2020-11-13T16:54:56-06:00 2019-12-31 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-01-01 432016287 MT ENTERPRISE COMMUNITY HEALTH CLINIC MTEN 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 KENNETH WHITE CEO 9033928203 2020-11-02 1 KURT BENNION P01469618 4252506100 2020-11-02 67.137.57.251 2020-11-02 22:21:33 PS P 87E3409653555B290C86EAF0E3FAB606BDED7821 AFCD7F9A41873079145CE562B0D1596B0D4DEB3A 2019 2021-01-29 14:40:06Z CROSSROADS FAMILY CARE KENNETH WHITE PO BOX 489 MT ENTERPRISE TX 75681 4868036 0 X HTTPS://CROSSROADSFAMILYCARE.COM X 2003 TX TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 13 13 68 13 0 0 2835367 2406136 1886505 2398888 95 49 73788 62963 4795755 4868036 0 0 0 0 2884864 3464139 0 0 0 1099698 1216788 3984562 4680927 811193 187109 1763985 1927976 276964 253846 1487021 1674130 X TO PROVIDE PREVENTIVE, ACUTE, AND PRIMARY CARE TO THE LOCAL COMMUNITY. 0 1 3747240 0 2398888 AT THREE LOCATIONS (MT. ENTERPRISE, HENDERSON AND PALESTINE, TEXAS), MT. ENTERPRISE COMMUNITY HEALTH CLINIC (DBA: CROSSROADS FAMILY CARE) PROVIDES PRIMARY CARE, DENTAL, AND BEHAVIORAL HEALTH SERVICES TO ALL MEMBERS OF THE COMMUNITY, WITH AN EMPHASIS ON ENSURING MEDICAL CARE FOR THE LOW-INCOME AND UNINSURED POPULATION. IN 2019, THE HEALTH CENTER PROVIDED OVER 22,000 VISITS TO THE OVER 7,500 PATIENTS SERVED. 43% OF THESE PATIENTS DID NOT HAVE INSURANCE AT THE TIME OF THEIR VISIT AND 37% WERE BELOW 100% OF THE FEDERAL POVERTLY LEVEL. 3747240 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 13 0 68 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 0 X JESTIN STOWE 9033928203 PO BOX 489 MT ENTERPRISE TX 75681 RAYMOND JORDAN DO PROVIDER 40.00 X 164511 0 4554 ROBIN WATSON PMHNP-BC PROVIDER 40.00 X 133100 0 11288 BROOKE MARTIN APRN FNP-C PROVIDER 40.00 X 127965 0 6054 LACEE PIERCE APRN FNP-C PROVIDER 40.00 X 125392 0 5016 KENNETH WHITE CEO 40.00 X 106877 0 10363 PATRICIA EDWARDS PA-C PROVIDER 40.00 X 114519 0 1555 JESTIN STOWE CFO 40.00 X 19138 0 629 JULIE STOWE CFO (THROUGH SEPTEMBER 2019) 7.00 X 0 0 0 BECKY ELDRIDGE PRESIDENT 1.00 X X 0 0 0 LEO GONZALEZ VICE PRESIDENT 1.00 X X 0 0 0 JOHN GRUBBS SECRETARY 1.00 X X 0 0 0 TOM VAUGHT TREASURER & BOARD MEMBER 1.00 X X 0 0 0 MICHELLE SIMMONS BOARD MEMBER & TREASURER 1.00 X X 0 0 0 PATSY FOGLEMAN BOARD MEMBER 1.00 X 0 0 0 MATT GHOLSON BOARD MEMBER 1.00 X 0 0 0 HARVEY GRAVES BOARD MEMBER 1.00 X 0 0 0 MAMIE HODGE BOARD MEMBER 1.00 X 0 0 0 POLLY VARDEMAN BOARD MEMBER 1.00 X 0 0 0 RD WHITTNER BOARD MEMBER 1.00 X 0 0 0 JEAN WILLIAMS BOARD MEMBER 1.00 X 0 0 0 JOYCE YBARRA BOARD MEMBER 1.00 X 0 0 0 791502 0 39459 9 0 1 0 GENESIS PRIMECARE 1500 W GRAND STREET MARSHALL TX 75670 BILLING/CFO SERVICES 180243 DOUBLE EAGLE CONSTRUCTION 302 HIGHWAY 43 HENDERSON TX 75652 GENERAL CONTRACTOR 156234 MEDCON PO BOX 935 FORNEY TX 75126 MEDICAL SUPERVISION (CMO) SERVICES 114000 3 2396836 9300 68668 2406136 MEDICAL SERVICE INCOME 624100 2398888 2398888 2398888 49 49 OTHER REVENUE 624110 62963 62963 62963 4868036 2398888 0 63012 X 137007 137007 2810992 2576349 234643 56680 47231 9449 248979 195488 53491 210481 161338 49143 3870 3870 547377 447755 99622 12 12 166036 27013 139023 79962 