COMMUNITY CARE OF WEST VIRGINIA INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY CARE OF WEST VIRGINIA INC (EIN 55-0599096)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2022-09-12
- IRS object ID
- 202242559349300704
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule K
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-09-12T07:36:22-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E ST LOUIS 200/PO BOX 1190 | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 658062523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550599096 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY CARE OF WEST VIRGINIA INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % CONNIE JOHNSTON CFO | InCareOfNm |
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3049246262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 217 | AddressLine1Txt |
| City | ROCK CAVE | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26234 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD SIMON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3049246262 | PhoneNum |
| Signature | 2022-07-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Krystal K Creach | PreparerPersonNm |
| PTIN | P01248198 | PTIN |
| Phone | 4178658701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | Yes (X) | AmendedReturnInd |
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DBA TRI-COUNTY HEALTH CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RICHARD SIMON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 217 | AddressLine1Txt |
| City | ROCK CAVE | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26234 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $39,737,248 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | CCWV.ORG | WebsiteAddressTxt |
| Formation | 1979 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HIGH QUALITY, ACCESSIBLE COMPREHENSIVE AND COST-EFFECTIVE HEALTHCARE SERVICES TO OUR PATIENTS WHILE SERVING AS THEIR MEDICAL HOME. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 431 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $421 | TotalGrossUBIAmt |
| PY Contributions Grants | $5,421,359 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,020,717 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $30,987,939 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,704,239 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,296 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,292 | CYInvestmentIncomeAmt |
| PY Other Revenue | $421 | PYOtherRevenueAmt |
| CY Other Revenue | $479 | CYOtherRevenueAmt |
| PY Total Revenue | $36,414,015 | PYTotalRevenueAmt |
| CY Total Revenue | $39,728,727 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $9,084 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $54,330 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,197,421 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,448,953 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,322,439 | PYOtherExpensesAmt |
| CY Other Expenses | $17,079,798 | CYOtherExpensesAmt |
| PY Total Expenses | $34,528,944 | PYTotalExpensesAmt |
| CY Total Expenses | $39,583,081 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,885,071 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $145,646 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,397,573 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,641,994 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,117,791 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $21,216,566 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,279,782 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,425,428 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF CCWV IS TO HELP OUR COMMUNITIES LIVE THE HEALTHIEST LIVES POSSIBLE BY MEETING THEIR IMMEDIATE AND LONG-TERM HEALTHCARE NEEDS. SEE SCHEDULE O. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $32,235,099 | ExpenseAmt |
| Grant | $54,330 | GrantAmt |
| Revenue | $34,704,239 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES RURAL MEDICAL, DENTAL AND PHARMACY HEALTHCARE SERVICES TO APPROXIMATELY 43,000 PATIENTS IN BRAXTON, CLAY, HARRISON, LEWIS, POCAHONTAS, RANDOLPH AND UPSHUR COUNTIES IN WEST VIRGINIA. | Desc |
| Total Program Service Expenses | $32,235,099 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 431 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CONNIE JOHNSTON CFO | PersonNm |
