MAPLE CITY HEALTH CARE CENTER INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MAPLE CITY HEALTH CARE CENTER INC (EIN 35-1749398)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-08-25
- IRS object ID
- 202142379349300044
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-25T13:01:57-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351307701 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KRUGGEL LAWTON & COMPANY LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 317 W FRANKLIN ST | AddressLine1Txt |
| City | ELKHART | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46516 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351749398 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAPLE CITY HEALTH CARE CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MAPL | BusinessNameControlTxt |
| Phone | 5745343300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 MIDDLEBURY ST | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 465282956 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAREN MILLER RUSH | PersonNm |
| Person Title | OFFICER | PersonTitleTxt |
| Phone | 5745343300 | PhoneNum |
| Signature | 2021-07-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KAREN | PersonFirstNm |
| Person Last | MILLER RUSH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARGENE ZINK | PreparerPersonNm |
| PTIN | P01222961 | PTIN |
| Phone | 5742642247 | PhoneNum |
| Preparation | 2021-06-30 | PreparationDt |
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 | VISTA COMMUNITY HC NORTHSIDE COMMUNITY HC AND MAPLE CITY DENTAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KAREN MILLER RUSH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 MIDDLEBURY ST | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 465282956 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,756,934 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCHCC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1988 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF MAPLE CITY HEALTH CARE CENTER IS TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 126 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,302,169 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,447,642 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,132,402 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,253,557 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,715 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,109 | CYInvestmentIncomeAmt |
| PY Other Revenue | $653 | PYOtherRevenueAmt |
| CY Other Revenue | $49,626 | CYOtherRevenueAmt |
| PY Total Revenue | $8,442,939 | PYTotalRevenueAmt |
| CY Total Revenue | $8,756,934 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $5,150 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,243,197 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,784,229 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,991,306 | PYOtherExpensesAmt |
| CY Other Expenses | $2,132,326 | CYOtherExpensesAmt |
| PY Total Expenses | $8,239,653 | PYTotalExpensesAmt |
| CY Total Expenses | $8,921,555 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $203,286 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$164,621 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,220,632 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,619,027 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $764,081 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,296,490 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,456,551 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,322,537 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF MAPLE CITY HEALTH CARE CENTER IS TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $7,259,305 | ExpenseAmt |
| Grant | $5,000 | GrantAmt |
| Revenue | $3,303,183 | RevenueAmt |
| Desc | FOSTERING HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND ARTICULATING AND PROMOTING OUR EXPERIENCE AS A SUSTAINABLE MODEL. WE PROVIDE MEDICAL, BEHAVIOR HEALTH, DENTAL, VISION, AND SOCIAL SERVICES. | Desc |
| Total Program Service Expenses | $7,259,305 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | Yes (1) | 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 | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 126 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAREN MILLER RUSH | PersonNm |
| Phone | 5745343300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 MIDDLEBURY ST | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46528 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ADAM SCHARF | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $708 | ||
| MIGUEL MILLAN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $165 | ||
