CHOPTANK COMMUNITY HEALTH SYSTEM INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- CHOPTANK COMMUNITY HEALTH SYSTEM INC (EIN 52-1116591)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-08
- IRS object ID
- 201843129349302294
- 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 | 2018-11-08T14:04:05-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 341876254 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CBIZ MHM LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 28614 MARLBORO AVE SUITE 103 | AddressLine1Txt |
| City | EASTON | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21601 | 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 | 521116591 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHOPTANK COMMUNITY HEALTH SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHOP | BusinessNameControlTxt |
| Phone | 4104794306 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 660 | AddressLine1Txt |
| City | DENTON | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21629 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SARA RICH | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4104794306 | PhoneNum |
| Signature | 2018-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CARVILLE B LEAF JR | PreparerPersonNm |
| PTIN | P00040844 | PTIN |
| Phone | 4108226950 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 138.207.175.194 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-07 | IPDt |
| IP Tm | 12:54:52 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B7262524F9D6FC8FD70D077A6FA39F78D7814145 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SARA RICH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 660 | AddressLine1Txt |
| City | DENTON | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21629 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,318,710 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | CHOPTANKHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | MD | LegalDomicileStateCd |
| Activity Or Mission | PRIMARY HEALTH CARE SERVICES, DELIVERY OF HEALTH CARE TO MEDICALLY UNDERSERVED COMMUNITY | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 197 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,266,085 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,291,692 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,936,405 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,889,048 | CYProgramServiceRevenueAmt |
| PY Investment Income | $97,108 | PYInvestmentIncomeAmt |
| CY Investment Income | $127,334 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,576,515 | PYOtherRevenueAmt |
| CY Other Revenue | $2,010,636 | CYOtherRevenueAmt |
| PY Total Revenue | $17,876,113 | PYTotalRevenueAmt |
| CY Total Revenue | $18,318,710 | 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 | $12,956,513 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,502,158 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,965,919 | PYOtherExpensesAmt |
| CY Other Expenses | $4,130,601 | CYOtherExpensesAmt |
| PY Total Expenses | $16,922,432 | PYTotalExpensesAmt |
| CY Total Expenses | $17,632,759 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $953,681 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $685,951 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,591,527 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,015,400 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,790,193 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,574,515 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,801,334 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,440,885 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PRIMARY HEALTH CARE SERVICES: DELIVERY OF HEALTH CARE TO MEDICALLY UNDERSERVED COMMUNITY | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,581,658 | ExpenseAmt |
| Revenue | $13,027,018 | RevenueAmt |
| Desc | PRIMARY HEALTH CARE SERVICES: DELIVERY OF HEALTHCARE TO MEDICALLY UNDERSERVED COMMUNITY | Desc |
| Total Program Service Expenses | $13,581,658 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | 41 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 197 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIMBERLY R LOVE FINANCE DIRECTOR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4104794306 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 RANDOLPH ST | AddressLine1Txt |
| City | DENTON | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 21629 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 |
|---|---|---|---|---|---|---|---|
| JOHN MASONE | |||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| IVONNE GARRIDO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| REBECCA LOUKIDES | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CRYSTAL DADDS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM CORBA | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL CAMPBELL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TANIA ALEXANDER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAULINE PINKETT | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW PETERS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL SHERTENLIEB | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JENNIFER YOST | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| AUSTIN WEBSTER | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SARA VISINTAINER | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SARA RICH | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $163,015 | $0 | $34,556 | ||
| RICARDO DAJANI | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $65,828 | $0 | $11,849 | ||
| MARK FABER MD | |||||||
| PHYSICIAN | 40.00 | $181,838 | $0 | $38,362 | Yes (X) | ||
| KATELIN HALEY | |||||||