| Phone | 3049246262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 217 | AddressLine1Txt |
| City | ROCK CAVE | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26234 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| RICHARD SIMON | ||||||||
| CEO | 40.0 | 0.0 | Yes (X) | $237,219 | $0 | $165,199 | ||
| SARAH CHOUINARD | ||||||||
| MEDICAL DIRECTOR | 40.0 | 0.0 | Yes (X) | $347,229 | $0 | $16,772 | ||
| GREGORY PETERS | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $288,114 | $0 | $16,875 | Yes (X) | ||
| KEVIN JUNKINS | ||||||||
| PSYCHIATRIST | 40.0 | 0.0 | $256,211 | $0 | $391 | Yes (X) | ||
| BENJAMIN HINES | ||||||||
| PSYCHIATRIST | 40.0 | 0.0 | $251,951 | $0 | $1,246 | Yes (X) | ||
| KELLY DUNAVANT | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $231,501 | $0 | $14,637 | Yes (X) | ||
| CHRISTINA GILLENWATER | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $222,703 | $0 | $9,668 | Yes (X) | ||
| CONNIE JOHNSTON | ||||||||
| CFO | 40.0 | 0.0 | Yes (X) | $150,154 | $0 | $11,118 | ||
| PATRICIA COLLETT | ||||||||
| COO | 40.0 | 0.0 | Yes (X) | $145,638 | $0 | $14,859 | ||
| MARTIN BAECHTEL | ||||||||
| CIO | 40.0 | 0.0 | Yes (X) | $88,347 | $0 | $3,653 | ||
| TOM LYNCH | ||||||||
| PRESIDENT | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| GREG MOORE | ||||||||
| TREAS/VICE PRESIDENT BEG 01/20 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KAPPY HORNER | ||||||||
| MEMBER/SECRETARY BEG 01/20 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SARINA SMITH | ||||||||
| MEMBER/TREASURER BEG 01/20 | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| STEVE FLAUGHERS | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| DAVID MALCOMB | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| J CHAD MORRISON | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| SELAH RAINES | ||||||||
| BOARD MEMBER BEG 02/20 | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| MICHELLE SAMPLES | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| ROSEMARY THOMAS | ||||||||
| BOARD MEMBER BEG 02/20 | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| DAVID TAYLOR | ||||||||
| BOARD MEMBER | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| JAMES ESTEP | ||||||||
| BOARD MEMBER BEG 04/20 | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| KAREN GRANTS | ||||||||
| SECRETARY END 12/19 | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| THELMA SAMPLES | ||||||||
| VICE PRESIDENT END 12/19 | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,219,067 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $254,418 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 41 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | QUALITY HOME AND OFFICE CLEANING L | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 34 BOGGESS STREET | AddressLine1Txt |
| City | BUCKHANNON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26201 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | CLEANING | ServicesDesc |
| Compensation | $168,540 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,779,141 | GovernmentGrantsAmt |
| All Other Contributions | $241,576 | AllOtherContributionsAmt |
| Noncash Contributions | $93,388 | NoncashContributionsAmt |
| Total Contributions | $5,020,717 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $32,077,522 | $32,077,522 |
| OTHER INCOME | 900099 | $2,626,717 | $2,626,717 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,704,239 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,292 | TotalRevenueColumnAmt |
| Exclusion | $3,292 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,000 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,521 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $479 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $479 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $421 | UnrelatedBusinessRevenueAmt |
| Exclusion | $58 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,728,727 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,704,239 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $421 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,350 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,330 | TotalAmt |
| Program Services | $54,330 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,180,188 | TotalAmt |
