MYCARE HEALTH CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- MYCARE HEALTH CENTER (EIN 37-1593312)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201743199349307879
- 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 | 2017-11-15T12:36:54-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382706146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YEO & YEO PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3275 | AddressLine1Txt |
| City | SAGINAW | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48605 | 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 | 371593312 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MYCARE HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MYCA | BusinessNameControlTxt |
| Phone | 5866499986 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6800 EAST 10 MILE ROAD | AddressLine1Txt |
| City | CENTER LINE | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48015 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAREN WOOD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5866499986 | PhoneNum |
| Signature | 2017-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRIAN R DIXON | PreparerPersonNm |
| PTIN | P01321580 | PTIN |
| Phone | 9897939830 | PhoneNum |
| Preparation | 2017-11-02 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | 34ACAEEA348D66301BCF1BE042D7AF5AAA310BDA | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 94A0B18387F388711E48F1C280F31DA279B52269 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KAREN WOOD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6800 EAST 10 MILE ROAD | AddressLine1Txt |
| City | CENTER LINE | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48015 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,105,262 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MYCAREHEALTHCENTER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE COMMUNITY WE SERVE BY DELIVERING QUALITY PRIMARY HEALTH CARE TO ALL PEOPLE REGARDLESS OF LANGUAGE, FINANCIAL OR CULTURAL BARRIERS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 35 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,123,598 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,254,097 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,910,603 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,838,268 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,205 | PYInvestmentIncomeAmt |
| CY Investment Income | $440 | CYInvestmentIncomeAmt |
| PY Other Revenue | $27,251 | PYOtherRevenueAmt |
| CY Other Revenue | $12,457 | CYOtherRevenueAmt |
| PY Total Revenue | $4,062,657 | PYTotalRevenueAmt |
| CY Total Revenue | $5,105,262 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,739,012 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,900,965 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,678,820 | PYOtherExpensesAmt |
| CY Other Expenses | $2,739,570 | CYOtherExpensesAmt |
| PY Total Expenses | $3,417,832 | PYTotalExpensesAmt |
| CY Total Expenses | $4,640,535 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $644,825 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $464,727 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,744,280 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,225,858 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $128,571 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $145,422 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,615,709 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,080,436 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IMPROVE THE COMMUNITY WE SERVE BY DELIVERING QUALITY PRIMARY HEALTH CARE TO ALL PEOPLE REGARDLESS OF LANGUAGE, FINANCIAL OR CULTURAL BARRIERS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $3,626,896 | ExpenseAmt |
| Revenue | $3,735,725 | RevenueAmt |
| Desc | PRIMARY HEALTH CARE SERVICES | Desc |
| Total Program Service Expenses | $3,626,896 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | 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 | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | 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 | 18 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 35 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | 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 | 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 | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | false | 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 |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMIE WETHERELL CFO | PersonNm |
| Phone | 5866199986 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6800 EAST 10 MILE ROAD | AddressLine1Txt |
| City | CENTER LINE | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48015 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 |
|---|---|---|---|---|---|---|---|
| TIM JOHNSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SUSAN DOHERTY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TERESA THIENEL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG SILLS | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LORETTA BROWNLEE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LYNN KHADRA | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| PHILESHA GOUGH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALYIA HAKIM | |||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MIMI SULLIVAN-PHILLIPS | |||||||
| VICE PRESIDE | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| VALERIE NUNN | |||||||
| VICE PRESIDE | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DAVID CLAYTON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHARRON GALLOP | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHELLE BUSUITO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALEKSANDER DOMICZEK | |||||||
| CMO | 40.00 | $183,033 | $0 | $27,263 | Yes (X) | ||
| DARLENE VASI | |||||||
| FORMER CEO | 40.00 | $141,704 | $0 | $11,236 | Yes (X) | ||
| KAREN WOOD | |||||||
| CEO | 40.00 | $85,245 | $0 | $8,013 | Yes (X) | ||
| JAMIE WETHERELL | |||||||
| CFO | 40.00 | $60,307 | $0 | $2,991 | Yes (X) | ||
| BARBARA GOLDMAN | |||||||
| PHYSICIAN | 40.00 | $148,937 | $0 | $12,990 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $619,226 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $62,493 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | Address Line2ContractorAddress/USAddress/AddressLine2Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|---|
| DELIVER DENTAL SOLUTIONS | ||||||
| 79 ALEXANDRINE STREET WEST | 3RD FLOOR | DETROIT | MI | 48201 | DENTAL | $923,184 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN | ||||||
| 600 E LAFAYETTE BLVD | DETROIT | MI | 48226 | MEDICAL | $141,460 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,198,570 | GovernmentGrantsAmt |
| All Other Contributions | $55,527 | AllOtherContributionsAmt |
| Total Contributions | $2,254,097 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $2,838,268 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,838,268 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,838,268 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $440 | TotalRevenueColumnAmt |
| Exclusion | $440 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| 340B PHARMACY | 900099 | $12,220 | $12,220 |
| OTHER INCOME | 900099 | $237 | $237 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $12,457 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,105,262 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,850,725 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $440 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $519,793 | TotalAmt |
| Program Services | $224,361 | ProgramServicesAmt |
| Management And General | $295,432 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,149,599 | TotalAmt |
| Program Services | $964,376 | ProgramServicesAmt |
