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ADAMS COUNTY HEALTH CENTER INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
ADAMS COUNTY HEALTH CENTER INC (EIN 20-8341138)
Tax period
2017-10-01 to 2018-09-30
Filed
2019-02-05
IRS object ID
201940369349301109
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

FieldValueIRS element (for citing)
Return2019-02-05T15:20:45-06:00ReturnTs
Tax Period End2018-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN200079326PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DINGUS ZARECOR & ASSOCIATES PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line112015 E MAIN AVEAddressLine1Txt
CitySPOKANE VALLEYCityNm
State AbbreviationWAStateAbbreviationCd
ZIP99206ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN208341138EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ADAMS COUNTY HEALTH CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlADAMBusinessNameControlTxt
Phone2082534242PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 428AddressLine1Txt
CityCOUNCILCityNm
State AbbreviationIDStateAbbreviationCd
ZIP836120428ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARY ANN DOMECQPersonNm
Person TitleCFOPersonTitleTxt
Phone2082534242PhoneNum
Signature2019-01-31SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLUKE ZARECORPreparerPersonNm
PTINP02161725PTIN
Phone5092420874PhoneNum
Preparation2019-02-05PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address63.131.236.90IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-02-05IPDt
IP Tm15:20:45IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id2474EFBFE268E1323248D70D812BABF32F861C74AtSubmissionCreationDeviceId
At Submission Filing Device Id2474EFBFE268E1323248D70D812BABF32F861C74AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKIM SMITHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 428AddressLine1Txt
CityCOUNCILCityNm
State AbbreviationIDStateAbbreviationCd
ZIP836120428ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,978,909GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ACHCID.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2007FormationYr
Legal Domicile StateIDLegalDomicileStateCd
Activity Or MissionADAMS COUNTY HEALTH CENTER PROVIDES HIGH QUALITY HEALTH SERVICES TO RESIDENTS OF ADAMS COUNTY AND THE SURROUNDING AREA, REGARDLESS OF SOCIAL OR ECONOMIC STATUS.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee51TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$1,270,997PYContributionsGrantsAmt
CY Contributions Grants$1,312,803CYContributionsGrantsAmt
PY Program Service Revenue$1,342,698PYProgramServiceRevenueAmt
CY Program Service Revenue$1,637,547CYProgramServiceRevenueAmt
PY Investment Income$7,518PYInvestmentIncomeAmt
CY Investment Income$7,853CYInvestmentIncomeAmt
PY Other Revenue$115,041PYOtherRevenueAmt
CY Other Revenue$20,706CYOtherRevenueAmt
PY Total Revenue$2,736,254PYTotalRevenueAmt
CY Total Revenue$2,978,909CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,035,464PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,111,803CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$141CYTotalFundraisingExpenseAmt
PY Other Expenses$682,770PYOtherExpensesAmt
CY Other Expenses$834,524CYOtherExpensesAmt
PY Total Expenses$2,718,234PYTotalExpensesAmt
CY Total Expenses$2,946,327CYTotalExpensesAmt
PY Revenues Less Expenses$18,020PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$32,582CYRevenuesLessExpensesAmt
Total Assets BOY$1,717,905TotalAssetsBOYAmt
Total Assets EOY$1,783,798TotalAssetsEOYAmt
Total Liabilities BOY$122,567TotalLiabilitiesBOYAmt
Total Liabilities EOY$155,878TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,595,338NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,627,920NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionADAMS COUNTY HEALTH CENTER PROVIDES HIGH QUALITY HEALTH SERVICES TO RESIDENTS OF ADAMS COUNTY AND THE SURROUNDING AREA, REGARDLESS OF SOCIAL OR ECONOMIC STATUS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$2,178,785ExpenseAmt