| Program Services | $524,498 | ProgramServicesAmt |
| Management And General | $655,690 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,757,525 | TotalAmt |
| Program Services | $15,083,613 | ProgramServicesAmt |
| Management And General | $2,673,912 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,773 | TotalAmt |
| Program Services | $170,773 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,959,262 | TotalAmt |
| Program Services | $1,362,111 | ProgramServicesAmt |
| Management And General | $597,151 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,381,205 | TotalAmt |
| Program Services | $957,331 | ProgramServicesAmt |
| Management And General | $423,874 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,680 | TotalAmt |
| Management And General | $157,680 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,956 | TotalAmt |
| Management And General | $103,956 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,033,601 | TotalAmt |
| Program Services | $1,485,107 | ProgramServicesAmt |
| Management And General | $548,494 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $216,379 | TotalAmt |
| Management And General | $216,379 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,068,787 | TotalAmt |
| Program Services | $751,999 | ProgramServicesAmt |
| Management And General | $316,788 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,128,736 | TotalAmt |
| Program Services | $2,286,647 | ProgramServicesAmt |
| Management And General | $842,089 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,156,425 | TotalAmt |
| Program Services | $845,226 | ProgramServicesAmt |
| Management And General | $311,199 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,548 | TotalAmt |
| Program Services | $104,188 | ProgramServicesAmt |
| Management And General | $38,360 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,169 | TotalAmt |
| Program Services | $67,000 | ProgramServicesAmt |
| Management And General | $30,169 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,807 | TotalAmt |
| Program Services | $137,701 | ProgramServicesAmt |
| Management And General | $52,106 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $651,797 | TotalAmt |
| Program Services | $475,427 | ProgramServicesAmt |
| Management And General | $176,370 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,122 | TotalAmt |
| Management And General | $154,122 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $713,894 | $713,894 | |
| MEDICAL SUPPLIES & DRUGS | $7,176,381 | $7,176,381 | |
| LICENSES, DUES, SUBSCRIPTIONS | $88,516 | $38,873 | $49,643 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,583,081 | TotalAmt |
| Program Services | $32,235,099 | ProgramServicesAmt |
| Management And General | $7,347,982 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,543,218 | BOYAmt |
| EOY | $10,093,954 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $671,166 | BOYAmt |
| EOY | $587,860 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,796 | BOYAmt |
| EOY | $690,490 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,397,319 | BOYAmt |
| EOY | $3,249,500 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,094,829 | BOYAmt |
| EOY | $1,272,477 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,625 | BOYAmt |
| EOY | $160,380 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,975,598 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,985,939 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,631,981 | BOYAmt |
| EOY | $5,989,659 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,598 | BOYAmt |
| EOY | $14,432 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,250 | BOYAmt |
| EOY | $178,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,657,791 | BOYAmt |
| EOY | $5,405,242 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,397,573 | BOYAmt |
| EOY | $27,641,994 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,717,464 | BOYAmt |
| EOY | $7,052,794 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,586 | BOYAmt |
| EOY | $6,985,548 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,615 | BOYAmt |
| EOY | $65,893 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,288,126 | BOYAmt |