67300 12662 134990 59406 75584 55354 4721 50633 45913 20551 25362 5626 5626 55136 44138 10998 13433 13433 MEDICAL SUPPLIES 87813 87813 REPAIRS & MAINTENANCE 15637 3450 12187 DUES & SEMINARS 5629 4687 942 4680927 3747240 933687 0 467915 487400 9383 95229 92103 28790 32700 2400738 1084965 1162668 1315773 1763985 1927976 146607 169689 130357 84157 276964 253846 X 1487021 1674130 1487021 1674130 1763985 1927976 187109 0 X 0 1 X 1 0 X 1937836 1644094 1972114 2835367 2406136 10795547 1937836 1644094 1972114 2835367 2406136 10795547 10795547 50 75 95 49 269 6302 5389 17198 73788 62963 165640 10961456 8558828 0.98490 0.98940 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 34320 34320 1290747 107969 1182778 573912 552086 21826 501759 424910 76849 1315773 X 4868036 0 4868036 0 4868036 4680927 0 4680927 0 4680927 PART X, LINE 2: THE ORGANIZATION HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE ORGANIZATION EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2019 AND 2018, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. ALL TAX EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE, AND OTHER APPLICABLE STATE STATUTES. X X 0 0 0 0 0 0 0 0 0 RAYMOND JORDAN DO PROVIDER 164511 0 0 0 0 0 0 0 4554 0 169065 0 0 0 X 12 68668 INVOICE PRICE 0 0 0 0 FORM 990, PART III, LINE 3 IN 2019, THE ORGANIZATION'S DENTAL CLINIC EXPANDED FROM FOUR CHAIRS TO EIGHT CHAIRS, DOUBLING THE NUMBER OF PEOPLE WHO CAN BE SERVED, IN A STATE-OF-THE-ART CLINIC SPACE. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD AND THE CEO. THE EXECUTIVE COMMITTEE SERVES IN PLACE OF THE FULL BOARD IN EMERGENCY SITUATIONS WHEN A FULL BOARD QUORUM AT AN EMERGENCY MEETING CANNOT BE PRESENT. THE EXECUTIVE COMMITTEE ALSO REVIEWS CERTAIN PROSPECTIVE BUSINESS TRANSACTIONS AND MAKES RECOMMENDATIONS ON SUCH MATTERS TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 FINANCIAL MANAGEMENT SERVICES (THE CFO POSITION) WERE PROVIDED BY GENESIS PRIME CARE THROUGH OCTOBER 2019, AT WHICH TIME A FULL-TIME CFO AS HIRED. MEDICAL MANAGEMENT SERVICES (THE CMO POSITION) WERE PROVIDED BY MEDCON. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CFO AND THE FINANCE COMMITTEE AND PROVIDED TO THE BOARD OF DIRECTORS BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST FORMS ARE COMPLETED EVERY YEAR BY BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES. FORMS RECEIVED ARE REVIEWED BY THE CFO AND FINANCE COMMITTEE AND MONITORED AS NECESSARY. NO BOARD MEMBER MAY VOTE ON ANY MATTER IN WHICH THEY HAVE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE COMPENSATION OF THE CEO IS DISCUSSED AT LENGTH BY THE BOARD OF DIRECTORS YEARLY. AS PART OF THEIR ANNUAL EVALUATION/REVIEW OF THE CEO, THEY REVIEW WHETHER ESTABLISHED GOALS WERE MET AND REVIEW COMPENSATION IN COMPARISON WITH OTHER COMMUNITY HEALTH ORGANIZATION CEO'S WITH THE HELP OF AN ANNUAL SALARY COMPARISON REPORT ISSUED BY THE NATIONAL ORGANIZATION OF COMMUNITY HEALTH ORGANIZATIONS. ALL OF THESE DISCUSSIONS ARE DOCUMENTED IN THE ORGANIZATION'S BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 447,755. MANAGEMENT AND GENERAL EXPENSES 99,622. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 547,377.