CENTERPLACE HEALTH INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CENTERPLACE HEALTH INC (EIN 20-2779327)
- Tax period
- 2021-05-01 to 2022-04-30
- Filed
- 2024-03-15
- IRS object ID
- 202440759349300319
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-03-15T09:29:34-05:00 | ReturnTs |
| Tax Period End | 2022-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 593204548 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES MOORE & CO PL | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5931 NW 1ST PL | AddressLine1Txt |
| City | GAINESVILLE | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 326072063 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202779327 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTERPLACE HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CENT | BusinessNameControlTxt |
| Phone | 9415290249 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1750 17TH STREET BLDG N | AddressLine1Txt |
| City | SARASOTA | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34234 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KARI ELLINGSTAD | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 9415290249 | PhoneNum |
| Signature | 2024-03-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KARI | PersonFirstNm |
| Person Last | ELLINGSTAD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CORINNE LAROCHE | PreparerPersonNm |
| PTIN | P01500189 | PTIN |
| Phone | 3523781331 | PhoneNum |
| Preparation | 2024-03-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | Yes (X) | AmendedReturnInd |
| Principal Officer | KARI ELLINGSTAD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1750 17TH STREET BLDG N | AddressLine1Txt |
| City | SARASOTA | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34234 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,434,510 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | CENTERPLACEHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | FL | LegalDomicileStateCd |
| Activity Or Mission | A FQHC (FEDERALLY QUALIFIED HEALTHCARE CENTER) EMPLOYING MEDICAL & DENTAL PROVIDERS SPECIALIZING IN QUALITY PRIMARY CARE SERVICES TO PATIENTS THAT ARE UNDERSERVED, UNDERINSURED AND/OR UNINSURED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 195 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,985,261 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,850,810 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,361,540 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,581,893 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,540 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,807 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $15,349,341 | PYTotalRevenueAmt |
| CY Total Revenue | $17,434,510 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,669,002 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,197,563 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,831,342 | PYOtherExpensesAmt |
| CY Other Expenses | $6,078,851 | CYOtherExpensesAmt |
| PY Total Expenses | $14,500,344 | PYTotalExpensesAmt |
| CY Total Expenses | $17,276,414 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $848,997 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $158,096 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,600,335 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,724,060 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,207,716 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,173,345 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,392,619 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,550,715 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CENTERPLACE HEALTH, AS A FQHC (FEDERALLY QUALIFIED HEALTHCARE CENTER), EMPLOYS MEDICAL AND DENTAL PROVIDERS SPECIALIZING IN QUALITY, EFFICIENT AND EFFECTIVE PRIMARY CARE SERVICES AND PREVENTABLE HEALTH EDUCATION TO PATIENTS THAT ARE AT RISK, VULNERABLE, UNDERSERVED, UNDERINSURED AND/OR UNINSURED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,920,561 | ExpenseAmt |
