BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- BOUNDARY REGIONAL COMMUNITY HEALTH CENTER INC (EIN 04-3634356)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-10-23
- IRS object ID
- 202042979349301844
- Schema version
- 2019v5.1
- 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 L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-10-23T17:15:32-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | 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 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 043634356 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BOUNDARY REGIONAL HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BOUN | BusinessNameControlTxt |
| Phone | 2082678422 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 CEDAR STREET NO 206 | AddressLine1Txt |
| City | SANDPOINT | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83864 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KEVIN KNEPPER | PersonNm |
| Person Title | CEO/CFO | PersonTitleTxt |
| Phone | 2082678422 | PhoneNum |
| Signature | 2020-10-19 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2020-10-19 | 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 | 2020-10-19 | IPDt |
| IP Tm | 20:13:51 | IPTm |
| IP Timezone | PD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 437A48F7A65F248D0909731AA99F0A79285329FF | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KANIKSU HEALTH SERVICE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEVIN KNEPPER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 CEDAR STREET NO 206 | AddressLine1Txt |
| City | SANDPOINT | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83864 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,301,341 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KANIKSUHEALTHSERVICES.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | ID | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 196 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,602,844 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,969,709 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,395,117 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,034,534 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $353,766 | PYOtherRevenueAmt |
| CY Other Revenue | $297,098 | CYOtherRevenueAmt |
| PY Total Revenue | $13,351,727 | PYTotalRevenueAmt |
| CY Total Revenue | $14,301,341 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,692 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $9,186 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,513,440 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,064,460 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,538,348 | PYOtherExpensesAmt |
| CY Other Expenses | $4,079,212 | CYOtherExpensesAmt |
| PY Total Expenses | $13,060,480 | PYTotalExpensesAmt |
| CY Total Expenses | $14,152,858 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $291,247 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $148,483 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,820,749 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,976,861 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,147,931 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,155,560 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $672,818 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $821,301 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF KANIKSU HEALTH SERVICES IS TO PROVIDE HIGH QUALITY, COST EFFECTIVE, CULTURALLY SENSITIVE HEALTH CARE SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,118,830 | ExpenseAmt |
| Grant | $9,186 | GrantAmt |
| Revenue | $5,438,717 | RevenueAmt |
| Desc | KANIKSU HEALTH SERVICES (CENTER) PROVIDED MEDICAL VISITS TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED MEDICAL ATTENTION REGARDLESS OF A PERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,257,871 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,006,907 | RevenueAmt |
| Desc | KANIKSU HEALTH SERVICES (CENTER) PROVIDED PEDIATRIC MEDICAL VISITS TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED PEDIATRIC CARE REGARDLESS F A PERSON'S ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,964,348 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,746,009 | RevenueAmt |
| Desc | KANIKSU HEALTH SERVICES (CENTER) PROVIDED DENTAL VISITS TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED DENTAL ATTENTION REGARDLESS OF A PERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $948,305 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $842,901 | RevenueAmt |
| Desc | KANIKSU HEALTH SERVICES (CENTER) PROVIDED BEHAVIORAL HEALTH SERVICES TO THE CITIZENS OF BOUNDARY AND BONNER COUNTIES. THESE SERVICES WERE PROVIDED TO ALL WHO NEEDED BEHAVIORAL HEALTH ATTENTION REGARDLESS OF A PERSONS ABILITY TO PAY. THE CENTER UTILIZES A SLIDING FEE SCHEDULE UP TO 200% OF THE FEDERAL POVERTY GUIDELINES. FOR APPLICANTS THAT QUALIFY BASED ON INCOME AND FAMILY SIZE, A PORTION OF OR ALL THEIR CHARGES MAY BE FORGONE FOR A NOMINAL FEE OR A PERCENTAGE OF CHARGES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $948,305 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $842,901 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $11,289,354 | 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 | Yes (1) | 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 | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 196 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KEVIN KNEPPER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2082678422 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 CEDAR STREET NO 206 | AddressLine1Txt |
