VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC (EIN 20-8998983)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-10-09
- IRS object ID
- 202232829349300508
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-10-09T21:41:23-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208998983 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VALLEY PROFESSIONALS COMMUNITY HEALTH | BusinessNameLine1Txt |
| Business Name Line2 | CENTER INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | VALL | BusinessNameControlTxt |
| Phone | 7658281003 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 S MAIN STREET SUITE 100 | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47842 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERRY WARREN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7658281003 | PhoneNum |
| Signature | 2022-10-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TERRY | PersonFirstNm |
| Person Last | WARREN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANGELA N CRAWFORD CPA | PreparerPersonNm |
| PTIN | P00573197 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2022-10-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERRY WARREN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 S MAIN STREET SUITE 100 | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47842 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,608,577 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | VALLEYPROHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER PROVIDES COMPREHENSIVE-INTEGRATED HEALTH CARE FOR ALL INDIVIDUALS AND FAMILIES, WHILE PROMOTING EDUCATIONAL OPPORTUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 280 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,360,016 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,128,805 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,039,714 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,261,947 | CYProgramServiceRevenueAmt |
| PY Investment Income | $16,052 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,830 | CYInvestmentIncomeAmt |
| PY Other Revenue | $104,824 | PYOtherRevenueAmt |
| CY Other Revenue | $210,995 | CYOtherRevenueAmt |
| PY Total Revenue | $24,520,606 | PYTotalRevenueAmt |
| CY Total Revenue | $30,608,577 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,829,267 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,865,956 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,901,660 | PYOtherExpensesAmt |
| CY Other Expenses | $8,426,687 | CYOtherExpensesAmt |
| PY Total Expenses | $22,730,927 | PYTotalExpensesAmt |
| CY Total Expenses | $26,292,643 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,789,679 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,315,934 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,639,670 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,208,599 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,295,610 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,548,605 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,344,060 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,659,994 | NetAssetsOrFundBalancesEOYAmt |
| Mission | VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER PROVIDES COMPREHENSIVE-INTEGRATED HEALTH CARE FOR ALL INDIVIDUALS AND FAMILIES, WHILE PROMOTING EDUCATIONAL OPPORTUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $16,384,406 | ExpenseAmt |
| Revenue | $14,456,063 | RevenueAmt |
| Desc | TO PROVIDE PRIMARY HEALTH CARE AND RELATED SERVICES TO THOSE IN NEED OF MEDICAL CARE, INCLUDING THE MEDICALLY UNDER SERVED AND VULNERABLE POPULATIONS OF VERMILLION, PARKE, VIGO, AND MONTGOMERY COUNTIES IN INDIANA, WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $711,576 | ExpenseAmt |
| Revenue | $3,435,854 | RevenueAmt |
| Desc | SCHOOL BASED MOBILE CLINICS OFFERS SCHOOL-BASED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICES MAKING IT EVEN EASIER TO ACCESS QUALITY AND AFFORDABLE HEALTH CARE. EVERY STUDENT IS ELIGIBLE TO RECEIVE HEALTH CARE SERVICES , WITHOUT REGARD TO THE ABILITY TO PAY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,522,229 | ExpenseAmt |
| Revenue | $4,581,025 | RevenueAmt |
| Desc | THE 340B PHARMACEUTICALS PROGRAM PROVIDES REDUCED COST PRESCRIPTIONS TO QUALIFIED PATIENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $20,618,211 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 37 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 280 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TERRY WARREN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7658321001 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 S MAIN ST 100 | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47842 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| MIKE MILLER | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOUGLAS FAUBER | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LOU BONOMO | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARY HELDERMAN | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KRISTIN CRAIG | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVE CHAPMAN | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JERRY HAWKINS | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CINDY HEIN | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LORETTA JOHNSON | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JACKIE MATHIS | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHERYL MONTGOMERY | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JILL PASTORE | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK RUSSELL | |||||||
