ISLANDS COMMUNITY MEDICAL SERVICES INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ISLANDS COMMUNITY MEDICAL SERVICES INC (EIN 01-6012835)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-09
- IRS object ID
- 201812829349300801
- 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 | 2018-10-09T09:03:47-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MARKET SQUARE | AddressLine1Txt |
| City | AUGUSTA | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04330 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 016012835 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ISLANDS COMMUNITY MEDICAL SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ISLA | BusinessNameControlTxt |
| Phone | 2078634341 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEDICAL CENTER LOOP | AddressLine1Txt |
| City | VINALHAVEN | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04863 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DINAH MOYER | PersonNm |
| Person Title | EXECUTIVE DIREC | PersonTitleTxt |
| Phone | 2078634341 | PhoneNum |
| Signature | 2018-10-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ROBERT P DUBE JR | PreparerPersonNm |
| PTIN | P01231018 | PTIN |
| Phone | 2076224766 | PhoneNum |
| Preparation | 2018-10-05 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 66.186.191.122 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-10-05 | IPDt |
| IP Tm | 14:06:07 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 349BBAAB5D25EE150171BB1D89AA958A37864D47 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 4905E349CBAC89AB2555E7BD7131420A378BE896 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEDICAL CENTER LOOP | AddressLine1Txt |
| City | VINALHAVEN | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04863 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,132,193 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | ME | LegalDomicileStateCd |
| Activity Or Mission | ISLANDS COMMUNITY MEDICAL SERVICES IS COMMITTED TO SERVING OUR ISLAND COMMUNITIES BY DEDICATING OURSELVES TO THE HEALTH OF OUR PATIENTS. WE SUPPORT WHOLE HEALTH THROUGH EASE OF ACCESS, PREVENTION, OUTREACH, EDUCATION AND TREATMENT BY PROVIDING THE HIGHEST QUALITY PRIMARY, URGENT AND EMERGENT CARE TO OUR PATIENTS AND COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 32 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,326,156 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,951,778 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,206,595 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,062,905 | CYProgramServiceRevenueAmt |
| PY Investment Income | $289,967 | PYInvestmentIncomeAmt |
| CY Investment Income | $117,510 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $2,822,718 | PYTotalRevenueAmt |
| CY Total Revenue | $3,132,193 | 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 | $1,309,132 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,509,508 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $7,779 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $883,652 | PYOtherExpensesAmt |
| CY Other Expenses | $776,278 | CYOtherExpensesAmt |
| PY Total Expenses | $2,192,784 | PYTotalExpensesAmt |
| CY Total Expenses | $2,285,786 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $629,934 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $846,407 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,574,491 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,782,448 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $101,222 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $114,882 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,473,269 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,667,566 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ISLANDS COMMUNITY MEDICAL SERVICES IS COMMITTED TO SERVING OUR ISLAND COMMUNITIES BY DEDICATING OURSELVES TO THE HEALTH OF OUR PATIENTS. WE SUPPORT WHOLE HEALTH THROUGH EASE OF ACCESS, PREVENTION, OUTREACH, EDUCATION AND TREATMENT BY PROVIDING THE HIGHEST QUALITY PRIMARY, URGENT AND EMERGENT CARE TO OUR PATIENTS AND COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,093,817 | ExpenseAmt |
| Revenue | $716,272 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED MEDICAL SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATION OPERATES A MEDICAL CLINIC WITH THREE FULL TIME AND TWO PART TIME MEDICAL PROVIDERS. THE CLINIC PROVIDED COVERAGE 24 HOURS A DAY, 7 DAYS A WEEK. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $257,826 | ExpenseAmt |
| Revenue | $199,885 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED DENTAL SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATION OPERATES A DENTAL CLINIC WITH TWO DENTAL PROVIDERS WHO WORK 2.5 DAYS PER WEEK. DENTAL EMERGENCIES ARE GENERALLY HANDLED BY THE MEDICAL PROVIDERS IF THE DENTIST IS NOT AVAILABLE. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $98,478 | ExpenseAmt |
| Revenue | $146,748 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED BEHAVIORAL HEALTH SERVICES TO THE COMMUNITIES OF VINALHAVEN, MATINICUS, AND NORTH HAVEN. THE ORGANIZATION OPERATES THE BEHAVIORAL HEALTH CLINIC WITH ONE FULL TIME THERAPIST WHO WORKS 5 DAYS PER WEEK AND ONE PART TIME THERAPIST. BEHAVIORAL HEALTH EMERGENCIES ARE GENERALLY HANDLED BY THE MEDICAL PROVIDERS IF THE THERAPIST IS NOT AVAILABLE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,450,121 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | 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 | Yes (1) | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 32 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | 0 | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | 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 | DINAH B MOYER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2078634341 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 MEDICAL CENTER LOOP | AddressLine1Txt |
| City | VINALHAVEN | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04863 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| BRUCE HOPKINS | |||||||