| City | SANDPOINT | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83864 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| SHEILA FARMIN-AUMICK | ||||||||
| CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOY JANSEN PHD | ||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MARY READER | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW WILLIAMS | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOE ENGLISH | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| PEGGY FRYE | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| DEBORAH KERR | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSH LEONARD | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KATE MCALLISTER | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KARI SNYDER | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| ASHLEY WENDLAND | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| VICTORIA MCCLELLAN KING | ||||||||
| CEO (THROUGH SEPTEMBER 2019) | 40.00 | Yes (X) | $132,141 | $0 | $11,926 | |||
| KEVIN KNEPPER | ||||||||
| CEO/CFO | 40.00 | Yes (X) | $147,487 | $0 | $24,000 | |||
| AMBER VILLELLI | ||||||||
| COO | 40.00 | Yes (X) | $95,364 | $0 | $6,752 | |||
| STEPHEN CHRISTIENSEN | ||||||||
| FAMILY PRACTICE CHIEF | 36.00 | $222,035 | $0 | $26,073 | Yes (X) | |||
| HAILEY ROSE | ||||||||
| PEDIATRICS CHIEF | 40.00 | $192,078 | $0 | $20,327 | Yes (X) | |||
| ADAM WEAVER | ||||||||
| DENTAL CHIEF | 40.00 | $189,800 | $0 | $20,805 | Yes (X) | |||
| PETER KELTERBORN | ||||||||
| INTERNAL MEDICINE PHYSICIAN | 40.00 | $211,050 | $0 | $21,360 | Yes (X) | |||
| GEORGE DELAND | ||||||||
| PEDIATRICIAN | 36.00 | $195,401 | $0 | $12,328 | Yes (X) | |||
| NICK MILLER | ||||||||
| DENTIST | 40.00 | $186,967 | $0 | $7,479 | Yes (X) | |||
| TERESA KUHTA | ||||||||
| PEDIATRICIAN | 40.00 | $158,535 | $0 | $21,360 | Yes (X) | |||
| JOHN SEAMAN | ||||||||
| CHIEF MEDICAL OFFICER | 36.00 | $141,479 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,872,337 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $172,410 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| N IDAHO FAMILY PHYSICIANS | |||||
| 700 IRONWOOD DR 220E | COEUR DALENE | ID | 83814 | BILLING SERVICES | $599,629 |
| KOOTENAI HEALTH | |||||
| 2003 KOOTENAI HEALTH WAY | COEUR DALENE | ID | 83814 | SOFTWARE SUPPORT | $134,985 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,969,709 | GovernmentGrantsAmt |
| Noncash Contributions | $597,503 | NoncashContributionsAmt |
| Total Contributions | $3,969,709 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE, NET | 621110 | $8,322,968 | $8,322,968 |
| 340B PHARMACY REVENUE | 621110 | $1,711,566 | $1,711,566 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,034,534 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 561499 | BusinessCd |
| Total Revenue Column | $297,098 | TotalRevenueColumnAmt |
| Exclusion | $297,098 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $297,098 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,301,341 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,034,534 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $297,098 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,186 | TotalAmt |
| Program Services | $9,186 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,088,788 | TotalAmt |
| Program Services | $604,006 | ProgramServicesAmt |
| Management And General | $484,782 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,449,467 | TotalAmt |
| Program Services | $5,410,969 | ProgramServicesAmt |
| Management And General | $1,038,498 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,720 | TotalAmt |
| Program Services | $126,720 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,808,255 | TotalAmt |
| Program Services | $1,583,608 | ProgramServicesAmt |
| Management And General | $224,647 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $591,230 | TotalAmt |
| Program Services | $511,995 | ProgramServicesAmt |
| Management And General | $79,235 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $207,071 | TotalAmt |
| Program Services | $83,626 | ProgramServicesAmt |
| Management And General | $123,445 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,335 | TotalAmt |
| Program Services | $943 | ProgramServicesAmt |
| Management And General | $1,392 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,062,235 | TotalAmt |
| Program Services | $493,041 | ProgramServicesAmt |
| Management And General | $569,194 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,334 | TotalAmt |
| Program Services | $7,126 | ProgramServicesAmt |
| Management And General | $7,208 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,561 | TotalAmt |
| Management And General | $54,561 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $703,746 | TotalAmt |
| Program Services | $577,253 | ProgramServicesAmt |
| Management And General | $126,493 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,915 | TotalAmt |
