INFINITY HEALTH: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- INFINITY HEALTH (EIN 39-1908462)
- Tax period
- 2018-12-01 to 2019-11-30
- Filed
- 2020-10-14
- IRS object ID
- 202002889349301940
- Schema version
- 2018v3.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-10-14T21:32:57-05:00 | ReturnTs |
| Tax Period End | 2019-11-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 WEST 22ND STREET SUITE 1100 | AddressLine1Txt |
| City | OAK BROOK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-12-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391908462 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH CENTERS OF | BusinessNameLine1Txt |
| Business Name Line2 | SOUTHERN IOWA | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 6414462383 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 302 NE 14TH STREET | AddressLine1Txt |
| City | LEON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50144 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SAMANTHA CANNON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6414462383 | PhoneNum |
| Signature | 2020-10-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CHRIS MANDERFIELD | PreparerPersonNm |
| PTIN | P01238973 | PTIN |
| Phone | 6305738600 | PhoneNum |
| Preparation | 2020-10-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-13 | IPDt |
| IP Tm | 14:05:12 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 818A38AF944F766214C5223DB74141538F6091E6 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | DBDBF52EAC2BB495685EFE5302A3527750B2664D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SAMANTHA CANNON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 302 NE 14TH STREET | AddressLine1Txt |
| City | LEON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50144 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,874,065 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHCSI.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | CHCSI PROVIDES ACCESSIBLE, HIGH-QUALITY HEALTH CARE TO EVERYONE IN OUR REGION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 143 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,274,727 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,261,131 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,841,536 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,384,243 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$9,347 | PYInvestmentIncomeAmt |
| CY Investment Income | -$7,028 | CYInvestmentIncomeAmt |
| PY Other Revenue | $112,716 | PYOtherRevenueAmt |
| CY Other Revenue | $1,201 | CYOtherRevenueAmt |
| PY Total Revenue | $11,219,632 | PYTotalRevenueAmt |
| CY Total Revenue | $13,639,547 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,162 | 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 | $6,690,537 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,297,608 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,339,386 | PYOtherExpensesAmt |
| CY Other Expenses | $3,771,723 | CYOtherExpensesAmt |
| PY Total Expenses | $10,034,085 | PYTotalExpensesAmt |
| CY Total Expenses | $12,069,331 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,185,547 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,570,216 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,902,536 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,027,120 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,180,008 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,687,099 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,722,528 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,340,021 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CHCSI PROVIDES ACCESSIBLE, HIGH-QUALITY HEALTH CARE TO EVERYONE IN OUR REGION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,084,897 | ExpenseAmt |
| Revenue | $4,007,639 | RevenueAmt |
| Desc | COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA (CHCSI) WAS FUNDED AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) IN DECATUR COUNTY, IOWA, IN 2005. TODAY, CHCSI MANAGES TEN LOCATIONS, TWO OF WHICH PROVIDE PRIMARY AND PREVENTIVE HEALTH CARE SERVICES. THE REGION SERVED IS INCREDIBLY RURAL, AND ACCESSIBILITY CAN OFTEN PRESENT A BARRIER TO HEALTH CARE. THE COMMUNITIES SERVED ARE IN GREAT NEED OF THE ACCESSIBLE, AFFORDABLE PRIMARY AND PREVENTIVE HEALTH CARE, AND THE ORGANIZATION IS COMMITTED TO ENSURING THAT THE COMMUNITIES' NEEDS ARE MET. THE ORGANIZATION CURRENTLY SERVES 10,000 UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 23,000 VISITS ARE FOR MEDICAL SERVICES. THE ORGANIZATION CURRENTLY HAS 7 FTE MEDICAL PROVIDERS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,832,053 | ExpenseAmt |
| Revenue | $3,759,577 | RevenueAmt |
| Desc | COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA IS THE ONLY FQHC IN THE STATE OF IOWA THAT HAS ALSO RECEIVED THE DESIGNATION OF BEING A COMMUNITY MENTAL HEALTH CENTER (CMHC). CHCSI CURRENTLY PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN THE IOWA COUNTIES OF APPANOOSE, LUCAS, MONROE, WAYNE, AND DECATUR. TELEMEDICINE SERVICES ARE PROVIDED IN FIVE OF THE SIX LOCATIONS. THE ORGANIZATION CURRENTLY SERVES 10,000 UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 25,000 VISITS ARE FOR BEHAVIORAL HEALTH SERVICES AND 2,000 ARE FOR SUBSTANCE ABUSE SERVICES. THE ORGANIZATION CURRENTLY HAS 25 FTE BEHAVIORAL PROVDERS AND 4 FTE SUBSTANCE ABUSE PROVIDERS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $508,506 | ExpenseAmt |
