CHESPENN HEALTH SERVICES: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CHESPENN HEALTH SERVICES (EIN 23-7354899)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-01-29
- IRS object ID
- 201830299349300228
- Schema version
- 2016v3.0
- 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 | 2018-01-29T10:58:36-06:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Tilly Virchow Krause LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1650 Market Street Suite 4500 | AddressLine1Txt |
| City | Philadelphia | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 191037341 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237354899 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHESPENN HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHES | BusinessNameControlTxt |
| Phone | 6104853800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1510 Chester Pike No 200 | AddressLine1Txt |
| City | Eddystone | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19022 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL G LUCAS | PersonNm |
| Person Title | President/CEO | PersonTitleTxt |
| Phone | 6104853800 | PhoneNum |
| Signature | 2018-01-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Julius C Green CPA | PreparerPersonNm |
| PTIN | P00350393 | PTIN |
| Phone | 2159720701 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.255.126.197 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-01-29 | IPDt |
| IP Tm | 10:34:53 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B61FA1639B1C05FB95829B38B50E43F553865046 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | Michael G Lucas | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1510 Chester Pike No 200 | AddressLine1Txt |
| City | Eddystone | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19022 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,231,403 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHESPENN.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | CHESPENN HEALTH SERVICES OPERATES THREE COMPREHENSIVE HEALTH CENTERS LOCATED IN CHESTER AND DELAWARE COUNTIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 135 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,095,923 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,990,080 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,644,227 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,234,651 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,443 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,672 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $11,742,593 | PYTotalRevenueAmt |
| CY Total Revenue | $11,231,403 | 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 | $6,598,496 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,212,109 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,588,765 | PYOtherExpensesAmt |
| CY Other Expenses | $4,680,100 | CYOtherExpensesAmt |
| PY Total Expenses | $11,187,261 | PYTotalExpensesAmt |
| CY Total Expenses | $10,892,209 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $555,332 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $339,194 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,292,995 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,229,219 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,456,189 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,053,219 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,836,806 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,176,000 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CHESPENN HEALTH SERVICES IS A NETWORK OF NON-PROFIT, FEDERALLY QUALIFIED HEALTH CENTERS THAT PROVIDES COMPREHENSIVE PRIMARY AND PREVENTIVE HEALTH CARE AND SOCIAL SERVICES TO MEDICALLY UNDERSERVED FAMILIES AND INDIVIDUALS ON A SLIDING SCALE. CHESPENN HEALTH SERVICES STRIVES TO MEET THE UNIQUE HEALTH NEEDS IN ITS COMMUNITIES IN LINGUISTICALLY AND CULTURALLY COMPETENT WAYS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,608,195 | ExpenseAmt |
| Revenue | $7,234,651 | RevenueAmt |
| Desc | SINCE 1973, CHESPENN HEALTH SERVICES HAS PROVIDED COMPREHENSIVE FAMILY MEDICAL AND DENTAL CARE TO THE RESIDENTS OF CHESTER, PA AND NEIGHBORING COMMUNITIES. IN 2005, CHESPENN EXPANDED THESE HEALTH CARE SERVICES TO THE COATESVILLE AREA, AND IN 2009, CHESPENN OPENED THE CENTER FOR FAMILY HEALTH IN UPPER DARBY, PA. ADDITIONAL SERVICES THAT ARE OFFERED INCLUDE HOMELESS HEALTH CARE, FAMILY PLANNING SERVICES, OB/GYN, HIV/AIDS CARE, BEHAVIORAL HEALTH AND AN IN-HOUSE PHYSICIAN DISPENSARY. CHESPENN IS PRINCIPALLY FUNDED BY GRANTS FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. DURING THE 2016 TAX YEAR, CHESPENN RECEIVED TOTAL GRANT REVENUE OF $2,932,714.DURING THE 2016 TAX YEAR, CHESPENN HAD TOTAL ENCOUNTERS OF 51,310, OF WHICH 47,304 WERE BILLABLE. THE BILLABLE ENCOUNTERS CONSISTED OF THE FOLLOWING IN CHESTER, PA: 6,208 PEDIATRIC ENCOUNTERS, 10,476 ADULT ENCOUNTERS, AND 6,211 DENTAL ENCOUNTERS. IN ADDITION, THERE WERE 9,180 ENCOUNTERS AT THE UPPER DARBY ENTER FOR FAMILY HEALTH AND 15,229 ENCOUNTERS IN THE COATESVILLE SERVICE AREA. NON BILLABLE ENCOUNTERS CONSISTED OF 4,006 NURSE ONLY VISITS.CHESPENN PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE AMOUNTS DETERMINED TO BE CHARITY CARE ARE NOT REPORTED AS REVENUES. DURING THE 2016 TAX YEAR, CHESPENN PROVIDED CHARITY CARE OF APPROXIMATELY $1,194,000 TO PATIENTS. | Desc |
