GREAT MINES HEALTH CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GREAT MINES HEALTH CENTER (EIN 81-0546390)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201743199349303309
- 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 | 2017-11-15T08:27:44-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 431157811 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROUCH FARLEY & HEURING PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 599 | AddressLine1Txt |
| City | FARMINGTON | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63640 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810546390 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT MINES HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GREA | BusinessNameControlTxt |
| Phone | 5734389355 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 SOUTHTOWNE DRIVE | AddressLine1Txt |
| City | POTOSI | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63664 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREG ROEBACK | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5734389355 | PhoneNum |
| Signature | 2017-11-13 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANITA SKAGGS CPA | PreparerPersonNm |
| PTIN | P00611331 | PTIN |
| Phone | 5737568961 | PhoneNum |
| Preparation | 2017-11-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | 5E6E0C2ECD91C9E5E7E6604EF52C294B2DD7935A | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 5E6E0C2ECD91C9E5E7E6604EF52C294B2DD7935A | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2018-03-14 21:41:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GREG ROEBACK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 SOUTHTOWNE DRIVE | AddressLine1Txt |
| City | POTOSI | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63664 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $7,385,832 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | GMHCENTER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | GREAT MINES HEALTH CENTER'S MISSION IS TO IMPROVE THE HEALTH OF OUR WHOLE COMMUNITY THROUGH EXCELLENCE IN PATIENT CARE AND HEALTH EDUCATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 70 | TotalEmployeeCnt |
| Total Gross UBI | $8,388 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $7,388 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,581,014 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,290,357 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,911,539 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,075,858 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$22 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,229 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,619 | PYOtherRevenueAmt |
| CY Other Revenue | $8,388 | CYOtherRevenueAmt |
| PY Total Revenue | $6,499,150 | PYTotalRevenueAmt |
| CY Total Revenue | $7,385,832 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,696,343 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,787,691 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,195,313 | PYOtherExpensesAmt |
| CY Other Expenses | $2,255,107 | CYOtherExpensesAmt |
| PY Total Expenses | $5,891,656 | PYTotalExpensesAmt |
| CY Total Expenses | $6,042,798 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $607,494 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,343,034 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,726,496 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,809,102 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $524,014 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $281,297 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,202,482 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,527,805 | NetAssetsOrFundBalancesEOYAmt |
| Mission | GREAT MINES HEALTH CENTER'S MISSION IS TO IMPROVE THE HEALTH OF OUR WHOLE COMMUNITY THROUGH EXCELLENCE IN PATIENT CARE AND HEALTH EDUCATION. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,179,901 | ExpenseAmt |
| Revenue | $5,075,858 | RevenueAmt |
| Desc | GREAT MINES HEALTH CENTER HAS IMPROVED THE HEALTH OF THE COMMUNITY THROUGH EXCELLENCE IN PATIENT HEALTH CARE AND ALSO THROUGH HEALTH EDUCATION, PATIENT HEALTH CARE AND EDUCATION FOR DENTAL, MENTAL AND PRIMARY HEALTH CARE. | Desc |
| Total Program Service Expenses | $4,179,901 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 70 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREG ROEBACK | BusinessNameLine1Txt |
| Business Name Line2 | GREAT MINES HEALTH CENTER | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5734389355 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 SOUTHTOWNE DRIVE | AddressLine1Txt |
| Address Line2 | 1 SOUTHTOWNE DRIVE | AddressLine2Txt |
| City | POTOSI | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63664 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| BOBBY ROUSAN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CANDY JOHNSON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LINDA LOYD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BRENDA ECKHOFF | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JUDY WRIGHT | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JENNIFER SADLER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TR DUDLEY | ||||||||
| TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| MICHAEL DOTY | ||||||||
| VICE PRESIDE | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| SYLVIA ROWE | ||||||||
| PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| CLAY LOOMIS | ||||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| BENJAMIN DEWAAL | ||||||||
| DOCTOR | 40.00 | $200,000 | $0 | $0 | Yes (X) | |||
| JOHN PEARSON | ||||||||
| DOCTOR | 40.00 | $167,727 | $0 | $0 | Yes (X) | |||
| KEVIN FALLERT | ||||||||
| DOCTOR | 40.00 | $165,000 | $0 | $0 | Yes (X) | |||
| WILLIAM TAYLOR | ||||||||
| DOCTOR | 40.00 | $164,193 | $0 | $0 | Yes (X) | |||
| MICHAEL HENRY | ||||||||
| DOCTOR | 40.00 | $149,377 | $0 | $0 | Yes (X) | |||
| MICHAEL JOHNSON | ||||||||
| FORMER CEO | 40.00 | $170,403 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,016,700 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS BLUE SHIELD | |||||
| 1831 CHESTNUT STREET | ST LOUIS | MO | 63103 | HEALTH INS | $411,347 |
| NORTH AMERICAN HEALTHCARE MGMT SRV | |||||
| 100A KENRICK PLAZA | ST LOUIS | MO | 63119 | BILLING/MGMT | $246,309 |
| PATTERSON DENTAL | |||||
| 4819 PARK HIGHWAY 370 | HAZELWOOD | MO | 63042 | DENTAL SUPPLIES | $229,178 |
| SOMETHING COOLCOM LLC | |||||
| 121 E HIGH ST | POTOSI | MO | 63664 | COMPUTER SRV | $112,508 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,290,357 | GovernmentGrantsAmt |
| Total Contributions | $2,290,357 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PRIMARY HEALTH CARE | 624100 | $4,646,805 | $4,646,805 |
| PHARMACY | 624100 | $429,053 | $429,053 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,075,858 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,229 | TotalRevenueColumnAmt |
| Exclusion | $11,229 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,388 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,388 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,388 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $8,388 | UnrelatedBusinessRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,385,832 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,075,858 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $8,388 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,229 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,120,953 | TotalAmt |
