2019-09-05T16:14:20-05:00 2018-12-31 481032601 ALLEN GIBBS & HOULIK LC 301 N MAIN SUITE 1700 WICHITA KS 672024868 990 2018-01-01 481159633 GRACEMED HEALTH CLINIC INC GRAC 3168662000 1122 N TOPEKA WICHITA KS 67214 DAVID SANFORD CEO 3168662011 2019-08-22 1 ELLEN K DECKER P01411318 3162677231 70.167.48.183 2019-08-22 11:17:36 CD P 9343088ABA35253E194B332883AF04A29100DC5C 8077F98C4D1E24DE07FDF7F80461D81F1D2A1766 2018 2019-02-21 02:37:17Z DAVID SANFORD 1122 N TOPEKA WICHITA KS 67214 32786210 0 X WWW.GRACEMED.ORG X 1979 KS TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 14 14 423 75 0 0 11113551 10143523 13213387 15859720 -17943 200440 52240 61109 24361235 26264792 0 0 0 0 14564712 17206570 0 0 275130 5612176 6589732 20176888 23796302 4184347 2468490 24736698 26780879 3156161 3012761 21580537 23768118 TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 0 0 19274811 15910118 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 19274811 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 47 0 1 423 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 KS X DAVID WUTHNOW 3168662049 1122 N TOPEKA WICHITA KS 67214 ROB DAKIN VICE - PRESIDENT 4.00 X X 0 0 0 MARLON KING BOARD MEMBER 4.00 X 0 0 0 MARCIA NEWTON SECRETARY 4.00 X X 0 0 0 MARC MINNIS PRESIDENT 4.00 X X 0 0 0 FRED ERVIN BOARD MEMBER 4.00 X 0 0 0 JASON FEBRES BOARD MEMBER 4.00 X 0 0 0 JULIE HEDRICK BOARD MEMBER 4.00 X 0 0 0 LAURIE LABARCA BOARD MEMBER 4.00 X 0 0 0 TIM NORTON BOARD MEMBER 4.00 X 0 0 0 RON STEPHEN BOARD MEMBER 4.00 X 0 0 0 LAZARO VASQUEZ BOARD MEMBER 4.00 X 0 0 0 MYRON LEINWETTER BOARD MEMBER 4.00 X 0 0 0 RICK WOODS BOARD MEMBER 4.00 X 0 0 0 GAROLD MINNS BOARD MEMBER 4.00 X 0 0 0 JULIE A ELDER OFFICER 40.00 X 243396 0 17610 VENUS L LEE OFFICER 40.00 X 152560 0 5037 ROGER G NOLTE CHIEF DENTAL OFFICER 1/1/18-7/9/18 40.00 X 166270 0 4187 DAVID WUTHNOW OFFICER 40.00 X 107138 0 12201 DAVID SANFORD CHIEF EXECUTIVE OFFICER 40.00 X 186956 0 10758 ERIC DESHAZER CHIEF DENTAL OFFICER 7/9/18-12/31/18 40.00 X 78185 0 5610 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYEE 40.00 X 202015 0 15069 AMANDA WILLIS HIGHLY COMPENSATED EMPLOYEE 40.00 X 146998 0 9631 BILLY RICHARDSON HIGHLY COMPENSATED EMPLOYEE 40.00 X 184078 0 11694 DELANE VAUGHN-JACOBS HIGHLY COMPENSATED EMPLOYEE 40.00 X 181917 0 909 HOLLY ALLEN TERRELL HIGHLY COMPENSATED EMPLOYEE 40.00 X 172717 0 16022 1822230 0 108728 23 0 1 0 SHIRLEY CONSTRUCTION INC 2139 SW WESTPORT DR TOPEKA KS 66614 BUILDING CONTRACTOR 2253796 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 600550241 MEDICAL/DENTAL EQUIPMENT AND SUPPLIES 1223019 MCKESSON PO BOX 848442 DALLAS TX 752848442 340B PHARMACEUTICALS 448606 SECURITY 1ST TITLE 727 N WACO WICHITA KS 67203 BUILDING PURCHASE 361529 SCHWERDT DESIGN GROUP 2231 SW WANAMAKER RD STE 3 TOPEKA KS 666144275 ARCHITECT 271671 19 62996 7374618 2705909 10143523 MEDICAL & DENTAL SERVICES 621110 15838470 15838470 HIT CERT INCENTIVE 621110 21250 21250 15859720 204114 204114 6482351 2915 6481212 7728 1139 -4813 -3674 -3674 43189 62996 32478 10711 10711 MISC REVENUE 900099 50398 50398 50398 26264792 15910118 0 211151 934506 761473 173033 14828524 11886346 2701739 240439 200823 170540 27466 2817 1242717 1025375 203401 13941 93416 93416 741930 719925 22005 185929 3335 182201 393 197947 123171 74624 152 568841 500296 68545 139224 47775 91449 882165 748565 133600 53437 2024 51413 MEDICAL SUPPLIES 1478291 1472219 6072 CONSULTING & COMPUTER E 776171 622477 153694 REPAIRS 745275 702803 42472 UTILITIES 352228 