COMMUNITY HEALTH CENTERS OF WESTERN KENTUCKY INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH CENTERS OF WESTERN KENTUCKY INC (EIN 61-1268014)
- Tax period
- 2017-05-01 to 2018-04-30
- Filed
- 2018-08-23
- IRS object ID
- 201842359349301114
- 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 | 2018-08-23T16:26:17-05:00 | ReturnTs |
| Tax Period End | 2018-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 610920132 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RINEY HANCOCK CPAS PSC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2900 VEACH ROAD SUITE 2 | AddressLine1Txt |
| City | OWENSBORO | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42303 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 611268014 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH CENTERS OF WESTERN | BusinessNameLine1Txt |
| Business Name Line2 | KENTUCKY INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 2703385777 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 480 HOPKINSVILLE STREET | AddressLine1Txt |
| City | GREENVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42345 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOSEPH SWAB | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2703385777 | PhoneNum |
| Signature | 2018-08-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CARLA J DOWELL CPA | PreparerPersonNm |
| PTIN | P00104892 | PTIN |
| Phone | 2709264540 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROGER ARBUCKLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 480 HOPKINSVILLE ST | AddressLine1Txt |
| City | GREENVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42345 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,257,895 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1994 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE AFFORDABLE PRIMARY HEALTHCARE SERVICES | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 89 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,918,975 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,350,109 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,595,883 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,871,372 | CYProgramServiceRevenueAmt |
| PY Investment Income | $27,883 | PYInvestmentIncomeAmt |
| CY Investment Income | $35,904 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$281 | PYOtherRevenueAmt |
| CY Other Revenue | $510 | CYOtherRevenueAmt |
| PY Total Revenue | $8,542,460 | PYTotalRevenueAmt |
| CY Total Revenue | $8,257,895 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,232,721 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,131,993 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,994,436 | PYOtherExpensesAmt |
| CY Other Expenses | $2,359,037 | CYOtherExpensesAmt |
| PY Total Expenses | $6,227,157 | PYTotalExpensesAmt |
| CY Total Expenses | $7,491,030 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,315,303 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $766,865 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,020,571 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,818,842 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $392,270 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $423,676 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,628,301 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,395,166 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE AFFORDABLE PRIMARY HEALTHCARE SERVICES IN MUHLENBERG AND LOGAN COUNTIES, KENTUCKY, AND IN MEDICALLY UNDER-SERVED URBAN, SUBURBAN, AND RURAL AREAS HAVING LIMITED AVAILABLE HEALTH RESOURCES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,557,705 | ExpenseAmt |
| Revenue | $5,871,372 | RevenueAmt |
| Desc | OPERATION OF COMMUNITY HEALTH CENTER AS AUTHORIZED BY SECTION 330 OF THE PUBLIC HEALTH SERVICES GRANT | Desc |
| Total Program Service Expenses | $6,557,705 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | 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 | 24 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 89 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| 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 | 0 | LocalChaptersInd |
| 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 | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | 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 | JOSEPH SWAB | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2703385777 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 480 HOPKINSVILLE ST | AddressLine1Txt |
| City | GREENVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42345 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CINDY BAIRD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BILLY STEELE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JULIE HANSEN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ELIZABETH EAVES | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MOLLY ALWARD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ELIZABETH GENTRY | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ANDREHIA HATFIELD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CARY DAVIS | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD NEATHAMER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA MILAM | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROSEMARY BUCK | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROGER ARBUCKLE | ||||||||
| CEO | 40.00 | $165,000 | $0 | $19,741 | Yes (X) | |||
| JOSEPH SWAB | ||||||||
| CFO | 40.00 | $100,000 | $0 | $9,365 | Yes (X) | |||
| DAVID CONATSER | ||||||||
| PHYSICIAN | 40.00 | $160,000 | $0 | $8,000 | Yes (X) | |||
| SUSAN HAWKINS | ||||||||
| PHYSICIAN | 40.00 | $200,000 | $0 | $10,000 | Yes (X) | |||
| STEVEN ZELLER | ||||||||