| IRMA PEREZ | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $292 | ||
| JENNY MARTINEZ | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $226 | ||
| ROEL CERVANTES | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $125 | ||
| DENICE METTERT | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $200 | ||
| KEVIN FARMWALD | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $45 | ||
| SARAH METZLER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN DRIVER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| YEIMI PEREZ GARCIA | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MAX MERTZ | |||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JAMES NELSON GINGERICH | |||||||
| GUARDIAN OF VISION | 60.00 | $164,981 | $0 | $18,370 | Yes (X) | ||
| KAREN MILLER RUSH | |||||||
| DIRECTOR OF FINANCE | 40.00 | $61,334 | $0 | $11,250 | Yes (X) | ||
| THOMAS KREIDER | |||||||
| PSYCHIATRIST | 40.00 | $151,299 | $0 | $16,417 | Yes (X) | ||
| STEPHEN HARMON | |||||||
| GUARDIAN OF MEDICAL SERVICE | 50.00 | $134,170 | $0 | $20,861 | Yes (X) | ||
| REBECCA JOHNSON | |||||||
| NURSE MIDWIFE | 40.00 | $102,743 | $0 | $5,261 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $614,527 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $73,920 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | 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 |
|---|---|---|---|---|---|
| MG TRUST COMPANY | |||||
| 1PO BOX 3144 | MOBILE | AL | 36652 | RETIREMENT BENEFITS | $710,678 |
| DJ CONSTRUCTION | |||||
| 3414 ELKHART RD | GOSHEN | IN | 46526 | RENOVATION | $507,351 |
| ABG DENTAL | |||||
| 622 W LINCOLN | GOSHEN | IN | 46526 | DENTAL SERVICES | $214,572 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,639,074 | GovernmentGrantsAmt |
| All Other Contributions | $808,568 | AllOtherContributionsAmt |
| Noncash Contributions | $357,469 | NoncashContributionsAmt |
| Total Contributions | $5,447,642 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE FE | 621400 | $2,950,206 | $2,950,206 |
| MHS CONTRACTS | 621400 | $154,118 | $154,118 |
| PHARMACY | 621400 | $125,802 | $125,802 |
| CAPITATION | 621400 | $23,431 | $23,431 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,253,557 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,109 | TotalRevenueColumnAmt |
| Exclusion | $6,109 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $49,626 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $49,626 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $49,626 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,756,934 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,303,183 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $6,109 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,000 | TotalAmt |
| Program Services | $5,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $578,681 | TotalAmt |
| Program Services | $457,158 | ProgramServicesAmt |
| Management And General | $121,523 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,403,811 | TotalAmt |
| Program Services | $3,469,994 | ProgramServicesAmt |
| Management And General | $933,817 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,560 | TotalAmt |
| Program Services | $269,138 | ProgramServicesAmt |
| Management And General | $72,422 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,097,063 | TotalAmt |
| Program Services | $863,606 | ProgramServicesAmt |
| Management And General | $233,457 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $363,114 | TotalAmt |
| Program Services | $286,194 | ProgramServicesAmt |
| Management And General | $76,920 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,820 | TotalAmt |
| Management And General | $24,820 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,040 | TotalAmt |
| Management And General | $6,040 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,624 | TotalAmt |
| Program Services | $44,697 | ProgramServicesAmt |
| Management And General | $42,927 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,643 | TotalAmt |
| Program Services | $344,147 | ProgramServicesAmt |
| Management And General | $92,496 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,568 | TotalAmt |
| Program Services | $160,875 | ProgramServicesAmt |
| Management And General | $19,693 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,057 | TotalAmt |
| Program Services | $15,213 | ProgramServicesAmt |
| Management And General | $3,844 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,938 | TotalAmt |
| Management And General | $11,938 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,407 | TotalAmt |
| Program Services | $94,802 | ProgramServicesAmt |
