	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	727371	BOY
EOY	1014716	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	1933105	BOY
EOY	2487833	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

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	246554	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	321644	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	396000	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	443993	CurrentTaxYearMinus1Year
Current Tax Year	1625820	CurrentTaxYear
Total	3034011	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	246554	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	321644	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	396000	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	443993	CurrentTaxYearMinus1Year
Current Tax Year	1625820	CurrentTaxYear
Total	3034011	Total

Field	Value	IRS element (for citing)
Public Support Total170	3034011	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1538	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1304	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	212	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	31	CurrentTaxYearMinus1Year
Current Tax Year	44	CurrentTaxYear
Total	3129	Total

Field	Value	IRS element (for citing)
Total Support	3037140	TotalSupport
Gross Receipts From Admissions Etc	2997285	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	0.99900	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.99810	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

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

Field	Value	IRS element (for citing)
Disclosed Orgs Legal Control	false	DisclosedOrgsLegalControl
Disclosed For Charitable Purposes	false	DisclosedForCharitablePurposes
Written Policy Monitoring	false	WrittenPolicyMonitoring
Sect170h Requirements Satisfied	false	Sect170hRequirementsSatisfied
Solicited Assets For Sale	false	SolicitedAssetsForSale
Agent Trustee Etc	false	AgentTrusteeEtc
Included On FS	false	IncludedOnFS
Endowments Held By Unrelated Orgs	false	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	false	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	103000	OtherCostOrOtherBasis
Book Value	103000	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	893788	OtherCostOrOtherBasis
Depreciation	42777	Depreciation
Book Value	851011	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	178813	OtherCostOrOtherBasis
Depreciation	48617	Depreciation
Book Value	130196	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	528149	OtherCostOrOtherBasis
Depreciation	165992	Depreciation
Book Value	362157	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	1446364	TotalOfBookValueLandBuildings
Total Revenue	4096813	TotalRevenue
Total Expenses	3809468	TotalExpenses
Excess Or Deficit For Year	287345	ExcessOrDeficitForYear
Excess Or Deficit Per FS	287345	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	4623105	TotRevenueEtcAuditedFinclStmt
Other Revenues	526292	OtherRevenues
Revenue Not Rptd F990	526292	RevenueNotRptdF990
Revenue Subtotal	4096813	RevenueSubtotal
Total Revenue Per Form990	4096813	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	4335760	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	526292	OtherExpensesIncluded
Expenses Not Rptd F990	526292	ExpensesNotRptdF990
Expenses Subtotal	3809468	ExpensesSubtotal
Total Expenses Per Form990	3809468	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
RECONCILIATION OF CHANGES - OTHER	SCHEDULE D, PAGE 4, PART XI, LINE 8	PHARMACY COST OF GOODS SOLD 526,292 PHARMACY COST OF GOODS SOLD -526,292
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XII, LINE 2D	PHARMACY COST OF GOODS SOLD 526,292
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER	SCHEDULE D, PAGE 4, PART XIII, LINE 2D	PHARMACY COST OF GOODS SOLD 526,292

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	true	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Bonus Filing OrgBonusFilingOrg	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
LAVAL JENSEN
125000	24768	17622	167390
DAVID J BALLINGHAM
125000	31303	17820	174123

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATION	Identifier
Return Reference	SCHEDULE J, PAGE 1, PART I, LINE 6A	ReturnReference
Explanation	THE EXECUTIVE DIRECTOR'S AND THE MEDICAL DIRECTOR'S EMPLOYMENT AGREEMENTS PROVIDE THEM WITH INCENTIVE COMPENSATION EQUAL TO 10 PERCENT OF THE CHANGE IN NET ASSETS OF THE CENTER. THIS INCENTIVE COMPENSATION IS CAPPED AT A SPECIFIED AMOUNT WHICH WAS NOT REACHED DURING FISCAL YEAR 2010.	Explanation