| EOY | $6,713,925 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $125,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $273,406 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,117,791 | BOYAmt |
| EOY | $21,216,566 | 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 | $6,279,782 | BOYAmt |
| EOY | $6,425,428 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,279,782 | BOYAmt |
| EOY | $6,425,428 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,397,573 | BOYAmt |
| EOY | $27,641,994 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $145,646 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $577,025 | OtherCostOrOtherBasisAmt |
| Book Value | $577,025 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,703,026 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,789,544 | DepreciationAmt |
| Book Value | $2,913,482 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,877,618 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,724,342 | DepreciationAmt |
| Book Value | $2,153,276 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,817,929 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,472,053 | DepreciationAmt |
| Book Value | $345,876 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildingsGrp | |
| Total Book Value Land Buildings | $5,989,659 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM THIRD PARTY | $1,770,000 |
| DEPOSITS | $18,901 |
| OTHER RECEIVABLE | $3,616,341 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,405,242 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LESSOR FINANCED DEBT | Desc |
| Amt | $273,406 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $273,406 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $39,344,753 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $321,399 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$705,373 | OtherRevenueAmt |
| Revenue Not Reported | -$383,974 | RevenueNotReportedAmt |
| Revenue Subtotal | $39,728,727 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $39,728,727 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $39,199,107 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $321,399 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $321,399 | ExpensesNotReportedAmt |
| Expenses Subtotal | $38,877,708 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $705,373 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $705,373 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $39,583,081 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X, LINE 2 | UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | AMOUNTS ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ (713,894) BAD DEBT EXPENSE 8,521 RENTAL EXPENSE ----------- $ (705,373) |
| SCHEDULE D, PART XII, LINE 4B | AMOUNTS ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 713,894 BAD DEBT EXPENSE ( 8,521) RENTAL EXPENSE ---------- $ 705,373 |
Schedule I IRS990ScheduleI
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | PATIENT ASSISTANCE PROGRAM | GrantTypeTxt |
| Recipient | 316 | RecipientCnt |
| Cash Grant | $54,330 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | MONITORING USE OF GRANT FUNDS: THE PATIENT MUST BE ELIGIBLE FOR SLIDING FEE IN ORDER TO BE ELIGIBLE FOR KV GRANT ASSISTANCE. THE PATIENT REQUESTS ASSISTANCE THROUGH THEIR MEDICAL PROVIDER, WHO THEN REFERS THE PATIENT FOR ELIGIBILITY REVIEW FOR THE PROGRAM ASSISTANCE. THE FUNDS ARE AVAILABLE ON A FIRST COME, FIRST SERVE BASIS. FOR UTILITY ASSISTANCE, A COPY OF THE PATIENT'S APPROVED SLIDING FEE APPLICATION AND COPY OF THE UTILITY BILL ARE FORWARDED TO THE ACCOUNTING DEPARTMENT WHERE A CHECK IS CUT DIRECTLY TO THE UTILITY COMPANY. FOR PRESCRIPTION ASSISTANCE, THE MEDICAL PROVIDER SENDS A COPY OF THE PATIENT'S APPROVED SLIDING FEE PROGRAM APPROVAL FORM THAT INCLUDES BEGINNING AND ENDING DATES TO THE PHARMACY. THE PHARMACY SCANS THE INFORMATION INTO THE PATIENT'S ELECTRONIC PHARMACY RECORD. FOR PRODUCE ASSISTANCE, EACH PATIENT IS ALREADY SCREENED FOR FOOD SECURITY DURING VISITS. PATIENTS WITH INSECURITY WERE GIVEN $50 VOUCHERS TO VISIT THE SMALL TOWN MARKET IN CLAY COUNTY AT THEIR VISITS. SMALL TOWN MARKET REMITTED COPIES OF USED VOUCHERS BACK TO THE ORGANIZATION FOR RECORD. FARMACY - PATIENTS WITH POORLY CONTROLLED DIABETES (A1C OVER 7) AND WHO ENDORSED FOOD INSECURITY AS AN ISSUE WERE IDENTIFIED AND ENROLLED IN THE PROGRAM. THE ORGANIZATION KEPT DOCUMENTATION OF VISITS, PICKUPS, AND RELATED HEALTH SCREENING FOR THE PROGRAM WERE KEPT. FARMERS TO FAMILIES - PROVIDERS IN CLINICS WERE ASKED TO COMPILE LISTS PATIENTS THAT HAD LACK OF ACCESS TO PRODUCE WITH A CONCENTRATION ON THOSE WITH DIABETES, AND BOXES WERE DISTRIBUTED TO THE 120 PERSON LIST WEEKLY. THE ORGANIZATION KEPT RECORD OF SCHEDULED DELIVERIES, AND PATIENT LISTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SARAH CHOUINARD | ||||||||||||||
