2021-10-15T15:19:36-05:00 2020-12-31 481032601 ALLEN GIBBS & HOULIK LC 301 N MAIN SUITE 1700 WICHITA KS 672024868 990 2020-01-01 481159633 GRACEMED HEALTH CLINIC INC GRAC 3168662000 1150 N BROADWAY AVE WICHITA KS 67214 VENUS LEE CEO 3168662011 2021-10-11 1 VENUS LEE 999009999 D SHAWN SULLIVAN P00287292 3162677231 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z VENUS LEE 1150 N BROADWAY AVE WICHITA KS 67214 41820721 0 X WWW.GRACEMED.ORG X 1979 KS TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 11 11 450 80 0 0 9531593 13492489 18811832 17383630 234118 75675 62768 2800417 28640311 33752211 0 0 0 0 18809036 20048438 0 0 211351 7725625 8374013 26534661 28422451 2105650 5329760 29108064 34999936 2760704 3005474 26347360 31994462 TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 0 0 23247440 20186987 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 23247440 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 44 0 1 450 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 KS X DAVID WUTHNOW 3168662049 1150 N BROADWAY AVE WICHITA KS 67214 ROB DAKIN BOARD MEMBER 4.00 X 0 0 0 MARLON KING TREASURER 4.00 X X 0 0 0 FRANK CHORIEGO BOARD MEMBER 4.00 X 0 0 0 FRED ERVIN BOARD MEMBER 4.00 X 0 0 0 JULIE HEDRICK SECRETARY 4.00 X X 0 0 0 TIM NORTON BOARD MEMBER 4.00 X 0 0 0 RON STEPHEN PRESIDENT 4.00 X X 0 0 0 LAZARO VASQUEZ VICE PRESIDENT 4.00 X X 0 0 0 RICK WOODS BOARD MEMBER 4.00 X 0 0 0 MORLEY HEALY BOARD MEMBER 4.00 X 0 0 0 CAROLYN WARD BOARD MEMBER 4.00 X 0 0 0 JULIE A ELDER CHIEF MEDICAL OFFICER 40.00 X 264039 0 16215 VENUS L LEE CEO FROM 1/23/20 TO 12/31/20 40.00 X 203091 0 6557 DAVID WUTHNOW CHIEF FINANCIAL OFFICER 40.00 X 122841 0 14898 DAVID SANFORD CEO FROM 1/1/20 TO 1/22/20 40.00 X 70537 0 939 ERIC DESHAZER CHIEF DENTAL OFFICER 40.00 X 184410 0 16709 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYEE 40.00 X 165402 0 15607 BILLY RICHARDSON HIGHLY COMPENSATED EMPLOYEE 40.00 X 211345 0 16424 REGAN M DEHART HIGHLY COMPENSATED EMPLOYEE 40.00 X 189422 0 14951 LANCE A JEPSON HIGHLY COMPENSATED EMPLOYEE 40.00 X 191128 0 11868 JOYCE M ALLEN HIGHLY COMPENSATED EMPLOYEE 40.00 X 212825 0 13107 1815040 0 127275 27 0 1 0 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 600550241 MEDICAL/DENTAL EQUIPMENT AND SUPPLIES 616759 MCKESSON PO BOX 848442 DALLAS TX 752848442 340B PHARMACEUTICALS 461979 SINOCHIPS KANSAS LLC 2002 W 39TH AVE SUITE G029 KANSAS CITY KS 66103 COVID TESTING 328226 QUEST DIAGNOSTICS PO BOX 772976 CHICAGO IL 60677 MEDICAL LAB 319714 COX COMMUNICATIONS PO BOX 248871 OKLAHOMA CITY OK 73124 PHONE & DATA COMMUNICATIONS 234607 12 69221 10270269 3152999 1745578 13492489 MEDICAL & DENTAL SERVICES 621110 17383630 17383630 17383630 209197 209197 7923895 8057417 -133522 -133522 -133522 8153 69221 11093 -2940 -2940 PPP LOAN REVENUE 900099 2521500 2521500 COVID CREDITS 900099 186516 186516 OTHER MISC REVENUE 900099 95341 95341 2803357 33752211 20186987 0 72735 X 900236 734459 165777 17393977 14041195 3170032 182750 265315 219307 42321 3687 1488910 1222551 254620 11739 108987 108987 52509 52509 1094098 1051899 42199 174257 174257 179351 98756 80595 796531 630143 166388 757264 661334 95930 65977 20727 45250 1137713 912507 225206 84148 1023 83125 MEDICAL SUPPLIES 3299431 3227818 71613 REPAIRS 338853 290867 47986 MISCELLANEOUS 135910 8780 113955 13175 CONTINUING EDUCATION 85789 78545 7244 63195 47529 15666 28422451 23247440 4963660 211351 544467 144671 3160923 10012210 454350 312069 1175589 1150733 14126 12216 76503 