NORTHWEST MICHIGAN HEALTH SERVICES INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- NORTHWEST MICHIGAN HEALTH SERVICES INC (EIN 38-1958790)
- Tax period
- 2021-04-01 to 2022-03-31
- Filed
- 2022-08-24
- IRS object ID
- 202222369349300302
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-24T07:37:53-04:00 | ReturnTs |
| Tax Period End | 2022-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382963463 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | QUAST JANKE & CO CPA'S PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1010 N JOHNSON | AddressLine1Txt |
| City | BAY CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48708 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381958790 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHWEST MICHIGAN HEALTH SERVICES | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 2319471112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10767 EAST TRAVERSE HIGHWAY | AddressLine1Txt |
| City | TRAVERSE CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 496876219 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HEIDI BRITTON | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 2319471112 | PhoneNum |
| Signature | 2022-08-22 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | HEIDI | PersonFirstNm |
| Person Last | BRITTON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ROBERT E FRISKE CPA | PreparerPersonNm |
| PTIN | P01083831 | PTIN |
| Phone | 9898924549 | PhoneNum |
| Preparation | 2022-08-22 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | HEIDI BRITTON | PrincipalOfficerNm |
| Gross Receipts | $10,103,872 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NMHSI.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY MEDICAL AND DENTAL PRIMARY CARE SERVICES TO PERSONS OF ALL AGES IN NORTHWEST MICHIGAN REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 128 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $8,645,124 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,428,657 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,114,449 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,674,381 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,302 | PYInvestmentIncomeAmt |
| CY Investment Income | $834 | CYInvestmentIncomeAmt |
| PY Other Revenue | $86,877 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $11,849,752 | PYTotalRevenueAmt |
| CY Total Revenue | $10,103,872 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,119,538 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,595,593 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,735,083 | PYOtherExpensesAmt |
| CY Other Expenses | $3,104,195 | CYOtherExpensesAmt |
| PY Total Expenses | $9,854,621 | PYTotalExpensesAmt |
| CY Total Expenses | $9,699,788 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,995,131 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $404,084 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,103,929 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,841,056 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,113,052 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,446,095 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,990,877 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,394,961 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE QUALITY MEDICAL AND DENTAL PRIMARY CARE SERVICES TO PERSONS OF ALL AGES IN NORTHWEST MICHIGAN REGARDLESS OF ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,996,585 | ExpenseAmt |
| Revenue | $1,697,915 | RevenueAmt |
| Desc | MEDICAL SERVICES - TO PROMOTE AND PROVIDE GOOD CLINICAL SERVICES THAT MEET THE NEEDS OF THE PATIENTS AND ARE PROVIDED IN ACCORDANCE WITH ETHICAL AND PROFESSIONAL PRACTICES AND LEGAL REQUIREMENTS. THESE SERVICES ARE PROVIDED AND COORDINATED WITHIN THE WELLNESS HOME MODEL AND ARE PATIENT-CENTERED, PHYSICIAN-DIRECTED, COMPREHENSIVE, ACCESSIBLE, CONTINUOUS, AND ORGANIZED TO MEET THE NEEDS OF THE INDIVIDUAL PATIENT SERVED. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,864,854 | ExpenseAmt |
| Revenue | $1,623,274 | RevenueAmt |
| Desc | DENTAL SERVICES - TO PROMOTE AND PROVIDE GOOD DENTAL SERVICES THAT MEET THE NEEDS OF THE PATIENTS AND ARE PROVIDED IN ACCORDANCE WITH ETHICAL AND PROFESSIONAL PRACTICES AND LEGAL REQUIREMENTS. THESE SERVICES ARE PROVIDED AND COORDINATED WITHIN THE WELLNESS HOME MODEL AND ARE PATIENT-CENTERED, DENTIST-DIRECTED, COMPREHENSIVE, ACCESSIBLE, CONTINUOUS, AND ORGANIZED TO MEET THE NEEDS OF THE INDIVIDUAL PATIENT SERVED. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $623,335 | ExpenseAmt |
| Revenue | $353,192 | RevenueAmt |