| PHYSICIAN | 40.00 | $180,671 | $0 | $38,094 | Yes (X) | ||
| SANDRA GARBELY-KERKOVICH DMD | |||||||
| PHYSICIAN | 40.00 | $180,531 | $0 | $38,119 | Yes (X) | ||
| LISA URBAN MD | |||||||
| PHYSICIAN | 40.00 | $175,460 | $0 | $36,991 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $947,343 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $197,971 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 28 | 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 |
|---|---|---|---|---|---|
| HEALTH CHOICE NETWORK INC | |||||
| 9064 NW 13TH TERRACE | DORAL | FL | 33172 | HEALTH TECHNOLOGY SOLUTIONS | $652,134 |
| MCALLISTER DETAR SHOWALTER & WALKER LL | |||||
| 100 N WEST STREET | EASTON | MD | 21601 | LEGAL SERVICES | $312,348 |
| HENRY SCHEIN | |||||
| PO BOX 382023 | PITTSBURGH | PA | 15250 | MEDICAL SUPPLIES | $308,789 |
| BENCO DENTAL | |||||
| PO BOX 731372 | DELLAS | TX | 75397 | DENTAL SUPPLIES | $194,789 |
| GEORGE MILES & BUHR LLC | |||||
| 206 WEST MAIN STREET | SALISBURY | MD | 21801 | ARCHITECTURAL AND ENGINEERING DESIGN | $146,129 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,921,482 | GovernmentGrantsAmt |
| All Other Contributions | $370,210 | AllOtherContributionsAmt |
| Total Contributions | $5,291,692 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEDICAL SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $10,889,048 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,889,048 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,889,048 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $127,334 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $127,334 | RelatedOrExemptFuncIncomeAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,872,836 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,872,836 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $137,800 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $137,800 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $137,800 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,318,710 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,027,018 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,720,159 | TotalAmt |
| Program Services | $8,194,659 | ProgramServicesAmt |
| Management And General | $2,525,500 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $226,491 | TotalAmt |
| Program Services | $173,133 | ProgramServicesAmt |
| Management And General | $53,358 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,733,574 | TotalAmt |
| Program Services | $1,325,171 | ProgramServicesAmt |
| Management And General | $408,403 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $821,934 | TotalAmt |
| Program Services | $628,299 | ProgramServicesAmt |
| Management And General | $193,635 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,129 | TotalAmt |
| Program Services | $42,929 | ProgramServicesAmt |
| Management And General | $42,200 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,142 | TotalAmt |
| Program Services | $59,142 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $444,012 | TotalAmt |
| Program Services | $333,520 | ProgramServicesAmt |
| Management And General | $110,492 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,004 | TotalAmt |
| Program Services | $58,099 | ProgramServicesAmt |
| Management And General | $17,905 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $553,205 | TotalAmt |
| Program Services | $442,564 | ProgramServicesAmt |
| Management And General | $110,641 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,289 | TotalAmt |
| Program Services | $27,730 | ProgramServicesAmt |
| Management And General | $19,559 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROFESSIONAL FEES | $1,210,475 | $996,434 | $214,041 |
| SUPPLIES | $964,480 | $909,929 | $54,551 |
| TELEPHONE | $117,756 | $58,878 | $58,878 |
| BAD DEBTS | $113,313 | $113,313 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $459,796 | TotalAmt |
| Program Services | $217,858 | ProgramServicesAmt |
| Management And General | $241,938 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,632,759 | TotalAmt |
| Program Services | $13,581,658 | ProgramServicesAmt |
| Management And General | $4,051,101 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1 | BOYAmt |
| EOY | -$3 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,906,332 | BOYAmt |
| EOY | $6,189,064 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $906,888 | BOYAmt |
| EOY | $857,714 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $350,966 | BOYAmt |
| EOY | $347,795 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,649 | BOYAmt |
| EOY | $87,127 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,511,942 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,978,339 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,238,464 | BOYAmt |
| EOY | $6,533,603 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100 | BOYAmt |
| EOY | $100 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,127 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,591,527 | BOYAmt |
| EOY | $14,015,400 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,505,915 | BOYAmt |
| EOY | $1,262,561 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $185,922 | BOYAmt |
| EOY | $212,900 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,356 | BOYAmt |
| EOY | $99,054 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,790,193 | BOYAmt |
| EOY | $1,574,515 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,801,334 | BOYAmt |
| EOY | $12,440,885 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,801,334 | BOYAmt |
| EOY | $12,440,885 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,591,527 | BOYAmt |