Revenue$1,637,547RevenueAmt
DescADAMS COUNTY HEALTH CENTER (ACHC) IS A FEDERALLY QUALIFIED HEALTH CENTER PROVIDING PRIMARY AND PREVENTATIVE HEALTH, DENTAL, MENTAL HEALTH, VISION CARE, MEDICATION MANAGEMENT SERVICES, PHYSICAL THERAPY SERVICES, X-RAY AND LABORATORY SERVICES TO A TOTAL OF 2,235 UNDUPLICATED PATIENTS DURING THE PERIOD 10/1/2017 TO 9/30/2018. THERE WERE A TOTAL OF 4,584 ENCOUNTERS WITH MEDICAL PROVIDERS, 2,447 ENCOUNTERS WITH DENTAL PROVIDERS, 329 ENCOUNTERS FOR OPTOMETRY SERVICES AND 839 PHYSICAL THERAPY ENCOUNTERS FOR THE YEAR ENDED SEPTEMBER 30, 2018. ACHC ALSO PROVIDES TELEPHARMACY SERVICES WITH A TOTAL OF 8,487 PRESCRIPTIONS FILLED DURING FISCAL YEAR 2018. ACHC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 106,848 FOR CHARITY CARE AND SLIDING FEE, 162,222 FOR MEDICARE AND 107,988 FOR OTHER THIRD-PARTY PAYORS FOR THE YEAR ENDED SEPTEMBER 30, 2018. THE HEALTH CENTER HAS NUMEROUS INDIVIDUALS ACCESSING HEALTH CARE WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINE. A TOTAL OF 474 PERSONS ENROLLED IN THE SLIDING FEE PROGRAM HAD ACCESS TO ONE OR MORE OF THE FOLLOWING PROGRAMS: PROGRAM CHARITY SLIDING FEE DISCOUNT MEDICAL SERVICES 41,287 (INCLUDES OPTOMETRY AND PT SERVICES) DENTAL SERVICES 65,561 THE PROGRAMS OFFERED AT ACHC PROVIDE HEALTH CARE SERVICES TO UNINSURED/UNDERINSURED INDIVIDUALS WHO MAY NOT HAVE OTHERWISE RECEIVED THESE SERVICES DUE TO FINANCIAL BARRIERS.Desc
Total Program Service Expenses$2,178,785TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document11IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee51EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldIDStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKIM SMITHPersonNm
Phone2082534242PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 428AddressLine1Txt
CityCOUNCILCityNm
State AbbreviationIDStateAbbreviationCd
ZIP836120428ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
SHIRLEY HALSEY
TRUSTEE2.00Yes (X)$0$0$0
DORIS CROSSLEY
CHAIR10.00Yes (X)$0$0$0Yes (X)
NELLO JENKINS
TREASURER6.00Yes (X)$0$0$0Yes (X)
KARI DAWN IVESON
SECRETARY2.00Yes (X)$0$0$0Yes (X)
LYNN MARQUARD
VICE CHAIR6.00Yes (X)$0$0$0Yes (X)
KEITH TRAPPETT
TRUSTEE2.00Yes (X)$0$0$0
JACK RUBELT
TRUSTEE2.00Yes (X)$0$0$0
MICHAEL PARADIS
TRUSTEE2.00Yes (X)$0$0$0
DEBBIE MAXWELL
TRUSTEE2.00Yes (X)$0$0$0
KIM SMITH
CEO40.00$88,150$0$10,488Yes (X)
MARY ANN DOMECQ
CFO40.00$85,043$0$13,101Yes (X)
MICHAEL HOLM
DENTIST36.00$119,741$0$13,558Yes (X)
KEVIN MCSWEENEY
OPTOMETRIST30.00$119,207$0$14,873Yes (X)
TAWNI PETERSON
NURSE PRACTI40.00$113,728$0$14,912Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$525,869TotalReportableCompFromOrgAmt
Total Other Compensation$66,932TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Government Grants$1,311,175GovernmentGrantsAmt
All Other Contributions$1,628AllOtherContributionsAmt
Noncash Contributions$327NoncashContributionsAmt
Total Contributions$1,312,803TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE, NET624100$1,305,654$1,305,654
TELEPHARMACY SERVICE REVENUE621399$331,893$331,893
FieldValueIRS element (for citing)
Total Program Service Revenue$1,637,547TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,853TotalRevenueColumnAmt
Exclusion$7,853ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$6,000RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$6,000RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,000TotalRevenueColumnAmt
Exclusion$6,000ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business900099BusinessCd
Total Revenue Column$14,706TotalRevenueColumnAmt
Exclusion$14,706ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$14,706OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,978,909TotalRevenueColumnAmt
Related Or Exempt Func Income$1,637,547RelatedOrExemptFuncIncomeAmt
Exclusion$28,559ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$190,424TotalAmt
Management And General$190,424ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,506,990TotalAmt
Program Services$1,128,245ProgramServicesAmt
