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MAPLE CITY HEALTH CARE CENTER INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
MAPLE CITY HEALTH CARE CENTER INC (EIN 35-1749398)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-06-18
IRS object ID
201801699349301155
Schema version
2017v2.2
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)
Return2018-06-18T14:57:10-05:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN351307701PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KRUGGEL LAWTON & COMPANY LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1317 W FRANKLIN STAddressLine1Txt
CityELKHARTCityNm
State AbbreviationINStateAbbreviationCd
ZIP46516ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351749398EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MAPLE CITY HEALTH CARE CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMAPLBusinessNameControlTxt
Phone5745343300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP465282956ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKAREN MILLER RUSHPersonNm
Person TitleOFFICERPersonTitleTxt
Phone5745343300PhoneNum
Signature2018-06-08SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARGENE ZINKPreparerPersonNm
PTINP01222961PTIN
Phone5742642247PhoneNum
Preparation2018-06-08PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address199.58.74.130IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-06-08IPDt
IP Tm11:50:54IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id0AAAEEC478E15EFE5F1B41E9CE22463606C5FBB8AtSubmissionCreationDeviceId
At Submission Filing Device Id0AAAEEC478E15EFE5F1B41E9CE22463606C5FBB8AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1VISTA COMMUNITY HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerKAREN MILLER RUSHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP465282956ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$7,600,186GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MCHCC.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1988FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTHE MISSION OF MAPLE CITY HEALTH CARE CENTER IS:I. TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE ANDII. TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee101TotalEmployeeCnt
Total Volunteers19TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$3,968,815PYContributionsGrantsAmt
CY Contributions Grants$3,607,161CYContributionsGrantsAmt
PY Program Service Revenue$2,616,745PYProgramServiceRevenueAmt
CY Program Service Revenue$3,982,732CYProgramServiceRevenueAmt
PY Investment Income$8,935PYInvestmentIncomeAmt
CY Investment Income$9,669CYInvestmentIncomeAmt
PY Other Revenue$1,486PYOtherRevenueAmt
CY Other Revenue$624CYOtherRevenueAmt
PY Total Revenue$6,595,981PYTotalRevenueAmt
CY Total Revenue$7,600,186CYTotalRevenueAmt
PY Grants And Similar Paid$5,500PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$6,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$4,367,073PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,916,336CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,845,925PYOtherExpensesAmt
CY Other Expenses$1,845,341CYOtherExpensesAmt
PY Total Expenses$6,218,498PYTotalExpensesAmt
CY Total Expenses$6,767,677CYTotalExpensesAmt
PY Revenues Less Expenses$377,483PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$832,509CYRevenuesLessExpensesAmt
Total Assets BOY$3,858,807TotalAssetsBOYAmt
Total Assets EOY$4,723,318TotalAssetsEOYAmt
Total Liabilities BOY$427,570TotalLiabilitiesBOYAmt
Total Liabilities EOY$623,174TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,431,237NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,100,144NetAssetsOrFundBalancesEOYAmt
MissionTHE MISSION OF MAPLE CITY HEALTH CARE CENTER IS:I. TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE ANDII. TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$5,937,629ExpenseAmt
Grant$6,000GrantAmt
Revenue$3,983,356RevenueAmt
DescFOSTERING HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND ARTICULATING AND PROMOTING OUR EXPERIENCE AS A SUSTAINABLE MODEL. WE PROVIDE MEDICAL, BEHAVIOR HEALTH, DENTAL, VISION, AND SOCIAL SERVICES.Desc
Total Program Service Expenses$5,937,629TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee101EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKAREN MILLER RUSHPersonNm
Phone5745340088PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP46528ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
ADAM SCHARF
BOARD MEMBER1.00Yes (X)$0$0$0
ROEL CERVANTES
BOARD MEMBER1.00Yes (X)$0$0$490
JOHN DRIVER
BOARD MEMBER1.00Yes (X)$0$0$10
KEVIN FARMWALD
BOARD MEMBER1.00Yes (X)$0$0$153
DENISE METTERT
BOARD MEMBER1.00Yes (X)$0$0$2,593
MIGUEL MILLAN
BOARD MEMBER1.00Yes (X)$0$0$449
RACHEL MILLER JACOBS
BOARD MEMBER1.00Yes (X)$0$0$0
IRMA PEREZ
BOARD MEMBER1.00Yes (X)$0$0$1,952
JENNY MARTINEZ
BOARD MEMBER1.00Yes (X)$0$0$0
SARAH METZLER
BOARD MEMBER1.00Yes (X)$0$0$1,900
FELISA REYES
BOARD MEMBER1.00Yes (X)$0$0$901
MAX MERTZ
PRESIDENT1.00Yes (X)$0$0$0Yes (X)
JAMES NELSON GINGERICH
GUARDIAN OF VISION60.00Yes (X)$132,597$0$17,063Yes (X)
KAREN MILLER RUSH
DIRECTOR OF FINANCE40.00$64,539$0$12,205Yes (X)
STEPHEN HARMON
GUARDIAN OF MEDICAL SERVICE50.00$129,202$0$25,126Yes (X)
THOMAS KREIDER