Schedule L IRS990ScheduleL

Field	Value	IRS element (for citing)
Total Balance Due	10000	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
LAVAL JENSEN
EXEC. DIRECTOR	382760	BLDG. REMODEL	false
DAVID J BALLINGHAM
MEDICAL DIR.	382760	BLDG. REMODEL	false

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Description	MEDICAL EQUIP.	Description
Number Of Contributions	1	NumberOfContributions
Noncash Contribs Rptd F990	45564	NoncashContribsRptdF990
Method Of Determining Revenues	FAIR VALUE	MethodOfDeterminingRevenues

Field	Value	IRS element (for citing)
Any Property That Must Be Held	false	AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts	false	ReviewProcessUnusualNCGifts
Third Parties Used	false	ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ANY SIGNIFICANT NEW PROGRAM SERVICES NOT LISTED ON A PRIOR RETURN	FORM 990, PAGE 2, PART III, LINE 2	BEAR LAKE COMMUNITY HEALTH CENTER OPERATES A HEALTH CLINIC IN GARDEN CITY, UT. DURING FISCAL YEAR 2008, THEY OPENED A HEALTH CLINIC IN LOGAN, UT UNDER THE NAME CACHE VALLEY COMMUNITY HEALTH CENTER. DURING FISCAL YEAR 2010, THEY OPENED A HEALTH CLINIC IN HYRUM, UT UNDER THE NAME CACHE VALLEY COMMUNITY HEALTH CENTER SOUTH.
ALL OTHER ACHIEVEMENTS DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4D	PROVIDED PHARMACY SERVICES & HEALTH AND WELLNESS SERVICES TO LOW-INCOME FAMILIES.
RELATED PARTY INFORMATION AMONG OFFICERS	FORM 990, PAGE 6, PART VI, LINE 2	LAVAL JENSEN DAVID J. BALLINGHAM EXEC. DIR. MEDICAL DIR. OWNERS OF SHIMMERING WATERS
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11	FORM 990 IS PREPARED BY OUTSIDE ACCOUNTANT AND PROVIDED TO EXECUTIVE DIRECTOR FOR APPROVAL PRIOR TO SUBMISSION. FORM 990 IS THEN PROVIDED TO BOARD FOR REVIEW AND APPROVAL PRIOR TO SUBMISSION.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	THE CONFLICTS OF INTEREST POLICY IS REVIEWED AND DISCUSSED ANNUALLY AT THE BOARD RETREAT.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) SALARY SURVEY INFORMATION IS USED TO IDENTIFY WAGE RANGES FOR SIMILAR POSITIONS.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) SALARY SURVEY INFORMATION IS USED TO IDENTIFY WAGE RANGES FOR SIMILAR POSITIONS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST JUST AS FORMS 990.
ADDITIONAL INFORMATION	SCHEDULE O	THE CENTER DESIRED TO OBTAIN A NEW LOCATION FOR ITS LOGAN CLINIC. THE CENTER IDENTIFIED A DESIRABLE PROPERTY , BUT THE CENTER WAS UNABLE TO SECURE FINANCING TO PURCHASE THE PROPERTY. THE CENTER'S EXECUTIVE DIRECTOR AND MEDICAL DIRECTOR ARE THE OWNERS OF AN ENTITY, SHIMMERING WATERS, LLC WHO PURCHASED THE PROPERTY WITH THE INTENT TO SELL IT TO THE CENTER WHEN FINANCING COULD BE OBTAINED. THE CENTER HAS A PURCHASE AGREEMENT WITH SHIMMERING WATERS TO PURCHASE THE FACILITY. AS IDENTIFIED ON SCHEDULE J, THE CENTER PAID SHIMMERING WATERS 382,760 DURING FISCAL YEAR 2010 FOR THE COST OF IMPROVEMENTS TO THE BUILDING. THE CENTER PURCHASED THE BUILDING FROM SHIMMERING WATERS IN JULY 2010 FOR A PRICE OF 2,100,000. THIS TRANSACTION WILL BE REPORTED IN DETAIL ON SCHEDULE J OF THE CENTER'S 2010 FORM 990.