308578 43650 374878 179909 177581 17388 23796302 19274811 4246361 275130 219378 401646 5380087 2930356 1088436 911029 571137 860083 24487 15559 34692 61759 18361945 4184225 11294664 14177720 2054806 4026750 4067100 3394066 1911 1911 24736698 26780879 1272198 1677936 1883963 1334825 3156161 3012761 X 20667105 23661732 913432 106386 21580537 23768118 24736698 26780879 X 2468490 -280437 961283 -961755 X X 0 1 X 1 1 1 X 4095940 5019173 9487166 11113551 10130406 39846236 4095940 5019173 9487166 11113551 10130406 39846236 39846236 48409 36303 19328 49734 146131 299905 40146141 60042692 0.99250 0.99710 X 622330 622330 8025142 450700 7574442 5321678 1377285 3944393 4134561 2356240 1778321 258234 258234 14177720 CERTIFICATES OF DEPOSIT 3394066 C 3394066 26977524 -280437 961283 32478 713324 26264200 592 592 26264792 24789943 961283 32478 993761 23796182 120 120 23796302 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 32,478. PART XI, LINE 4B - OTHER ADJUSTMENTS: K-1 INTEREST 11. K-1 DIVIDENDS 581. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 32,478. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE FROM K-1 120. 5K RACE 87550 47000 40550 1125 14420 14384 HOTCAKES FUNDRAISER 18635 15996 2639 0 0 2549 106185 62996 43189 1125 14420 16933 32478 10711 X X 0 0 0 0 0 0 0 0 0 JULIE A ELDER OFFICER 243396 0 0 0 0 0 7575 0 10035 0 261006 0 0 0 VENUS L LEE OFFICER 152560 0 0 0 0 0 4629 0 408 0 157597 0 0 0 ROGER G NOLTE CHIEF DENTAL OFFICER 1/1/18-7/9/18 166270 0 0 0 0 0 0 0 4187 0 170457 0 0 0 DAVID SANFORD CHIEF EXECUTIVE OFFICER 186956 0 0 0 0 0 5703 0 5055 0 197714 0 0 0 FARIBA BEHZADPOUR HIGHLY COMPENSATED EMPLOYEE 202015 0 0 0 0 0 6309 0 8760 0 217084 0 0 0 AMANDA WILLIS HIGHLY COMPENSATED EMPLOYEE 146998 0 0 0 0 0 4576 0 5055 0 156629 0 0 0 BILLY RICHARDSON HIGHLY COMPENSATED EMPLOYEE 184078 0 0 0 0 0 1195 0 10499 0 195772 0 0 0 DELANE VAUGHN-JACOBS HIGHLY COMPENSATED EMPLOYEE 181917 0 0 0 0 0 909 0 0 0 182826 0 0 0 HOLLY ALLEN TERRELL HIGHLY COMPENSATED EMPLOYEE 172717 0 0 0 0 0 5523 0 10499 0 188739 0 0 0 CHAD SANFORD SON OF CEO 54840 CHAD SANFORD IS THE SON OF DAVID SANFORD, CEO OF GRACEMED. CHAD IS AN EMPLOYEE OF GRACEMED. 0 SARA BAYLESS DAUGHTER OF OFFICER 43141 SARA BAYLESS IS THE DAUGHTER OF ROGER NOLTE, GRACEMED'S CHIEF DENTAL OFFICER FROM 1/1/2018 TO 7/9/2018. SARA BAYLESS IS AN EMPLOYEE OF GRACEMED. 0 KYLE BOWEN SON OF DIRECTOR OF MARKETING 21226 KYLE BOWEN IS THE SON OF LARRY BOWEN, GRACEMED'S DIRECTOR OF MARKETING. KYLE BOWEN IS THE OWNER OF SUPERHELPFUL (PREVIOUSLY TURTLE BOX DESIGN, LLC) WHO DEVELOPED AND MAINTAINS GRACEMED'S WEBSITE. 0 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HIRES AN OUTSIDE CPA TO PREPARE THE FINANCIAL STATEMENT AUDIT AND THE FORM 990 EACH YEAR. AFTER THE CPA HAS COMPLETED BOTH THE AUDIT AND FORM 990, THE CFO FOR THE ORGANIZATION AND THE CPA REVIEW THE INITIAL DRAFT OF THE RETURN TO ENSURE ITS COMPLETENESS AND ACCURACY. FOLLOWING THE REVIEW, THE FORM 990 IS COMPLETED AND THE ORGANIZATION FILES THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: INVESTMENT INCOME - BROOKFIELD INFRASTRUCTURE PARTNERS, L.P. -472. DONATED SERVICES AND USE OF FACILITIES EXPENSES -961,283. FORM 990, PART XII, LINE 2C THIS POLICY HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART XI, LINE 5 & SCH D, PART XI, LINE 2A REALIZED/UNREALIZED GAIN LOSS ON AUDIT REPORT FOOTNOTE AND THE AMOUNTS REPORTED ON FORM 990 DO NOT MATCH DUE TO THE USE OF DIFFERENT REPORTING METHODS BETWEEN THE AUDIT REPORT AND THE 990.