| Total Program Service Expenses | $8,608,195 | 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 | Yes (1) | 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 | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 135 | 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | 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 | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Daniel A Caplan | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6104853800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1510 Chester Pike No 200 | AddressLine1Txt |
| City | Eddystone | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19022 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| WILLIE MAE WELLS | ||||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RAE ROEDER | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KAREN VESELY | ||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CAROL ALLEN | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DONNA LAWLER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID KEITH | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFFREY GREEN | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GWEN SMITH | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Michael G Lucas | ||||||||
| President/CEO | 40.00 | 0.00 | Yes (X) | $214,655 | $0 | $36,174 | ||
| KEVIN MCCABE MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $168,765 | $0 | $9,809 | Yes (X) | ||
| RAQUIBUL ISLAM MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $153,040 | $0 | $19,394 | Yes (X) | ||
| CYNTHIA LACAPRA MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $146,280 | $0 | $13,562 | Yes (X) | ||
| MICHAEL KANE | ||||||||
| DENTIST | 39.50 | 0.00 | $135,057 | $0 | $7,858 | Yes (X) | ||
| VINCENT DEPANICIS | ||||||||
| DENTIST | 39.50 | 0.00 | $132,343 | $0 | $12,616 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $950,140 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $99,413 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| COORDINATED CARE NETWORK | |||||
| 300 PENN CENTER BLVD | PITTSBURGH | PA | 15235 | CONTRACTED PHARMACY SERVICES | $342,751 |
| PROSPECT HEALTH ACCESS NETWORK | |||||
| ONE MEDICAL CENTER BLVD | UPLAND | PA | 19013 | CONTRACTED PHYSICIAN SERVICES | $200,027 |
| NO BOUNDARIES - LANGUAGE & INTERPRETING | |||||
| 475 TIMBERLINE TRL | WEST CHESTER | PA | 19382 | TRANSLATION SERVICES | $153,254 |
| THE CHESTER COUNTY HOSPITAL | |||||
| 701 EAST MARSHALL STREET | WEST CHESTER | PA | 19380 | CONTRACTED PHYSICIAN SERVICES | $116,025 |
| GE HEALTHCARE IITS USA CORP | |||||
| 15724 COLLECTIONS CTR DR | CHICAGO | IL | 60693 | INFORMATION TECHNOLOGY SERVICES | $105,853 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $130,661 | FederatedCampaignsAmt |
| Government Grants | $2,932,714 | GovernmentGrantsAmt |
| All Other Contributions | $926,705 | AllOtherContributionsAmt |
| Total Contributions | $3,990,080 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Service Revenue | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $7,234,651 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,234,651 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,234,651 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,672 | TotalRevenueColumnAmt |
| Exclusion | $6,672 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,231,403 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,234,651 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $6,672 | 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 | $260,233 | TotalAmt |
| Management And General | $260,233 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,873,808 | TotalAmt |
| Program Services | $3,909,637 | ProgramServicesAmt |
| Management And General | $964,171 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $226,510 | TotalAmt |
| Program Services | $208,293 | ProgramServicesAmt |
| Management And General | $18,217 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $451,542 | TotalAmt |
| Program Services | $372,570 | ProgramServicesAmt |
| Management And General | $78,972 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,016 | TotalAmt |
| Program Services | $328,267 | ProgramServicesAmt |
| Management And General | $71,749 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,279 | TotalAmt |
| Management And General | $18,279 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,929 | TotalAmt |
| Program Services | $12,984 | ProgramServicesAmt |
| Management And General | $50,945 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,821,990 | TotalAmt |
| Program Services | $1,591,257 | ProgramServicesAmt |
| Management And General | $230,733 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,019 | TotalAmt |
| Program Services | $300 | ProgramServicesAmt |
| Management And General | $4,719 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $351,846 | TotalAmt |
| Program Services | $284,903 | ProgramServicesAmt |
| Management And General | $66,943 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,319 | TotalAmt |
| Program Services | $35,417 | ProgramServicesAmt |