| Program Services | $2,571,925 | ProgramServicesAmt |
| Management And General | $549,028 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $430,844 | TotalAmt |
| Program Services | $316,197 | ProgramServicesAmt |
| Management And General | $114,647 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,894 | TotalAmt |
| Program Services | $196,589 | ProgramServicesAmt |
| Management And General | $39,305 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,472 | TotalAmt |
| Management And General | $8,472 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,021 | TotalAmt |
| Management And General | $78,021 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,331 | TotalAmt |
| Management And General | $24,331 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,265 | TotalAmt |
| Management And General | $78,265 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,535 | TotalAmt |
| Program Services | $83,000 | ProgramServicesAmt |
| Management And General | $79,535 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,547 | TotalAmt |
| Program Services | $12,108 | ProgramServicesAmt |
| Management And General | $62,439 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,012 | TotalAmt |
| Management And General | $10,012 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,434 | TotalAmt |
| Program Services | $194,898 | ProgramServicesAmt |
| Management And General | $120,536 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,736 | TotalAmt |
| Program Services | $1,535 | ProgramServicesAmt |
| Management And General | $70,201 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $456,883 | $456,883 | |
| CONTRACT SERVICES | $261,548 | $261,548 | |
| CONTRACTED MIS | $240,450 | $240,450 | |
| LAB FEES | $106,338 | $106,338 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366,535 | TotalAmt |
| Program Services | $240,428 | ProgramServicesAmt |
| Management And General | $126,107 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,042,798 | TotalAmt |
| Program Services | $4,179,901 | ProgramServicesAmt |
| Management And General | $1,862,897 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,880,334 | BOYAmt |
| EOY | $2,221,356 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,700 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $412,973 | BOYAmt |
| EOY | $840,761 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,387 | BOYAmt |
| EOY | $15,406 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,151,077 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,426,398 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,393,202 | BOYAmt |
| EOY | $1,724,679 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,900 | BOYAmt |
| EOY | $6,900 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,726,496 | BOYAmt |
| EOY | $4,809,102 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $202,909 | BOYAmt |
| EOY | $280,697 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $321,105 | BOYAmt |
| EOY | $600 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $524,014 | BOYAmt |
| EOY | $281,297 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,202,482 | BOYAmt |
| EOY | $4,527,805 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,202,482 | BOYAmt |
| EOY | $4,527,805 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,726,496 | BOYAmt |
| EOY | $4,809,102 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,343,034 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$17,711 | PriorPeriodAdjustmentsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | 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 | $4,216,089 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,310,889 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,490,879 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,483,621 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,290,357 | CurrentTaxYearAmt |
| Total | $23,791,835 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,216,089 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,310,889 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,490,879 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,483,621 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,290,357 | CurrentTaxYearAmt |
| Total | $23,791,835 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $23,791,835 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,323 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,821 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $7,446 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,910 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,229 | CurrentTaxYearAmt |
| Total | $40,729 | TotalAmt |
Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $7,388 | CurrentTaxYearAmt |
| Total | $7,388 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,534 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $12,875 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,906 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,619 | CurrentTaxYearMinus1YearAmt |
| Total | $33,934 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $23,873,886 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $5,075,858 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99660 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99730 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, LINE 10 | FormAndLineReferenceDesc |
| Explanation | 33,934 | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $127,008 | OtherCostOrOtherBasisAmt |
| Book Value | $127,008 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $744,270 | OtherCostOrOtherBasisAmt |
| Depreciation | $65,325 | DepreciationAmt |
| Book Value | $678,945 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,279,799 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,361,073 | DepreciationAmt |
| Book Value | $918,726 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,724,679 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $7,385,832 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $7,385,832 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $7,385,832 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $6,042,798 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $6,042,798 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $6,042,798 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| BENJAMIN DEWAAL | ||
| DOCTOR | $200,000 | $200,000 |
| JOHN PEARSON | ||
| DOCTOR | $167,727 | $167,727 |
| KEVIN FALLERT | ||
| DOCTOR | $165,000 | $165,000 |
| WILLIAM TAYLOR | ||
| DOCTOR | $164,193 | $164,193 |
| MICHAEL JOHNSON | ||
| FORMER CEO | $170,403 | $170,403 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FINANCE OFFICER BEFORE BEING FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE CHIEF FINANCE OFFICER AND CHIEF EXECUTIVE OFFICER MONITOR THIS POLICY |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE BOARD REVIEWS SALARIES BY UTILIZING INFORMATION FROM THE PRIMARY CARE ASSOCIATION AND SALARY COMPARISONS FOR THE STATE AND FEDERAL GOVERNMENT. |
| FORM 990, PAGE 6, PART VI, LINE 19 | FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CONFLICT OF INTEREST POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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