| Revenue | $498,889 | RevenueAmt |
| Desc | DENTAL SERVICES: COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA BEGAN PROVIDING ORAL HEALTH SERVICES IN THE LEON, IOWA FACILITY IN JANUARY 2011. THE ORGANIZATION CURRENTLY SERVES 10,000, UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 3,000 VISITS ARE FOR DENTAL SERVICES. THE ORGANIZATION CURRENTLY HAS 3 FTE DENTAL PROVIDERS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (2 entries)
| ExpenseExpenseAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|
| $47,461 | $46,563 | COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA BEGAN PROVIDING VISION SERVICES IN 2016. THE ORGANIZATION CURRENTLY SERVES APPROXIMATELY 10,000 UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 300 ARE FOR VISION SERVICES. THE ORGANIZATION CURRENTLY HAS .07 FTE VISION PROVIDERS. |
| $1,084,486 | $1,063,975 | CHCSI BEGAN PROVIDING IN HOUSE PHARMACY SERVICES IN THE LEON, IOWA FACILITY IN 2017. THE ORGANIZATION CURRENTLY HAS 2.25 FTE PHARMACISTS. IN 2019, APPROXIMATELY 20,500 PRESCRIPTIONS WERE DISPENSED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,131,947 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $1,110,538 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $9,557,403 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 43 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 143 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | IA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SAMANTHA CANNON | PersonNm |
| Phone | 6414462383 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 302 NE 14TH STREET | AddressLine1Txt |
| City | LEON | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50144 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 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 |
|---|---|---|---|---|---|---|---|
| SHIRLEY KESSEL | |||||||
| BOARD PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHARON SOUTH | |||||||
| BOARD VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARCY BIESEMEYER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA BAYNES | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JUSTIN AKERS | |||||||
| BOARD TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DIEN JUDGE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALAN WILSON | |||||||
| AT-LARGE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK WAITS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALAN DYKENS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PATRICIA MAGLE LEFT 819 | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL MORAIN | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JONATHAN ERB 1019 | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RACHEL CECIL 519 | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SAMANTHA CANNON | |||||||
| CEO | 40.00 | Yes (X) | $134,116 | $0 | $5,965 | ||
| JANEEN EDDY | |||||||
| CCO | 40.00 | Yes (X) | $86,751 | $0 | $4,070 | ||
| JANELLE ANDERS | |||||||
| CFO | 40.00 | Yes (X) | $11,055 | $0 | $1,042 | ||
| DR ROSHAN DASARI | |||||||
| PSYCHIATRIST | 40.00 | $313,590 | $0 | $13,144 | Yes (X) | ||
| DR LARRY RICHARD | |||||||
| MD | 40.00 | $229,001 | $0 | $9,760 | Yes (X) | ||
| DR NATHAN ALLEN | |||||||
| DO | 40.00 | $209,849 | $0 | $8,994 | Yes (X) | ||
| DR MARK EASTER | |||||||
| DO | 40.00 | $210,004 | $0 | $9,000 | Yes (X) | ||
| JENNIFER SPOERL | |||||||
| ARNP | 40.00 | $164,912 | $0 | $7,196 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,359,278 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $59,171 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | 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 |
|---|---|---|---|---|---|
| INTEGRATED TELEHEALTH PARTNERS | |||||
| 318 5TH STREET | WEST DES MOINES | IA | 50265 | TELEHEALTH SERVICES | $415,386 |
| JAMES BROOKS | |||||
| PO BOX 1030 | KALAHEO | HI | 96741 | CONTRACT DOCTOR | $183,240 |
| BKD LLP | |||||
| 910 E ST LOUIS STREET SUITE 400 | SPRINGFIELD | MO | 65806 | ACCOUNTING | $130,883 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,170,675 | GovernmentGrantsAmt |
| All Other Contributions | $90,456 | AllOtherContributionsAmt |
| Total Contributions | $4,261,131 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621400 | $9,202,960 | $9,202,960 |
| OTHER REVENUE | 621400 | $181,283 | $181,283 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,384,243 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $572 | TotalRevenueColumnAmt |
| Exclusion | $572 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,201 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,201 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,201 | TotalRevenueColumnAmt |
| Exclusion | $1,201 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $226,918 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $234,518 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$7,600 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,600 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$7,600 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,639,547 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,376,643 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,773 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243,000 | TotalAmt |