| Desc | BEHAVIORAL HEALTH - TO PROMOTE AND MAINTAIN GOOD MENTAL AND BEHAVIORAL HEALTH OF OUR PATIENTS BY INCREASING HEALTH KNOWLEDGE, PROVIDING AN IMMEDIATE ACCESS POINT, AND COORDINATING CARE WITHIN THE WELLNESS HOME MODEL. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $6,484,774 | 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 | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | 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 | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| 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 | false | 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 | 50 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 128 | 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 |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HEIDI BRITTON | PersonNm |
| Phone | 2349471112 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10767 EAST TRAVERSE HIGHWAY | AddressLine1Txt |
| City | TRAVERSE CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 496845549 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| JHANDI RAMANDEEP | |||||||
| DENTIST | 40.00 | Yes (X) | $170,536 | $0 | $0 | ||
| HEIDI BRITTON | |||||||
| EXECUTIVE DI | 40.00 | $167,084 | $0 | $0 | Yes (X) | ||
| KATHRYN WYNKOOP IKUMA | |||||||
| DENTIST | 40.00 | Yes (X) | $166,029 | $0 | $0 | ||
| DEREK SCHMIDT | |||||||
| DENTIST | 40.00 | Yes (X) | $131,624 | $0 | $0 | ||
| DIANA MORAN | |||||||
| FAMILY NP | 40.00 | Yes (X) | $124,091 | $0 | $0 | ||
| MIMI APPEL | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| KAREN GOODMAN | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| KATHLEEN JOHNSON | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| KIRK MEYERS | |||||||
| PRESIDENT | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| FERNANDO MEZA | |||||||
| VICE PRESIDE | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| J EDSON PONTES | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| ROCHELLE RADLINSKI | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| CATHY RYBICKI | |||||||
| SECRETARY | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| LARRY VAN SICKLE | |||||||
| TREASURER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| DAVID WILD | |||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $759,364 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LONG VIEW CONSULTING | |||||
| 239 N WESTVIEW | KNOXVILLE | IL | 61448 | PROFESSIONAL | $189,094 |
| MUNSON MEDICAL CENTER | |||||
| PO BOX 1188 | TRAVERSE CITY | MI | 496851188 | MEDICAL | $101,503 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,466,596 | GovernmentGrantsAmt |
| All Other Contributions | $1,962,061 | AllOtherContributionsAmt |
| Total Contributions | $6,428,657 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT FEES | $3,369,698 | $3,369,698 |
| THIRD PARTY INCENTIVE PAYMENT | $157,015 | $157,015 |
| OTHER PROGRAM REVENUES | $118,546 | $118,546 |
| SPACE IN CLINIC | $29,122 | $29,122 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,674,381 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $834 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $834 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,103,872 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,675,215 | RelatedOrExemptFuncIncomeAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,084 | TotalAmt |
| Management And General | $167,084 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,343,476 | TotalAmt |
| Program Services | $3,951,407 | ProgramServicesAmt |
| Management And General | $1,392,069 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,085,033 | TotalAmt |
| Program Services | $698,679 | ProgramServicesAmt |
| Management And General | $386,354 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $765,263 | TotalAmt |
| Program Services | $433,448 | ProgramServicesAmt |
| Management And General | $331,815 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,528 | TotalAmt |
| Management And General | $84,528 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,157 | TotalAmt |
| Program Services | $12,363 | ProgramServicesAmt |
| Management And General | $120,794 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $371,000 | TotalAmt |
| Program Services | $371,000 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,520 | TotalAmt |
| Program Services | $188,728 | ProgramServicesAmt |
| Management And General | $90,792 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,910 | TotalAmt |
| Program Services | $11,578 | ProgramServicesAmt |
| Management And General | $75,332 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,719 | TotalAmt |
| Program Services | $40,550 | ProgramServicesAmt |
| Management And General | $95,169 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $286,793 | TotalAmt |
| Program Services | $198,309 | ProgramServicesAmt |
| Management And General | $88,484 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,241 | TotalAmt |
| Management And General | $38,241 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CLINIC SUPPLIES | $369,461 | $369,461 | |
| MINOR EQUIPMENT | $155,777 | $38,057 | $117,720 |
| PHARMACY | $109,157 | $109,157 | |
| COVID & EMERGENCY | $96,282 | $96,282 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,387 | TotalAmt |
