RIVER VALLEY HEALTH: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- RIVER VALLEY HEALTH (EIN 20-8979596)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2021-12-17
- IRS object ID
- 202113519349300416
- Schema version
- 2020v4.1
- 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 | 2021-12-17T09:54:37-06:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1570 FRUITVILLE PIKE SUITE 400 | AddressLine1Txt |
| City | LANCASTER | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208979596 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSQUEHANNA COMMUNITY HEALTH AND | BusinessNameLine1Txt |
| Business Name Line2 | DENTAL CLINIC INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SUSQ | BusinessNameControlTxt |
| Phone | 5705675400 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 471 HEPBURN ST | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MAX HOUSEKNECHT JR | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5705675400 | PhoneNum |
| Signature | 2021-12-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MAX | PersonFirstNm |
| Person Last | HOUSEKNECHT JR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KERRI N BOGDA CPA | PreparerPersonNm |
| PTIN | P00760402 | PTIN |
| Phone | 7177404863 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVER VALLEY HEALTH & DENTAL CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES YOXTHEIMER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 471 HEPBURN ST | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,981,635 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RIVERVALLEYHEALTHANDDENTAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | TO EXTEND GOD'S HEALING BY PROVIDING INCLUSIVE, QUALITY PRIMARY MEDICAL AND DENTAL CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 121 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,267,477 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,851,348 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,328,562 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,473,883 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$3,608 | PYInvestmentIncomeAmt |
| CY Investment Income | -$2,141 | CYInvestmentIncomeAmt |
| PY Other Revenue | $872,652 | PYOtherRevenueAmt |
| CY Other Revenue | $2,651,376 | CYOtherRevenueAmt |
| PY Total Revenue | $10,465,083 | PYTotalRevenueAmt |
| CY Total Revenue | $14,974,466 | 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 | $7,375,721 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,380,885 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,966,571 | PYOtherExpensesAmt |
| CY Other Expenses | $5,405,238 | CYOtherExpensesAmt |
| PY Total Expenses | $11,342,292 | PYTotalExpensesAmt |
| CY Total Expenses | $12,786,123 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$877,209 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,188,343 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,225,205 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,033,017 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,518,006 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,137,475 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $707,199 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,895,542 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE ORGANIZATION'S MISSION IS TO EXTEND GOD'S HEALING BY PROVIDING INCLUSIVE, QUALITY PRIMARY MEDICAL AND DENTAL CARE TO ALL THOSE WHO NEED IT. CONTINUED ON SCHEDULE O.LOCATED IN THE CENTER OF WILLIAMSPORT, PENNSYLVANIA, WE SERVE THE RESIDENTS OF THE GREATER RIVER VALLEY COMMUNITY WITH COMPREHENSIVE PRIMARY CARE (MEDICAL AND DENTAL) INCLUDING SPECIALIZED SERVICES FOR BEHAVIORAL AND REPRODUCTIVE HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,153,545 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $5,091,711 | RevenueAmt |
| Desc | PRIMARY HEALTH CARE: WE PROVIDE COMPREHENSIVE PRIMARY CARE SERVICES REGARDLESS OF ABILITY TO PAY. OUR SERVICES INCLUDE SOCIAL WORK, DIRECTLY; AND BEHAVIORAL HEALTH, SUBSTANCE ABUSE, EMERGENCY, CHIROPRACTIC SERVICES, AND SPECIALTY CARE THROUGH REFERRAL RELATIONSHIPS. WE ACCEPT MEDICAID, MEDICARE, PRIVATE INSURANCE, AND HAVE A SLIDING FEE SCALE BASED ON FAMILY INCOME FOR THOSE WITHOUT INSURANCE. WE ARE THE ONLY PRIMARY CARE PROVIDER AND LYCOMING COUNTY THAT IS ACCEPTING PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. WE ARE A COMMUNITY-BASED ORGANIZATION WORKING WITH OTHERS TO INCREASE ACCESS FOR THE UNDER-INSURED AND UN-INSURED. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,087,496 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,382,172 | RevenueAmt |
| Desc | DENTAL CARE:WE PROVIDE PREVENTIVE AND RESTORATIVE DENTISTRY INCLUDING CLEANINGS SEALANTS, AND EXTRACTIONS. WE GO THE EXTRA MILE TO HELP OUR PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. WE HAVE A CHILDREN'S READINESS PROGRAM AND ARE BUILDING A COMMUNITY DENTAL EDUCATION PROGRAM. WE ALSO HAVE A DENTAL OUTREACH PROGRAM THAT GOES TO SCHOOLS AND OTHER COMMUNITY EVENTS TO PROVIDE ONSITE DENTAL CARE FOR CHILDREN. WE DO OUR BEST TO GET THOSE SUFFERING FROM PAIN IN TO BE SEEN THE SAME DAY. WE ARE THE ONLY DENTAL CLINIC IN LYCOMING COUNTY AND ARE ACCEPTING NEW PATIENTS. WE ARE A COMMUNITY-BASED ORGANIZATION WORKING WITH OTHERS TO INCREASE ACCESS FOR THE UNDER-INSURED AND UN-INSURED. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $10,241,041 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | 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 | Yes (1) | 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 | 42 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 121 | 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 | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAX HOUSEKNECHT JR CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5705675418 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 471 HEPBURN ST | AddressLine1Txt |