| Revenue | $11,581,893 | RevenueAmt |
| Desc | CENTERPLACE HEALTH, AS A FQHC (FEDERALLY QUALIFIED HEALTHCARE CENTER), EMPLOYS MEDICAL AND DENTAL PROVIDERS SPECIALIZING IN QUALITY, EFFICIENT AND EFFECTIVE PRIMARY CARE SERVICES AND PREVENTABLE HEALTH EDUCATION TO PATIENTS THAT ARE AT RISK, VULNERABLE, UNDERSERVED, UNDERINSURED AND/OR UNINSURED. | Desc |
| Total Program Service Expenses | $11,920,561 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 195 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTINA GARAWAY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9415290249 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1750 17TH STREET BLDG N | AddressLine1Txt |
| City | SARASOTA | CityNm |
| State Abbreviation | FL | StateAbbreviationCd |
| ZIP | 34234 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| KARI ELLINGSTAD | |||||||
| CHAIR | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| IRENE FLESHNER | |||||||
| IMMEDIATE PAST CHAIR | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ARNOLD DENNARD | |||||||
| SECRETARY | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HOWARD BERMAN | |||||||
| TREASURER | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BILL LITTLE | |||||||
| VICE-CHAIR | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARIA RAM | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| MARIA DECARLO | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| GLORIA DEHAVEN | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| JANIS COHEN | |||||||
| DIRECTOR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| PATRICIA EGAN | |||||||
| COO | 40.00 | Yes (X) | $156,399 | $0 | $14,927 | ||
| LISA GONZALEZ-ABELLO | |||||||
| CMO AS OF JULY 1, 2021 | 40.00 | Yes (X) | $179,512 | $0 | $15,278 | ||
| STEPHEN NICHOLAS | |||||||
| CMO UNTIL JANUARY 24, 2021 | 40.00 | Yes (X) | $17,838 | $0 | $128 | ||
| JAMES REID | |||||||
| CFO AS OF OCTOBER 11, 2021 | 40.00 | Yes (X) | $31,148 | $0 | $115 | ||
| MELISSA PARKER | |||||||
| CEO | 40.00 | Yes (X) | $217,627 | $0 | $16,376 | ||
| DEBORAH GREEN | |||||||
| CFO UNTIL JUNE 30, 2021 | 40.00 | Yes (X) | $98,208 | $0 | $4,608 | ||
| FREDERICK FITZGERALD MD | |||||||
| PROVIDER | 40.00 | $229,927 | $0 | $15,988 | Yes (X) | ||
| CHRISTINE TRUPIANO MD | |||||||
| PROVIDER | 40.00 | $276,892 | $0 | $9,984 | Yes (X) | ||
| JOSEPH SINGER MD | |||||||
| PROVIDER | 40.00 | $260,380 | $0 | $19,102 | Yes (X) | ||
| SEAN MEYER | |||||||
| CHIEF TECHNOLOGY OFFICER | 40.00 | $174,941 | $0 | $13,421 | Yes (X) | ||
| YUSIF ADDAE MD | |||||||
| PROVIDER | 40.00 | $214,241 | $0 | $8,119 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,857,113 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $118,046 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ARCH HEALTHCARE INC | |||||
| 3231 GULF GATE DR STE 202 | SARASOTA | FL | 34231 | HEALTHCARE SERVICES | $301,581 |
| NURSECORE OF SARASOTA STAFFING | |||||
| 1223 BENEVA RD SOUTH STE 105 | SARASOTA | FL | 34232 | STAFFING SERVICES | $234,353 |
| CENTERSTONE OF FLORIDA INC | |||||
| 391 6TH AVENUE WEST | BRADENTON | FL | 34205 | HEALTHCARE SERVICES | $164,302 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,241,097 | GovernmentGrantsAmt |
| All Other Contributions | $609,713 | AllOtherContributionsAmt |
| Total Contributions | $5,850,810 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICAID FEES | 624100 | $6,176,989 | $6,176,989 |
| PHARMACY FEES | 624100 | $2,884,060 | $2,884,060 |
| PATIENT FEES | 624100 | $1,984,689 | $1,984,689 |
| MEDICARE FEES | 624100 | $536,155 | $536,155 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,581,893 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,807 | TotalRevenueColumnAmt |
| Exclusion | $1,807 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,434,510 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,581,893 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,807 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $735,843 | TotalAmt |