98728 21198454 6340415 15754128 14858039 4652321 6384023 3273393 2024357 2264 2890 29108064 34999936 1788594 1449777 972110 1555697 2760704 3005474 X 26256126 31918300 91234 76162 26347360 31994462 29108064 34999936 X 5329760 317342 98217 -98217 X X 0 1 X 1 1 1 X 9487166 11113551 10130406 9490711 13492489 53714323 9487166 11113551 10130406 9490711 13492489 53714323 53714323 19328 49734 146131 243162 209197 667552 54381875 77536180 0.98770 0.98920 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 622330 622330 10471389 1241213 9230176 5266270 1705791 3560479 4781376 3393411 1387965 57089 57089 14858039 CERTIFICATES OF DEPOSIT 2024357 C 2024357 34126354 317342 98217 11093 426652 33699702 52509 52509 33752211 28479252 98217 11093 109310 28369942 52509 52509 28422451 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 11,093. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 11,093. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES REPORTED AS INCOME ON FINANCIAL STATEMENTS 52,509. 5K RACE 39928 31775 8153 5990 938 HOTCAKES FUNDRAISER 37446 37446 4165 77374 69221 8153 5990 5103 11093 -2940 X X 1 0 0 0 0 0 0 0 0 JULIE A ELDER CHIEF MEDICAL OFFICER 264039 0 0 0 0 0 8160 0 8055 0 280254 0 0 0 BILLY RICHARDSON HIGHLY COMPENSATED EMPLOYEE 211345 0 0 0 0 0 5551 0 10873 0 227769 0 0 0 JOYCE M ALLEN HIGHLY COMPENSATED EMPLOYEE 212825 0 0 0 0 0 6601 0 6506 0 225932 0 0 0 VENUS L LEE CEO FROM 1/23/20 TO 12/31/20 203091 0 0 0 0 0 6143 0 414 0 209648 0 0 0 REGAN M DEHART HIGHLY COMPENSATED EMPLOYEE 189422 0 0 0 0 0 5957 0 8994 0 204373 0 0 0 LANCE A JEPSON HIGHLY COMPENSATED EMPLOYEE 191128 0 0 0 0 0 995 0 10873 0 202996 0 0 0 ERIC DESHAZER CHIEF DENTAL OFFICER 184410 0 0 0 0 0 5836 0 10873 0 201119 0 0 0 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYEE 165402 0 0 0 0 0 4734 0 10873 0 181009 0 0 0 PART I, LINE 4A DAVID SANFORD RECEIVED $46,027.20 OF SEVERANCE PAY IN 2020. CHAD SANFORD SON OF CEO 61447 CHAD SANFORD IS THE SON OF DAVID SANFORD, CEO OF GRACEMED UNTIL 1/22/2020. CHAD IS AN EMPLOYEE OF GRACEMED. 0 X 38138 1728420 AVG. PER UNIT CDC PRICE X DENTAL KITS & SUPPLIES 10080 17157 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HIRES AN OUTSIDE CPA TO PREPARE THE FINANCIAL STATEMENT AUDIT AND THE FORM 990 EACH YEAR. AFTER THE CPA HAS COMPLETED BOTH THE AUDIT AND FORM 990, THE CFO FOR THE ORGANIZATION AND THE CPA REVIEW THE INITIAL DRAFT OF THE RETURN TO ENSURE ITS COMPLETENESS AND ACCURACY. FOLLOWING THE REVIEW, THE FORM 990 IS COMPLETED AND THE ORGANIZATION FILES THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL & CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,051,899. MANAGEMENT AND GENERAL EXPENSES 42,199. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,094,098. FORM 990, PART IX, LINE 24E DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 20,057. MANAGEMENT AND GENERAL EXPENSES 14,919. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,976. STAFF RECRUITING: PROGRAM SERVICE EXPENSES 27,472. MANAGEMENT AND GENERAL EXPENSES 747. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,219. FORM 990, PART XI, LINE 9: DONATED SERVICES AND USE OF FACILITIES EXPENSES -98,217. FORM 990, PART XII, LINE 2C THIS POLICY HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART XI, LINE 5 & SCH D, PART XI, LINE 2A REALIZED/UNREALIZED GAIN LOSS ON AUDIT REPORT FOOTNOTE AND THE AMOUNTS REPORTED ON FORM 990 DO NOT MATCH DUE TO THE USE OF DIFFERENT REPORTING METHODS BETWEEN THE AUDIT REPORT AND THE 990.