| City | WILLIAMSPORT | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 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 |
|---|---|---|---|---|---|---|---|
| DR JOHN BOLL | |||||||
| CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ABIGAIL ESCHBACH | |||||||
| VICE CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOROTHY HILLIARD | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BARBARA BARBUS | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THOMAS ZIMMERMAN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHANTAY HALL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DWIGHT WYATT | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KIMBERLY WETHERHOLD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ADANMA AKUJIEZE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEAN MYERS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTOPHER EBNER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR RALPH KAISER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PASTOR VELINDA WEBB SMITH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW MCLAUGHLIN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES YOXTHEIMER | |||||||
| PRESIDENT/CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $151,280 | $0 | $11,371 | ||
| MAX HOUSEKNECHT JR | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $97,342 | $0 | $9,991 | ||
| DR KAYLA RICHARDSON | |||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $284,684 | $0 | $22,491 | ||
| CHRISTOPHER COYNER | |||||||
| DENTIST | 40.00 | $243,848 | $0 | $25,474 | Yes (X) | ||
| STEVEN LEUNG | |||||||
| PHYSICIAN | 40.00 | $241,876 | $0 | $1,810 | Yes (X) | ||
| WILLIAM BARTLOW | |||||||
| PHYSICIAN | 40.00 | $217,183 | $0 | $24,098 | Yes (X) | ||
| GWEN MARTIN | |||||||
| PHYSICIAN | 40.00 | $256,063 | $0 | $11,870 | Yes (X) | ||
| DANIEL BOZZA | |||||||
| DENTIST | 40.00 | $178,322 | $0 | $25,193 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,670,598 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $132,298 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CARDINAL HEALTH PHARMACY SOLUTIONA | |||||
| 21377 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY MANAGEMENT | $343,680 |
| INSIGHT | |||||
| PO BOX 392798 | PITTSBURGH | PA | 15251 | BEHAVIORAL HEALTH SERVICES | $214,875 |
| CHIROPRACTIC SERVICES | |||||
| 14460 FALLS OF NEUSE RD STE 14-3 | RALEIGH | NC | 27614 | CHIROPRACTIC SERVICES | $214,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $10,000 | FederatedCampaignsAmt |
| Government Grants | $3,835,973 | GovernmentGrantsAmt |
| All Other Contributions | $5,375 | AllOtherContributionsAmt |
| Total Contributions | $3,851,348 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $8,473,883 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,473,883 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,473,883 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $691 | TotalRevenueColumnAmt |
| Exclusion | $691 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,825 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $4,337 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $488 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $488 | TotalRevenueColumnAmt |
| Exclusion | $488 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,832 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$2,832 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,832 | TotalRevenueColumnAmt |
| Exclusion | -$2,832 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| 340B PROGRAM REVENUE | 900099 | $1,299,876 | $1,299,876 |
| PPP LOAN FORGIVENESS | 900099 | $1,205,560 | $1,205,560 |
| INCENTIVE PAYMENTS | 900099 | $121,896 | $121,896 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,556 | TotalRevenueColumnAmt |
| Exclusion | $23,556 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,650,888 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,974,466 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,473,883 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,649,235 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $273,987 | TotalAmt |
| Management And General | $273,987 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,684,568 | TotalAmt |
| Program Services | $5,068,284 | ProgramServicesAmt |
| Management And General | $616,284 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,269 | TotalAmt |
| Program Services | $52,986 | ProgramServicesAmt |
| Management And General | $6,283 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $974,864 | TotalAmt |
| Program Services | $852,948 | ProgramServicesAmt |
| Management And General | $121,916 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $388,197 | TotalAmt |
| Program Services | $333,177 | ProgramServicesAmt |
| Management And General | $55,020 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,561 | TotalAmt |
| Management And General | $14,561 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,764 | TotalAmt |