| Management And General | $243,000 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,564,767 | TotalAmt |
| Program Services | $5,125,163 | ProgramServicesAmt |
| Management And General | $1,439,604 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,012 | TotalAmt |
| Program Services | $117,528 | ProgramServicesAmt |
| Management And General | $45,484 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $811,992 | TotalAmt |
| Program Services | $585,430 | ProgramServicesAmt |
| Management And General | $226,562 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $514,837 | TotalAmt |
| Program Services | $393,558 | ProgramServicesAmt |
| Management And General | $121,279 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,770 | TotalAmt |
| Program Services | $16,770 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,639 | TotalAmt |
| Program Services | $23,639 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $937,887 | TotalAmt |
| Program Services | $664,870 | ProgramServicesAmt |
| Management And General | $273,017 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,041 | TotalAmt |
| Program Services | $66,041 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,165 | TotalAmt |
| Program Services | $132,888 | ProgramServicesAmt |
| Management And General | $63,277 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $404,654 | TotalAmt |
| Program Services | $404,654 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171,647 | TotalAmt |
| Program Services | $171,647 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,219 | TotalAmt |
| Program Services | $85,728 | ProgramServicesAmt |
| Management And General | $41,491 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,025 | TotalAmt |
| Program Services | $95,025 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,369 | TotalAmt |
| Program Services | $39,453 | ProgramServicesAmt |
| Management And General | $8,916 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $460,850 | TotalAmt |
| Program Services | $411,552 | ProgramServicesAmt |
| Management And General | $49,298 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,819 | TotalAmt |
| Program Services | $62,819 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES, DRUGS | $890,956 | $890,956 |
| REPAIRS AND MAINTENANCE | $117,061 | $117,061 |
| DUES AND SUBSCRIPTIONS | $80,804 | $80,804 |
| MISCELLANEOUS EXPENSES | $61,445 | $61,445 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,372 | TotalAmt |
| Program Services | $10,372 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,069,331 | TotalAmt |
| Program Services | $9,557,403 | ProgramServicesAmt |
| Management And General | $2,511,928 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $130,499 | BOYAmt |
| EOY | $81,703 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,304 | BOYAmt |
| EOY | $105,973 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,703 | BOYAmt |
| EOY | $192,763 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $761,108 | BOYAmt |
| EOY | $742,803 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $217,644 | BOYAmt |
| EOY | $264,900 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,128 | BOYAmt |
| EOY | $54,421 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,910,767 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,492,346 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,483,289 | BOYAmt |
| EOY | $6,418,421 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,861 | BOYAmt |
| EOY | $166,136 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,902,536 | BOYAmt |
| EOY | $8,027,120 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,015,362 | BOYAmt |
| EOY | $1,929,620 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,164,646 | BOYAmt |
| EOY | $757,479 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,180,008 | BOYAmt |
| EOY | $2,687,099 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,710,110 | BOYAmt |
| EOY | $5,252,603 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,418 | BOYAmt |
| EOY | $87,418 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,722,528 | BOYAmt |
| EOY | $5,340,021 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,902,536 | BOYAmt |
| EOY | $8,027,120 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,570,216 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $47,277 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,272,808 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,728,503 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,335,002 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,274,727 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,261,131 | CurrentTaxYearAmt |
| Total | $12,872,171 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,272,808 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,728,503 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,335,002 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,274,727 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,261,131 | CurrentTaxYearAmt |
