FURP.ORG / PUBLIC DATA EXPLORER

BLUE MOUNTAIN CLINIC INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
BLUE MOUNTAIN CLINIC INC (EIN 81-0365291)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-08-05
IRS object ID
202212179349301016
Schema version
2021v4.0
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

FieldValueIRS element (for citing)
Return2022-08-05T08:51:51-07:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN810390489PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Boyle Deveny & Meyer PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1305 South 4th East Suite 200AddressLine1Txt
CityMissoulaCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59801ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN810365291EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUE MOUNTAIN CLINIC INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBLUEBusinessNameControlTxt
Phone4067211646PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1610 N CALIFORNIA STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59802ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonNICOLE SMITHPersonNm
Person TitleExecutive DirectorPersonTitleTxt
Signature2022-08-05SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstNICOLEPersonFirstNm
Person LastSMITHPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJaime Ward CPAPreparerPersonNm
PTINP00441760PTIN
Phone4067213555PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
Federated Assurance LevelFAL1FederatedAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerNICOLE SMITHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1610 N CALIFORNIA STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59802ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,963,844GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.bluemountainclinic.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1976FormationYr
Legal Domicile StateMTLegalDomicileStateCd
Activity Or MissionThe mission of Blue Mountain Clinic is to provide individualized, choice-based healthcare that respects the power of personal connection.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee19TotalEmployeeCnt
Total Volunteers50TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$373,055PYContributionsGrantsAmt
CY Contributions Grants$363,146CYContributionsGrantsAmt
PY Program Service Revenue$1,549,637PYProgramServiceRevenueAmt
CY Program Service Revenue$1,600,632CYProgramServiceRevenueAmt
PY Investment Income$273PYInvestmentIncomeAmt
CY Investment Income$66CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$1,922,965PYTotalRevenueAmt
CY Total Revenue$1,963,844CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,133,002PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,210,530CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$68,214CYTotalFundraisingExpenseAmt
PY Other Expenses$797,404PYOtherExpensesAmt
CY Other Expenses$687,276CYOtherExpensesAmt
PY Total Expenses$1,930,406PYTotalExpensesAmt
CY Total Expenses$1,897,806CYTotalExpensesAmt
PY Revenues Less Expenses-$7,441PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$66,038CYRevenuesLessExpensesAmt
Total Assets BOY$2,445,307TotalAssetsBOYAmt
Total Assets EOY$2,367,708TotalAssetsEOYAmt
Total Liabilities BOY$1,115,755TotalLiabilitiesBOYAmt
Total Liabilities EOY$972,032TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,329,552NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,395,676NetAssetsOrFundBalancesEOYAmt
MissionThe mission of Blue Mountain Clinic is to provide individualized, choice-based healthcare that respects the power of personal connection.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$1,606,688ExpenseAmt
DescBlue Mountain Clinic is a mission-driven 501(c)3 non-profit corporation organized in the state of Montana and is governed by a volunteer board of directors. Located at 610 N California Street in Missoula, MT, we are the only independent, family medicine clinic in the United States that has fully integrated primary care, mental health counseling, contraceptive and abortion care, and comprehensive gender affirming care into our daily practice. BMC directly impacts the lives of over 3,000 patients per year who access a wide range of health services within our choice-based, primary medicine model. This is evidenced by the fact that 25% of our clients are traveling 100 miles or more to receive care at BMC. Blue Mountain Clinic is called upon daily by those who need care for their families, at an ever-increasing rate. This is a direct reflection of changes in our current healthcare environment; expanded services at BMC, lack of access due to clinic closures both in our region, across the state, and across the country. Per the US Census Bureau, Montana and the Northern Rockies are home to some of the least populated regions, resulting in a large concentration of rural areas. These sparsely populated areas often result in very limited access to many of lifes necessities, including health care. Reports released by the American Medical Association and the American Academy of Family Physicians indicate that we will continue to experience a critical shortage of family medicine clinicians and clinics. The shortage is due in part to retiring physicians as well as a recent trend emerging where providers are choosing specialty areas of medicine over family medicine because they offer much higher salaries. In a report released by the Montana Office of Rural Health (MORH) a serious shortage of primary care physician services is cited in Montana. It is of the utmost importance that we remain a sound presence to ensure access to independent, choice-based health care that respects the power of personal connection.We are starting our 11th year providing critical gynecological training to residents in the Western Montana Family Medicine Residency Program. We train 10 residents a year preparing them to provide reproductive and family medical care through our choice-based lens. We strive to ensure that these residents will continue to practice and provide comprehensive healthcare in our rural areas, many of which Blue Mountain Clinic currently serves.Throughout 2021, we continued to face challenges in health care delivery due to the COVID-19 pandemic. Our clinic has responded rapidly and decisively with a combination of telemedicine and in-person access. We have been and will continue to meet the primary care, gender affirming, and reproductive health care needs of our community.Desc