| PRESIDENT | 8.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BARBARA HAMILTON | |||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KATHI YOUNG | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JON EMERSON | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LAURA BLANKERTZ PHD | |||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WILLIAM A LIEBER MD | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD YOUNG | |||||||
| VICE PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CONNIE GEMMER | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MARC CANDAGE | |||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DIANE COCHRAN | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KEELEY PHILBROOK | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| WESLEY ROBINSON | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN BLATT | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| EMILY LANE | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTOPHER RADLEY | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| HEATHER WHITE | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DINAH MOYER | |||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $100,824 | $0 | $18,585 | ||
| JENNIFER DESMOND | |||||||
| CLINICAL DIRECTOR, NURSE P | 40.00 | $135,915 | $0 | $19,191 | Yes (X) | ||
| CHRISTINA QUINLAN | |||||||
| DIRECTOR OF OPERATIONS | 26.00 | $113,390 | $0 | $14,084 | Yes (X) | ||
| ALISON WOOD | |||||||
| PHYSICIAN'S ASSISTANT | 40.00 | $112,252 | $0 | $24,146 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $462,381 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $76,006 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | 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 | $1,026,666 | GovernmentGrantsAmt |
| All Other Contributions | $925,112 | AllOtherContributionsAmt |
| Total Contributions | $1,951,778 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENU | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $1,062,905 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,062,905 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,062,905 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $117,510 | TotalRevenueColumnAmt |
| Exclusion | $117,510 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,132,193 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,062,905 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $117,510 | 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 | $462,381 | TotalAmt |
| Program Services | $315,512 | ProgramServicesAmt |
| Management And General | $146,869 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $756,011 | TotalAmt |
| Program Services | $515,874 | ProgramServicesAmt |
| Management And General | $240,137 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,607 | TotalAmt |
| Program Services | $26,201 | ProgramServicesAmt |
| Management And General | $11,406 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,844 | TotalAmt |
| Program Services | $111,801 | ProgramServicesAmt |
| Management And General | $52,043 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,665 | TotalAmt |
| Program Services | $61,184 | ProgramServicesAmt |
| Management And General | $28,481 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,001 | TotalAmt |
| Management And General | $15,001 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,485 | TotalAmt |
| Management And General | $19,485 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,706 | TotalAmt |
| Program Services | $39,303 | ProgramServicesAmt |
| Management And General | $23,403 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,025 | TotalAmt |
| Management And General | $1,025 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,441 | TotalAmt |
| Program Services | $43,913 | ProgramServicesAmt |
| Management And General | $14,528 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,179 | TotalAmt |
| Program Services | $8,907 | ProgramServicesAmt |
| Management And General | $13,272 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL, LAB, & XRAY SU | $106,408 | $106,408 | |
| OFFICE SUPPLIES | $82,178 | $10,175 | $72,003 |
| MISCELLANEOUS | $63,683 | $9,918 | $53,765 |
| DISPENSARY SUPPLIES | $62,503 | $62,503 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $282,669 | TotalAmt |
| Program Services | $138,422 | ProgramServicesAmt |
| Management And General | $136,468 | ManagementAndGeneralAmt |
| Fundraising | $7,779 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,285,786 | TotalAmt |
| Program Services | $1,450,121 | ProgramServicesAmt |
| Management And General | $827,886 | ManagementAndGeneralAmt |
| Fundraising | $7,779 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,941 | BOYAmt |
| EOY | $22,407 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $360,143 | BOYAmt |
| EOY | $359,035 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,893 | BOYAmt |
| EOY | $69,551 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,161 | BOYAmt |
| EOY | $194,960 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,098 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,271 | BOYAmt |
| EOY | $77,967 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,350 | BOYAmt |
| EOY | $20,885 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,638,538 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $484,924 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $405,791 | BOYAmt |
| EOY | $1,153,614 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,233,339 | BOYAmt |
| EOY | $2,583,119 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,172,504 | BOYAmt |
| EOY | $1,300,910 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,574,491 | BOYAmt |
| EOY | $5,782,448 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,681 | BOYAmt |
| EOY | $30,422 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,005 | BOYAmt |
| EOY | $26,661 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,932 | BOYAmt |
| EOY | $10,042 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,604 | BOYAmt |
| EOY | $47,757 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,222 | BOYAmt |
| EOY | $114,882 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,874,271 | BOYAmt |