| Management And General | $31,764 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,250 | TotalAmt |
| Management And General | $1,250 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,482,470 | TotalAmt |
| Program Services | $1,213,799 | ProgramServicesAmt |
| Management And General | $268,671 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,235 | TotalAmt |
| Management And General | $105,235 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,323 | TotalAmt |
| Program Services | $215,988 | ProgramServicesAmt |
| Management And General | $41,335 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495,713 | TotalAmt |
| Program Services | $313,789 | ProgramServicesAmt |
| Management And General | $181,924 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $214,162 | TotalAmt |
| Management And General | $214,162 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,389 | TotalAmt |
| Program Services | $2,389 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,047 | TotalAmt |
| Program Services | $188,860 | ProgramServicesAmt |
| Management And General | $31,187 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $714,615 | TotalAmt |
| Program Services | $613,331 | ProgramServicesAmt |
| Management And General | $101,284 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,822 | TotalAmt |
| Program Services | $26,360 | ProgramServicesAmt |
| Management And General | $46,462 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PHARMACEUTICALS | $589,906 | $589,906 |
| BAD DEBT | $213,421 | $213,421 |
| MEDICAL SUPPLIES | $193,109 | $193,109 |
| MINOR EQUIPMENT | $179,093 | $179,093 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $617,358 | TotalAmt |
| Program Services | $183,601 | ProgramServicesAmt |
| Management And General | $433,757 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,786,123 | TotalAmt |
| Program Services | $10,241,041 | ProgramServicesAmt |
| Management And General | $2,545,082 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,450,991 | BOYAmt |
| EOY | $1,426,985 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $171,448 | BOYAmt |
| EOY | $277,831 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $256,875 | BOYAmt |
| EOY | $449,383 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $386,569 | BOYAmt |
| EOY | $642,933 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,106 | BOYAmt |
| EOY | $102,651 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,345,954 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,270,797 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,886,216 | BOYAmt |
| EOY | $5,075,157 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $58,077 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,225,205 | BOYAmt |
| EOY | $8,033,017 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,205,137 | BOYAmt |
| EOY | $1,296,835 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $135,500 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $169,976 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,198,800 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,114,069 | BOYAmt |
| EOY | $3,535,164 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,518,006 | BOYAmt |
| EOY | $5,137,475 | 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 | $707,199 | BOYAmt |
| EOY | $2,895,542 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $707,199 | BOYAmt |
| EOY | $2,895,542 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,225,205 | BOYAmt |
| EOY | $8,033,017 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,188,343 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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 |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,250 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,250 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS DUES TO THE PENNSYLVANIA ASSOCIATION OF COMMUNITY HEALTH CENTERS. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,725,424 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,828,250 | DepreciationAmt |
| Book Value | $2,897,174 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $843,787 | OtherCostOrOtherBasisAmt |
| Depreciation | $330,110 | DepreciationAmt |
| Book Value | $513,677 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,996,764 | OtherCostOrOtherBasisAmt |
| Depreciation | $946,439 | DepreciationAmt |
| Book Value | $1,050,325 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $779,979 | OtherCostOrOtherBasisAmt |
| Depreciation | $165,998 | DepreciationAmt |
| Book Value | $613,981 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,075,157 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASE OBLIGATIONS | Desc |
| Amt | $3,535,164 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,535,164 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,768,214 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$213,421 | OtherRevenueAmt |