| Management And General | $11,605 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,251 | TotalAmt |
| Program Services | $5,251 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $682,646 | $682,646 | |
| VACCINES | $444,966 | $444,966 | |
| FEDERAL GRANT REIMBURSE | $57,841 | $57,841 | |
| PROFESSIONAL DUES | $50,736 | $39,988 | $10,748 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,789 | TotalAmt |
| Program Services | $17,789 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,921,555 | TotalAmt |
| Program Services | $7,259,305 | ProgramServicesAmt |
| Management And General | $1,662,250 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,688 | BOYAmt |
| EOY | $65,648 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,022 | BOYAmt |
| EOY | $2,005 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,236,659 | BOYAmt |
| EOY | $107,112 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $835,080 | BOYAmt |
| EOY | $672,809 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,248 | BOYAmt |
| EOY | $162,019 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $263,616 | BOYAmt |
| EOY | $384,479 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,972,938 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $747,983 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,628,319 | BOYAmt |
| EOY | $3,224,955 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,220,632 | BOYAmt |
| EOY | $4,619,027 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $512,392 | BOYAmt |
| EOY | $749,250 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $58,691 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $286 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,689 | BOYAmt |
| EOY | $488,263 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $764,081 | BOYAmt |
| EOY | $1,296,490 | 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 | $2,051,227 | BOYAmt |
| EOY | $3,181,809 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,405,324 | BOYAmt |
| EOY | $140,728 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,456,551 | BOYAmt |
| EOY | $3,322,537 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,220,632 | BOYAmt |
| EOY | $4,619,027 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$164,621 | ReconcilationRevenueExpnssAmt |
| Donated Services And Use Fclts | $30,676 | DonatedServicesAndUseFcltsAmt |
| Other Changes In Net Assets | -$69 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $440,287 | OtherCostOrOtherBasisAmt |
| Book Value | $440,287 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,470,893 | OtherCostOrOtherBasisAmt |
| Depreciation | $118,674 | DepreciationAmt |
| Book Value | $1,352,219 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $766,352 | OtherCostOrOtherBasisAmt |
| Depreciation | $327,597 | DepreciationAmt |
| Book Value | $438,755 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $874,071 | OtherCostOrOtherBasisAmt |
| Depreciation | $170,590 | DepreciationAmt |
| Book Value | $703,481 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $421,335 | OtherCostOrOtherBasisAmt |
| Depreciation | $131,122 | DepreciationAmt |
| Book Value | $290,213 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,224,955 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,817,775 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $118,682 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$57,841 | OtherRevenueAmt |
| Revenue Not Reported | $60,841 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,756,934 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,756,934 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,951,789 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $88,006 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | -$57,772 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $30,234 | ExpensesNotReportedAmt |
| Expenses Subtotal | $8,921,555 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,921,555 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | REPRESENTS UNCLAIMED PROPERTY NOT YET REMITTED TO STATE OF INDIANA. |