| Management And General | $296,902 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $930,170 | TotalAmt |
| Program Services | $853,151 | ProgramServicesAmt |
| Management And General | $77,019 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,601 | TotalAmt |
| Program Services | $38,594 | ProgramServicesAmt |
| Management And General | $13,007 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,951 | TotalAmt |
| Program Services | $194,289 | ProgramServicesAmt |
| Management And General | $26,662 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,669 | TotalAmt |
| Program Services | $14,983 | ProgramServicesAmt |
| Management And General | $15,686 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Patient Care | $590,772 | $585,065 | $5,707 |
| PROVISION FOR DOUBTFUL | $126,161 | $126,161 | |
| Equipment Rental | $52,680 | $31,378 | $21,302 |
| DUES AND SUBSCRIPTIONS | $40,272 | $1,904 | $38,368 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,442 | TotalAmt |
| Program Services | $19,042 | ProgramServicesAmt |
| Management And General | $24,400 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,892,209 | TotalAmt |
| Program Services | $8,608,195 | ProgramServicesAmt |
| Management And General | $2,284,014 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $235,732 | BOYAmt |
| EOY | $259,365 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,644,794 | BOYAmt |
| EOY | $5,580,411 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $162,527 | BOYAmt |
| EOY | $112,680 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $598,593 | BOYAmt |
| EOY | $748,578 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,500 | BOYAmt |
| EOY | $9,801 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,959 | BOYAmt |
| EOY | $105,259 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,760,989 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,347,864 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,353,361 | BOYAmt |
| EOY | $1,413,125 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,529 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,292,995 | BOYAmt |
| EOY | $8,229,219 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,277,022 | BOYAmt |
| EOY | $2,097,308 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $179,167 | BOYAmt |
| EOY | $93,750 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $862,161 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,456,189 | BOYAmt |
| EOY | $3,053,219 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,836,806 | BOYAmt |
| EOY | $5,176,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,836,806 | BOYAmt |
| EOY | $5,176,000 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,292,995 | BOYAmt |
| EOY | $8,229,219 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $339,194 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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 | $2,753,950 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,029,337 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,859,067 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,095,923 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,990,080 | CurrentTaxYearAmt |
| Total | $17,728,357 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,242,581 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,871,117 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,443,999 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $7,644,227 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,234,651 | CurrentTaxYearAmt |
| Total | $33,436,575 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,996,531 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,900,454 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,303,066 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,740,150 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,224,731 | CurrentTaxYearAmt |
| Total | $51,164,932 | 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 | $51,164,932 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,454 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,118 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,877 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,443 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,672 | CurrentTaxYearAmt |
| Total | $18,564 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,454 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,118 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,877 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,443 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,672 | CurrentTaxYearAmt |
| Total | $18,564 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,001,985 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,902,572 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,304,943 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,742,593 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,231,403 | CurrentTaxYearAmt |
| Total | $51,183,496 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99960 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99960 | PublicSupportPY509Pct |
| Investment Income CY | 0.00040 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00040 | 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 | $100,838 | OtherCostOrOtherBasisAmt |