| MEMBER-TERM BEGAN JAN'21 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFF WILLIAMSON | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| YALE YAGER | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR STEVEN WALTZ | |||||||
| VP & CMO | 40.00 | Yes (X) | $317,300 | $0 | $28,850 | ||
| TERRY WARREN | |||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $219,205 | $0 | $21,666 | ||
| SCOTT ANDRITSCH | |||||||
| VP & CFO | 40.00 | Yes (X) | $148,905 | $0 | $18,004 | ||
| THOMAS MCFARLAND | |||||||
| VP & COO-TERM ENDED JUL'21 | 40.00 | Yes (X) | $115,703 | $0 | $7,812 | ||
| TIFFANI MARTIN | |||||||
| VP & CHIEF HR/LEGAL OFFICER | 40.00 | Yes (X) | $143,457 | $0 | $17,783 | ||
| AMY REED | |||||||
| VP MARKETING | 40.00 | Yes (X) | $104,026 | $0 | $18,597 | ||
| STEPHANIE JEFFERY | |||||||
| VP & CHIEF QUALITY OFFICER | 40.00 | Yes (X) | $137,321 | $0 | $11,795 | ||
| DR JULIA WERNZ | |||||||
| VP & CHIEF BEHAVIORAL HEALTH OFFICER | 40.00 | Yes (X) | $162,042 | $0 | $19,635 | ||
| LORI MOON | |||||||
| VP & COO-TERM BEGAN OCT'21 | 40.00 | Yes (X) | $36,521 | $0 | $773 | ||
| CHRISTOPHER FITZSIMMONS | |||||||
| PHYSICIAN | 40.00 | $256,396 | $0 | $14,758 | Yes (X) | ||
| PAUL TARASKA | |||||||
| PSYCHOLOGIST | 40.00 | $254,010 | $0 | $24,908 | Yes (X) | ||
| BING GALE | |||||||
| PHYSICIAN | 40.00 | $235,665 | $0 | $17,112 | Yes (X) | ||
| DANIELLE CUNDIFF | |||||||
| PHYSICIAN | 40.00 | $228,902 | $0 | $14,937 | Yes (X) | ||
| ANGELA HATFIELD | |||||||
| PHYSICIAN | 40.00 | $211,059 | $0 | $20,999 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,570,512 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $237,629 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 32 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| UNION HOSPITAL | |||||
| 1606 N 7TH STREET | TERRE HAUTE | IN | 47804 | NETWORK, RENT AND RESIDENCY PROGRAM COST | $1,214,056 |
| ECLINICAL WORKS | |||||
| PO BOX 847950 | BOSTON | MA | 02284 | SOFTWARE VENDOR | $533,745 |
| CDI INC | |||||
| 600 WABASH AVENUE | TERRE HAUTE | IN | 47807 | GENERAL CONTRACTOR | $313,415 |
| CHAD'S COMMUNICATION SOLUTION | |||||
| 15 HUNTER CT | CLINTON | IN | 47842 | IT AND NETWORK SUPPORT | $296,771 |
| EXPERIAN HEALTH INC | |||||
| PO BOX 846133 | LOS ANGELES | CA | 90084 | SOFTWARE VENDOR | $241,516 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,869,824 | GovernmentGrantsAmt |
| All Other Contributions | $258,981 | AllOtherContributionsAmt |
| Total Contributions | $8,128,805 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $17,680,922 | $17,680,922 |
| PATIENT REVENUE-340B PHARMACY | 900099 | $4,581,025 | $4,581,025 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,261,947 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,830 | TotalRevenueColumnAmt |
| Exclusion | $6,830 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $210,995 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $210,995 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $210,995 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,608,577 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,472,942 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $6,830 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,529,395 | TotalAmt |
| Program Services | $1,279,341 | ProgramServicesAmt |
| Management And General | $250,054 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,895,443 | TotalAmt |
| Program Services | $10,787,057 | ProgramServicesAmt |
| Management And General | $2,108,386 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,933 | TotalAmt |
| Program Services | $364,713 | ProgramServicesAmt |
| Management And General | $91,220 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,005,027 | TotalAmt |
| Program Services | $1,603,873 | ProgramServicesAmt |
| Management And General | $401,154 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $980,158 | TotalAmt |
| Program Services | $784,054 | ProgramServicesAmt |
| Management And General | $196,104 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,980 | TotalAmt |
| Program Services | $1,356 | ProgramServicesAmt |
| Management And General | $6,624 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,812 | TotalAmt |
| Program Services | $8,125 | ProgramServicesAmt |
| Management And General | $39,687 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,831,161 | TotalAmt |
| Program Services | $311,180 | ProgramServicesAmt |
| Management And General | $1,519,981 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,194 | TotalAmt |