Management And General$378,745ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$52,660TotalAmt
Program Services$40,107ProgramServicesAmt
Management And General$12,553ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$225,296TotalAmt
Program Services$141,565ProgramServicesAmt
Management And General$83,731ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$136,433TotalAmt
Program Services$93,022ProgramServicesAmt
Management And General$43,411ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$27,959TotalAmt
Management And General$27,959ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$242,978TotalAmt
Program Services$210,992ProgramServicesAmt
Management And General$31,986ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$10,313TotalAmt
Program Services$6,835ProgramServicesAmt
Management And General$3,478ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$304,013TotalAmt
Program Services$284,579ProgramServicesAmt
Management And General$19,293ManagementAndGeneralAmt
Fundraising$141FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$23,115TotalAmt
Program Services$18,476ProgramServicesAmt
Management And General$4,639ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$25,652TotalAmt
Program Services$18,278ProgramServicesAmt
Management And General$7,374ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$19,853TotalAmt
Program Services$15,696ProgramServicesAmt
Management And General$4,157ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$441TotalAmt
Program Services$100ProgramServicesAmt
Management And General$341ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$84,800TotalAmt
Program Services$80,041ProgramServicesAmt
Management And General$4,759ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$11,529TotalAmt
Program Services$766ProgramServicesAmt
Management And General$10,763ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
DUES, FEES, LICENSES & OT$83,871$58,008$25,863
ALLOCATED INDIRECT COSTS$82,075-$82,075

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,946,327TotalAmt
Program Services$2,178,785ProgramServicesAmt
Management And General$767,401ManagementAndGeneralAmt
Fundraising$141FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$249,714BOYAmt
EOY$204,505EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$858,627BOYAmt
EOY$987,910EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$110,505BOYAmt
EOY$120,133EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$29,373BOYAmt
EOY$37,795EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$33,170BOYAmt
EOY$36,293EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,149,717LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$752,555LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$436,516BOYAmt
EOY$397,162EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,717,905BOYAmt
EOY$1,783,798EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$122,567BOYAmt
EOY$155,878EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$122,567BOYAmt
EOY$155,878EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,595,338BOYAmt
EOY$1,627,920EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,595,338BOYAmt
EOY$1,627,920EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,717,905BOYAmt
EOY$1,783,798EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$32,582ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$22,431OtherCostOrOtherBasisAmt
Book Value$22,431BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$57,679OtherCostOrOtherBasisAmt
Depreciation$9,854DepreciationAmt
Book Value$47,825BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$363,343OtherCostOrOtherBasisAmt
Depreciation$215,537DepreciationAmt
Book Value$147,806BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$706,264OtherCostOrOtherBasisAmt
Depreciation$527,164DepreciationAmt
Book Value$179,100BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$397,162TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$2,978,909TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$2,978,909RevenueSubtotalAmt