| EOY | $3,926,723 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $426,494 | BOYAmt |
| EOY | $439,933 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,172,504 | BOYAmt |
| EOY | $1,300,910 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,473,269 | BOYAmt |
| EOY | $5,667,566 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,574,491 | BOYAmt |
| EOY | $5,782,448 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $846,407 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $219,484 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $128,406 | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $105,675 | OtherCostOrOtherBasisAmt |
| Book Value | $105,675 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $646,560 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,694 | DepreciationAmt |
| Book Value | $643,866 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $381,018 | OtherCostOrOtherBasisAmt |
| Depreciation | $111,955 | DepreciationAmt |
| Book Value | $269,063 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $402,475 | OtherCostOrOtherBasisAmt |
| Depreciation | $289,424 | DepreciationAmt |
| Book Value | $113,051 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $102,810 | OtherCostOrOtherBasisAmt |
| Depreciation | $80,851 | DepreciationAmt |
| Book Value | $21,959 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,153,614 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTEREST - PERP. CHAR. TRUST | Desc |
| Book Value | $1,300,910 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,300,910 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED EXPENSES | $36,793 |
| ACCRUED PENSION PAYABLE | $10,964 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $47,757 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $3,516,478 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $219,484 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $36,395 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $128,406 | OtherRevenueAmt |
| Revenue Not Reported | $384,285 | RevenueNotReportedAmt |
| Revenue Subtotal | $3,132,193 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $3,132,193 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,322,181 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $36,395 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $36,395 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,285,786 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,285,786 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART XI, LINE 2D - OTHER ADJUSTMENTS: | FormAndLineReferenceDesc |
| Explanation | BENEFICIAL INTEREST IN PERPETUAL CHARITA 128,406. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER DESMOND | PersonNm |
| Title | CLINICAL DIRECTOR, NURSE P | TitleTxt |
| Base Compensation Filing Org | $135,915 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $6,796 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $12,395 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $155,106 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $730,000 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | APPRAISAL | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | LINE 11A EXPLANATION - THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS FOR DISCUSSION, REVIEW AND APPROVAL BEFORE FILING. |
| FORM 990, PART VI, SECTION C, LINE 19 | PRINT COPIES OF GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY COULD BE PICKED UP AT OFFICE HEADQUARTERS. FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC HOWEVER PERTINENT ANNUAL FINANCIAL RESULTS ARE REPORTED IN THE ORGANIZATION'S ANNUAL REPORT. |
| FORM 990, PART IX, LINE 24E | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 62,399. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,399. BILLING SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 31,255. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,255. CONSULTANTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 26,672. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,672. TELEPHONE: PROGRAM SERVICE EXPENSES 15,207. MANAGEMENT AND GENERAL EXPENSES 8,772. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,979. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 3,609. MANAGEMENT AND GENERAL EXPENSES 19,420. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,029. UTILITIES: PROGRAM SERVICE EXPENSES 19,284. MANAGEMENT AND GENERAL EXPENSES 3,403. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,687. CONTRACTED PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 21,107. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,107. WORKERS COMP INSURANCE: PROGRAM SERVICE EXPENSES 9,242. MANAGEMENT AND GENERAL EXPENSES 10,839. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,081. INVESTMENT MANAGEMENT FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 10,699. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,699. POSTAGE & FREIGHT: PROGRAM SERVICE EXPENSES 2,909. MANAGEMENT AND GENERAL EXPENSES 5,528. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,437. FUNDRAISING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 7,779. TOTAL EXPENSES 7,779. BANK CHARGES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 7,237. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,237. STAFF DEVELOPMENT: PROGRAM SERVICE EXPENSES 1,456. MANAGEMENT AND GENERAL EXPENSES 4,859. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,315. EQUIPMENT LEASE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,473. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,473. LICENSES & PERMITS: PROGRAM SERVICE EXPENSES 2,606. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,606. ADVERTISING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,311. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,311. LOCUMS TENENS: PROGRAM SERVICE EXPENSES 603. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 603. |
| FORM 990, PART XI, LINE 9: | BENEFICIAL INTEREST IN PERPETUAL CHARITABLE TRUST 128,406. |
| FORM 990, PART XII, LINE 2C: | NO CHANGES FROM PRIOR YEAR. |
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