| Program Services | $537,165 | ProgramServicesAmt |
| Management And General | $198,678 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,593,909 | TotalAmt |
| Program Services | $6,273,551 | ProgramServicesAmt |
| Management And General | $2,320,358 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,074 | TotalAmt |
| Program Services | $118,314 | ProgramServicesAmt |
| Management And General | $43,760 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,062,823 | TotalAmt |
| Program Services | $775,861 | ProgramServicesAmt |
| Management And General | $286,962 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $642,914 | TotalAmt |
| Program Services | $469,327 | ProgramServicesAmt |
| Management And General | $173,587 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,509 | TotalAmt |
| Management And General | $33,509 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,830 | TotalAmt |
| Management And General | $56,830 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,096,859 | TotalAmt |
| Program Services | $1,503,060 | ProgramServicesAmt |
| Management And General | $593,799 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,521 | TotalAmt |
| Program Services | $8,181 | ProgramServicesAmt |
| Management And General | $73,340 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,265 | TotalAmt |
| Program Services | $111,594 | ProgramServicesAmt |
| Management And General | $91,671 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $381,887 | TotalAmt |
| Program Services | $129,094 | ProgramServicesAmt |
| Management And General | $252,793 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $494,932 | TotalAmt |
| Program Services | $225,402 | ProgramServicesAmt |
| Management And General | $269,530 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,477 | TotalAmt |
| Management And General | $25,477 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,277 | TotalAmt |
| Program Services | $34,530 | ProgramServicesAmt |
| Management And General | $4,747 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,348 | TotalAmt |
| Program Services | $32 | ProgramServicesAmt |
| Management And General | $4,316 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,455 | TotalAmt |
| Program Services | $66,356 | ProgramServicesAmt |
| Management And General | $82,099 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,227 | TotalAmt |
| Program Services | $25,970 | ProgramServicesAmt |
| Management And General | $78,257 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHARMACEUTICALS/SUPPLIE | $1,064,893 | $991,171 | $73,722 |
| BAD DEBT EXPENSE | $457,410 | $457,410 | |
| DISPENSING FEE | $400,939 | $400,939 | |
| DUES & SUBSCRIPTIONS | $170,714 | $91,191 | $79,523 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,308 | TotalAmt |
| Program Services | $158,823 | ProgramServicesAmt |
| Management And General | $155,485 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,276,414 | TotalAmt |
| Program Services | $11,920,561 | ProgramServicesAmt |
| Management And General | $5,355,853 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $213,705 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,338,349 | BOYAmt |
| EOY | $1,037,595 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,463,665 | BOYAmt |
| EOY | $2,755,443 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $248,802 | BOYAmt |
| EOY | $198,238 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $778,192 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $259,113 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $549,519 | BOYAmt |
| EOY | $519,079 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,600,335 | BOYAmt |
| EOY | $4,724,060 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,120,592 | BOYAmt |
| EOY | $1,183,796 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $30,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $277,475 | BOYAmt |