| Program Services | $59,769 | ProgramServicesAmt |
| Management And General | $181,425 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $557,371 | TotalAmt |
| Program Services | $311,415 | ProgramServicesAmt |
| Management And General | $245,956 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $651,740 | TotalAmt |
| Program Services | $431,643 | ProgramServicesAmt |
| Management And General | $220,097 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,922 | TotalAmt |
| Program Services | $19,805 | ProgramServicesAmt |
| Management And General | $60,117 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,490 | TotalAmt |
| Program Services | $28,619 | ProgramServicesAmt |
| Management And General | $86,871 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,665 | TotalAmt |
| Program Services | $155,665 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $741,944 | TotalAmt |
| Program Services | $645,324 | ProgramServicesAmt |
| Management And General | $96,620 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,198 | TotalAmt |
| Program Services | $23,343 | ProgramServicesAmt |
| Management And General | $70,855 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| 340B DISPENSING FEE | $2,674,663 | $2,674,663 | |
| MEDICAL SUPPLIES | $1,035,483 | $1,028,096 | $7,387 |
| DENTAL, RX AND PATIENT | $69,896 | $69,896 | |
| DUES AND SUBSCRIPTIONS | $67,771 | $16,794 | $50,977 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,397 | TotalAmt |
| Program Services | $13,480 | ProgramServicesAmt |
| Management And General | $40,917 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,292,643 | TotalAmt |
| Program Services | $20,618,211 | ProgramServicesAmt |
| Management And General | $5,674,432 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,801 | BOYAmt |
| EOY | $613,712 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,418,667 | BOYAmt |
| EOY | $8,597,634 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $601,991 | BOYAmt |
| EOY | $978,430 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $176,702 | BOYAmt |
| EOY | $132,626 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,424,111 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,860,312 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,890,557 | BOYAmt |
| EOY | $12,563,799 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,486,952 | BOYAmt |
| EOY | $322,398 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,639,670 | BOYAmt |
| EOY | $23,208,599 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,156,969 | BOYAmt |
| EOY | $1,499,933 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,087,662 | BOYAmt |
| EOY | $6,178,800 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,979 | BOYAmt |
| EOY | $869,872 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,295,610 | BOYAmt |
| EOY | $8,548,605 | 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 | $10,206,688 | BOYAmt |
| EOY | $14,317,244 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,372 | BOYAmt |
| EOY | $342,750 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,344,060 | BOYAmt |
| EOY | $14,659,994 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,639,670 | BOYAmt |
| EOY | $23,208,599 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,315,934 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,265,470 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,048,623 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,199,729 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,360,016 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,128,805 | CurrentTaxYearAmt |
| Total | $28,002,643 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,265,470 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,048,623 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,199,729 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,360,016 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,128,805 | CurrentTaxYearAmt |
| Total | $28,002,643 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $28,002,643 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $194 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $166 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,900 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,052 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,830 | CurrentTaxYearAmt |
| Total | $37,142 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $190,319 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $228,394 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $133,708 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $104,824 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $210,995 | CurrentTaxYearAmt |
| Total | $868,240 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $28,908,025 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $85,740,605 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.96870 | PublicSupportCY170Pct |