| PHYSICIAN | 40.00 | $197,442 | $0 | $18,389 | Yes (X) | |||
| BILLIE GALYEN | ||||||||
| PHYSICIAN | 40.00 | $190,000 | $0 | $22,568 | Yes (X) | |||
| DEANDRA DAVIS | ||||||||
| PHYSICIAN | 40.00 | $180,000 | $0 | $2,077 | Yes (X) | |||
| NATALIE HUTTON | ||||||||
| PHYSICIAN | 40.00 | $165,000 | $0 | $21,318 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,357,442 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $111,458 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,350,109 | GovernmentGrantsAmt |
| Total Contributions | $2,350,109 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL SERVICES | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $5,871,372 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,871,372 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,871,372 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,904 | TotalRevenueColumnAmt |
| Exclusion | $35,904 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $510 | TotalRevenueColumnAmt |
| Exclusion | $510 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $510 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,257,895 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,871,372 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $36,414 | 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 | $1,552,827 | TotalAmt |
| Program Services | $1,287,816 | ProgramServicesAmt |
| Management And General | $265,011 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,764,498 | TotalAmt |
| Program Services | $2,611,481 | ProgramServicesAmt |
| Management And General | $153,017 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,489 | TotalAmt |
| Program Services | $138,578 | ProgramServicesAmt |
| Management And General | $19,911 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $345,743 | TotalAmt |
| Program Services | $264,953 | ProgramServicesAmt |
| Management And General | $80,790 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $310,436 | TotalAmt |
| Program Services | $276,710 | ProgramServicesAmt |
| Management And General | $33,726 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,300 | TotalAmt |
| Program Services | $4,300 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,984 | TotalAmt |
| Program Services | $73,984 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $879,700 | TotalAmt |
| Program Services | $755,367 | ProgramServicesAmt |
| Management And General | $124,333 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,865 | TotalAmt |
| Program Services | $69,865 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274,301 | TotalAmt |
| Program Services | $176,165 | ProgramServicesAmt |
| Management And General | $98,136 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,713 | TotalAmt |
| Program Services | $14,713 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,342 | TotalAmt |
| Program Services | $21,930 | ProgramServicesAmt |
| Management And General | $111,412 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,255 | TotalAmt |
| Program Services | $791 | ProgramServicesAmt |
| Management And General | $1,464 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,857 | TotalAmt |
| Program Services | $30,669 | ProgramServicesAmt |
| Management And General | $14,188 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $278,248 | TotalAmt |
| Program Services | $278,248 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,092 | TotalAmt |
| Program Services | $31,092 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| IMMUNIZATION EXPENSE | $255,375 | $255,375 |
| BAD DEBT EXPENSE | $115,375 | $115,375 |
| OPERATIONAL SUPPLIES | $84,004 | $84,004 |
| MEDICAL RECRUITMENT | $39,165 | $39,165 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,461 | TotalAmt |
| Program Services | $27,124 | ProgramServicesAmt |
| Management And General | $31,337 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,491,030 | TotalAmt |
| Program Services | $6,557,705 | ProgramServicesAmt |
| Management And General | $933,325 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,525 | BOYAmt |
| EOY | $429,578 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,806,381 | BOYAmt |
| EOY | $3,461,817 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $742,113 | BOYAmt |
| EOY | $952,795 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,177 | BOYAmt |
| EOY | $79,364 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,447 | BOYAmt |
| EOY | $46,755 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,463,736 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,615,203 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,339,928 | BOYAmt |
| EOY | $4,848,533 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,020,571 | BOYAmt |
| EOY | $9,818,842 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $392,270 | BOYAmt |
| EOY | $423,676 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $392,270 | BOYAmt |
| EOY | $423,676 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,439,036 | BOYAmt |
| EOY | $9,211,115 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $189,265 | BOYAmt |
| EOY | $184,051 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,628,301 | BOYAmt |
| EOY | $9,395,166 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,020,571 | BOYAmt |
| EOY | $9,818,842 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $766,865 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,378,531 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,631,828 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,859,345 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,918,975 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,350,109 | CurrentTaxYearAmt |