| EOY | $149,900 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $809,649 | BOYAmt |
| EOY | $809,649 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,207,716 | BOYAmt |
| EOY | $2,173,345 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,392,619 | BOYAmt |
| EOY | $2,550,715 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,392,619 | BOYAmt |
| EOY | $2,550,715 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,600,335 | BOYAmt |
| EOY | $4,724,060 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $158,096 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $425,667 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,278,200 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,876,798 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,985,261 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,850,810 | CurrentTaxYearAmt |
| Total | $20,416,736 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $425,667 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,278,200 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,876,798 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,985,261 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,850,810 | CurrentTaxYearAmt |
| Total | $20,416,736 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,254,801 | SubstantialContributorsTotAmt |
| Public Support Total170 | $19,161,935 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $446 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $918 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,522 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,540 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,807 | CurrentTaxYearAmt |
| Total | $16,233 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $20,432,969 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $30,016,404 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.93780 | PublicSupportCY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,552 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,033 | DepreciationAmt |
| Book Value | $16,519 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $705,140 | OtherCostOrOtherBasisAmt |
| Depreciation | $247,589 | DepreciationAmt |
| Book Value | $457,551 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $51,500 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,491 | DepreciationAmt |
| Book Value | $45,009 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $519,079 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED PPP FUNDING | Desc |
| Amt | $809,649 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $809,649 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $17,106,345 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $129,245 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$457,410 | OtherRevenueAmt |
| Revenue Not Reported | -$328,165 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,434,510 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,434,510 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $16,948,249 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $129,245 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $129,245 | ExpensesNotReportedAmt |
| Expenses Subtotal | $16,819,004 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $457,410 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $457,410 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,276,414 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, INCOME EARNED IN THE FURTHERANCE OF THE ORGANIZATION'S TAX-EXEMPT PURPOSE IS EXEMPT FROM FEDERAL INCOME TAXES AND THE FINANCIAL STATEMENTS CONTAIN NO PROVISION OR LIABILITY FOR INCOME TAXES. THE ORGANIZATION FILES INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. THE ORGANIZATION'S RETURNS FOR THE PAST THREE YEARS ARE SUBJECT TO EXAMINATIONS BY TAX AUTHORITIES AND MAY CHANGE UPON EXAMINATION. THE ORGANIZATION HAS REVIEWED AND EVALUATED THE RELEVANT TECHNICAL MERITS OF EACH OF ITS TAX POSITIONS IN ACCORDANCE WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, AND DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT WOULD HAVE A MATERIAL IMPACT ON THE FINANCIAL STATEMENTS OF THE ORGANIZATION. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSES NOT INCLUDED ON 990 PART VIII -457,410. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSES NOT INCLUDED ON 990 PART VIII 457,410. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHRISTINE TRUPIANO MD | ||||||||||||||
