PACKARD HEALTH INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- PACKARD HEALTH INC (EIN 38-2269817)
- Tax period
- 2017-09-01 to 2018-08-31
- Filed
- 2019-03-27
- IRS object ID
- 201930869349300403
- Schema version
- 2017v2.3
- 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 | 2019-03-27T07:08:11-05:00 | ReturnTs |
| Tax Period End | 2018-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382706146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YEO & YEO PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1450 EISENHOWER PLACE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 481083283 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382269817 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKARD HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PACK | BusinessNameControlTxt |
| Phone | 7349711073 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD RD | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR RAYMOND RION | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 7349711073 | PhoneNum |
| Signature | 2019-03-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRIAN R DIXON | PreparerPersonNm |
| PTIN | P01321580 | PTIN |
| Phone | 7347691331 | PhoneNum |
| Preparation | 2019-03-27 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 70.34.166.253 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-03-27 | IPDt |
| IP Tm | 07:08:11 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 94A0B18387F388711E48F1C280F31DA279B52269 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 737A3B877C7B33C039D624E1942B5CD8B6791E98 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR RAYMOND RION | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD ROAD | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $7,349,254 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PACKARDHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 84 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $537,178 | PYContributionsGrantsAmt |
| CY Contributions Grants | $553,223 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,419,007 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,738,025 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,825 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,212 | CYInvestmentIncomeAmt |
| PY Other Revenue | $18,244 | PYOtherRevenueAmt |
| CY Other Revenue | $54,794 | CYOtherRevenueAmt |
| PY Total Revenue | $5,977,254 | PYTotalRevenueAmt |
| CY Total Revenue | $7,349,254 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,905,519 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,645,754 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $163,115 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,858,421 | PYOtherExpensesAmt |
| CY Other Expenses | $2,180,190 | CYOtherExpensesAmt |
| PY Total Expenses | $5,763,940 | PYTotalExpensesAmt |
| CY Total Expenses | $6,825,944 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $213,314 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $523,310 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,468,079 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,299,535 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $366,324 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $664,116 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,101,755 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,635,419 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $5,438,300 | ExpenseAmt |
| Revenue | $6,796,031 | RevenueAmt |
| Desc | PRIMARY HEALTH SERVICES, INCLUDING MENTAL HEALTH CARE AND HEALTH PROMOTION TO PATIENTS IN THE WASHTENAW COUNTY AREA. | Desc |
| Total Program Service Expenses | $5,438,300 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 84 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK JACOBY | PersonNm |
| Phone | 7349264934 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD RD | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| DR RAYMOND RION | |||||||
| EXECUTIVE DI | 40.00 | Yes (X) | $201,781 | $0 | $18,370 | ||
| MARK JACOBY | |||||||
| CFO | 40.00 | Yes (X) | $102,565 | $0 | $0 | ||
| DR SHANNON CAMPBELL | |||||||
| MEDICAL DIRE | 40.00 | Yes (X) | $94,333 | $0 | $0 | ||
| DR HOLLY ROSS | |||||||
| MEDICAL DIRE | 40.00 | Yes (X) | $113,771 | $0 | $0 | ||
| DR ANKOOR SONI | |||||||
| MEDICAL DIRE | 40.00 | Yes (X) | $153,160 | $0 | $12,810 | ||
| GARY BOREN | |||||||
| CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SHARON MOORE | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| THOMAS BIGGS | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| NORA MALOY | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BARBARA CAMPBELL | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| JPAUL DIXON | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| CHUCK HOFFMAN | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| PAULA LANTZ | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DUANE NEWLAND | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ELLEN RABINOWITZ | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| EDD SNYDER | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DOUG STRONG | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DEBORAH VANDENBROEK | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| BRYAN WAGONER | |||||||
| TRUSTEE | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| LINDSEY KOTAGAL | |||||||
| PHYSICIAN | 40.00 | $145,571 | $0 | $7,772 | Yes (X) | ||
| VICTORIA NICOLS | |||||||
| PHYSICIAN | 40.00 | $162,927 | $0 | $13,034 | Yes (X) | ||
| RONALD ROMERO | |||||||
| PHYSICIAN | 40.00 | $124,141 | $0 | $11,222 | Yes (X) | ||
| RAVI VADLAMUDI | |||||||
| PHYSICIAN | 40.00 | $169,630 | $0 | $23,226 | Yes (X) | ||
| ELIZABETH ORLOWSKI | |||||||
| PHYSICIAN | 40.00 | $115,192 | $0 | $19,588 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,383,071 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $106,022 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $553,223 | AllOtherContributionsAmt |
| Noncash Contributions | $331,725 | NoncashContributionsAmt |
| Total Contributions | $553,223 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT FEES | 624100 | $4,212,685 | $4,212,685 |
| CONTRACT SERVICE FEES | 624100 | $2,403,591 | $2,403,591 |
| CAPITATION FEES | 624100 | $121,749 | $121,749 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,738,025 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,212 | TotalRevenueColumnAmt |
| Exclusion | $3,212 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $54,794 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $54,794 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $54,794 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,349,254 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,792,819 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $3,212 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $771,554 | TotalAmt |