| Total | $10,138,788 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,108,863 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,803,134 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,435,106 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,595,883 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,871,372 | CurrentTaxYearAmt |
| Total | $22,814,358 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,487,394 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,434,962 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,294,451 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,514,858 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,221,481 | CurrentTaxYearAmt |
| Total | $32,953,146 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $32,953,146 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,688 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,511 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,344 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,883 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $35,904 | CurrentTaxYearAmt |
| Total | $83,330 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,688 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,511 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,344 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,883 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $35,904 | CurrentTaxYearAmt |
| Total | $83,330 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,490,082 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,438,473 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,307,795 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,542,741 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,257,385 | CurrentTaxYearAmt |
| Total | $33,036,476 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99750 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99840 | PublicSupportPY509Pct |
| Investment Income CY | 0.00250 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00160 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 | $248,389 | OtherCostOrOtherBasisAmt |
| Book Value | $248,389 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,964,042 | OtherCostOrOtherBasisAmt |
| Depreciation | $733,633 | DepreciationAmt |
| Book Value | $4,230,409 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,628 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,582 | DepreciationAmt |
| Book Value | $3,046 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,018,892 | OtherCostOrOtherBasisAmt |
| Depreciation | $746,341 | DepreciationAmt |
| Book Value | $272,551 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $219,785 | OtherCostOrOtherBasisAmt |
| Depreciation | $125,647 | DepreciationAmt |
| Book Value | $94,138 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,848,533 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,257,895 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,257,895 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,257,895 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $7,491,030 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $7,491,030 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $7,491,030 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE CENTER IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT ON INCOME DERIVED FROM UNRELATED BUSINESS ACTIVITIES. THE CENTER BELIEVES THAT IT HAS SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROGER ARBUCKLE | ||||||||||||||
| CEO | $165,000 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $11,491 | $0 | $184,741 | $0 | $0 | $0 |
| DAVID CONATSER | ||||||||||||||
| PHYSICIAN | $160,000 | $0 | $0 | $0 | $0 | $0 | $8,000 | $0 | $0 | $0 | $168,000 | $0 | $0 | $0 |
| SUSAN HAWKINS | ||||||||||||||
| PHYSICIAN | $200,000 | $0 | $0 | $0 | $0 | $0 | $10,000 | $0 | $0 | $0 | $210,000 | $0 | $0 | $0 |
| STEVEN ZELLER | ||||||||||||||
| PHYSICIAN | $197,442 | $0 | $0 | $0 | $0 | $0 | $5,321 | $0 | $13,068 | $0 | $215,831 | $0 | $0 | $0 |
| BILLIE GALYEN | ||||||||||||||
| PHYSICIAN | $190,000 | $0 | $0 | $0 | $0 | $0 | $9,500 | $0 | $13,068 | $0 | $212,568 | $0 | $0 | $0 |
| DEANDRA DAVIS | ||||||||||||||
| PHYSICIAN | $180,000 | $0 | $0 | $0 | $0 | $0 | $2,077 | $0 | $0 | $0 | $182,077 | $0 | $0 | $0 |
| NATALIE HUTTON | ||||||||||||||
| PHYSICIAN | $165,000 | $0 | $0 | $0 | $0 | $0 | $8,250 | $0 | $13,068 | $0 | $186,318 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | PROVIDERS ARE ELIGIBLE TO RECEIVE A BONUS BASED ON A PRODUCTIVITY FORMULA | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT PRESENTS THE FEDERAL FORM 990 TO THE BOARD AT THE REGULARLY SCHEDULED BOARD MEETING IMMEDIATELY PRECEDING THE RETURN'S DUE DATE. THE RETURN IS FILED AFTER BOARD REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND OFFICERS SIGN ANNUAL CONFLICT OF INTEREST STATEMENTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD DETERMINED THE CEO'S SALARY BASED ON SALARY SURVEY DATA FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND CONDUCTS AN ANNUAL PERFORMANCE EVALUATION. THE CEO DETERMINED THE CFO'S SALARY BASED ON THE SAME INFORMATION WHICH IS EVALUATED ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES GOVERNING DOCUMENTS, ITS CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. ANNUAL FORMS 990 ARE AVAILABLE ON GUIDESTAR.ORG. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 755,367. MANAGEMENT AND GENERAL EXPENSES 124,223. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 879,590. BANK FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 110. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS FROM THE PRIOR YEAR. |
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