| PROVIDER | $276,892 | $0 | $0 | $0 | $0 | $0 | $8,434 | $0 | $1,550 | $0 | $286,876 | $0 | $0 | $0 |
| JOSEPH SINGER MD | ||||||||||||||
| PROVIDER | $260,380 | $0 | $0 | $0 | $0 | $0 | $8,098 | $0 | $11,004 | $0 | $279,482 | $0 | $0 | $0 |
| FREDERICK FITZGERALD MD | ||||||||||||||
| PROVIDER | $229,927 | $0 | $0 | $0 | $0 | $0 | $7,398 | $0 | $8,590 | $0 | $245,915 | $0 | $0 | $0 |
| MELISSA PARKER | ||||||||||||||
| CEO | $217,627 | $0 | $0 | $0 | $0 | $0 | $6,732 | $0 | $9,644 | $0 | $234,003 | $0 | $0 | $0 |
| YUSIF ADDAE MD | ||||||||||||||
| PROVIDER | $214,241 | $0 | $0 | $0 | $0 | $0 | $6,780 | $0 | $1,339 | $0 | $222,360 | $0 | $0 | $0 |
| LISA GONZALEZ-ABELLO | ||||||||||||||
| CMO AS OF JULY 1, 2021 | $179,512 | $0 | $0 | $0 | $0 | $0 | $5,929 | $0 | $9,349 | $0 | $194,790 | $0 | $0 | $0 |
| SEAN MEYER | ||||||||||||||
| CHIEF TECHNOLOGY OFFICER | $174,941 | $0 | $0 | $0 | $0 | $0 | $1,680 | $0 | $11,741 | $0 | $188,362 | $0 | $0 | $0 |
| PATRICIA EGAN | ||||||||||||||
| COO | $156,399 | $0 | $0 | $0 | $0 | $0 | $4,877 | $0 | $10,050 | $0 | $171,326 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER IS APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION AMOUNTS ARE DETERMINED BY AVAILABLE SALARY SURVEY DATA AND COMPENSATION PAID BY SIMILAR ORGANIZATIONS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, HEADING, ITEM B: | CHANGES WERE MADE TO THE AUDITED FINANCIAL STATEMENTS AFTER THE PREVIOUS FORM 990 WAS FILED. EACH PART OR SCHEDULE AND LINE ITEM OF THE FORM 990 THAT WAS AMENDED IS AS FOLLOWS: FORM 990, PART I LINE 6 - TOTAL NUMBER OF VOLUNTEERS: INCREASED TO 8 VOLUNTEERS TO REFLECT THE NUMBER OF INDEPENDENT BOARD MEMBERS LINE 8 - CONTRIBUTIONS AND GRANTS: INCREASED BY $199,999 LINE 12 - TOTAL REVENUE: INCREASED BY $199,999 LINE 15 - SALARIES, OTHER COMPENSATION, EMPLOYEE BENEFITS: DECREASED BY $7,662 LINE 17 - OTHER EXPENSES: INCREASED BY $703,413 LINE 18 - TOTAL EXPENSES: INCREASED BY $695,751 LINE 19 - REVENUE LESS EXPENSES: DECREASED BY $495,752 LINE 20 - TOTAL ASSETS: DECREASED BY $695,752 LINE 21 - TOTAL LIABILITIES: DECREASED BY $200,000 LINE 22 - NET ASSETS: DECREASED BY $495,752 FORM 990, PART III LINE 4A - EXPENSES: INCREASED BY $16,954 LINE 4E - TOTAL PROGRAM SERVICE EXPENSES: INCREASED BY $16,954 FORM 990, PART VI SECTION A, LINE 1A - ADDED SCHEDULE O DISCLOSURE TO DESCRIBE THE DELEGATION OF BROAD AUTHORITY BY THE GOVERNING BODY TO AN EXECUTIVE COMMITTEE PER THE BYLAWS SECTION A, LINE 4 - MARKED YES TO REFLECT THE REVISION OF THE BYLAWS DURING THE FISCAL YEAR. ADDED SCHEDULE O DISCLOSURE TO DESCRIBE SUCH CHANGES SECTION A, LINE 7A & 7B - MARKED NO AS THERE ARE NO MEMBERS PER THE BYLAWS AND REMOVED RELATED SCHEDULE O DISCLOSURES FORM 990, PART VIII LINE 1E - GOVERNMENT GRANTS: DECREASED BY $1 LINE 1F - ALL OTHER CONTRIBUTIONS, GIFTS, GRANTS, AND SIMILAR AMOUNTS: INCREASED BY $200,000 LINE 1H - TOTAL: INCREASED BY $199,999 LINE 12, COLUMN A - TOTAL REVENUE: INCREASED BY $199,999 FORM 990, PART IX LINE 9, COLUMN A - OTHER EMPLOYEE BENEFITS: DECREASED BY $7,662 LINE 9, COLUMN B - OTHER EMPLOYEE BENEFITS: DECREASED BY $5,593 LINE 9, COLUMN C - OTHER EMPLOYEE BENEFITS: DECREASED BY $2,069 LINE 11G, COLUMN B - OTHER FEES FOR SERVICES: INCREASED BY $153,488 LINE 11G, COLUMN C - OTHER FEES FOR SERVICES: DECREASED BY $153,488 LINE 13, COLUMN A - OFFICE EXPENSES: DECREASED BY $1 LINE 13, COLUMN B - OFFICE EXPENSES: DECREASED BY $76,040 LINE 13, COLUMN C - OFFICE EXPENSES: INCREASED BY $76,039 LINE 14, COLUMN B - INFORMATION TECHNOLOGY: DECREASED BY $252,793 LINE 14, COLUMN C - INFORMATION TECHNOLOGY: INCREASED BY $252,793 LINE 16, COLUMN B - OCCUPANCY: INCREASED BY $114,076 LINE 16, COLUMN C - OCCUPANCY: DECREASED BY $114,076 LINE 17, COLUMN B - TRAVEL: DECREASED BY $157 LINE 17, COLUMN C - TRAVEL: INCREASED BY $157 LINE 19, COLUMN B - CONFERENCES, CONVENTIONS, AND MEETINGS: INCREASED BY $2,252 LINE 19, COLUMN C - CONFERENCES, CONVENTIONS, AND MEETINGS: DECREASED BY $2,252 LINE 22, COLUMN A - DEPRECIATION, DEPLETION, AND AMORTIZATION: INCREASED BY $39,370 LINE 22, COLUMN B - DEPRECIATION, DEPLETION, AND AMORTIZATION: INCREASED BY $66,356 LINE 22, COLUMN C - DEPRECIATION, DEPLETION, AND AMORTIZATION: DECREASED BY $26,986 LINE 23, COLUMN B - INSURANCE: DECREASED BY $1 LINE 23, COLUMN C - INSURANCE: INCREASED BY $1 LINE 24, COLUMN A - BAD DEBT EXPENSE: INCREASED BY $656,382 LINE 24, COLUMN C - BAD DEBT EXPENSE: INCREASED BY $656,382 LINE 24, COLUMN A - OTHER: INCREASED BY $7,662 LINE 24, COLUMN B - OTHER: DECREASED BY $9,442 LINE 24, COLUMN C - OTHER: INCREASED BY $17,104 LINE 24, COLUMN B - DUES & SUBSCRIPTIONS: INCREASED BY $24,809 LINE 24, COLUMN C - DUES & SUBSCRIPTIONS: DECREASED BY $24,809 LINE 24, COLUMN B - BANK/FINACNE EXPENSE: DECREASED BY $1 LINE 24, COLUMN C - BANK/FINACNE EXPENSE: INCREASED BY $1 LINE 25, COLUMN A - TOTAL FUNCTIONAL EXPENSES: INCREASED BY $695,751 LINE 25, COLUMN B - TOTAL FUNCTIONAL EXPENSES: INCREASED BY $16,954 LINE 25, COLUMN C - TOTAL FUNCTIONAL EXPENSES: INCREASED BY $678,797 FORM 990, PART X LINE 4 - ACCOUNTS RECEIVABLE, NET: DECREASED BY $656,382 LINE 10B - LESS: ACCUMULATED DEPRECIATION: INCREASED BY $39,370 LINE 16 - TOTAL ASSETS: DECREASED BY $695,752 LINE 19 - DEFERRED REVENUE: DECREASED BY $200,000 LINE 26 - TOTAL LIABILITIES: DECREASED BY $200,000 LINE 27 - NET ASSETS WITHOUT DONOR RESTRICTIONS: DECREASED BY $495,752 LINE 32 - TOTAL NET ASSETS OR FUND BALANCES: DECREASED BY $495,752 LINE 33 - TOTAL LIABILITIES AND NET ASSETS/FUND BALANCES: DECREASED BY $695,752 FORM 990, PART XI LINE 1 - TOTAL REVENUE : INCREASED BY $199,999 LINE 2 - TOTAL EXPENSES: INCREASED BY $695,751 LINE 3 - REVENUE LESS EXPENSES: DECREASED BY $495,752 LINE 10 - NET ASSETS AT END OF YEAR: DECREASED BY $495,752 SCHEDULE A, PART II LINE 1, COLUMN E - GIFTS, GRANTS, AND CONTRIBUTIONS, AND MEMBERSHIP FEES RECEIVED : INCREASED BY $199,999 LINE 4, COLUMN E - TOTAL: INCREASED BY $199,999 LINE 7, COLUMN E - AMOUNTS FROM LINE 4: INCREASED BY $199,999 LINE 1, COLUMN F - GIFTS, GRANTS, AND CONTRIBUTIONS, AND MEMBERSHIP FEES RECEIVED : INCREASED BY $199,999 LINE 4, COLUMN F - TOTAL: INCREASED BY $199,999 LINE 5, COLUMN F - THE PORTION OF TOTAL CONTRIBUTIONS BY EACH PERSON (OTHER THAN A GOVERNMENTAL UNIT OR PUBLICLY SUPPORTED ORGANIZATION) INCLUDED ON LINE 1 THAT EXCEEDS 2% OF THE AMOUNT SHOWN ON LINE 11, COLUMN (F): INCREASED BY $196,000 LINE 6, COLUMN F - PUBLIC SUPPORT: INCREASED BY $3,999 LINE 7, COLUMN F - AMOUNTS FROM LINE 4: INCREASED BY $199,999 LINE 11, COLUMN F - TOTAL SUPPORT: INCREASED BY $199,999 LINE 14 - PUBLIC SUPPORT PERCENTAGE FOR 2021: DECREASED BY 0.91% SCHEDULE A, IDENTIFICATION OF EXCESS CONTRIBUTIONS INCLUDED ON PART II, LINE 5 TOTAL CONTRIBUTIONS: INCREASED BY $200,000 EXCESS CONTRIBUTIONS: INCREASED BY $196,000 TOTAL EXCESS CONTRIBUTIONS TO SCHEDULE A, PART II, LINE 5: INCREASED BY $196,000 SCHEDULE B, PART I THIS SCHEDULE HAS BEEN UPDATED TO REFLECT THE RECEIPT OF CASH CONTRIBUTIONS OF $200,000. SCHEDULE D, PART VI LINE 1C, COLUMN B - LEASEHOLD IMPROVEMENTS: DECREASED BY $16,526 LINE 1C, COLUMN D - LEASEHOLD IMPROVEMENTS: DECREASED BY $16,526 LINE 1D, COLUMN B - EQUIPMENT: INCREASED BY $16,526 LINE 1D, COLUMN C - EQUIPMENT: INCREASED BY $39,370 LINE 1D, COLUMN D - EQUIPMENT: DECREASED BY $22,844 SCHEDULE D, PART XI LINE 1 - TOTAL REVENUE, GAINS, AND OTHER SUPPORT PER AUDITED FINANCIAL STATEMENTS: DECREASED BY $456,383 LINE 2D - AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 - OTHER ADJUSTMENTS: DECREASED BY $656,382 LINE 3 - SUBTRACT LINE 2E FROM LINE 1 : INCREASED BY $199,999 LINE 5 - TOTAL REVENUE: INCREASED BY $199,999 SCHEDULE D, PART XII LINE 1 - TOTAL EXPENSES AND LOSSES PER AUDITED FINANCIAL STATEMENTS: INCREASED BY $39,369 LINE 3 - SUBTRACT LINE 2E FROM LINE 1 : INCREASED BY $39,369 LINE 4B - AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 - OTHER ADJUSTMENTS: INCREASED BY $656,382 LINE 5 - TOTAL EXPENSES: INCREASED BY $695,751 SCHEDULE D, PART XIII THE SUPPLEMENTAL INFORMATION HAS BEEN UPDATED TO REFLECT THE ENTIRE FOOTNOTE SHOWN ON THE AUDITED FINANCIAL STATEMENTS THAT ADDRESSES THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS SCHEDULE J, PART III THE SUPPLEMENTAL INFORMATION HAS BEEN UPDATED TO PROVIDE AN EXPLANATION FOR METHODS THE ORGANIZATION USED TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO |
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL CONSIST ONLY OF THE OFFICERS OF THE CORPORATION AND WILL MEET AS NEEDED TO CONDUCT BUSINESS OF THE CORPORATION AS DEFINED IN THE BYLAWS TO: (A) TAKE ACTIONS ON BEHALF OF THE BOARD BETWEEN MEETINGS, AS NECESSARY; (B) CONDUCT THE BUSINESS OF THE BOARD; (C) OVERSEE THE EVALUATION OF THE CEO, INCLUDING ALL PROCESSES RELATED TO THIS FUNCTION INCLUDING ESTABLISHING CRITERIA, INTERVIEWING, AND PREPARING SUMMARY INFORMATION TO THE BOARD; AND (D) RECOMMEND SUCCESSION PLANNING FOR KEY FQHC LEADERSHIP. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZATION AMENDED ITS BYLAWS AS OF 8/19/2021. THESE REVISIONS INCLUDE CHANGES TO THE ORGANIZATION'S PURPOSE AND OBJECTIVES, BOARD COMPOSITION, ELECTION AND TERM OF OFFICE, AND THE ADDITION OF THE COMPLIANCE COMMITTEE. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 DRAFT IS MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO ISSUANCE. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER IS APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION AMOUNTS ARE DETERMINED BY AVAILABLE SALARY SURVEY DATA AND COMPENSATION PAID BY SIMILAR ORGANIZATIONS. COMPENSATION FOR THE CHIEF FINANCIAL OFFICER IS APPROVED BY THE CEO. COMPENSATION OF KEY EMPLOYEES IS APPROVED BY THE CHIEF FINANCIAL OFFICER. COMPENSATION AMOUNTS ARE DETERMINED BY AVAILABLE SALARY SURVEY DATA AND COMPENSATION PAID BY SIMILAR ORGANIZATIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC BY REQUEST BY VISITING THE HEADQUARTERS OF THE ORGANIZATION WITH SUFFICIENT NOTICE GIVEN. |
| FORM 990, PART IX, LINE 11G | CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 49,045. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,045. CONTRACTED PROFESSIONALS: PROGRAM SERVICE EXPENSES 850,106. MANAGEMENT AND GENERAL EXPENSES 429,890. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,279,996. MEDICAL BILLING: PROGRAM SERVICE EXPENSES 82,532. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 82,532. OTHER SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 547,582. MANAGEMENT AND GENERAL EXPENSES 94,947. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 642,529. PAYROLL SERVICES: PROGRAM SERVICE EXPENSES 22,840. MANAGEMENT AND GENERAL EXPENSES 19,917. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,757. |
| FORM 990, PART IX, LINE 24E | LABORATORY FEES: PROGRAM SERVICE EXPENSES 98,224. MANAGEMENT AND GENERAL EXPENSES 35,017. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,241. RECRUITING: PROGRAM SERVICE EXPENSES 22,240. MANAGEMENT AND GENERAL EXPENSES 57,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,325. LICENSING/CRENDENTIALING: PROGRAM SERVICE EXPENSES 27,706. MANAGEMENT AND GENERAL EXPENSES 24,161. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,867. OTHER: PROGRAM SERVICE EXPENSES 10,515. MANAGEMENT AND GENERAL EXPENSES 17,246. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,761. BANK/FINANCE EXPENSE: PROGRAM SERVICE EXPENSES 138. MANAGEMENT AND GENERAL EXPENSES 21,976. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,114. |
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