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NORTHWINDS INTEGRATED HEALTH NETWORK IPA INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
NORTHWINDS INTEGRATED HEALTH NETWORK IPA INC (EIN 83-4123043)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-14
IRS object ID
202213189349315271
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

FieldValueIRS element (for citing)
Return2022-11-14T15:53:55-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN161131146PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BONADIO & CO LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line17936 SENECA TPKEAddressLine1Txt
CityCLINTONCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13323ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN834123043EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NORTHWINDS INTEGRATED HEALTH NETWORK IPABusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlNORTBusinessNameControlTxt
Phone5186232590PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line122 US OVAL SUITE 218AddressLine1Txt
CityPLATTSBURGHCityNm
State AbbreviationNYStateAbbreviationCd
ZIP12903ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARK LUKENSPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone5186232590PhoneNum
Signature2022-11-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMARKPersonFirstNm
Person LastLUKENSPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRICHARD ZWEIFELPreparerPersonNm
PTINP00085938PTIN
Phone3157977781PhoneNum
Preparation2022-11-14PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMARK LUKENSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line122 US OVAL SUITE 218AddressLine1Txt
CityPLATTSBURGHCityNm
State AbbreviationNYStateAbbreviationCd
ZIP12903ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$108,251GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2019FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionIT IS THE MISSION OF NORTHWINDS INTEGRATED HEALTH NETWORK IPA TO LEVERAGE OUR EXTENSIVE NETWORK OF COMMUNITY-BASED PROVIDERS TO CONNECT PEOPLE TO ESSENTIALS FOR LIVING AND HIGH QUALITY CARE.ActivityOrMissionDesc
Voting Members Governing Body4VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers12TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$769,333PYProgramServiceRevenueAmt
CY Program Service Revenue$108,251CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$769,333PYTotalRevenueAmt
CY Total Revenue$108,251CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$326,339PYOtherExpensesAmt
CY Other Expenses$282,219CYOtherExpensesAmt
PY Total Expenses$326,339PYTotalExpensesAmt
CY Total Expenses$282,219CYTotalExpensesAmt
PY Revenues Less Expenses$442,994PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$173,968CYRevenuesLessExpensesAmt
Total Assets BOY$1,441,475TotalAssetsBOYAmt
Total Assets EOY$1,218,339TotalAssetsEOYAmt
Total Liabilities BOY$69,509TotalLiabilitiesBOYAmt
Total Liabilities EOY$20,341TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,371,966NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,197,998NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionIT IS THE MISSION OF NORTHWINDS INTEGRATED HEALTH NETWORK IPA TO LEVERAGE OUR EXTENSIVE NETWORK OF COMMUNITY-BASED PROVIDERS TO CONNECT PEOPLE TO ESSENTIALS FOR LIVING AND HIGH QUALITY CARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$250,061ExpenseAmt
Revenue$108,251RevenueAmt
