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COALITION TO TRANSFORM ADVANCED CARE: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
COALITION TO TRANSFORM ADVANCED CARE (EIN 45-2604332)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-15
IRS object ID
201723199349314602
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

FieldValueIRS element (for citing)
Return2017-11-15T15:50:11-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN814319449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CALDWELL & ASSOCIATES LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line18120 Woodmont Avenue 400AddressLine1Txt
CityBethesdaCityNm
State AbbreviationMDStateAbbreviationCd
ZIP20814ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN452604332EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Coalition To Transform Advanced CareBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOALBusinessNameControlTxt
Phone2029092865PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11299 Pennsylvania Avenue NW No 1175AddressLine1Txt
CityWashingtonCityNm
State AbbreviationDCStateAbbreviationCd
ZIP20004ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJON BROYLESPersonNm
Person TitleCO-CHAIRPersonTitleTxt
Phone2029092865PhoneNum
Signature2017-11-15SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWilliam J Caldwell CPAPreparerPersonNm
PTINP00187908PTIN
Phone3019418090PhoneNum
Preparation2017-11-13PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address96.86.10.225IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-15IPDt
IP Tm15:50:10IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device Id3AB311E47B105BD19DB2FBAE10AB5F111342F771AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOHN T KOUTSOUMPASPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11299 Pennsylvania Avenue NW No 1175AddressLine1Txt
CityWashingtonCityNm
State AbbreviationDCStateAbbreviationCd
ZIP20004ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,208,163GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.thectac.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateDCLegalDomicileStateCd
Activity Or MissionCOALITION TO TRANSFORM ADVANCED CARE (C-TAC) IS A NON-PARTISAN GROUP OFPATIENT AND CONSUMER ADVOCACY GROUPS, HEALTH CARE PROFESSIONALS ANDPROVIDERS, PRIVATE SECTOR STAKEHOLDERS, FAITH-BASED ORGANIZATIONS, AND HEALTHCARE PAYERS. OUR VISION IS THAT ALL AMERICANS WITH ADVANCED ILLNESS, ESPECIALLY THE SICKEST AND THE MOST VULNERABLE, WILL RECEIVE COMPREHENSIVE, HIGH-QUALITY CARE THAT IS CONSISTENT WITH THEIR GOALS AND VALUES AND HONORS THEIR DIGNITY. THE C-TAC MISSION IS TO TRANSFORM ADVANCED ILLNESS CARE BY EMPOWERING CONSUMERS, CHANGING THE HEALTH CARE DELIVERY SYSTEM, IMPROVING PUBLIC AND PRIVATE POLICIES, AND ENHANCING PROVIDER CAPACITY. C-TAC OPERATES AS A VOLUNTEER-DRIVEN ORGANIZATION THROUGH WORKGROUPS AND COMMITTEES TO ACCOMPLISH ITS OVERARCHING GOALS.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee9TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$905,983PYContributionsGrantsAmt
CY Contributions Grants$2,208,163CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$905,983PYTotalRevenueAmt
CY Total Revenue$2,208,163CYTotalRevenueAmt
PY Grants And Similar Paid$5,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$311,695PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$463,285CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$69,493CYTotalFundraisingExpenseAmt
PY Other Expenses$618,384PYOtherExpensesAmt
CY Other Expenses$1,187,920CYOtherExpensesAmt
PY Total Expenses$935,079PYTotalExpensesAmt
CY Total Expenses$1,651,205CYTotalExpensesAmt
PY Revenues Less Expenses-$29,096PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$556,958CYRevenuesLessExpensesAmt
Total Assets BOY$335,193TotalAssetsBOYAmt
Total Assets EOY$899,227TotalAssetsEOYAmt
Total Liabilities BOY$2,355TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,431TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$332,838NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$889,796NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES COALITION TO TRANSFORM ADVANCED CARE (C-TAC) IS A NON-PARTISAN GROUP OF PATIENT AND CONSUMER ADVOCACY GROUPS, HEALTH CARE PROFESSIONALS AND PROVIDERS, PRIVATE SECTOR STAKEHOLDERS, FAITH-BASED ORGANIZATIONS, AND HEALTHCARE PAYERS. OUR VISION IS THAT ALL AMERICANS WITH ADVANCED ILLNESS, ESPECIALLY THE SICKEST AND THE MOST VULNERABLE, WILL RECEIVE COMPREHENSIVE, HIGH-QUALITY CARE THAT IS CONSISTENT WITH THEIR GOALS AND VALUES AND HONORS THEIR DIGNITY. THE C-TAC MISSION IS TO TRANSFORM ADVANCED ILLNESS CARE BY EMPOWERING CONSUMERS, CHANGING THE HEALTH CAREDELIVERY SYSTEM, IMPROVING PUBLIC AND PRIVATE POLICIES, AND ENHANCING PROVIDER CAPACITY.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$79,637ExpenseAmt
Revenue$244,606RevenueAmt