| Total | $12,872,171 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $12,872,171 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,613 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,217 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,439 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,533 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,773 | CurrentTaxYearAmt |
| Total | $10,575 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $12,882,746 | TotalSupportAmt |
| Public Support CY170 | 0.99920 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99200 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,440 | OtherCostOrOtherBasisAmt |
| Book Value | $19,440 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,757,839 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,258,249 | DepreciationAmt |
| Book Value | $3,499,590 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $83,045 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,297 | DepreciationAmt |
| Book Value | $54,748 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,782,564 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,205,800 | DepreciationAmt |
| Book Value | $576,764 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,267,879 | OtherCostOrOtherBasisAmt |
| Book Value | $2,267,879 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,418,421 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,639,547 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,639,547 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,639,547 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,069,331 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,069,331 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,069,331 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS TAX-EXEMPT UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND NOT A PRIVATE FOUNDATION AS DESCRIBED IN SECTION 509(A) FOR FEDERAL PURPOSES. THE ORGANIZATION IS ALSO TAX-EXEMPT UNDER IOWA STATUTES FOR STATE PURPOSES. CONSEQUENTLY, THE ORGANIZATION RECORDS NO PROVISION FOR INCOME TAXES. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. AS A RESULT OF THE APPLICATION OF THE STANDARD, THE ORGANIZATION HAS RECOGNIZED NO LIABILITY FOR UNRECOGNIZED TAX BENFITS. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. |
| SCHEDULE D, PARTI VI, LINE 1E | THE $2,267,879 OTHER LAND, BUILDING AND EQUIPMENT ASSET REPRERESNTS THE CURRENT COST OF A NEW FACILITY UNDER CONSTRUCTION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR ROSHAN DASARI | ||||||||||||||
| PSYCHIATRIST | $250,240 | $0 | $63,350 | $0 | $0 | $0 | $12,544 | $0 | $600 | $0 | $326,734 | $0 | $0 | $0 |
| DR LARRY RICHARD | ||||||||||||||
| MD | $219,401 | $0 | $9,600 | $0 | $0 | $0 | $9,160 | $0 | $600 | $0 | $238,761 | $0 | $0 | $0 |
| DR NATHAN ALLEN | ||||||||||||||
| DO | $205,849 | $0 | $4,000 | $0 | $0 | $0 | $8,394 | $0 | $600 | $0 | $218,843 | $0 | $0 | $0 |
| DR MARK EASTER | ||||||||||||||
| DO | $206,004 | $0 | $4,000 | $0 | $0 | $0 | $8,400 | $0 | $600 | $0 | $219,004 | $0 | $0 | $0 |
| JENNIFER SPOERL | ||||||||||||||
| ARNP | $160,912 | $0 | $4,000 | $0 | $0 | $0 | $6,596 | $0 | $600 | $0 | $172,108 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL BE ELECTED BY THE FULL BOARD OF DIRECTORS AND SHALL CONSIST OF THE CHAIRPERSON, VICE-CHAIRPERSON, SECRETARY, TREASURER, IMMEDIATED PAST CHAIRPERSON, AND ONE AT-LARGE MEMBER ELECTED BY THE BOARD. BETWEEN MEETING OF THE BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE SHALL, EXCEPT AS OTHERWISE PROVIDED BY LAW OR THE BYLAWS, HAVE THE POWER OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MAY ALSO MEET IN PLACE OF THE BOARD OF DIRECTORS IF DEEMED APPROPRIATE BY MAJORITY VOTE OF THE BOARD. THE COMMITTEE SHALL PROVIDE GENERAL OVERSIGHT AND SHALL PROVIDE ADVICE AND COUNSEL TO THE CHIEF EXECUTIVE OFFICER. THE COMMITTEE WILL REVIEW BYLAWS OF THE CORPORATION, AND SHALL MAKE RECOMMENDATIONS TO THE BOARD CONCERNING REVISIONS OR AMENDMENTS TO THE SAME. ACTIONS SHALL BE EXCERCISED BY A MAJORITY VOTE OF THE EXECUTIVE COMMITTEE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATIONS. PRIOR TO FILING, A DRAFT OF THE RETURN IS REVIEWED BY THE CEO. ONCE ANY UPDATES ARE MADE, A FINAL COPY IS PROVIDED TO THE FULL BOARD OF DIRECTORS FOR COMMENTS BEFORE THE RETURN IS FILED WITH IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION ANNUALLY INQUIRES INTO POTENTIAL CONFLICTS OF INTEREST AMONG INTERESTED PERSONS AND BETWEEN INTERESTED PERSONS AND THE ORGANIZATION. CONFLICTS SHOULD BE DISCLOSED PRIOR TO SPECIFIC BOARD DISCUSSIONS THAT MAY BE SENSITIVE TO ALLEGATIONS OF CONFLICT. IF A CONFLICT EXISTS, THE INTERESTED PERSON WILL REFRAIN FROM VOTING ON OR MAKING DECISIONS RELATED TO THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO SALARY IS REVIEWED BY THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. THEY USE COMPARABLE DATA FROM SALARY WEBSITES AND THE SALARY AND WAGE SURVEY DONE BY OUR STATE PRIMARY CARE ASSOCIATION. HER REVIEW AND ANNUAL INCREASE IS BASED ON HER PERFORMANCE AND WORKPLACE QUESTIONAIRE THAT IS DONE ON AN ANNUAL BASIS. THE CEO REVIEWS AND DETERMINES THE OTHER OFFICERS AND KEY EMPLOYEES SALARY AND WAGES. THE SALARY AND WAGES ARE COMPARED TO SALARY AND WAGE SURVEY DONE BY OUR STATE PRIMARY CARE ASSOCIATION AND THE INCREASE IS FROM THEIR FORMAL REVIEW. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST |