2017-11-14T15:36:23-06:00 2016-12-31 481032601 ALLEN GIBBS & HOULIK LC 301 N MAIN SUITE 1700 WICHITA KS 672024868 990 2016-01-01 481159633 GRACEMED HEALTH CLINIC INC GRAC 3168662000 1122 N TOPEKA WICHITA KS 67214 DAVID SANFORD CEO 3168662011 2017-11-10 1 JENNIFER A ALLEN P01338336 3162677231 70.167.48.183 2017-11-10 11:09:09 CS P DFC71ADCB6319C9AC1D429F4954231B22821B318 08D1FEEFFC0BFC055173BECF0F56E6A174C1D2DF 2016 2017-02-10 21:41:12Z DAVID SANFORD 1122 N TOPEKA WICHITA KS 67214 22334681 0 X WWW.GRACEMED.ORG X 1979 KS TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 13 13 318 70 0 0 5019173 9487166 10262962 11067226 171639 -4985 22422 60133 15476196 20609540 0 0 0 0 9124726 10843948 0 0 120571 3835398 5363760 12960124 16207708 2516072 4401832 13012957 21818945 1478174 4544457 11534783 17274488 TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS IN THE COMMUNITIES WE SERVE. 0 0 13232191 11117214 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 13232191 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 27 0 1 318 1 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 KS X DAVID WUTHNOW 3168662049 1122 N TOPEKA WICHITA KS 67214 ROB DAKIN VICE - PRESIDENT 4.00 X X 0 0 0 MARLON KING TREASURER 4.00 X X 0 0 0 MARCIA NEWTON SECRETARY 4.00 X X 0 0 0 MARC MINNIS PRESIDENT 4.00 X X 0 0 0 FRED ERVIN BOARD MEMBER 4.00 X 0 0 0 GAROLD MINNS BOARD MEMBER 4.00 X 0 0 0 RON ENGELBRECHT BOARD MEMBER 4.00 X 0 0 0 LAURIE LABARCA BOARD MEMBER 4.00 X 0 0 0 MICHAEL GOOD BOARD MEMBER 4.00 X 0 0 0 SUSAN HOWEY BOARD MEMBER 4.00 X 0 0 0 GLORIA OSORIO BOARD MEMBER 4.00 X 0 0 0 LAZARO VASQUEZ BOARD MEMBER 4.00 X 0 0 0 JOE WHITAKER BOARD MEMBER 4.00 X 0 0 0 JULIE A ELDER OFFICER 40.00 X 216922 0 12488 VENUS L LEE OFFICER 40.00 X 134106 0 4394 ROGER G NOLTE OFFICER 40.00 X 155770 0 5120 SHAROL A SULLIVAN OFFICER 40.00 X 39938 0 61 DAVID WUTHNOW OFFICER 40.00 X 62191 0 4157 DAVID SANFORD CHIEF EXECUTIVE OFFICER 40.00 X 160472 0 10075 ANDREA M BOOTHE HIGHLY COMPENSATED EMPLOYE 40.00 X 131614 0 9069 VALERIYA V GREENWOOD HIGHLY COMPENSATED EMPLOYE 40.00 X 146493 0 9515 JOSHUA TIBBE HIGHLY COMPENSATED EMPLOYE 40.00 X 141318 0 9360 DENSEY A MATTHEW HIGHLY COMPENSATED EMPLOYE 40.00 X 137369 0 7868 ANDREW POSEY HIGHLY COMPENSATED EMPLOYE 40.00 X 133335 0 9121 1459528 0 81228 13 0 1 0 HUTTON CONSTRUCTION CORP 2229 S WEST STREET WICHITA KS 67213 CONSTRUCTION 2770938 CONCERGENT LLC 245 N WACO WICHITA KS 67202 COMPUTER EQUIPMENT 544067 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 600550241 MEDICAL/DENTAL EQUIPMENT AND SUPPLIES 542175 CDW GOVERNMENT 75 REMITTANCE DR SUITE 1515 CHICAGO IL 606751515 COMPUTER EQUIPMENT 268888 MCKESSON PO BOX 848442 DALLAS TX 752848442 340B PHARMACEUTICALS 230798 12 32775 5115543 4338848 9487166 MEDICAL & DENTAL SERVICES 621110 10918476 10918476 HIT CERT INCENTIVE 621110 148750 148750 11067226 7000 7000 1681398 1691849 1534 -10451 -1534 -11985 -11985 41903 32775 31758 10145 10145 MISC REVENUE 900099 49988 49988 49988 20609540 11117214 0 5160 X 769399 611260 158139 9318772 7325282 1895120 98370 89357 75381 12590 1386 666420 537462 123184 5774 127355 127355 434800 424332 10468 36382 34376 2006 172102 106620 65482 485922 437730 48192 46885 9289 37596 1437 1437 512160 446246 65914 43715 2435 41280 MEDICAL SUPPLIES 2045152 2041986 3166 CONSULTING & COMPUTER E 609914 501109 108805 REPAIRS 389697 352653 37044 UTILITIES 284040 258922 25118 174199 101484 59680 13035 16207708 13232191 2854946 120571 212923 114574 4446049 8658298 751825 950765 482164 420339 10950 20534 30249 31528 13503924 2644627 5748676 10859297 1328427 11836 750000 1694 1774 13012957 21818945 765532 1306915 712642 2487542 0 750000 1478174 4544457 X 10699093 16876343 835690 398145 11534783 17274488 13012957 21818945 4401832 37675 1300198 0 X X 0 1 X 1 1 1 X 3961224 3211861 4095940 5019173 9487166 25775364 3961224 3211861 4095940 5019173 9487166 25775364 25775364 45973 -58447 48409 36303 19328 91566 25866930 46493647 0.99650 0.99440 X 112000 112000 1500000 30000 1470000 5205482 972971 4232511 2960925 1641656 1319269 3725517 3725517 10859297 LONG TERM NOTES PAYABLE 750000 750000 21979171 37675 1300198 31758 1369631 20609540 0 20609540 16239466 31758 31758 16207708 0 16207708 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 31,758. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCH G WHICH ARE NETTED WITH INCOME ON THE 990 31,758. 5K RACE 74678 32775 41903 1200 15517 0 15041 74678 32775 41903 1200 15517 15041 31758 10145 X X 0 0 0 0 0 0 0 0 0 JULIE A ELDER OFFICER 216922 0 0 0 0 0 0 0 12488 0 229410 0 0 0 ROGER G NOLTE OFFICER 155770 0 0 0 0 0 0 0 5120 0 160890 0 0 0 DAVID SANFORD CHIEF EXECUTIVE OFFICER 160472 0 0 0 0 0 0 0 10075 0 170547 0 0 0 VALERIYA V GREENWOOD HIGHLY COMPENSATED EMPLOYE 146493 0 0 0 0 0 0 0 9515 0 156008 0 0 0 JOSHUA TIBBE HIGHLY COMPENSATED EMPLOYE 141318 0 0 0 0 0 0 0 9360 0 150678 0 0 0 CHAD SANFORD SON OF CEO 50092 CHAD SANFORD IS THE SON OF DAVID SANFORD, CEO OF GRACEMED. CHAD IS AN EMPLOYEE OF GRACEMED. 0 SARA BAYLESS DAUGHTER OF OFFICER 47863 SARA BAYLESS IS THE DAUGHTER OF ROGER NOLTE, GRACEMED'S CHIEF DENTAL OFFICER. SARA BAYLESS IS AN EMPLOYEE OF GRACEMED. 0 KYLE BOWEN SON OF DIRECTOR OF MARKETING 14255 KYLE BOWEN IS THE SON OF LARRY BOWEN, GRACEMED'S DIRECTOR OF MARKETING. KYLE BOWEN IS THE OWNER OF TURTLE BOX DESIGN, LLC WHO DEVELOPED AND MAINTAINS GRACEMED'S WEBSITE. 0 JACQUELYN E SMITH DAUGHTER OF BOARD MEMBER 52096 JACQUELYN SMITH IS THE DAUGHTER OF RON ENGELBRECHT, A BOARD MEMBER OF GRACEMED. JACQUELYN SMITH IS AN EMPLOYEE OF GRACEMED. 0 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HIRES AN OUTSIDE CPA TO PREPARE THE FINANCIAL STATEMENT AUDIT AND THE FORM 990 EACH YEAR. AFTER THE CPA HAS COMPLETED BOTH THE AUDIT AND FORM 990, THE CFO FOR THE ORGANIZATION AND THE CPA REVIEW THE INITIAL DRAFT OF THE RETURN TO ENSURE ITS COMPLETENESS AND ACCURACY. FOLLOWING THE REVIEW, THE FORM 990 IS COMPLETED AND THE ORGANIZATION FILES THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 24E CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 60,584. MANAGEMENT AND GENERAL EXPENSES 11,623. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,207. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 16,842. MANAGEMENT AND GENERAL EXPENSES 39,056. FUNDRAISING EXPENSES 13,035. TOTAL EXPENSES 68,933. STAFF RECRUITING: PROGRAM SERVICE EXPENSES 16,579. MANAGEMENT AND GENERAL EXPENSES 3,504. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,083. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 7,479. MANAGEMENT AND GENERAL EXPENSES 5,497. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,976. FORM 990, PART XII, LINE 2C THIS POLICY HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART XI, LINE 5 & SCH D, PART XI, LINE 2A REALIZED/UNREALIZED GAIN LOSS ON AUDIT REPORT FOOTNOTE AND THE AMOUNTS REPORTED ON FORM 990 DO NOT MATCH DUE TO THE USE OF DIFFERENT REPORTING METHODS BETWEEN THE AUDIT REPORT AND THE 990. BOTH METHODS HAVE THE NET EFFECT OF $27,224 INVESTMENT GAIN/LOSS AND THERE IS NO IMPACT ON INCOME REPORTING.