| Program Services | $18,850 | ProgramServicesAmt |
| Management And General | $19,065 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,297 | TotalAmt |
| Program Services | $45,720 | ProgramServicesAmt |
| Management And General | $4,577 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,472 | TotalAmt |
| Program Services | $113,472 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,020 | TotalAmt |
| Program Services | $20,221 | ProgramServicesAmt |
| Management And General | $22,799 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,387,607 | $1,387,607 | |
| BAD DEBT | $170,548 | $170,548 | |
| EQUIP. MAINT. & REPAIRS | $91,200 | $73,816 | $17,384 |
| TRAINING | $62,635 | $31,140 | $31,495 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,236 | TotalAmt |
| Program Services | $19,507 | ProgramServicesAmt |
| Management And General | $58,729 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,152,858 | TotalAmt |
| Program Services | $11,289,354 | ProgramServicesAmt |
| Management And General | $2,863,504 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $408,074 | BOYAmt |
| EOY | $167,018 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $717,149 | BOYAmt |
| EOY | $1,084,110 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,234 | BOYAmt |
| EOY | $69,568 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,946,374 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,290,209 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,647,292 | BOYAmt |
| EOY | $1,656,165 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,820,749 | BOYAmt |
| EOY | $2,976,861 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $861,339 | BOYAmt |
| EOY | $1,010,270 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,286,592 | BOYAmt |
| EOY | $1,145,290 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,147,931 | BOYAmt |
| EOY | $2,155,560 | 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 | $672,818 | BOYAmt |
| EOY | $821,301 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $672,818 | BOYAmt |
| EOY | $821,301 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,820,749 | BOYAmt |
| EOY | $2,976,861 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $148,483 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,698,187 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,103,320 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,049,220 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,602,844 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,969,709 | CurrentTaxYearAmt |
| Total | $16,423,280 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,698,187 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,103,320 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,049,220 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,602,844 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,969,709 | CurrentTaxYearAmt |
| Total | $16,423,280 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $16,423,280 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $18 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1 | CurrentTaxYearMinus2YearsAmt |
| Total | $19 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $100,524 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $201,075 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $392,304 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $353,766 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $297,098 | CurrentTaxYearAmt |
| Total | $1,344,767 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $17,768,066 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $44,652,383 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.92430 | PublicSupportCY170Pct |
| Public Support PY170 | 0.91980 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS INCOME | ExplanationTxt |
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 | $266,881 | OtherCostOrOtherBasisAmt |
| Book Value | $266,881 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,844,002 | OtherCostOrOtherBasisAmt |
| Depreciation | $413,347 | DepreciationAmt |
| Book Value | $1,430,655 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $95,063 | OtherCostOrOtherBasisAmt |
| Book Value | $95,063 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $709,476 | OtherCostOrOtherBasisAmt |
| Depreciation | $876,862 | DepreciationAmt |
| Book Value | -$167,386 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,952 | OtherCostOrOtherBasisAmt |
| Book Value | $30,952 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,656,165 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,130,793 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,130,793 | RevenueSubtotalAmt |