PSYCHIATRIST40.00$143,928$0$15,663Yes (X)
SHANNON STEVENSON
PHYSICIAN50.00$110,299$0$22,081Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$580,565TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$100,586TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ABG DENTAL
622 W LINCOLNGOSHENIN46526DENTAL SERVICES$242,566
EVERENCE TRUST COMPANY
1110 N MAIN ST PO BOX 483GOSHENIN46527RETIREMENT BENEFITS$226,488
ELKHART COUNTY CLUBHOUSE
114 S FIFTH STGOSHENIN46528MENTAL HEALTH SERVICES$125,000
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$2,830,336GovernmentGrantsAmt
All Other Contributions$776,825AllOtherContributionsAmt
Noncash Contributions$326,724NoncashContributionsAmt
Total Contributions$3,607,161TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPROGRAM SERVICESDesc
Business621400BusinessCd
Total Revenue Column$3,982,732TotalRevenueColumnAmt
Related Or Exempt Func Income$3,982,732RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$3,982,732TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,669TotalRevenueColumnAmt
Exclusion$9,669ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business900099BusinessCd
Total Revenue Column$624TotalRevenueColumnAmt
Related Or Exempt Func Income$624RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$624OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,600,186TotalRevenueColumnAmt
Related Or Exempt Func Income$3,983,356RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$9,669ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$6,000TotalAmt
Program Services$6,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$230,606TotalAmt
Program Services$196,015ProgramServicesAmt
Management And General$34,591ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,318,788TotalAmt
Program Services$2,820,970ProgramServicesAmt
Management And General$497,818ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$218,848TotalAmt
Program Services$186,021ProgramServicesAmt
Management And General$32,827ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$876,293TotalAmt
Program Services$744,849ProgramServicesAmt
Management And General$131,444ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$271,801TotalAmt
Program Services$231,031ProgramServicesAmt
Management And General$40,770ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$314TotalAmt
Management And General$314ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$20,701TotalAmt
Management And General$20,701ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,780TotalAmt
Program Services$1,513ProgramServicesAmt
Management And General$267ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$67,033TotalAmt
Program Services$56,978ProgramServicesAmt
Management And General$10,055ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$160,367TotalAmt
Program Services$136,312ProgramServicesAmt
Management And General$24,055ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$159,559TotalAmt
Program Services$135,625ProgramServicesAmt
Management And General$23,934ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$42,292TotalAmt
Program Services$40,323ProgramServicesAmt
Management And General$1,969ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$733TotalAmt
Program Services$733ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$75,354TotalAmt
Program Services$64,051ProgramServicesAmt
Management And General$11,303ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$73,133TotalAmt
Program Services$73,133ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES$855,557$855,557
VACCINES$326,724$326,724
PROFESSIONAL DUES$39,479$39,479
MISCELLANEOUS$22,315$22,315

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$6,767,677TotalAmt
Program Services$5,937,629ProgramServicesAmt
Management And General$830,048ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$64,482BOYAmt
EOY$198,181EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,600,254BOYAmt
EOY$1,515,999EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$516,519BOYAmt
EOY$1,372,393EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$330,365BOYAmt
EOY$285,439EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$50,952BOYAmt
EOY$14,135EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,830,828LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$493,657LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,288,558BOYAmt
EOY$1,337,171EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$7,677BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,858,807BOYAmt
EOY$4,723,318EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$427,570BOYAmt
EOY$423,174EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
EOY$200,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$427,570BOYAmt
EOY$623,174EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,896,687BOYAmt
EOY$2,740,196EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,534,550BOYAmt
EOY$1,359,948EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,431,237BOYAmt
EOY$4,100,144EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,858,807BOYAmt
EOY$4,723,318EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$832,509ReconcilationRevenueExpnssAmt
Donated Services And Use Fclts-$163,602DonatedServicesAndUseFcltsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$165,417OtherCostOrOtherBasisAmt