Total Program Service Expenses$1,606,688TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document6IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee19EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Form8282 Filed0Form8282FiledCnt
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonBLUE MOUNTAIN CLINICPersonNm
Phone4067211646PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1610 N CALIFORNIA STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59802ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
CAITLIN BLAU
STAFF40.000.00$182,885$0$0
ERIC A RAVITZ
STAFF40.000.00$164,449$0$0
KELLY POLUS
STAFF40.000.00$114,722$0$0
NICOLE SMITH
Executive Dir.40.000.00$27,788$0$0Yes (X)
darci thorsrud
Director2.000.00$0$0$0Yes (X)
AMY SMITH
Director2.000.00$0$0$0Yes (X)
DANIELLE STANDLEY
Director2.000.00$0$0$0Yes (X)
HOLLY BIEHL
Director2.000.00$0$0$0Yes (X)
JACQUELYN COFFIN
Treasurer2.000.00$0$0$0Yes (X)
tom roberts
President4.000.00$0$0$0Yes (X)
juniper davis
Vice President4.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$489,844TotalReportableCompFromOrgAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Government Grants$230,325GovernmentGrantsAmt
All Other Contributions$132,821AllOtherContributionsAmt
Total Contributions$363,146TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHEALTH CARE DELIVERYDesc
Business621110BusinessCd
Total Revenue Column$1,600,632TotalRevenueColumnAmt
Related Or Exempt Func Income$1,600,632RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$1,600,632TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$66TotalRevenueColumnAmt
Exclusion$66ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISC. REIMBURSEMENTSDesc
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,963,844TotalRevenueColumnAmt
Related Or Exempt Func Income$1,600,632RelatedOrExemptFuncIncomeAmt
Exclusion$66ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$27,788TotalAmt
Management And General$20,841ManagementAndGeneralAmt
Fundraising$6,947FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,016,756TotalAmt
Program Services$864,242ProgramServicesAmt
Management And General$101,676ManagementAndGeneralAmt
Fundraising$50,838FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$89,770TotalAmt
Program Services$67,327ProgramServicesAmt
Management And General$22,443ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$76,216TotalAmt
Program Services$57,162ProgramServicesAmt
Management And General$19,054ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$87,856TotalAmt
Program Services$57,106ProgramServicesAmt
Management And General$26,357ManagementAndGeneralAmt
Fundraising$4,393FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$2,523TotalAmt
Program Services$2,523ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$1,700TotalAmt
Management And General$1,700ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$31,559TotalAmt
Program Services$24,503ProgramServicesAmt
Management And General$6,048ManagementAndGeneralAmt
Fundraising$1,008FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$367TotalAmt
Program Services$367ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,665TotalAmt
Program Services$3,033ProgramServicesAmt
Management And General$1,399ManagementAndGeneralAmt
Fundraising$233FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$17,016TotalAmt
Program Services$14,463ProgramServicesAmt
Management And General$1,702ManagementAndGeneralAmt
Fundraising$851FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$9,147TotalAmt
Program Services$7,318ProgramServicesAmt
Management And General$1,372ManagementAndGeneralAmt
Fundraising$457FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$167TotalAmt
Program Services$167ProgramServicesAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$15,844TotalAmt
Program Services$15,844ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$56,789TotalAmt
Program Services$48,271ProgramServicesAmt
Management And General$5,679ManagementAndGeneralAmt
Fundraising$2,839FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$64,421TotalAmt
Program Services$52,999ProgramServicesAmt
Management And General$11,422ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES$195,835$195,835
ELECTRONIC HEALTH RECORDS$96,099$96,099
REPAIRS & MAINTENANCE$38,773$38,773
SUPPLIES - LAB$27,477$27,477

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$37,038TotalAmt
Program Services$33,179ProgramServicesAmt
Management And General$3,211ManagementAndGeneralAmt
Fundraising$648FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,897,806TotalAmt
Program Services$1,606,688ProgramServicesAmt
Management And General$222,904ManagementAndGeneralAmt
Fundraising$68,214FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$812,374BOYAmt
EOY$464,063EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$119,175BOYAmt
EOY$409,014EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$84,860BOYAmt
EOY$62,039EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$27,571BOYAmt