| MEDICAL DIRECTOR | $347,229 | $0 | $0 | $0 | $0 | $0 | $14,000 | $0 | $2,772 | $0 | $364,001 | $0 | $0 | $0 |
| PATRICIA COLLETT | ||||||||||||||
| COO | $145,638 | $0 | $0 | $0 | $0 | $0 | $5,427 | $0 | $9,432 | $0 | $160,497 | $0 | $0 | $0 |
| CONNIE JOHNSTON | ||||||||||||||
| CFO | $150,154 | $0 | $0 | $0 | $0 | $0 | $6,203 | $0 | $4,915 | $0 | $161,272 | $0 | $0 | $0 |
| RICHARD SIMON | ||||||||||||||
| CEO | $237,219 | $0 | $0 | $0 | $0 | $0 | $162,418 | $0 | $2,781 | $0 | $402,418 | $0 | $0 | $0 |
| KELLY DUNAVANT | ||||||||||||||
| PHYSICIAN | $231,501 | $0 | $0 | $0 | $0 | $0 | $10,000 | $0 | $4,637 | $0 | $246,138 | $0 | $0 | $0 |
| CHRISTINA GILLENWATER | ||||||||||||||
| PHYSICIAN | $222,703 | $0 | $0 | $0 | $0 | $0 | $9,668 | $0 | $0 | $0 | $232,371 | $0 | $0 | $0 |
| BENJAMIN HINES | ||||||||||||||
| PSYCHIATRIST | $251,951 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,246 | $0 | $253,197 | $0 | $0 | $0 |
| KEVIN JUNKINS | ||||||||||||||
| PSYCHIATRIST | $256,211 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $391 | $0 | $256,602 | $0 | $0 | $0 |
| GREGORY PETERS | ||||||||||||||
| PHYSICIAN | $288,114 | $0 | $0 | $0 | $0 | $0 | $11,553 | $0 | $5,322 | $0 | $304,989 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST MILFORD BUILDING COMMISSION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issued | 2007-09-25 | BondIssuedDt |
| Issue Price | $391,000 | IssuePriceAmt |
| Purpose | CONSTRUCTION PROJECT | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $272,066 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $391,000 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $0 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $391,000 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $0 | CapitalExpendituresAmt |
| Other Spent Proceeds | $0 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | false | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | false | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0 | PrivateBusUseByOthersPct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | false | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | Yes (true) | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | Yes (true) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | false | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART I, LINE AB, AC | FormAndLineReferenceDesc |
| Explanation | ISSUER EIN AND CUSIP #: AN ATTEMPT TO DETERMINE THE ISSUER EIN AND CUSIP # OF THE WEST MILFORD BUILDING COMMISSION WAS UNSUCCESSFUL AT THE TIME OF THE 990 FILING. | ExplanationTxt |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArtGrp | |
| Art Historical Treasures | ArtHistoricalTreasuresGrp | |
| Art Fractional Interest | ArtFractionalInterestGrp | |
| Books And Publications | BooksAndPublicationsGrp | |
| Clothing And Household Goods | ClothingAndHouseholdGoodsGrp | |
| Cars And Other Vehicles | CarsAndOtherVehiclesGrp | |
| Boats And Planes | BoatsAndPlanesGrp | |
| Intellectual Property | IntellectualPropertyGrp | |
| Securities Publicly Traded | SecuritiesPubliclyTradedGrp | |
| Securities Closely Held Stock | SecuritiesCloselyHeldStockGrp | |
| Secur Prtnrshp Trust Intrsts | SecurPrtnrshpTrustIntrstsGrp | |
| Securities Miscellaneous | SecuritiesMiscellaneousGrp | |
| Qualified Contrib Hist Struct | QualifiedContribHistStructGrp | |
| Qualified Contrib Other | QualifiedContribOtherGrp | |
| Real Estate Residential | RealEstateResidentialGrp | |
| Real Estate Commercial | RealEstateCommercialGrp | |
| Real Estate Other | RealEstateOtherGrp | |
| Collectibles | CollectiblesGrp |
Food Inventory FoodInventoryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 720 | ContributionCnt |
| Noncash Contributions Rpt F990 | $21,600 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 2500 | ContributionCnt |
| Noncash Contributions Rpt F990 | $71,788 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Taxidermy | TaxidermyGrp | |