Total Revenue Per Form990$2,978,909TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$2,946,327TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$2,946,327ExpensesSubtotalAmt
Total Expenses Per Form990$2,946,327TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PAGE 3, PART XFormAndLineReferenceDesc
ExplanationTHE CENTER 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 CENTER EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF SEPTEMBER 30, 2018 AND 2017, THE CENTER HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990ACHC ACHIEVED LEVEL 3 PATIENT CENTERED MEDICAL HOME (PCMH) RECOGNITION STATUS BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA) EFFECTIVE FEBRUARY 1, 2018. ACHC IS A MEMBER OF THE IDAHO PRIMARY CARE ASSOCIATION (IPCA), WHICH IS COMPRISED OF SIXTEEN IDAHO NONPROFIT COMMUNITY HEALTH CENTERS AND IS ONE OF FOUR MEMBERS TO HAVE ACHIEVED LEVEL 3 PCMH RECOGNITION. ACHC CONTINUES TO PARTICIPATE IN IDAHO'S STATEWIDE HEALTH INNOVATION PLAN (SHIP) WHICH IS AIMED AT PROMOTING THE PCMH MODEL WHILE REDUCING THE COST OF CARE AND INTEGRATING THE MEDICAL HEALTH NEIGHBORHOOD. ACHC CONTINUES TO PARTICIPATE IN THE IDAHO HEALTH DATA EXCHANGE (IHDE), THE TECHNICAL COMPONENT OF THE SHIP PROGRAM. IHDE IS THE HEALTH INFORMATION EXCHANGE (HIE) FOR IDAHO. HIE ENABLES DOCTORS, NURSES, LABS, AND OTHER MEDICAL PROVIDERS TO SECURELY ACCESS THEIR PATIENTS' ELECTRONIC HEALTH INFORMATION QUICKLY TO IMPROVE THE SPEED, QUALITY, SAFETY AND COST OF PATIENT CARE. IHDE IS AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR. ACHC STAFF IS DEDICATED TO IMPROVING PATIENT CARE AND SATISFACTION WITH THE SERVICES IT PROVIDES AND PARTICIPATES IN REGULAR QUALITY ASSURANCE/QUALITY IMPROVEMENT ACTIVITIES INCLUDING MONTHLY ON-SITE MEETINGS AND ONGOING TRAININGS CONSISTING OF MONTHLY TELEPHONE MEETINGS AND QUARTERLY IN-PERSON TRAININGS CONDUCTED BY THE IPCA. DURING FY 2018 ACHC USED QUALITY IMPROVEMENT FUNDS AWARDED BY HRSA TO PURCHASE AND IMPLEMENT EQUIPMENT THAT AUTOMATICALLY FEEDS CERTAIN LABORATORY RESULTS DIRECTLY INTO THE PATIENT CHARTS WHICH ELIMINATES THE POSSIBILITY OF HUMAN ERROR WHEN MANUALLY ENTERING LAB RESULTS. 2018 WAS THE SIXTH YEAR THAT ACHC HAS WORKED IN COLLABORATION WITH THE CRITICAL ACCESS HOSPITAL IN MCCALL, ID TO PROVIDE DENTAL SERVICES THROUGH THEIR "BRIGHTER SMILES" DENTAL GRANT PROJECT. NINETY-THREE INDIVIDUALS AT OR BELOW 200% OF FPL RECEIVED DENTAL CARE UNDER THE PROJECT. ACHC CONTINUES TO COLLABORATE WITH THE CRITICAL ACCESS HOSPITAL IN MCCALL, ID ON THE "VALLEY ADAMS HEALTH IMPROVEMENT COALITION" PROJECT. THE FOCUS OF THE PROJECT IS THE SUPPORT OF AREA YOUTH WITH THE MAIN FOCUS BEING YOUTH MENTAL HEALTH. YOUTH MENTAL HEALTH EDUCATION AND TRAININGS INCLUDE: SUICIDE PREVENTION, SUBSTANCE ABUSE PREVENTION OR REDUCTION, SEXUAL ABUSE AND VIOLENCE AGAINST MINORS, PARENTING SKILLS AND FOOD ACCESS/SUSTAINABILITY. ACHC RECOGNIZES THAT PATIENTS ARE SHARED BETWEEN PROVIDERS, CLINIC LOCATIONS AND HOSPITALS, AND THAT PATIENTS WITH CHRONIC CONDITIONS SUCH AS DIABETES, CARDIAC DISEASES, PULMONARY CONDITIONS AND COMORBID BEHAVIORAL HEALTH ISSUES ARE DIFFICULT TO EFFECTIVELY MANAGE AND TRANSITION TO APPROPRIATE LEVELS OF CARE. CARE COORDINATION BETWEEN ACHC AND OTHER PROVIDERS AND INSTITUTIONS IS INTENDED TO TARGET THESE POPULATIONS TO BROADEN THE CLINICAL IMPACT OF THE "HEALTH NEIGHBORHOOD". SINCE JULY 2017 ACHC PATIENTS WITH TWO OR MORE CHRONIC, COMORBID MEDICAL CONDITIONS SUCH AS DIABETES, HYPERTENSION, CARDIAC DISEASE AND PULMONARY CONDITIONS HAVE BEEN REFERRED TO ACHC'S CHRONIC CARE MANAGER (CCM) BY THEIR PRIMARY CARE PROVIDER (PCP). THE CCM IS IN FREQUENT CONTACT WITH THE PATIENT, EITHER BY TELEPHONE OR FACE-TO-FACE AND REPORTS REGULARLY TO THE PCP IN ORDER TO EFFECTIVELY MANAGE THEIR CARE. IN JULY 2018 ACHC SUBMITTED A FY2018 EXPANDING ACCESS TO QUALITY SUBSTANCE USE DISORDER AND MENTAL HEALTH SERVICES (SUD-MH) GRANT APPLICATION REQUESTING FUNDING TO EXPAND EXISTING SERVICES IN ITS SCOPE OF PROJECT.