| Program Services | $62,037 | ProgramServicesAmt |
| Management And General | $130,350 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,699,788 | TotalAmt |
| Program Services | $6,484,774 | ProgramServicesAmt |
| Management And General | $3,215,014 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,667,695 | BOYAmt |
| EOY | $746,819 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $446,521 | BOYAmt |
| EOY | $459,605 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,009 | BOYAmt |
| EOY | $2,459 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,376,255 | BOYAmt |
| EOY | $1,969,243 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,637 | BOYAmt |
| EOY | $24,997 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,015,876 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,377,943 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,556,812 | BOYAmt |
| EOY | $3,637,933 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,103,929 | BOYAmt |
| EOY | $6,841,056 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $506,648 | BOYAmt |
| EOY | $404,529 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $641,520 | BOYAmt |
| EOY | $258,127 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $964,884 | BOYAmt |
| EOY | $783,439 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,113,052 | BOYAmt |
| EOY | $1,446,095 | 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 | $4,988,114 | BOYAmt |
| EOY | $5,391,347 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,763 | BOYAmt |
| EOY | $3,614 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,990,877 | BOYAmt |
| EOY | $5,394,961 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,103,929 | BOYAmt |
| EOY | $6,841,056 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $404,084 | 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,838,923 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,977,469 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,234,653 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,645,124 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,428,657 | CurrentTaxYearAmt |
| Total | $28,124,826 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,838,923 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,977,469 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,234,653 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,645,124 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,428,657 | CurrentTaxYearAmt |
| Total | $28,124,826 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $28,124,826 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,400 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,200 | CurrentTaxYearMinus3YearsAmt |
| Total | $4,600 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $28,129,426 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $16,726,423 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99980 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99970 | PublicSupportPY170Pct |
| 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $188,500 | OtherCostOrOtherBasisAmt |
| Book Value | $188,500 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,902,126 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,056,324 | DepreciationAmt |
| Book Value | $2,845,802 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $925,250 | OtherCostOrOtherBasisAmt |
| Depreciation | $321,619 | DepreciationAmt |
| Book Value | $603,631 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,637,933 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $10,103,872 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $10,103,872 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $10,103,872 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,699,788 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $9,699,788 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $9,699,788 | TotalExpensesPerForm990Amt |
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 |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| JHANDI RAMANDEEP | ||
| DENTIST | $170,536 | $170,536 |
| HEIDI BRITTON | ||
| EXECUTIVE DIRECTOR | $167,084 | $167,084 |
| KATHRYN WYNKOOP IKUMA | ||
| DENTIST | $166,029 | $166,029 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | VOLUNTEER BOARD OF DIRECTORS ALONG WITH OTHER HEALTH CARE PROVIDERS |
| FORM 990, PAGE 6, PART VI, LINE 11B | AUDITOR AND CFO REVIEWS 990 PRIOR TO SUBMISSION RECOMMENDATION BY CFO TO FULL BOARD TO FILE FORM UPON APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 12C | OFFICERS AND DIRECTORS MUST ANNUALLY FILL OUT A FORM DETAILING ANY POSSIBLE CONFLICTS OF INTEREST. THESE FORMS ARE MAINTAINED BY THE EXECUTIVE DIRECTOR IN ADDITION, AT EVERY BOARD MEETING ALL DIRECTORS REVIEW THE AGENDA TO SEE IF THERE ARE ANY CONFLICTS OF INTEREST |
| FORM 990, PAGE 6, PART VI, LINE 15A | BOARD AND COMPENSATION COMMITTE REVIEWS CEO ANNUALLY |
| FORM 990, PAGE 6, PART VI, LINE 19 | COPIES ARE AVAILABLE AT ADMINISTRATIVE OFFICE UPON REQUEST |