| PART X, LINE 2: | THE ORGANIZATION IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT THE ORGANIZATION IS NOT A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A). THE INCOME TAXES TOPIC, FASB ASC 740, CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. ASC 740 REQUIRES AN ENTITY TO DISCLOSE THE NATURE OF UNCERTAIN TAX POSITIONS TAKEN, IF ANY, WHEN FILING ITS INCOME TAX RETURN UTILIZING A TWO-STEP PROCESS TO RECOGNIZE AND MEASURE ANY UNCERTAIN TAX POSITIONS TAKEN. THE ENTITY RECOGNIZES A TAX BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THE POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. NO TAX BENEFIT WILL BE RECORDED ON TAX POSITIONS NOT MEETING THE MORE LIKELY THAN NOT TEST. INTEREST AND PENALTIES ACCRUED OR INCURRED, IF ANY, AS A RESULT OF APPLYING ASC 740 WILL BE RECORDED TO INTEREST EXPENSE AND OTHER EXPENSE, RESPECTIVELY. BASED ON ITS EVALUATION, THE ORGANIZATION HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS REQUIRING RECOGNITION IN ITS FINANCIAL STATEMENTS. THE ORGANIZATION'S EVALUATION WAS PERFORMED FOR ALL FEDERAL AND STATE TAX PERIODS STILL SUBJECT TO EXAMINATION. THE ORGANIZATION'S 2017 THROUGH 2019 FEDERAL AND STATE EXEMPT ORGANIZATION RETURNS REMAIN SUBJECT TO EXAMINATION BY THE IRS AND STATE TAXING AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | FEDERAL GRANT REPAYMENT |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE FEDERAL GRANT REPAYMENT |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHOLARSHIP AMERICA INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 113 ISLAND VIEW DRIVE | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46526 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 464993820 | RecipientEIN |
| IRC Section | 501(C)3 | IRCSectionDesc |
| Cash Grant | $5,000 | CashGrantAmt |
| Purpose Of Grant | NEIGHBORHOOD GOSHEN HIGH SCHOOL SCHOLARSHIPS | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | EACH YEAR THE ORGANIZATION GIVES $5,000 TO GOSHEN HIGH SCHOOL'S DOLLARS FOR SCHOLARS PROGRAM. THE RECIPIENTS ARE CHOSEN BY THE DOLLARS FOR SCHOLARS SCHOLARSHIP COMMITTEE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES NELSON GINGERICH | ||||||||||||||
| GUARDIAN OF VISION | $164,981 | $0 | $0 | $0 | $0 | $0 | $13,198 | $0 | $5,172 | $0 | $183,351 | $0 | $0 | $0 |
| THOMAS KREIDER | ||||||||||||||
| PSYCHIATRIST | $148,099 | $0 | $0 | $0 | $3,200 | $0 | $9,146 | $0 | $7,271 | $0 | $167,716 | $0 | $0 | $0 |
| STEPHEN HARMON | ||||||||||||||
| GUARDIAN OF MEDICAL SERVICE | $134,170 | $0 | $0 | $0 | $0 | $0 | $10,734 | $0 | $10,127 | $0 | $155,031 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE GUARDIAN OF VISION'S COMPENSATION IS SET USING THE SAME STANDARD MCHCC / VCHC WAGE SCALE USED FOR ESTABLISHING COMPENSATION FOR ALL OF OUR STAFF. THIS WAGE SCALE FACTORS IN: EDUCATION AND TRAINING, EXPERIENCE, LANGUAGE, CALL (IF APPLICABLE) AND MOST IMPORTANTLY RESPONSIBILITY LEVEL. EACH FACTOR IS ASSIGNED A POINT VALUE WHICH THEN TRANSLATES INTO HOURLY WAGE AMOUNTS. ALL NEW STAFF LEVELS ARE EVALUATED BY TWO STAFF MEMBERS AND A WRITTEN EMPLOYMENT CONTRACT IS ISSUED. IN SUBSEQUENT YEARS, ALL STAFF RECEIVE A LETTER INDICATING THEIR ANNUAL PAY INCREASE. ANNUAL INCREASES ARE BASED ON EXPERIENCE RAISES (THOUGH DR. GINGERICH HAS MAXED OUT THIS CATEGORY) AND ANNUAL COST OF LIVING RAISES. | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 12 | ContributionCnt |
| Noncash Contributions Rpt F990 | $302,669 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | EQUIPMENT | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $54,800 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION'S MEMBERSHIP INCLUDES HEALTH CARE CENTER STAFF AND PATIENTS AND IS OPEN TO ANYONE ELSE INTERESTED IN FURTHERING THE PURPOSE OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS ON THE BOARD OF DIRECTORS APPOINT NEW MEMBERS TO THE BOARD OF DIRECTORS AFTER A CONSULTATION PROCESS. |
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT OF THE FORM 990 IS EMAILED TO BOARD MEMBERS BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS REVIEWS CONFLICTS OF INTEREST ANNUALLY. STAFF IS MADE AWARE OF THE POLICY AND IN RELEVANT SITUATIONS, THE POLICY IS REVIEWED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS A POINT SYSTEM TO DETERMINE SALARY LEVELS FOR ALL STAFF INCLUDING ALL MANAGEMENT PERSONNEL. THE POINT SYSTEM IS BASED ON: EDUCATION, EXPERIENCE, LANGUAGE ABILITY, RESPONSIBILITY LEVEL, AND WHETHER OR NOT THEY HAVE CALL RESPONSIBILITIES. |
| 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 XI, LINE 9: | BAD DEBT EXPENSE -69. |
| PAGE 12, LINE 2C | THE ORGANIZATION DOES HAVE A COMMITTEE THAT OVERSEES THE FINANCIAL STATEMENT PREPARATION PROCESS AND THE SELECTION OF EXTERNAL ACCOUNTANTS. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHSIDE COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 808 NORTH THIRD STREET | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46528 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 473368774 | EIN |
| Primary Activities | TO PROVIDE HEALTH CARE IN THE GOSHEN, INDIANA COMMUNITY | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAPLE CITY HEALTH CARE CENTER INC DBA VISTA COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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