DescSUMMIT: THE C-TAC NATIONAL SUMMIT ON ADVANCED ILLNESS CARE IS AN ANNUAL EVENT TO CONVENE PARTICIPANTS FROM MANY DISCIPLINES AND ORGANIZATIONS, REPRESENTING PATIENTS, FAMILIES, POLICY MAKERS, FAITH COMMUNITIES, MEDIA, AND HEALTH CARE PROFESSIONALS GATHERED TO LEARN AND DISCUSS THE NEEDED CHANGES IN OUR NATION'S CARE SYSTEM TO ASSURE THAT PEOPLE WITH ADVANCED ILLNESSES RECEIVE CARE CONSISTENT WITH THEIR VALUES AND WISHES. THE CONFERENCE HAS TWO GOALS: (1) TO CREATE A COMMON UNDERSTANDING AMONG PARTICIPANTS OF THE ISSUES, CHALLENGES, AND RANGE OF POSSIBLE SOLUTIONS; (2) TO CREATE A SHARED SENSE OF MISSION AND ACTION STEPS FOR ACHIEVING HIGH-QUALITY, ADVANCED ILLNESS CARE.PLEASE SEE OUR WEBSITE FOR A FULL POST SUMMIT REPORT.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$493,411ExpenseAmt
Revenue$594,525RevenueAmt
DescADVANCED CARE model: The Advanced Care Model is a partnership between C-TAC, IHSS, trinity Health, Inova health and Care Oregon. It is building on the progress first realized with the advanced care project. It is a proven service delivery model and proposed new advanced alternative payment model (AAPM) to improve quality and cost outcomes for advanced illness beneficiaries. The ACM is specifically designed to meet these needs by "breaking down a range of silos between 'curative and palliative care, between professional groups to foster interdisciplinary practice, and between traditional medical and social services" (IOM Report: Dying in America). The ACM AAPM payment can operate as a stand-alone APM and or in conjunction with existing APMs to ensure all Medicare FFS beneficiaries can access the needed ACM services. Furthermore, the ACM supports primary care and/or specialty provider participation.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$100,200ExpenseAmt
Revenue$384,242RevenueAmt
Descserious illness program: The serious illness program is a partnership between C-TAC, Healthsperien, the Betty Irene Moore School of Nursing at UC Davis, the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the Gordon and Betty Moore Foundation. The program is designed to improve and equalize health care for the elderly and those who are chronically ill. The have developed a framework that has informed program development, replication, and scaling, integrated with care model payment design, informed care model and proforma simulator development and informed other aspects of design and development such as policy, standardized measurements, and regulatory analysis.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$581,924ExpenseAmt
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$581,924TotalOtherProgSrvcExpenseAmt
Total Program Service Expenses$1,255,172TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document10IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee9EmployeeCnt
Employment Tax Returns Filed0EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CALDWELL & COMPANYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3019418090PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line18120 WOODMONT AVE SUITE 400AddressLine1Txt
CityBETHESDACityNm
State AbbreviationMDStateAbbreviationCd
ZIP20814ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
J THOMAS KOUTSOUMPAS
CO-CHAIR15.00Yes (X)Yes (X)$0$0$0
WILLIAM NOVELLI
CO-CHAIR20.00Yes (X)Yes (X)$0$0$0
ALEXANDRA DRANE
DIRECTOR4.00Yes (X)$0$0$0
ANN F MONROE
DIRECTOR2.00Yes (X)$0$0$0
jeffrey burnich
DIRECTOR2.00Yes (X)$0$0$0
richard umbdenstock
DIRECTOR2.00Yes (X)$0$0$0
DR RANDALL KRAKAUER
DIRECTOR3.00Yes (X)$0$0$0
JEFF WEISS
DIRECTOR3.00Yes (X)$0$0$0
THOMAS HIGGINS
DIRECTOR2.00Yes (X)$0$0$0
NANCY BROWN
DIRECTOR3.00Yes (X)$0$0$0
DAVID E LONGNECKER MD
secRETARY - TREASURER8.00Yes (X)Yes (X)$0$0$0
rev dr yvonne v delk
dirECTOR3.00Yes (X)$0$0$0
LEONARD D SCHAEFFER
DIRECTOR2.00Yes (X)$0$0$0
jonathan a broyles
executive director40.00Yes (X)$100,000$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$100,000TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
gia khue nguyen
28 edinburgh plalamoCA94507medical consulting$240,000
brad stuart
5912 anderson roadforestvilleCA95436medical consulting$120,000
mark sterling
5845 sw 118th streetcoral gablesFL33156legal services$120,000
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Membership Dues$404,625MembershipDuesAmt
All Other Contributions$1,803,538AllOtherContributionsAmt
Total Contributions$2,208,163TotalContributionsAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,208,163TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$420,565TotalAmt
Program Services$252,339ProgramServicesAmt
Management And General$105,141ManagementAndGeneralAmt
Fundraising$63,085FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$7,820TotalAmt
Program Services$4,692ProgramServicesAmt
Management And General$1,955ManagementAndGeneralAmt
Fundraising$1,173FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$34,900TotalAmt
Program Services$20,940ProgramServicesAmt
Management And General$8,725ManagementAndGeneralAmt
Fundraising$5,235FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$263,258TotalAmt
Program Services$245,872ProgramServicesAmt
Management And General$17,386ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$40,432TotalAmt