| Historical Artifacts | HistoricalArtifactsGrp | |
| Scientific Specimens | ScientificSpecimensGrp | |
| Archaeological Artifacts | ArchaeologicalArtifactsGrp | |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE M, PART I, COLUMN B | FormAndLineReferenceDesc |
| Explanation | NUMBER OF CONTRIBUTORS: THE NUMBER REPORTED IN COLUMN B REPRESENTS THE NUMBER OF ITEMS CONTRIBUTED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, ITEM B | AMENDED RETURN: THE FORM 990 IS BEING AMENDED FOR CHANGES TO PART VIII, STATEMENT OF REVENUE, PART X, BALANCE SHEET, AND PART XI, RECONCILIATION OF NET ASSETS DUE TO CHANGES IN THE AUDIT REPORT BALANCE SHEET AND STATEMENT OF OPERATIONS. TOTAL REVENUE AS ORIGINALLY FILED: $42,652,650 TOTAL REVENUE AS AMENDED: $39,728,727 TOTAL ASSETS AS ORIGINALLY FILED: $ 27,084,717 TOTAL ASSETS AS AMENDED: $ 27,641,994 TOTAL LIABILITIES AS ORIGINALLY FILED: $ 17,735,366 TOTAL LIABILITIES AS AMENDED: $ 21,216,566 TOTAL NET ASSETS AS ORIGINALLY FILED: $ 9,349,351 TOTAL NET ASSETS AS AMENDED: $ 6,425,428 |
| FORM 990, PART III, LINE 1 | ORGANIZATION MISSION: THIS MISSION IS ACCOMPLISHED BY PROVIDING HIGH QUALITY, ACCESSIBLE, COMPREHENSIVE, CULTURALLY APPROPRIATE, COST-EFFECTIVE HEALTHCARE SERVICES, BY SERVING AS A TRUE COMPREHENSIVE MEDICAL HOME FOR OUR PATIENTS AND CUSTOMERS, AND BY STRIVING TO FULFILL THE OBJECTIVES OF THE INSTITUTE FOR HEALTHCARE IMPROVEMENT'S TRIPLE AIM. THE TRIPLE AIM SIMULTANEOUSLY SEEKS TO ACCOMPLISH THESE THREE (3) OBJECTIVES: (1) IMPROVING THE HEALTH OF POPULATIONS; (2) IMPROVING THE PATIENT EXPERIENCE OF CARE (INCLUDING QUALITY AND SATISFACTION); AND (3) REDUCING THE PER CAPITA COST OF HEALTHCARE SERVICES. |
| FORM 990, PART VI, SECTION B, LINE 11B | 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. ONCE THE FORM 990 IS PREPARED BY THE ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT, THE FORM IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO FILING. ANY QUESTIONS AND COMMENTS RAISED REGARDING THE FINAL FORM 990 ARE ADDRESSED AT THE FULL BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY: NO MEMBER OF THE BOARD OF DIRECTORS SHALL VOTE ON ANY QUESTION IN WHICH HE/SHE IS INTERESTED OTHERWISE THAN AS A BOARD MEMBER, EXCEPT WITH REGARD TO THE ELECTION OF A PRESIDENT OR OTHER OFFICER OR EMPLOYEE, OR BE PRESENT AT THE MEETING OF THE BOARD OF DIRECTORS WHILE THE SAME IS BEING CONSIDERED; BUT IF HIS/HER RETIREMENT FROM THE BOARD IN SUCH CASES REDUCES THE NUMBER PRESENT TO LESS THAN A QUORUM, THE QUESTION MAY NEVERTHELESS BE DECIDED BY THOSE WHO REMAIN. ON ANY QUESTION, THE NAMES OF THOSE VOTING EACH WAY SHALL BE ENTERED IN THE MINUTES OF THE PROCEDINGS, IF ANY DIRECTOR AY THE TIME REQUIRES IT. EACH BOARD MEMBER IS REQUIRED TO DISCLOSE ANY PROSPECTIVE CONFLICT OF INTEREST AND TO REFRAIN FROM ATTEMPTING TO INFLUENCE ANY CONSIDERATION OF ANY MATTER THAT WOULD CREATE A CONFLICT OF INTEREST FOR THE BOARD OF CORPORATION. EACH BOARD MEMBER IS ALSO REQUIRED TO REVIEW AND ACCEPT, AS A CONDITION OF ELECTION TO THE BOARD OF DIRECTORS, THE TERMS OF THE COMMUNITY CARE OF WEST VIRGINIA BOARD OF DIRECTORS CODE OF CONDUCT, AS ADOPTED BY THE CORPORATION, AND TO DISCLOSE ANY CONDITION OR SITUATION THAT EITHER WOULD CONSTITUTE A VIOLATION OF OR COULD CAUSE A VIOLATION OF ANY POLICY, PROCEDURE, RESTRICTION, OR PROHIBITION CONTAINED IN SAID CODE OF CONDUCT. CONFLICT OF INTEREST ISSUES ARE REPORTED TO THE SENIOR MANAGEMENT TEAM AND BOARD OF DIRECTORS, IF APPLICABLE. THE GOVERNING BOARD AND SENIOR MANAGEMENT ADDRESS AND MONITOR ANY ISSUES. CONFLICT OF INTEREST ISSUES ARE REPORTED TO THE SENIOR MANAGEMENT TEAM. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | COMPENSATION REVIEW: THE CEO'S COMPENSATION IS REVIEWED BY THE COO, THE BOARD PERSONNEL COMMITTEE AND THE FULL BOARD OF DIRECTORS DURING CONTRACT RENEWAL USING COMPARABILITY DATA PULLED FROM FORMS 990S OF SIMILAR SIZED FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS. THE COMMITTEE DOCUMENTS THE DELIBERATIONS. THE LAST REVIEW WAS CONDUCTED IN 2020. THE CEO AND BOARD PRESIDENT REVIEWS COMPENSATION OF KEY EMPLOYEES AND OTHER OFFICERS DURING CONTRACT RENEWAL USING COMPARABILITY DATA PULLED FORM 990S OF SIMILAR SIZED FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS. THE LAST REVIEW WAS CONDUCTED IN 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
Comments