Book Value$165,417BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$478,139OtherCostOrOtherBasisAmt
Depreciation$62,950DepreciationAmt
Book Value$415,189BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$597,440OtherCostOrOtherBasisAmt
Depreciation$275,719DepreciationAmt
Book Value$321,721BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$168,497OtherCostOrOtherBasisAmt
Depreciation$105,207DepreciationAmt
Book Value$63,290BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$421,335OtherCostOrOtherBasisAmt
Depreciation$49,781DepreciationAmt
Book Value$371,554BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,337,171TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$7,697,958TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts$58,094DonatedServicesAndUseFcltsAmt
Other Revenue$39,678OtherRevenueAmt
Revenue Not Reported$97,772RevenueNotReportedAmt
Revenue Subtotal$7,600,186RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$7,600,186TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$7,029,051TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$221,696DonatedServicesUseFcltsAmt
Other Expenses Included$39,678OtherExpensesIncludedAmt
Expenses Not Reported$261,374ExpensesNotReportedAmt
Expenses Subtotal$6,767,677ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$6,767,677TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE INCOME TAXES TOPIC, FASB ASC 740, CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. ASC 740 REQUIRES AN ORGANIZATION TO DISCLOSE THE NATURE OF UNCERTAIN TAX POSITIONS TAKEN, IF ANY, WHEN FILING ITS INCOME TAX RETURN UTILIZING A TWO-STEP PROCESS TO RECOGNIZE AND MEASURE ANY UNCERTAIN TAX POSITIONS TAKEN. THE ORGANIZATION RECOGNIZES A TAX BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THE POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. NO TAX BENEFIT WILL BE RECORDED ON TAX POSITIONS NOT MEETING THE MORE LIKELY THAN NOT TEST. INTEREST AND PENALTIES ACCRUED OR INCURRED, IF ANY, AS A RESULT OF APPLYING ASC 740 WILL BE RECORDED TO INTEREST EXPENSE AND OTHER EXPENSE, RESPECTIVELY. BASED ON ITS EVALUATION, THE ORGANIZATION HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS REQUIRING RECOGNITION IN ITS FINANCIAL STATEMENTS. THE ORGANIZATION'S EVALUATION WAS PERFORMED FOR ALL FEDERAL AND STATE TAX PERIODS STILL SUBJECT TO EXAMINATION. THE ORGANIZATION'S 2014 THROUGH 2016 FEDERAL AND STATE EXEMPT ORGANIZATION RETURNS REMAIN SUBJECT TO EXAMINATION BY THE IRS AND STATE TAXING AUTHORITIES.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE
PART XII, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
STEPHEN HARMON
GUARDIAN OF MEDICAL SERVICE$129,202$129,202$0$0$0$25,126$9,677$0$15,449$0$154,328$154,328$0$0
THOMAS KREIDER
PSYCHIATRIST$143,928$143,928$0$0$0$15,663$8,847$0$6,816$0$159,591$159,591$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationTHE GUARDIAN OF VISION'S COMPENSATION IS SET USING THE SAME STANDARD MCHCC / VCHC WAGE SCALE USED FOR ESTABLISHING COMPENSATION FOR ALL OF OUR STAFF. THIS WAGE SCALE FACTORS IN: EDUCATION AND TRAINING, EXPERIENCE, LANGUAGE, CALL (IF APPLICABLE) AND MOST IMPORTANTLY RESPONSIBILITY LEVEL. EACH FACTOR IS ASSIGNED A POINT VALUE WHICH THEN TRANSLATES INTO HOURLY WAGE AMOUNTS. ALL NEW STAFF LEVELS ARE EVALUATED BY TWO STAFF MEMBERS AND A WRITTEN EMPLOYMENT CONTRACT IS ISSUED. IN SUBSEQUENT YEARS, ALL STAFF RECEIVE A LETTER INDICATING THEIR ANNUAL PAY INCREASE. ANNUAL INCREASES ARE BASED ON EXPERIENCE RAISES (THOUGH DR. GINGERICH HAS MAXED OUT THIS CATEGORY) AND ANNUAL COST OF LIVING RAISES.ExplanationTxt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution12ContributionCnt
Noncash Contributions Rpt F990$326,724NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION'S MEMBERSHIP INCLUDES HEALTH CARE CENTER STAFF AND PATIENTS AND IS OPEN TO ANYONE ELSE INTERESTED IN FURTHERING THE PURPOSE OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AMEMBERS ON THE BOARD OF DIRECTORS APPOINT NEW MEMBERS TO THE BOARD OF DIRECTORS AFTER A CONSULTATION PROCESS.
FORM 990, PART VI, SECTION B, LINE 11BA DRAFT OF THE FORM 990 IS EMAILED TO BOARD MEMBERS BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE BOARD OF DIRECTORS REVIEWS CONFLICTS OF INTEREST ANNUALLY. STAFF IS MADE AWARE OF THE POLICY AND IN RELEVANT SITUATIONS, THE POLICY IS REVIEWED.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION HAS A POINT SYSTEM TO DETERMINE SALARY LEVELS FOR ALL STAFF INCLUDING ALL MANAGEMENT PERSONNEL. THE POINT SYSTEM IS BASED ON: EDUCATION, EXPERIENCE, LANGUAGE ABILITY, RESPONSIBILITY LEVEL, AND WHETHER OR NOT THEY HAVE CALL RESPONSIBILITIES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTHSIDE COMMUNITY HEALTH CENTER INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1808 NORTH THIRD STREETAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP46528ZIPCd
FieldValueIRS element (for citing)
EIN473368774EIN
Primary ActivitiesTO PROVIDE HEALTH CARE IN THE GOSHEN, INDIANA COMMUNITYPrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MAPLE CITY HEALTH CARE CENTER INC DBA VISTA COMMUNITY HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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