| Revenue Not Reported | -$213,421 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,981,635 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$7,169 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$7,169 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,974,466 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,579,871 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $7,169 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $7,169 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,572,702 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $213,421 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $213,421 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,786,123 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT HAS DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2021 AND 2020. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS -213,421. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PP&E NETTED AGAINST EXPENSES ON FINANCIALS -2,832. RENTAL EXPENSES -4,337. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PP&E NETTED AGAINST EXPENSES ON FINANCIALS 2,832. RENTAL EXPENSES 4,337. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE NETTED AGAINST REVENUE ON FINANCIALS 213,421. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 | 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 (7 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 KAYLA RICHARDSON | ||||||||||||||
| CHIEF MEDICAL OFFICER | $284,684 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,491 | $0 | $307,175 | $0 | $0 | $0 |
| CHRISTOPHER COYNER | ||||||||||||||
| DENTIST | $243,848 | $0 | $0 | $0 | $0 | $0 | $1,500 | $0 | $23,974 | $0 | $269,322 | $0 | $0 | $0 |
| GWEN MARTIN | ||||||||||||||
| PHYSICIAN | $256,063 | $0 | $0 | $0 | $0 | $0 | $1,500 | $0 | $10,370 | $0 | $267,933 | $0 | $0 | $0 |
| STEVEN LEUNG | ||||||||||||||
| PHYSICIAN | $241,876 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,810 | $0 | $243,686 | $0 | $0 | $0 |
| WILLIAM BARTLOW | ||||||||||||||
| PHYSICIAN | $217,183 | $0 | $0 | $0 | $0 | $0 | $1,500 | $0 | $22,598 | $0 | $241,281 | $0 | $0 | $0 |
| DANIEL BOZZA | ||||||||||||||
| DENTIST | $178,322 | $0 | $0 | $0 | $0 | $0 | $1,500 | $0 | $23,693 | $0 | $203,515 | $0 | $0 | $0 |
| JAMES YOXTHEIMER | ||||||||||||||
| PRESIDENT/CHIEF EXECUTIVE OFFICER | $151,280 | $0 | $0 | $0 | $0 | $0 | $1,500 | $0 | $9,871 | $0 | $162,651 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANGELA HOUSEKNECHT | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | MOTHER OF CFO | RelationshipDescriptionTxt |
| Transaction | $51,169 | TransactionAmt |
| Transaction | SALARY | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
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 REVIEWED BY THE CFO. ONCE APPROVED, THE FORM 990 IS SENT TO THE PRESIDENT/CEO FOR REVIEW AND APPROVAL. THE PRESIDENT/CEO WILL THEN FORWARD A COPY OF THE FORM 990 TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL MEMBERS OF THE BOARD, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE POTENTIONAL CONFLICTS OF INTEREST. ALL CONFLICTS ARE REVIEWED AT THE BOARD LEVEL. WHEN A POTENTIAL CONFLICT IS IDENTIFIED, AND THE FULL BOARD DETERMINES THAT A CONFLICT OR THE APPEARANCE OF A CONFLICT IS PRESENT, THE INDIVIDUAL IS EXCUSED FROM DELIBERATION AND DECISION MAKING. |
| FORM 990, PART VI, SECTION B, LINE 15 | REVIEW OF THE PRESIDENT/CEOS COMPENSATION IS PERFORMED ON AN ANNUAL BASIS. THE ORGANIZATION HAS A THIRD PARTY (R ELLEN K RAJEWSKI) CONDUCT A THOROUGH STUDY OF EXECUTIVE COMPENSATION UTILIZING NATIONAL, STATE, AND REGIONAL COMPENSATION DATA TO DEVELOP A RECOMMENDATION OF A COMPETITIVE, FAIR, AND EQUITABLE SALARY RANGE FOR THE CEO. THE BOARD THEN REVIEWS THE RECOMMENDATION AND COMPENSATES ACCORDINGLY. THE REVIEW IS DOCUMENTED IN THE MINUTES. REVIEW OF OTHER EXECUTIVE SALARIES IS COMPLETED BY BENCHMARKING DATA FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE DEPARTMENT OF LABOR BY THE BOARD OF DIRECTORS. THIS REVIEW IS DOCUMENTED IN THE MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | BEHAVIORAL HEALTH PROVIDER: PROGRAM SERVICE EXPENSES 101,790. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 101,790. CONSULTING: PROGRAM SERVICE EXPENSES 167,880. MANAGEMENT AND GENERAL EXPENSES 15,767. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 183,647. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 35,169. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,169. RHC: PROGRAM SERVICE EXPENSES 3,205. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,205. TEMP STAFFING FEES: PROGRAM SERVICE EXPENSES 207,410. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 207,410. PHARMACIST: PROGRAM SERVICE EXPENSES 174,233. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,233. SHREDDING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,440. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,440. OTHER: PROGRAM SERVICE EXPENSES 559,281. MANAGEMENT AND GENERAL EXPENSES 926. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 560,207. STORAGE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,758. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,758. SECURITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 39,877. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,877. ADMINISTRATIVE FEES 340B: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 134,376. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,376. COVID SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 22,392. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,392. EMPLOYEE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,083. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,083. TRANSLATORS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,883. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,883. |
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