| Management And General | $185,223 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,630 | TotalAmt |
| Program Services | $96,420 | ProgramServicesAmt |
| Management And General | $9,210 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,943 | TotalAmt |
| Program Services | $86,799 | ProgramServicesAmt |
| Management And General | $39,144 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,468 | TotalAmt |
| Management And General | $25,468 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,650 | TotalAmt |
| Management And General | $29,650 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,212,400 | TotalAmt |
| Program Services | $1,055,116 | ProgramServicesAmt |
| Management And General | $157,284 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,454 | TotalAmt |
| Program Services | $5,861 | ProgramServicesAmt |
| Management And General | $2,593 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,675 | TotalAmt |
| Program Services | $37,500 | ProgramServicesAmt |
| Management And General | $15,175 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,837 | TotalAmt |
| Program Services | $59,888 | ProgramServicesAmt |
| Management And General | $9,949 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,403 | TotalAmt |
| Program Services | $149,777 | ProgramServicesAmt |
| Management And General | $27,626 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,766 | TotalAmt |
| Program Services | $9,449 | ProgramServicesAmt |
| Management And General | $12,317 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,167 | TotalAmt |
| Program Services | $2,174 | ProgramServicesAmt |
| Management And General | $30,993 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,907 | TotalAmt |
| Management And General | $9,907 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,318 | TotalAmt |
| Program Services | $72,348 | ProgramServicesAmt |
| Management And General | $35,970 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,617 | TotalAmt |
| Management And General | $61,617 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $745,881 | $745,881 | |
| DUES AND SUBSCRIPTIONS | $33,275 | $11,587 | $21,688 |
| MEDICAL SUPPLIES | $29,990 | $29,990 | |
| PHARMACY | $29,288 | $29,288 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,474 | TotalAmt |
| Program Services | $46,081 | ProgramServicesAmt |
| Management And General | $44,393 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,640,535 | TotalAmt |
| Program Services | $3,626,896 | ProgramServicesAmt |
| Management And General | $1,013,639 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $242,501 | BOYAmt |
| EOY | $549,849 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $252,548 | BOYAmt |
| EOY | $252,970 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,000 | BOYAmt |
| EOY | $1,266 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $878,273 | BOYAmt |
| EOY | $1,217,054 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $165,381 | BOYAmt |
| EOY | $127,293 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,542 | BOYAmt |
| EOY | $89,750 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,370,839 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $386,748 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,067,450 | BOYAmt |
| EOY | $984,091 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,585 | BOYAmt |
| EOY | $3,585 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,744,280 | BOYAmt |
| EOY | $3,225,858 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,574 | BOYAmt |
| EOY | $121,969 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,997 | BOYAmt |
| EOY | $23,453 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,571 | BOYAmt |
| EOY | $145,422 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,615,709 | BOYAmt |
| EOY | $3,030,436 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $50,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,615,709 | BOYAmt |
| EOY | $3,080,436 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,744,280 | BOYAmt |
| EOY | $3,225,858 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $464,727 | ReconcilationRevenueExpnssAmt |
| 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 Minus2 Years | $727,863 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,123,598 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,254,097 | CurrentTaxYearAmt |
| Total | $4,105,558 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $727,863 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,123,598 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,254,097 | CurrentTaxYearAmt |
| Total | $4,105,558 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $4,105,558 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $1,343 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,205 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $440 | CurrentTaxYearAmt |
| Total | $2,988 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $293,693 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,251 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $12,457 | CurrentTaxYearAmt |
| Total | $333,401 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $4,441,947 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $2,850,725 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.92430 | PublicSupportCY170Pct |
| Public Support PY170 | 0.85130 | 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 | MEDICAL DIRECTOR INCOME 8,000 340B PHARMACY 25,105 OTHER INCOME 300,296 | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $921,550 | OtherCostOrOtherBasisAmt |
| Depreciation | $160,212 | DepreciationAmt |
| Book Value | $761,338 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $429,942 | OtherCostOrOtherBasisAmt |
| Depreciation | $223,311 | DepreciationAmt |
| Book Value | $206,631 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,347 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,225 | DepreciationAmt |
| Book Value | $16,122 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $984,091 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASE PAYABLE | Desc |
| Amt | $23,453 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $23,453 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $5,117,790 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $12,528 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $12,528 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,105,262 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $5,105,262 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,653,063 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $12,528 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $12,528 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,640,535 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $4,640,535 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| ALEKSANDER DOMICZEK | ||||
| CMO | $183,033 | $1,829 | $25,434 | $210,296 |
| DARLENE VASI | ||||
| FORMER CEO | $141,704 | $986 | $10,250 | $152,940 |
| BARBARA GOLDMAN | ||||
| PHYSICIAN | $148,937 | $12,990 | $161,927 | |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE CEO, CFO, AND FINANCE COMMITTEE REVIEW AND APPROVE THE 990 PRIOR TO FILING AND A COPY IS PRESENTED TO THE BOARD OF DIRECTORS AT THE NEXT REGULAR MEETING. |
| FORM 990, PAGE 6, PART VI, LINE 15A | CEO COMPENSATION IS COMPETITIVE BASED ON INDUSTRY STANDARDS WITHIN OUR GEOGRAPHIC AREA AND APPROVED BY THE BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | OTHER OFFICERS OR KEY EMPLOYEE COMPENSATION IS COMPETITIVE BASED ON INDUSTRY STANDARDS WITHIN OUR GEOGRAPHIC AREA AND APPROVED BY THE BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES 1,051,234 94,099 0 MANAGEMENT FEES 0 865 0 CONSULTANTS 3,882 62,320 0 TOTAL 1,055,116 157,284 0 |