| Public Support PY170 | 0.96920 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS INCOME - 2017 AMOUNT: $ 190,319. 2018 AMOUNT: $ 228,394. 2019 AMOUNT: $ 133,708. 2020 AMOUNT: $ 104,824. 2021 AMOUNT: $ 210,995. | ExplanationTxt |
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 | $145,752 | OtherCostOrOtherBasisAmt |
| Book Value | $145,752 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,772,365 | OtherCostOrOtherBasisAmt |
| Depreciation | $539,268 | DepreciationAmt |
| Book Value | $4,233,097 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,011,129 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,408,464 | DepreciationAmt |
| Book Value | $5,602,665 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,993,401 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,912,580 | DepreciationAmt |
| Book Value | $2,080,821 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $501,464 | OtherCostOrOtherBasisAmt |
| Book Value | $501,464 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,563,799 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO UNION HOSPITAL, INC. | $2,062 |
| DEFERRED RENT OBLIGATION | $152,581 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | $715,229 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $869,872 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $27,086,348 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$3,522,229 | OtherRevenueAmt |
| Revenue Not Reported | -$3,522,229 | RevenueNotReportedAmt |
| Revenue Subtotal | $30,608,577 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $30,608,577 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,770,414 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,770,414 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,522,229 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,522,229 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,292,643 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CENTER AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | 340B EXPENSES -3,522,229. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | 340B EXPENSES 3,522,229. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR STEVEN WALTZ | ||||||||||||||
| VP & CMO | $308,050 | $0 | $9,250 | $0 | $0 | $0 | $17,134 | $0 | $11,716 | $0 | $346,150 | $0 | $0 | $0 |
| PAUL TARASKA | ||||||||||||||
| PSYCHOLOGIST | $248,760 | $0 | $5,250 | $0 | $0 | $0 | $15,434 | $0 | $9,474 | $0 | $278,918 | $0 | $0 | $0 |
| CHRISTOPHER FITZSIMMONS | ||||||||||||||
| PHYSICIAN | $247,146 | $0 | $9,250 | $0 | $0 | $0 | $14,338 | $0 | $420 | $0 | $271,154 | $0 | $0 | $0 |
| BING GALE | ||||||||||||||
| PHYSICIAN | $227,665 | $0 | $8,000 | $0 | $0 | $0 | $13,799 | $0 | $3,313 | $0 | $252,777 | $0 | $0 | $0 |
| DANIELLE CUNDIFF | ||||||||||||||
| PHYSICIAN | $220,652 | $0 | $8,250 | $0 | $0 | $0 | $13,108 | $0 | $1,829 | $0 | $243,839 | $0 | $0 | $0 |
| TERRY WARREN | ||||||||||||||
| PRESIDENT & CEO | $198,701 | $0 | $20,504 | $0 | $0 | $0 | $12,417 | $0 | $9,249 | $0 | $240,871 | $0 | $0 | $0 |
| ANGELA HATFIELD | ||||||||||||||
| PHYSICIAN | $202,059 | $0 | $9,000 | $0 | $0 | $0 | $12,569 | $0 | $8,430 | $0 | $232,058 | $0 | $0 | $0 |
| DR JULIA WERNZ | ||||||||||||||
| VP & CHIEF BEHAVIORAL HEALTH OFFICER | $152,042 | $0 | $10,000 | $0 | $0 | $0 | $9,610 | $0 | $10,025 | $0 | $181,677 | $0 | $0 | $0 |
| SCOTT ANDRITSCH | ||||||||||||||
| VP & CFO | $138,905 | $0 | $10,000 | $0 | $0 | $0 | $8,774 | $0 | $9,230 | $0 | $166,909 | $0 | $0 | $0 |
| TIFFANI MARTIN | ||||||||||||||
| VP & CHIEF HR/LEGAL OFFICER | $133,457 | $0 | $10,000 | $0 | $0 | $0 | $8,453 | $0 | $9,330 | $0 | $161,240 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 6 | FormAndLineReferenceDesc |
| Explanation | END OF YEAR BONUSES WERE CONTINGENT ON NET EARNINGS OF THE CENTER. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WILL BE PRESENTED TO THE FINANCE COMMITTEE AND RECOMMENDED TO BE PUT BEFORE THE BOARD. AT THE FOLLOWING BOARD MEETING, THE 990 WILL BE PRESENTED AND VOTED ON BY THE BOARD OF DIRECTORS. WHEN APPROVED, THE 990 WILL BE FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CEO WITH THE ASSISTANCE OF OTHER KEY STAFF WILL INVESTIGATE ANY CONCERN REGARDING A CONFLICT BREACH. THE RESULTS WILL BE PRESENTED TO THE KEY STAFF AND BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF THE CEO WAS DETERMINED AND COMPLETED BY THE ENTIRE BOARD OF DIRECTORS. THE BOARD CHAIR LED THESE EFFORTS. ANNUAL REVIEW IS PERFORMED BY THE BOARD. EMPLOYEE EVALUATIONS ARE REVIEWED AND PREPARED BY THE CEO ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VALLEY PROFESSIONALS REALTY LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 S MAIN ST STE 100 | AddressLine1Txt |
| City | CLINTON | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47842 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | HOLDING COMPANY | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Total Income | $94,560 | TotalIncomeAmt |
| End Of Year Assets | $4,768,635 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VALLEY PROFESSIONALS COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |