ISLANDS COMMUNITY MEDICAL SERVICES INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ISLANDS COMMUNITY MEDICAL SERVICES INC (EIN 01-6012835)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-09
- IRS object ID
- 202203139349303985
- 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 | 2022-11-09T15:00:00-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | 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 | 016012835 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ISLANDS COMMUNITY MEDICAL SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ISLA | BusinessNameControlTxt |
| Phone | 2078634341 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEDICAL CENTER LOOP | AddressLine1Txt |
| City | VINALHAVEN | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04863 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICHARD YOUNG | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 2078634341 | PhoneNum |
| Signature | 2022-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RICHARD | PersonFirstNm |
| Person Last | YOUNG | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2022-11-02 | 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 | RICHARD YOUNG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEDICAL CENTER LOOP | AddressLine1Txt |
| City | VINALHAVEN | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04863 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,881,365 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTP://WWW.ICMSVH.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | COMMUNITY HEALTH CENTER DEVOTED TO PROVIDING CARE TO ALL IN NEED REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 48 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,063,450 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,888,825 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,148,093 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,561,892 | CYProgramServiceRevenueAmt |
| PY Investment Income | $153,246 | PYInvestmentIncomeAmt |
| CY Investment Income | $237,251 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $39,822 | CYOtherRevenueAmt |
| PY Total Revenue | $3,364,789 | PYTotalRevenueAmt |
| CY Total Revenue | $4,727,790 | 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 | $1,968,697 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,411,379 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $6,454 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,065,331 | PYOtherExpensesAmt |
| CY Other Expenses | $1,282,920 | CYOtherExpensesAmt |
| PY Total Expenses | $3,034,028 | PYTotalExpensesAmt |
| CY Total Expenses | $3,694,299 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $330,761 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,033,491 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,604,849 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,505,939 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $946,438 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $464,364 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,658,411 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,041,575 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ISLANDS COMMUNITY MEDICAL SERVICES IS COMMITTED TO SERVING OUR ISLAND COMMUNITIES BY DEDICATING OURSELVES TO THE HEALTH OF OUR PATIENTS. WE SUPPORT WHOLE HEALTH THROUGH EASE OF ACCESS, PREVENTION, OUTREACH, EDUCATION, AND TREATMENT BY PROVIDING THE HIGHEST QUALITY PRIMARY, URGENT, AND EMERGENT CARE TO OUR PATIENTS AND COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,527,607 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,151,703 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED MEDICAL SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATIONS OPERATED A MEDICAL CLINIC WITH THREE FULL TIME AND THREE PART TIME MEDICAL PROVIDERS. THE CLINIC PROVIDED COVERAGE 24 HOURS A DAY, 7 DAYS A WEEK. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $378,566 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $282,933 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED DENTAL SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATION OPERATES A DENTAL CLINIC WITH TWO DENTAL PROVIDERS WHO WORK 2.5 DAYS PER WEEK. DENTAL EMERGENCIES ARE GENERALLY HANDLED BY THE MEDICAL PROVIDERS IF THE DENTIST IS NOT AVAILABLE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $97,448 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $127,256 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED BEHAVIORAL HEALTH SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATION OPERATES THE BEHAVIORAL HEALTH CLINIC WITH ONE FULL TIME THERAPIST WHO WORK MONDAY THROUGH FRIDAY, AND THERE IS ALSO THE OPTION FOR AFTERHOURS VISITS VIA ZOOM WITH TELEHEALTH. BEHAVIORAL HEALTH EMERGENCIES ARE GENERALLY HANDLED BY THE MEDICAL PROVIDERS IF THE THERAPIST IS NOT AVAILABLE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $2,003,621 | 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 | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 20 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 48 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAMERON GARRETT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2078634341 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEDICAL CENTER LOOP | AddressLine1Txt |
| City | VINALHAVEN | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04863 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 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 |
|---|---|---|---|---|---|---|---|
| RICHARD YOUNG | |||||||
| PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| EMILY LANE | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BARBARA HAMILTON | |||||||
| TREASURER (THRU AUGUST) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GAIL EIERWEISS | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LAURA BLANKERTZ PHD | |||||||
| MEMBER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JEANNE BINEAU-AMES | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN BLATT | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MEREDITH BOONE | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DIANE COCHRAN | |||||||
| MEMBER (THRU MARCH) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CONNIE GEMMER | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CATHERINE HALEY | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BARBARA KINDER MD | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM LIEBER MD | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOANNA REIDY | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM TREVASKIS | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHESTER WARREN | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHI YOUNG | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CAMERON GARRETT | |||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $80,936 | $0 | $20,299 | ||
| DINAH MOYER | |||||||
| EXECUTIVE DIRECTOR (THRU MARCH) | 40.00 | Yes (X) | $139,049 | $0 | $28,944 | ||
| ROXANNE TOLMAN | |||||||
| FINANCE DIRECTOR | 40.00 | Yes (X) | $24,836 | $0 | $8,608 | ||
| JENNIFER DESMOND | |||||||
| CLINICAL DIRECTOR/NP | 40.00 | $160,728 | $0 | $24,363 | Yes (X) | ||
| CHRISTINA QUINLAN | |||||||
| DIRECTOR OF OPERATIONS | 32.00 | $175,623 | $0 | $15,541 | Yes (X) | ||
| JAMES HOGAN | |||||||
| PHYSICIAN ASSISTANT | 40.00 | $141,479 | $0 | $28,564 | Yes (X) | ||
| KIMBERLY SAUNDERS | |||||||
| PHYSICIAN/MEDICAL DIRECTOR | 40.00 | $215,907 | $0 | $32,829 | Yes (X) | ||
| PETER LEVANDOSKI | |||||||
| DENTIST | 40.00 | $124,976 | $0 | $6,249 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,063,534 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $165,397 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,254,360 | GovernmentGrantsAmt |
| All Other Contributions | $634,465 | AllOtherContributionsAmt |
| Noncash Contributions | $1,320 | NoncashContributionsAmt |
| Total Contributions | $2,888,825 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $1,561,892 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,561,892 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,561,892 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $89,358 | TotalRevenueColumnAmt |
| Exclusion | $89,358 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,301,468 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,153,575 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $147,893 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $147,893 | TotalRevenueColumnAmt |
| Exclusion | $147,893 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,822 | TotalRevenueColumnAmt |
| Exclusion | $39,822 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $39,822 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,727,790 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,561,892 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $277,073 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $302,672 | TotalAmt |
| Program Services | $161,537 | ProgramServicesAmt |
| Management And General | $141,135 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,702,370 | TotalAmt |
| Program Services | $1,059,470 | ProgramServicesAmt |
| Management And General | $642,900 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,043 | TotalAmt |
| Program Services | $25,769 | ProgramServicesAmt |
| Management And General | $8,274 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,671 | TotalAmt |
| Program Services | $153,615 | ProgramServicesAmt |
| Management And General | $88,056 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,623 | TotalAmt |
| Program Services | $79,927 | ProgramServicesAmt |
| Management And General | $50,696 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,423 | TotalAmt |
| Management And General | $153,423 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,471 | TotalAmt |
| Management And General | $15,471 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,759 | TotalAmt |
| Program Services | $13,764 | ProgramServicesAmt |
| Management And General | $201,995 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,551 | TotalAmt |
| Management And General | $2,551 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,746 | TotalAmt |
| Program Services | $19,622 | ProgramServicesAmt |
| Management And General | $127,124 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,597 | TotalAmt |
| Program Services | $37,907 | ProgramServicesAmt |
| Management And General | $6,690 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,752 | TotalAmt |
| Program Services | $94,648 | ProgramServicesAmt |
| Management And General | $41,104 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,585 | TotalAmt |
| Program Services | $13,585 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,388 | TotalAmt |
| Management And General | $12,388 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,943 | TotalAmt |
| Program Services | $85,108 | ProgramServicesAmt |
| Management And General | $44,835 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,560 | TotalAmt |
| Program Services | $11,952 | ProgramServicesAmt |
| Management And General | $19,608 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL, LAB, & XRAY SU | $137,560 | $137,560 | |
| REPAIRS & MAINTENANCE | $76,120 | $3,355 | $72,765 |
| DISPENSARY SUPPLIES | $54,306 | $54,306 | |
| LICENSES & PERMITS | $4,898 | $4,898 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,261 | TotalAmt |
| Program Services | $46,598 | ProgramServicesAmt |
| Management And General | $55,209 | ManagementAndGeneralAmt |
| Fundraising | $6,454 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,694,299 | TotalAmt |
| Program Services | $2,003,621 | ProgramServicesAmt |
| Management And General | $1,684,224 | ManagementAndGeneralAmt |
| Fundraising | $6,454 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,423 | BOYAmt |
| EOY | $19,111 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $943,231 | BOYAmt |
| EOY | $950,386 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,516 | BOYAmt |
| EOY | $6,382 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,298 | BOYAmt |
| EOY | $358,535 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,386 | BOYAmt |
| EOY | $96,386 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,056 | BOYAmt |
| EOY | $34,902 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,489,831 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $964,533 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,410,518 | BOYAmt |
| EOY | $1,525,298 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,625,787 | BOYAmt |
| EOY | $4,099,086 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,324,634 | BOYAmt |
| EOY | $1,415,853 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,604,849 | BOYAmt |
| EOY | $8,505,939 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $161,815 | BOYAmt |
| EOY | $195,714 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $491,159 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $273,609 | BOYAmt |
| EOY | $265,969 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,855 | BOYAmt |
| EOY | $2,681 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $946,438 | BOYAmt |
| EOY | $464,364 | 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 | $4,707,474 | BOYAmt |
| EOY | $5,906,739 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,950,937 | BOYAmt |
| EOY | $2,134,836 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,658,411 | BOYAmt |
| EOY | $8,041,575 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,604,849 | BOYAmt |
| EOY | $8,505,939 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,033,491 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $258,454 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $91,219 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL UNDER SECTION 170(B)(1)(A)(III). THEREFORE, SCHEDULE H IS NOT REQUIRED. | 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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,625,787 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $491,331 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $18,032 | GrantsOrScholarshipsAmt |
| End Year Balance | $4,099,086 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,208,293 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $452,343 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $14,849 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $20,000 | AdministrativeExpensesAmt |
| End Year Balance | $3,625,787 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.83980 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.16020 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $136,455 | OtherCostOrOtherBasisAmt |
| Book Value | $136,455 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $989,325 | OtherCostOrOtherBasisAmt |
| Depreciation | $196,274 | DepreciationAmt |
| Book Value | $793,051 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $662,766 | OtherCostOrOtherBasisAmt |
| Depreciation | $180,980 | DepreciationAmt |
| Book Value | $481,786 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $571,951 | OtherCostOrOtherBasisAmt |
| Depreciation | $457,945 | DepreciationAmt |
| Book Value | $114,006 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $129,334 | OtherCostOrOtherBasisAmt |
| Depreciation | $129,334 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,525,298 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTEREST IN CHARITABLE TRUST | Desc |
| Book Value | $1,415,853 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,415,853 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED PENSION PAYABLE | Desc |
| Amt | $2,681 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,681 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $5,077,463 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $258,454 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $91,219 | OtherRevenueAmt |
| Revenue Not Reported | $349,673 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,727,790 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,727,790 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,694,299 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $3,694,299 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $3,694,299 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | IN SUPPORT OF THE MISSION OF ISLANDS COMMUNITY MEDICAL SERVICES, THE FUND'S ASSETS ARE INVESTED TO PROVIDE ANNUAL SUPPORT FOR THE ORGANIZATION'S BUDGETARY REQUIREMENT AND TO MAINTAIN THE PRINICPAL FOR FUTURE OPERATIONAL NEEDS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BENEFICIAL INTEREST IN PERPETUAL CHARITABLE TRUST 91,219. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIMBERLY SAUNDERS | ||||||||||||||
| PHYSICIAN/MEDICAL DIRECTOR | $204,597 | $0 | $60 | $0 | $11,250 | $0 | $11,177 | $0 | $21,652 | $0 | $248,736 | $0 | $0 | $0 |
| CHRISTINA QUINLAN | ||||||||||||||
| DIRECTOR OF OPERATIONS | $107,818 | $0 | $15,600 | $0 | $52,205 | $0 | $5,600 | $0 | $9,941 | $0 | $191,164 | $0 | $0 | $0 |
| JENNIFER DESMOND | ||||||||||||||
| CLINICAL DIRECTOR/NP | $158,012 | $0 | $110 | $0 | $2,606 | $0 | $8,327 | $0 | $16,036 | $0 | $185,091 | $0 | $0 | $0 |
| JAMES HOGAN | ||||||||||||||
| PHYSICIAN ASSISTANT | $135,369 | $0 | $6,110 | $0 | $0 | $0 | $7,456 | $0 | $21,108 | $0 | $170,043 | $0 | $0 | $0 |
| DINAH MOYER | ||||||||||||||
| EXECUTIVE DIRECTOR (THRU MARCH) | $33,908 | $0 | $0 | $0 | $105,141 | $0 | $2,077 | $0 | $26,867 | $0 | $167,993 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE ORGANIZATION PROVIDED A HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE TO THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII: CAMERON GARRETT - $5,600 CHRISTINA QUINLAN - $2,000 JENNIFER DESMOND - $2,606 KIMBERLY SAUNDERS - $11,250 |
| PART I, LINE 4A | DINAH MOYER RECEIVED SEVERANCE COMPENSATION TOTALING $93,470 IN 2021. |
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 IS PROVIDED TO THE BOARD OF DIRECTORS FOR DISCUSSION, REVIEW, AND APPROVAL BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE CONFLICT OF INTEREST POLICY COVERS BOTH EMPLOYEES AND BOARD MEMBERS. EACH ARE EXPECTED TO SIGN A CONFLICT OF INTEREST FORM. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS FOR CONFLICTS ON THE BOARD, THE EXECUTIVE DIRECTOR AND RISK MANAGER FOR POTENTIAL CONFLICTS. THE EXECUTIVE COMMITTEE THEN BRINGS CONFLICTS OF INTEREST FOR REVIEW TO THE ENTIRE BOARD. IF A CONFLICT IS IDENTIFIED THE BOARD OR STAFF MEMBER IS ASKED TO RECUSE THEMSELVES FROM ANY DECISION MAKING OR PARTICIPATION IN A DECISION/EVENT RELATED TO THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION UTILIZED A COMPENSATION CONSULTANT AND FQHC SALARY SURVEY IN 2021 IN EVALUATING, DETERMINING AND APPROVING SALARIES FOR MANAGEMENT EMPLOYEES AND CERTAIN MD POSITIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | PRINT COPIES OF GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY COULD BE PICKED UP AT OFFICE HEADQUARTERS. FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC HOWEVER PERTINENT ANNUAL FINANCIAL RESULTS ARE REPORTED IN THE ORGANIZATION'S ANNUAL REPORT. |
| FORM 990, PART XI, LINE 9: | GAIN FROM BENEFICIAL INTEREST IN PERPETUAL CHARITABLE TRUST 91,219. |
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