FORM 990, PAGE 2, PART III, LINE 4APROVIDING CARE TO THESE PATIENTS WAS 106,848 FOR CHARITY CARE AND SLIDING FEE, 162,222 FOR MEDICARE AND 107,988 FOR OTHER THIRD-PARTY PAYORS FOR THE YEAR ENDED SEPTEMBER 30, 2018. THE HEALTH CENTER HAS NUMEROUS INDIVIDUALS ACCESSING HEALTH CARE WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINE. A TOTAL OF 474 PERSONS ENROLLED IN THE SLIDING FEE PROGRAM HAD ACCESS TO ONE OR MORE OF THE FOLLOWING PROGRAMS: PROGRAM CHARITY SLIDING FEE DISCOUNT MEDICAL SERVICES 41,287 (INCLUDES OPTOMETRY AND PT SERVICES) DENTAL SERVICES 65,561 THE PROGRAMS OFFERED AT ACHC PROVIDE HEALTH CARE SERVICES TO UNINSURED/UNDERINSURED INDIVIDUALS WHO MAY NOT HAVE OTHERWISE RECEIVED THESE SERVICES DUE TO FINANCIAL BARRIERS.
FORM 990, PAGE 6, PART VI, LINE 11BA COPY OF THE 990 IS PROVIDED TO THE CEO AND CFO WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PRESENTED TO THE BOARD OF TRUSTEES WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN.
FORM 990, PAGE 6, PART VI, LINE 12CIN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PARTY MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE EXECUTIVE TEAM AND/OR BOARD OF TRUSTEES DESCRIBING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS AND AFTER ANY DISCUSSION WITH THE INTERESTED PARTY THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL DETERMINE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THEN THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL DETERMINE WHETHER THE HEALTH CENTER CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HEALTH CENTER'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. A FINAL DECISION SHALL BE DETERMINED AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. VIOLATIONS OF THE CONFLICT OF INTEREST POLICY CAN RESULT IN DISCIPLINARY AND CORRECTIVE ACTION BEING TAKEN UP TO AND INCLUDING TERMINATION.
FORM 990, PAGE 6, PART VI, LINE 15ATHE BOARD OF TRUSTEES EVALUATES THE EXECUTIVE TEAM'S PERFORMANCE AND COMPENSATION ANNUALLY. SOURCES UTILIZED BY THE BOARD WHEN DETERMINING COMPENSATION INCLUDE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND STATE OF IDAHO SALARY SURVEYS AS WELL AS PERSONAL CONTACT WITH IDAHO COMMUNITY HEALTH CENTERS. SALARY CHANGES ARE DISCUSSED AND APPROVED BY MAJORITY VOTE OF THE BOARD OF TRUSTEES AND ARE INCLUDED IN THE MINUTES OF THE MEETING AT WHICH THE ACTION IS TAKEN.
FORM 990, PAGE 6, PART VI, LINE 15BTHE EXECUTIVE TEAM ARE THE ONLY OFFICERS OR KEY EMPLOYEES. SEE 990, PART VI, LINE 15A.
FORM 990, PAGE 6, PART VI, LINE 19THE HEALTH CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

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