| Other Revenues Not Included | $170,548 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $170,548 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,301,341 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,982,310 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,982,310 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $170,548 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $170,548 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,152,858 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE CENTER 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 TAXES IS SHOWN IN THE FINANCIAL STATEMENTS. MANAGEMENT EVALUATED THE CENTER'S TAX POSITIONS AND CONCLUDED THAT THE CENTER HAD TAKEN NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 170,548. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 170,548. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2: | CONTRIBUTIONS ARE MADE TO LOCAL CHARITIES AND GOVERNMENT AGENCIES. CONTRIBUTIONS ARE MADE TO OTHER ORGANIZATIONS WHOSE MISSION AND ACTIVITIES ARE CONSISTENT WITH OUR MISSION. ASIDE FROM CONFIRMING CHARITABLE OR GOVERNMENTAL STATUS OF THE RECIPIENT, WE DO NOT MONITOR HOW THE FUNDS ARE USED. |
| PART II: | NO RECIPIENT ORGANIZATION RECEIVED MORE THAN $5,000 DURING 2019. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Payments For Use Of Residence | Yes (X) | PaymentsForUseOfResidenceInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN KNEPPER | ||||||||||||||
| CEO/CFO | $147,487 | $0 | $0 | $0 | $0 | $0 | $24,000 | $0 | $0 | $0 | $171,487 | $0 | $0 | $0 |
| STEPHEN CHRISTIENSEN | ||||||||||||||
| FAMILY PRACTICE CHIEF | $222,035 | $0 | $0 | $0 | $0 | $0 | $25,000 | $0 | $1,073 | $0 | $248,108 | $0 | $0 | $0 |
| HAILEY ROSE | ||||||||||||||
| PEDIATRICS CHIEF | $192,078 | $0 | $0 | $0 | $0 | $0 | $14,711 | $0 | $5,616 | $0 | $212,405 | $0 | $0 | $0 |
| ADAM WEAVER | ||||||||||||||
| DENTAL CHIEF | $189,800 | $0 | $0 | $0 | $0 | $0 | $20,805 | $0 | $0 | $0 | $210,605 | $0 | $0 | $0 |
| PETER KELTERBORN | ||||||||||||||
| INTERNAL MEDICINE PHYSICIAN | $211,050 | $0 | $0 | $0 | $0 | $0 | $19,000 | $0 | $2,360 | $0 | $232,410 | $0 | $0 | $0 |
| GEORGE DELAND | ||||||||||||||
| PEDIATRICIAN | $195,401 | $0 | $0 | $0 | $0 | $0 | $12,328 | $0 | $0 | $0 | $207,729 | $0 | $0 | $0 |
| NICK MILLER | ||||||||||||||
| DENTIST | $186,967 | $0 | $0 | $0 | $0 | $0 | $7,479 | $0 | $0 | $0 | $194,446 | $0 | $0 | $0 |
| TERESA KUHTA | ||||||||||||||
| PEDIATRICIAN | $158,535 | $0 | $0 | $0 | $0 | $0 | $19,000 | $0 | $2,360 | $0 | $179,895 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION RENTS A CONDOMINIUM FROM GEORGE DELAND FOR A PEDIATRIC RESIDENT TO STAY AT. THE MONTHLY RENT PAYMENTS OF $1,000 ARE BELOW FAIR MARKET VALUE. THE ORGANIZATION OFFERS TO PAY $10 PER MONTH FOR ANY EMPLOYEE WITH A GYM MEMBERSHIP. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JORDAN MCCLELLAN | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | DAUGHTER OF FORMER CEO | RelationshipDescriptionTxt |
| Transaction | $68,837 | TransactionAmt |
| Transaction | EMPLOYEE COMPENSATION | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
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 | $597,503 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | INVOICE PRICE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE IS CHAIRED BY THE BOARD CHAIR AND IS RESPONSIBLE FOR MAKING RECOMMENDATIONS ON PROGRAMMATIC AND POLICY ISSUES AT TIMES WHEN THE BOARD IS UNABLE TO MEET. ALL SUCH DECISIONS MUST BE RATIFIED BY THE FULL BOARD AT ITS NEXT MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED BY THE DIRECTOR OF FINANCE AND THE CEO/CFO, THEN PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE COMPLETED AND REVIEWED ANNUALLY FOR THE BOARD OF DIRECTORS AND KEY EMPLOYEEES. EACH INDIVIDUAL IS REQUIRED TO DISCLOSE ANY PERSONAL INTEREST WHICH THEY MAY HAVE IN ANY MATTER PENDING BEFORE THE ORGANIZATION AND REFRAINS FROM PARTICIPATION IN ANY DECISION ON SUCH MATTER. SUCH REFRAINING MAY TAKE THE FORM OF SIMPLE DISCLOSURE, LEAVING THE ROOM DURING DISCUSSION, NOT PARTICIPATING IN THE DISCUSSION, OR RECUSING ONESELF FROM THE ISSUE ALTOGETHER. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE KANIKSU HEALTH SERVICES COMPENSATION MODEL - AS APPROVED BY THE BOARD OF DIRECTORS (BOD) - IS A COMPENSATION SCHEDULE BASED ON THE MOST RECENT NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER (NACHC) REGION 10 (WASHINGTON, OREGON, IDAHO) COMPENSATION SURVEY BASED ON SIZE OF THE ORGANIZATION - ANNUAL REVENUES, SCOPE OF RESPONSIBILITY, YEARS OF EXPERIENCE AND EDUCATIONAL DEGREES, CERTIFICATIONS, ETC. ALL JOB CATEGORIES (INCLUDING CEO, OTHER OFFICERS AND KEY EMPLOYEES, ALL CLINICAL PROVIDERS AND ALL STAFF) HAVE AN ASSOCIATED COMPENSATION MODEL - THIS APPROACH HAS BEEN APPROVED BY THE BOD. THIS IS USED FOR ALL NEW HIRES AND IS EVALUATED ANNUALLY TO BE SURE THAT THERE IS INTERNAL EQUITY AMONG EMPLOYEES, ETC. THIS COMPENSATION MODEL IS ADJUSTED ANNUALLY BASED ON THE MOST RECENT NACHC DATA - RANGES OF SALARY ARE REVIEWED. IT IS THE GOAL OF KHS TO BE IN THE MEDIAN RANGE OF THE COMPENSATION MODEL - THIS APPROACH HAS BEEN APPROVED BY THE BOD. ANY ADJUSTMENTS MADE TO CURRENT EMPLOYEES ARE BASED ON AVAILABILITY OF BUDGET AS APPROVED BY THE BOD AND ARE DETERMINED BY "RANGE MOVEMENT" FOR STAFF POSITIONS AND FOR MAINTAINING COMPETITIVE RECRUITMENT AND RETENTION FOR PROVIDERS AS COMPARED TO THE OTHER COMMUNITY HEALTH CENTERS IN IDAHO AND IN REGION 10. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. THIS PROCESS WAS LAST COMPLETED IN 2018 FOR THE CEO AND 2016 FOR THE REST OF THE OFFICERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE THE CONFLICT OF INTEREST POLICY OR GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE FEDERAL AUDIT CLEARINGHOUSE WEBSITE. |
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