DescACCOMPLISHMENTS FOR 2021 INCLUDE THE ENGAGEMENT IN OUR SECOND LEVEL TWO RISK-BASED CONTRACT THAT WILL SUPPORT THE ADVANCEMENT OF INTEGRATION OF PHYSICAL AND BEHAVIORAL HEALTH ACROSS THE REGION. WE ALSO SAW SHARED SAVINGS FROM 2020. THIS CONTRACT SUPPORTS THE SUCCESSFUL COMPLETION OF OUR WORKPLAN REQUIREMENTS WITH THE NYS OFFICE OF MENTAL HEALTH. ADDITIONALLY, NORTHWINDS CONTINUED ITS DATA AGGREGATION AND ANALYSIS BY UTILIZING MEDICAID CLAIMS DATA THROUGH PSYCKES. OUR IPA AND THE ADIRONDACK ACO ALSO FINALIZED THE CREATION OF A PROPRIETARY QUIC (QUALITY UTILIZATION AND INTEGRATED CARE) DASHBOARD THAT PROVIDES DATA ON THE 9 METRICS INCLUDED IN OUR VBP CONTRACT USING FIDELIS CLAIMS FOR PATIENTS IN THE ACO REGION. PSYCKES AND THE QUIC DASHBOARD ALLOW THE IPA TO EVALUATE INDIVIDUAL PROVIDER AND NETWORK PERFORMANCE ON KEY MEASURES. NORTHWINDS COLLABORATED EXTENSIVELY TO SUPPORT RURAL POPULATION HEALTH AND REGIONAL ALL-PAYER MODELS THAT ADVANCE QUALITY OF CARE FOR PATIENTS, COST SAVINGS AND IMPROVE PROVIDER SATISFACTION.Desc
Total Program Service Expenses$250,061TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members4GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1REBECCA EVANSKYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5186232590PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line122 US OVAL SUITE 218AddressLine1Txt
CityPLATTSBURGHCityNm
State AbbreviationNYStateAbbreviationCd
ZIP12903ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
MARK LUKENS
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
VALERIE AINSWORTH
TREASURER1.00Yes (X)Yes (X)$0$0$0
CONNIE WILLIE
SECRETARY1.00Yes (X)Yes (X)$0$0$0
TERRI MORSE
BOARD MEMBER1.00Yes (X)$0$0$0
ANDREA DEEPE
BOARD MEMBER1.00Yes (X)$0$0$0
JOANNE CASWELL
BOARD MEMBER1.00Yes (X)$0$0$0
JAY ULRICH
BOARD MEMBER1.00Yes (X)$0$0$0
MIKE KETTLE
BOARD MEMBER1.00Yes (X)$0$0$0
JULIA BEEBE
BOARD MEMBER1.00Yes (X)$0$0$0
BOB ROSS
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
JENNIFER BARRON
BOARD MEMBER1.00Yes (X)$0$0$0
JAMES BUTTON
BOARD MEMBER1.00Yes (X)$0$0$0
REBECCA EVANSKY
DIRECTOR OF OPERATIONS40.00Yes (X)$66,864$0$13,525
FieldValueIRS element (for citing)
Total Reportable Comp From Org$66,864TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$13,525TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEMBERSHIP DUES624100$81,584$81,584
COORDINATION OF INTERG624100$26,667$26,667
FieldValueIRS element (for citing)
Total Program Service Revenue$108,251TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$108,251TotalRevenueColumnAmt
Related Or Exempt Func Income$108,251RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$151,488TotalAmt
Program Services$128,765ProgramServicesAmt
Management And General$22,723ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$14,317TotalAmt
Program Services$12,169ProgramServicesAmt
Management And General$2,148ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$29,083TotalAmt
Program Services$24,721ProgramServicesAmt
Management And General$4,362ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$55,600TotalAmt
Program Services$55,600ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$5,921TotalAmt
Program Services$3,375ProgramServicesAmt
Management And General$2,546ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$2,529TotalAmt
Program Services$2,150ProgramServicesAmt
Management And General$379ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescDATA MANAGEMENTDesc
Total$23,281TotalAmt
Program Services$23,281ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$282,219TotalAmt
Program Services$250,061ProgramServicesAmt
Management And General$32,158ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,431,475BOYAmt
EOY$1,194,472EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$10,000BOYAmt
EOY$4,167EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$19,700EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,441,475BOYAmt
EOY$1,218,339EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$64,509BOYAmt
EOY$20,341EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$5,000BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$69,509BOYAmt