| EOY | $14,015,400 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $685,951 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$46,400 | NetUnrlzdGainsLossesInvstAmt |
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,045,666 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,144,570 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,541,975 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,266,085 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,291,692 | CurrentTaxYearAmt |
| Total | $23,289,988 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,045,666 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,144,570 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,541,975 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,266,085 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,291,692 | CurrentTaxYearAmt |
| Total | $23,289,988 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $23,289,988 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,713 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,638 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $82,065 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $97,108 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $127,334 | CurrentTaxYearAmt |
| Total | $331,858 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $170,074 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $109,762 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $69,848 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $51,463 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $137,800 | CurrentTaxYearAmt |
| Total | $538,947 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $24,160,793 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $50,132,205 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.96400 | PublicSupportCY170Pct |
| Public Support PY170 | 0.96980 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $603,175 | OtherCostOrOtherBasisAmt |
| Book Value | $603,175 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,842,715 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,814,259 | DepreciationAmt |
| Book Value | $5,028,456 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,066,052 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,164,080 | DepreciationAmt |
| Book Value | $901,972 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,533,603 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT OVERPAYMENTS | Desc |
| Amt | $99,054 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $99,054 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $18,263,998 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$46,398 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $105,000 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $58,602 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,205,396 | RevenueSubtotalAmt |
| Other Revenues Not Included | $113,313 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $113,313 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,318,709 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,624,447 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $105,000 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $105,000 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,519,447 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $113,313 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $113,313 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,632,760 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT 113,313. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT 113,313. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SARA RICH | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $163,015 | $0 | $0 | $0 | $0 | $0 | $5,214 | $0 | $29,342 | $0 | $197,571 | $0 | $0 | $0 |
| MARK FABER MD | ||||||||||||||
| PHYSICIAN | $158,810 | $0 | $23,028 | $0 | $0 | $0 | $5,631 | $0 | $32,731 | $0 | $220,200 | $0 | $0 | $0 |
| KATELIN HALEY | ||||||||||||||
| PHYSICIAN | $153,906 | $0 | $26,765 | $0 | $0 | $0 | $5,573 | $0 | $32,521 | $0 | $218,765 | $0 | $0 | $0 |
| SANDRA GARBELY-KERKOVICH DMD | ||||||||||||||
| PHYSICIAN | $157,408 | $0 | $23,123 | $0 | $0 | $0 | $5,624 | $0 | $32,495 | $0 | $218,650 | $0 | $0 | $0 |
| LISA URBAN MD | ||||||||||||||
| PHYSICIAN | $150,968 | $0 | $24,492 | $0 | $0 | $0 | $5,408 | $0 | $31,583 | $0 | $212,451 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 PREPARED BY AN OUTSIDE INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE ORGANIZATION'S FINANCIAL MANAGER AND CHIEF FINANCIAL OFFICER. THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION REVIEWS THE RETURN BEFORE SIGNING. |
| FORM 990, PART VI, SECTION B, LINE 12C | 1. EACH EMPLOYEE IS REQUIRED TO READ THE CONFLICT OF INTEREST POLICY IN THE EMPLOYEE HANDBOOK AND TO SIGN A STATMENT AS TO HAVING HAD REVIEWED AND UNDERSTOOD THE CONFLICT OF INTEREST POLICY. 2. CONFLICTS OF INTEREST OR THE APPEARANCE THEREOF ARE REVIEWED ON AN INDIVIDUAL BASIS AS POSSIBLE OR POTENTIAL CONFLICTS BECOME KNOWN. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AS A PART OF THE DEVELOPMENT OF THE CEO'S EMPLOYMENT CONTRACT. IN ESTABLISHING THE CEO'S COMPENSATION, THE EXECUTIVE COMMITTEE CONSIDERS THE INDIVIDUAL'S PERFORMANCE, ORGANIZATION'S PERFORMANCE, GENERAL MARKET CONDITIONS AND COMPENSATION PAID FOR COMPARABLE POSITIONS IN SIMILAR ORGANIZATIONS. THE DECISIONS OF THE EXECUTIVE COMMITTEE ARE DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMMITTEE WHICH ARE REVIEWED BY THE BOARD OF DIRECTORS. THE DECISIONS ARE REFLECTED IN THE CEO'S EMPLOYMENT CONTRACT WHICH IS APPROVED BY THE BOARD OF DIRECTORS. ALL OTHER COMPENSATION DECISIONS HAVE BEEN DELEGATED TO THE CEO BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC. |