| Program Services | $305,245 | ProgramServicesAmt |
| Management And General | $466,309 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,228,405 | TotalAmt |
| Program Services | $2,740,062 | ProgramServicesAmt |
| Management And General | $430,605 | ManagementAndGeneralAmt |
| Fundraising | $57,738 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,255 | TotalAmt |
| Program Services | $38,413 | ProgramServicesAmt |
| Management And General | $5,962 | ManagementAndGeneralAmt |
| Fundraising | $880 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $321,380 | TotalAmt |
| Program Services | $269,220 | ProgramServicesAmt |
| Management And General | $46,831 | ManagementAndGeneralAmt |
| Fundraising | $5,329 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,160 | TotalAmt |
| Program Services | $214,356 | ProgramServicesAmt |
| Management And General | $60,716 | ManagementAndGeneralAmt |
| Fundraising | $4,088 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,805 | TotalAmt |
| Program Services | $57,746 | ProgramServicesAmt |
| Management And General | $43,059 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $749,193 | TotalAmt |
| Program Services | $719,770 | ProgramServicesAmt |
| Management And General | $29,423 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,275 | TotalAmt |
| Fundraising | $36,275 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,303 | TotalAmt |
| Program Services | $35,321 | ProgramServicesAmt |
| Management And General | $35,321 | ManagementAndGeneralAmt |
| Fundraising | $17,661 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,421 | TotalAmt |
| Program Services | $115,699 | ProgramServicesAmt |
| Management And General | $64,481 | ManagementAndGeneralAmt |
| Fundraising | $32,241 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,921 | TotalAmt |
| Program Services | $62,921 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,916 | TotalAmt |
| Program Services | $44,212 | ProgramServicesAmt |
| Management And General | $8,087 | ManagementAndGeneralAmt |
| Fundraising | $1,617 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,985 | TotalAmt |
| Program Services | $56,668 | ProgramServicesAmt |
| Management And General | $6,317 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $704,380 | $704,380 | ||
| DUES, LICENSES & SUBSCRIP | $54,244 | $54,244 | ||
| REPAIRS & MAINTENANCE | $36,432 | $14,573 | $14,573 | $7,286 |
| OTHER | $18,315 | $5,470 | $12,845 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,825,944 | TotalAmt |
| Program Services | $5,438,300 | ProgramServicesAmt |
| Management And General | $1,224,529 | ManagementAndGeneralAmt |
| Fundraising | $163,115 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,542 | BOYAmt |
| EOY | $3,742 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $368,202 | BOYAmt |
| EOY | $1,492,337 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,875 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,512,708 | BOYAmt |
| EOY | $1,205,596 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,680 | BOYAmt |
| EOY | $88,884 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $976,330 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $578,109 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $448,075 | BOYAmt |
| EOY | $398,221 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,997 | BOYAmt |
| EOY | $110,755 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,468,079 | BOYAmt |
| EOY | $3,299,535 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $298,024 | BOYAmt |
| EOY | $351,695 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,300 | BOYAmt |
| EOY | $14,497 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $297,924 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $366,324 | BOYAmt |
| EOY | $664,116 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,094,880 | BOYAmt |
| EOY | $2,635,419 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,875 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,101,755 | BOYAmt |
| EOY | $2,635,419 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,468,079 | BOYAmt |
| EOY | $3,299,535 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $523,310 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $10,354 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,000 | OtherCostOrOtherBasisAmt |
| Book Value | $15,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $532,569 | OtherCostOrOtherBasisAmt |
| Depreciation | $361,252 | DepreciationAmt |
| Book Value | $171,317 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $258,596 | OtherCostOrOtherBasisAmt |
| Depreciation | $81,138 | DepreciationAmt |
| Book Value | $177,458 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $170,165 | OtherCostOrOtherBasisAmt |
| Depreciation | $135,719 | DepreciationAmt |
| Book Value | $34,446 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $398,221 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICARE SETTLEMENT COST | Desc |
| Amt | $297,924 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $297,924 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $7,359,608 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $10,354 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $10,354 | RevenueNotReportedAmt |
| Revenue Subtotal | $7,349,254 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $7,349,254 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $6,825,944 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $6,825,944 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $6,825,944 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|
| DR RAYMOND RION | |||
| EXECUTIVE DIRECTOR | $201,781 | $18,370 | $220,151 |
| DR ANKOOR SONI | |||
| MEDICAL DIRECTOR | $153,160 | $12,810 | $165,970 |
| LINDSEY KOTAGAL | |||
| PHYSICIAN | $145,571 | $7,772 | $153,343 |
| VICTORIA NICOLS | |||
| PHYSICIAN | $162,927 | $13,034 | $175,961 |
| RAVI VADLAMUDI | |||
| PHYSICIAN | $169,630 | $23,226 | $192,856 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1400 | ContributionCnt |
| Noncash Contributions Rpt F990 | $331,725 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | PRICES VERIFIED ONLINE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE CFO AND TREASURER IN DETAIL, THE 990 IS ALSO PROVIDED TO THE EXECUTIVE DIRECTOR AND BOARD PRIOR TO FILING FOR REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD REVISITS THE CONFLICTS OF INTEREST POLICY ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD DETERMINES THE COMPENSATION OF THE EXCUTIVE DIRECTOR BASED ON PERFORMANCE AND OTHER FACTORS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE DIRECTOR DETERMINES THE COMPENSATION FOR OFFICERS & KEY EMPLOYEES, SALARIES ARE ALSO APPROVED BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES 719,770 29,423 0 |
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