Management And General$40,432ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$24,983TotalAmt
Management And General$24,983ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$732,259TotalAmt
Program Services$731,329ProgramServicesAmt
Management And General$930ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$9,243TotalAmt
Management And General$9,243ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,288TotalAmt
Management And General$3,288ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$54,627TotalAmt
Management And General$54,627ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$17,648TotalAmt
Management And General$17,648ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$19,715TotalAmt
Management And General$19,715ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$14,293TotalAmt
Management And General$14,293ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmt
misc taxes & licenses$5,190$5,190
bank fees$2,785$2,785
PROFESSIONAL DEVELOPMEN$199$199

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,651,205TotalAmt
Program Services$1,255,172ProgramServicesAmt
Management And General$326,540ManagementAndGeneralAmt
Fundraising$69,493FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$244,114BOYAmt
EOY$760,554EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$91,079BOYAmt
EOY$91,079EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$47,594EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$335,193BOYAmt
EOY$899,227EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,355BOYAmt
EOY$9,431EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,355BOYAmt
EOY$9,431EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
EOY$889,796EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$332,838BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$332,838BOYAmt
EOY$889,796EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$335,193BOYAmt
EOY$899,227EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$556,958ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$401,450CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$613,467CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$663,750CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$905,983CurrentTaxYearMinus1YearAmt
Current Tax Year$2,208,163CurrentTaxYearAmt
Total$4,792,813TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$401,450CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$613,467CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$663,750CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$905,983CurrentTaxYearMinus1YearAmt
Current Tax Year$2,208,163CurrentTaxYearAmt
Total$4,792,813TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$4,792,813PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$416CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$496CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$167CurrentTaxYearMinus2YearsAmt
Total$1,079TotalAmt
FieldValueIRS element (for citing)
Total Support$4,793,892TotalSupportAmt
Public Support CY1700.99980PublicSupportCY170Pct
Public Support PY1700.99960PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
Descdue from related organizationDesc
Book Value$47,594BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$47,594TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
CREDIT CARD PAYABLE$4,668
payroll taxes payable$4,763
FieldValueIRS element (for citing)
Total Liability$9,431TotalLiabilityAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section B, line 11bCOPY OF FORM 990 IS PROVIDED TO THE MEMBERS OF GOVERNING BODY FOR REVIEW BEFORE FILING.
Form 990, Part VI, Section B, line 12cWHEN THERE IS A POTENTIAL CONFLICT OF INTEREST, THE ISSUE IS RAISED IN PUBLIC AND A DISCUSSION ENSUES. IN THE LIMITED CASES WHEN THAT HAS HAPPENED, THE MEMBER WITH THE POTENTIAL CONFLICT RECUSES HIMSELF FROM VOTING.
Form 990, Part VI, Section C, line 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part IX, line 11g2016 NATIONAL SUMMIT: Program service expenses 79,712. Management and general expenses 0. Fundraising expenses 0. Total expenses 79,712. 2017 NATIONAL SUMMIT: Program service expenses 380. Management and general expenses 0. Fundraising expenses 0. Total expenses 380. clinical model implementation: Program service expenses 493,411. Management and general expenses 0. Fundraising expenses 0. Total expenses 493,411. COMMUNICATION: Program service expenses 0. Management and general expenses 930. Fundraising expenses 0. Total expenses 930. pAYMENT MODEL SIMULATOR: Program service expenses 43,333. Management and general expenses 0. Fundraising expenses 0. Total expenses 43,333. pcori community action project: Program service expenses 14,293. Management and general expenses 0. Fundraising expenses 0. Total expenses 14,293. serious illness care framework: Program service expenses 100,200. Management and general expenses 0. Fundraising expenses 0. Total expenses 100,200.

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