MT ENTERPRISE COMMUNITY HEALTH CLINIC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- MT ENTERPRISE COMMUNITY HEALTH CLINIC (EIN 43-2016287)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-09-14
- IRS object ID
- 201142579349301014
- Schema version
- 2010v3.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-09-14T16:48:03-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-01-01 | 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 | 2011-08-01 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRE MCLEMORE | Name |
| Phone | 9365648186 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | 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 | 1916561 | 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 | 34 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1000330 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1033528 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 486483 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 676414 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 34 | InvestmentIncomePriorYear |
| Investment Income Current Year | 95 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 206524 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1486847 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1916561 | 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 | 502044 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 906120 | 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 | 433745 | OtherExpensePriorYear |
| Other Expenses Current Year | 1040928 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 935789 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1947048 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 551058 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -30487 | RevenuesLessExpensesCY |
| Total Assets BOY | 752624 | TotalAssetsBOY |
| Total Assets EOY | 728632 | TotalAssetsEOY |
| Total Liabilities BOY | 230243 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 236739 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 522381 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 491893 | 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 | 1546607 | Expense |
| Grants | 1025550 | Grants |
| Revenue | 676815 | Revenue |
| Description | PROVIDED PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY | Description |
| Total Program Service Expense | 1546607 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| 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 | 1 | 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 | 1 | 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 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 34 | 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 |
| 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 (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| KENNETH MILEY | ||||||||
| PRESIDENT | 5.00 | X | 0 | 0 | 0 | |||
| RAMONA SMITH | ||||||||
| VICE PRESIDENT | 2.00 | X | 0 | 0 | 0 | |||
| DR WILLIAM SHEEHAN | ||||||||
| 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 | |||
| BARBARA CATES | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| MAMIE HODGE | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| DEBRA JILL COOLEY | ||||||||
| CEO | 40.00 | 83322 | 0 | 0 | X | |||
| ROBIN BIRDWELL | ||||||||
| CFO | 40.00 | 53501 | 0 | 0 | X | |||
| BECKY ELDRIDGE | ||||||||
| COO | 40.00 | 8951 | 0 | 0 | X | |||
| CHERYL ROWELL | ||||||||
| KEY EMPLOYEE | 40.00 | 57020 | 0 | 19300 | X | |||
| TAD TITLOW | ||||||||
| FORMER KEY EMPLOYEE | 40.00 | 113591 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 259365 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ROBERT GRIFFITH | |||||
| 521 HICKORY STREET | HENDERSON | TX | 75652 | MEDICAL DIRECTOR | 125045 |
| ONE SOURCE | |||||
| PO BOX 6741 | TYLER | TX | 75711 | CONSTRUCTION MANAGEMENT & DESIGN | 114158 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Federated Campaigns | 1025550 | FederatedCampaigns |
| All Other Contributions | 7978 | AllOtherContributions |
| Total Contributions | 1033528 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICAL SERVICE INCOME | 624100 | 433424 | 433424 |
| MEDICARE/MEDICAID PMTS | 624100 | 242990 | 242990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 676414 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 95 | TotalRevenueColumn |
| Related Or Exempt Function Income | 95 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| IN-KIND DONATIONS | 624110 | 201835 | 201835 |
| OTHER REVENUES | 624110 | 4689 | 4689 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 206524 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1916561 | TotalRevenueColumn |
| Related Or Exempt Function Income | 883033 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 202793 | Total |
| Program Services | 115329 | ProgramServices |
| Management And General | 87464 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 586151 | Total |
| Program Services | 580727 | ProgramServices |
| Management And General | 5424 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117176 | Total |
| Program Services | 64823 | ProgramServices |
| Management And General | 52353 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3795 | Total |
| Program Services | 3695 | ProgramServices |
| Management And General | 100 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47871 | Total |
| Program Services | 1637 | ProgramServices |
| Management And General | 46234 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28235 | Total |
| Program Services | 5149 | ProgramServices |
| Management And General | 23086 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30600 | Total |
| Management And General | 30600 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16417 | Total |
| Program Services | 1162 | ProgramServices |
| Management And General | 15255 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7063 | Total |
| Management And General | 7063 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115435 | Total |
| Program Services | 115435 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8336 | Total |
| Management And General | 8336 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| IN-KIND EXPENSE | 201835 | 201835 | |
| CONTRACTED SERVICES | 192826 | 144350 | 48476 |
| WRITE-OFFS | 144382 | 144382 | |
| MEDICAL SERVICES | 139419 | 139419 | |
| CONTRACTUAL ADJUSTMENTS | 42951 | 42951 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61763 | Total |
| Program Services | -14287 | ProgramServices |
| Management And General | 76050 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1947048 | Total |
| Program Services | 1546607 | ProgramServices |
| Management And General | 400441 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93998 | BOY |
| EOY | 90034 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27209 | BOY |
| EOY | 15983 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 170146 | BOY |
| EOY | 91958 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6590 | BOY |
| EOY | 5707 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 679081 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 268289 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 454681 | BOY |
| EOY | 410792 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 114158 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 752624 | BOY |
| EOY | 728632 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57340 | BOY |
| EOY | 57072 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118360 | BOY |
| EOY | 115345 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54543 | BOY |
| EOY | 64322 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 230243 | BOY |
| EOY | 236739 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 522381 | BOY |
| EOY | 491893 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 522381 | BOY |
| EOY | 491893 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 752624 | BOY |
| EOY | 728632 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -30487 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | 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 | 400 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 200 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 15827 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1000330 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1038217 | CurrentTaxYear |
| Total | 2054974 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 400 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 200 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 15827 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1000330 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1038217 | CurrentTaxYear |
| Total | 2054974 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 2054974 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 34 | CurrentTaxYearMinus1Year |
| Current Tax Year | 95 | CurrentTaxYear |
| Total | 129 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 796 | CurrentTaxYearMinus4Years |
| Current Tax Year | 201835 | CurrentTaxYear |
| Total | 202631 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 2257734 | TotalSupport |
| Gross Receipts From Admissions Etc | 1603458 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.91020 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.99800 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 433393 | InvestmentCostOrOtherBasis |
| Depreciation | 126924 | Depreciation |
| Book Value | 306469 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 245688 | InvestmentCostOrOtherBasis |
| Depreciation | 141365 | Depreciation |
| Book Value | 104323 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 410792 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CONSTRUCTION IN PROGRESS | Description |
| Book Value | 114158 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 114158 | TotalBookValueOtherAssets |
| Total Revenue | 1916561 | TotalRevenue |
| Total Expenses | 1947048 | TotalExpenses |
| Excess Or Deficit For Year | -30487 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | -30487 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 1916561 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 1916561 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1916561 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1947048 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1947048 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1947048 | 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 |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | TAD TITLOW | NamePerson |
| Base Compensation Filing Org | 113591 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 113591 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
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 | 115345 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 115345 | 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 | 201835 | 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 (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 WAS REVIEWED BY THE CFO AND THE FINANCE COMMITTEE BEFORE BEING FILED. | |
| 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 12C | |
| 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 B, LINE 15A | |
| THE ORGANIZATION MAKES FORM 1023 AND FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON WRITTEN REQUEST. | FORM 990, PART VI, SECTION C, LINE 18 | |
| THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| THE PROCESS OF SELECTING THE INDEPENDENT ACCOUNTANT RESPONSIBLE FOR THE ANNUAL FINANCIAL AUDIT HAS NOT CHANGED FROM THE PRIOR YEAR. |