EOY$20,341EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,371,966BOYAmt
EOY$1,197,998EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,371,966BOYAmt
EOY$1,197,998EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,441,475BOYAmt
EOY$1,218,339EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$173,968ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (1)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
FS Audited0FSAuditedInd
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations12SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp (12 entries)

EINEINOrganization TypeOrganizationTypeCdGoverning Document ListedGoverningDocumentListedIndSupportSupportAmtOther SupportOtherSupportAmt
CITIZEN ADVOCATES INC
141577715100$0$0
CHAMPLAIN VALLEY FAMILY CENTER
141638308100$0$0
MHA IN ESSEX
141579531100$0$0
FAMILIES FIRST IN ESSEX COUNTY
141763863100$0$0
BEHAVIORAL HEALTH SERVICES NORTH INC
141338346100$0$0
WARREN WASHINGTON ASSOCIATES FOR MENTAL HEALTH INC
141495169100$0$0
ST JOSEPH'S ADDICTION TREATMENT & RECOVERY
141536222100$0$0
CONIFER PARK INC
042806417100$0$0
NORTH COUNTRY FREEDOM HOMES
161180179100$0$0
ESSEX COUNTY MENTAL HEALTH
146002889100$0$0
ST LAWRENCE COUNTY COMMUNITY SERVICES
156000465100$0$0
LIBERTY HOUSE FOUNDATION
141568361100$0$0
FieldValueIRS element (for citing)
Supported Organizations Total12SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationYes (1)SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgYes (1)OrganizationChangeSuprtOrgInd
Supported Org Class Designated0SupportedOrgClassDesignatedInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, SECTION A, LINE 2IN ACCORDANCE WITH THE BYLAWS, CERTIAN SUPPORTED ORGANIZATIONS WHO ARE NOT REQUIRED TO BE RECOGNIZED AS EXEMPT FROM TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE, MAY BE A MEMBER IF THE ORGANIZATION IS A GOVERNMENT-RELATED ENTITY OR A TIER 3 MEMBER AND THEY MEET OTHER CRITIERA FOR PARTICIPATION.
PART IV SECTION A, LINE 5ATHE FOLLOWING ORGANIZATIONS ARE NO LONGER MEMBERS AND SUPPORTED ORGANIZATIONS: (I) UNITED HELPERS, INC. EIN 22-2412205 CLINTON COUNTY COMMUNITY SERVICES EIN 14-6002565 (II) THE ORGANIZATIONS VOLUNTARILY WITHDREW THEIR MEMBERSHIP (III) THEIR VOLUNTARY WITHDRAWAL DID NOT REQUIRE AMENDMENT OF THE ORGANIZING DOCUMENT PART IV SECTION A, LINE 5B NO SUPPORTED ORGANIZATIONS WERE ADDED OR SUBSTITUTED DURING THE CURRENT YEAR

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6ORGANIZATION MEMBERS CONSIST OF TIER 1, TIER 2 AND TIER 3 CLASSES. TIER 1 MEMBERS EACH HAVE ONE VOTE AND TIER 2 MEMBERS COLLECTIVELY HAVE 1 VOTE. TIER 3 MEMBERS HAVE NO VOTING RIGHTS.
FORM 990, PART VI, SECTION A, LINE 7AEACH TIER 1 MEMBER APPOINTS A REPRESENTATIVE TO THE BOARD TO VOTE ON MATTERS IN ACCORDANCE WITH THE INSTRUCTIONS OF THE MEMBER. TIER 2 MEMBERS SHALL DETERMINE HOW TO CAST THEIR ONE COLLECTIVE VOTE BY A TWO-THIRDS MAJORITY VOTE AMONG ALL TIER 2 MEMBERS. EACH TIER 2 MEMBER SHALL HAVE ONE VOTE FOR SUCH MATTERS.
FORM 990, PART VI, SECTION B, LINE 11BBOARD MEMBERS ARE PROVIDED A COPY OF THE 990 TO REVIEW PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, ALL STAFF AND BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICT OF INTEREST BY SIGNING "CODE OF ETHICS" QUESTIONNAIRES.
FORM 990, PART VI, SECTION B, LINE 15ATHE BOARD OF DIRECTORS COMPARES POSITIONS TO SIMILAR ROLES IN MEMBER ORGANIZATIONS, MARKET DATA, AND REGIONAL PUBLIC SALARY DATA WHEN DETERMINING COMPENSATION FOR SENIOR LEADERSHIP.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE ORGANIZATION.
FORM 990, PART IX, LINE 11GCLINICAL CONTRACTUAL: PROGRAM SERVICE EXPENSES 55,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,600.

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