| Book Value | $100,838 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,673,971 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,739,012 | DepreciationAmt |
| Book Value | $934,959 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $596,154 | OtherCostOrOtherBasisAmt |
| Depreciation | $276,244 | DepreciationAmt |
| Book Value | $319,910 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,341,554 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,284,136 | DepreciationAmt |
| Book Value | $57,418 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $48,472 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,472 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,413,125 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party payor settlements | Desc |
| Amt | $862,161 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $862,161 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $11,231,403 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,231,403 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,231,403 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,892,209 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $10,892,209 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,892,209 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Corporation accounts for uncertainty in income taxes using a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold is met. Management determined there were no tax uncertainties that met the recognition threshold in 2017 and 2016. The Corporation does not perform any activities that would be subject to unrelated business income tax; therefore, it has not filed Form 990-T, Exempt Organization Business Income Tax Return. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael G Lucas | ||||||||||||||
| President/CEO | $203,013 | $0 | $11,642 | $0 | $0 | $0 | $27,233 | $0 | $8,941 | $0 | $250,829 | $0 | $0 | $0 |
| KEVIN MCCABE MD | ||||||||||||||
| PHYSICIAN | $165,653 | $0 | $3,112 | $0 | $0 | $0 | $8,438 | $0 | $1,371 | $0 | $178,574 | $0 | $0 | $0 |
| RAQUIBUL ISLAM MD | ||||||||||||||
| PHYSICIAN | $149,965 | $0 | $3,075 | $0 | $0 | $0 | $7,652 | $0 | $11,742 | $0 | $172,434 | $0 | $0 | $0 |
| CYNTHIA LACAPRA MD | ||||||||||||||
| PHYSICIAN | $143,419 | $0 | $2,861 | $0 | $0 | $0 | $7,314 | $0 | $6,248 | $0 | $159,842 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 7 | FormAndLineReferenceDesc |
| Explanation | The Board of Directors approves an annual Strategic Plan for the organization. The Bonus is based on the achievement of the individual corporate goals in the Strategic Plan. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | KEY FINANCIAL DECISIONS AND REPORTS ARE APPROVED BY THE FINANCE COMMITTEE AND THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. MEMBERS OF THE FINANCE COMMITTEE ARE ALSO MEMBERS OF THE BOARD OF DIRECTORS. |
| Form 990, Part VI, Section A, line 3 | CROZER KEYSTONE HEALTH SYSTEM PROVIDES CONTRACTED PHYSICIAN AND INFORMATION TECHNOLOGY SERVICES. |
| Form 990, Part VI, Section B, line 11b | THE FINAL 990 RETURN WAS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE ALONG WITH THE BOARD OF DIRECTORS OF CHESPENN HEALTH SERVICES. |
| Form 990, Part VI, Section B, line 12c | BOARD MEMBERS MUST ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY. BOARD MEMBERS ARE ALSO REQUIRED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR AND MUST REFRAIN FROM DISCUSSING, AS WELL AS VOTING ON, SUCH MATTERS THAT PERTAIN TO THE CONFLICT. EMPLOYEES OF THE ORGANIZATION ARE ALSO REQUIRED TO REPORT ANY POTENTIAL OR ACTUAL CONFLICT TO THE PRESIDENT/CEO. THE PRESIDENT/CEO IS RESPONSIBLE FOR MONITORING AND RESOLVING ANY CONFLICT OF INTEREST THAT MAY ARISE WITHIN THE ORGANIZATION. |
| Form 990, Part VI, Section B, line 15 | TO DETERMINE THE SALARY OF THE PRESIDENT/CEO, CHESPENN HEALTH SERVICES RELIES ON SURVEY INFORMATION FROM TWO SOURCES. THE FIRST SOURCE IS AN ANNUAL SURVEY CONDUCTED BY THE HOSPITAL AND THE HEALTHCARE COMPENSATION SERVICE FOR THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS WHICH CATEGORIZES ALL COMMUNITY HEALTH CENTERS BY SERVICE LEVEL, GEOGRAPHY AND, BUDGET. THE SECOND SOURCE IS THE IRS FORM 990 IN WHICH A COMPENSATION SURVEY OF REGIONAL COMMUNITY HEALTH CENTERS IS CONDUCTED. BOTH SOURCES OF INFORMATION ARE USED BY CHESPENN HEALTH SERVICES' BOARD OF DIRECTORS TO DETERMINE THE COMPENSATION LEVEL. THIS COMPENSATION REVIEW IS CONDUCTED ON AN ANNUAL BASIS TO ASSURE THAT COMPENSATION IS IN LINE WITH FAIR MARKET VALUE, AND THE PROcESS IS DOCUMENTED IN THE BOARD MINUTES. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. |
| Form 990, Part IX, line 11g | physicians, dental, interpreting: Program service expenses 1,591,257. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,591,257. grant writing & consulting, billing, IT: Program service expenses 0. Management and general expenses 230,733. Fundraising expenses 0. Total expenses 230,733. |
| Form 990, Part VI, Section B, Line 13: | The Organization is currently developing a whistleblower policy which is expected to be approved by the Board in 2017. |
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