EOY$37,165EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,252,630LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$898,332LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,401,327BOYAmt
EOY$1,354,298EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$41,129EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,445,307BOYAmt
EOY$2,367,708EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$108,151BOYAmt
EOY$69,040EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$996,778BOYAmt
EOY$902,992EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$10,826BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,115,755BOYAmt
EOY$972,032EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,329,552BOYAmt
EOY$1,395,676EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,329,552BOYAmt
EOY$1,395,676EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,445,307BOYAmt
EOY$2,367,708EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$66,038ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$86NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$320,280CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$996,312CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$547,193CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$373,055CurrentTaxYearMinus1YearAmt
Current Tax Year$363,146CurrentTaxYearAmt
Total$2,599,986TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,594,377CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,536,723CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,559,518CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,549,637CurrentTaxYearMinus1YearAmt
Current Tax Year$1,600,632CurrentTaxYearAmt
Total$7,840,887TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,914,657CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,533,035CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,106,711CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,922,692CurrentTaxYearMinus1YearAmt
Current Tax Year$1,963,778CurrentTaxYearAmt
Total$10,440,873TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$218,117CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$565,408CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$468,670CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$227,956CurrentTaxYearMinus1YearAmt
Current Tax Year$104,751CurrentTaxYearAmt
Total$1,584,902TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$218,117CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$565,408CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$468,670CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$227,956CurrentTaxYearMinus1YearAmt
Current Tax Year$104,751CurrentTaxYearAmt
Total$1,584,902TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$8,855,971PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$610CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,599CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$130CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$273CurrentTaxYearMinus1YearAmt
Current Tax Year$66CurrentTaxYearAmt
Total$2,678TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$610CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,599CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$130CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$273CurrentTaxYearMinus1YearAmt
Current Tax Year$66CurrentTaxYearAmt
Total$2,678TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,915,267CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,534,634CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,106,841CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,922,965CurrentTaxYearMinus1YearAmt
Current Tax Year$1,963,844CurrentTaxYearAmt
Total$10,443,551TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.84800PublicSupportCY509Pct
Public Support PY5090.85350PublicSupportPY509Pct
Investment Income CY0.00030InvestmentIncomeCYPct
Investment Income PY0.00030InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$79,989OtherCostOrOtherBasisAmt
Book Value$79,989BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,905,377OtherCostOrOtherBasisAmt
Depreciation$647,059DepreciationAmt
Book Value$1,258,318BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$232,871OtherCostOrOtherBasisAmt
Depreciation$226,408DepreciationAmt
Book Value$6,463BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$34,393OtherCostOrOtherBasisAmt
Depreciation$24,865DepreciationAmt
Book Value$9,528BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,354,298TotalBookValueLandBuildingsAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
CAITLIN BLAU
STAFF$182,885$182,885
ERIC A RAVITZ
STAFF$164,449$164,449

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 11b: Form 990 Review ProcessTHE CURRENT BOARD TREASURER REVIEWS THE 990 IN DETAIL WITH THE EXECUTIVE DIRECTOR. A DRAFT OF THE 990 IS THEN PRESENTED TO THE EXECUTIVE COMMITTEE. ANY CHANGES AND/OR SIGNIFICANT INFORMATION THAT IS RELEVANT TO BOARD MEMBERS IS PASSED ON TO THE BOARD FOR DISCUSSION PURPOSES VIA THE TREASURER.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsBOARD MEMBERS AND KEY STAFF MEMBERS ARE ASKED TO DIVULGE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO JOINING THE BOARD OR COMMENCING EMPLOYMENT AT THE CLINIC. BOTH BOARD AND STAFF MEMBERS UNDERGO A THOROUGH APPLICATION PROCESS DESIGNED TO PREVENT AND AVOID ANY POTENTIAL CONFLICTS OF INTEREST.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesCOMPENSATION OF THE EXECUTIVE DIRECTOR AND THE MEDICAL DIRECTOR IS SUBJECT TO ANNUAL REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS. CHANGES TO COMPENSATION BASED ON PERFORMANCE EVALUATIONS, COST OF LIVING INCREASE, OR ANNUAL BUDGET CONSTRAINTS ARE REVIEWED AND VOTED ON BY THE BOARD AS A WHOLE.
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableANY OF THESE DOCUMENTS ARE READILY AVAILIBLE UPON REQUEST.