COMMUNITY CARE OF WEST VIRGINIA INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY CARE OF WEST VIRGINIA INC (EIN 55-0599096)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-12
- IRS object ID
- 201701329349306920
- Schema version
- 2015v3.0
- 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 | 2017-05-12T16:57:57-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550596200 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HERMAN & CORMANY CPAS AC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8 CAPITOL STREET STE 600 | AddressLine1Txt |
| City | CHARLESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25301 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550599096 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY CARE OF WEST VIRGINIA INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 3049246262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 217 | AddressLine1Txt |
| City | ROCK CAVE | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26234 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICK SIMON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3049246262 | PhoneNum |
| Signature | 2017-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DEREK S GODWIN | PreparerPersonNm |
| PTIN | P00617370 | PTIN |
| Phone | 3043452320 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DBA TRI-COUNTY HEALTH CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RICK SIMON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 217 | AddressLine1Txt |
| City | ROCK CAVE | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26234 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,948,808 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | CCWV.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HIGH QUALITY, ACCESSIBLE, COMPREHENSIVE, AND COST-EFFECTIVE HEALTHCARE SERVICES TO THE COMMUNITIES SERVED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 329 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,511,296 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,348,117 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $20,188,451 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,519,921 | CYProgramServiceRevenueAmt |
| PY Investment Income | $430 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,295 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $78,475 | CYOtherRevenueAmt |
| PY Total Revenue | $23,700,177 | PYTotalRevenueAmt |
| CY Total Revenue | $26,948,808 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,847,602 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,608,364 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,723,603 | PYOtherExpensesAmt |
| CY Other Expenses | $10,169,792 | CYOtherExpensesAmt |
| PY Total Expenses | $22,571,205 | PYTotalExpensesAmt |
| CY Total Expenses | $26,778,156 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,128,972 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $170,652 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,909,898 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,773,736 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,863,138 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,556,324 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,046,760 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,217,412 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE CLINIC WAS DEVELOPED TO PROVIDE PRIMARY CARE HEALTH SERVICES TO THE UNDERSERVED AREAS OF UPSHUR, LEWIS AND WEBSTER COUNTIES OF WEST VIRGINIA. THE CLINIC HAS CONTINUALLY ASSESSED COMMUNITY NEEDS AND RESPONDED WITH EXPANSION AND DEVELOPMENT OF APPROPRIATE SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $22,860,667 | ExpenseAmt |
| Revenue | $21,598,396 | RevenueAmt |
| Desc | PROVIDING RURAL HEALTH CARE SERVICES TO LOW INCOME FAMILIES OF UPSHUR, WEBSTER, LEWIS, CLAY, POCAHONTAS AND HARRISON COUNTIES OF WEST VIRGINIA. | Desc |
| Total Program Service Expenses | $22,860,667 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 329 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WV | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICHARD SIMON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3049246262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 217 | AddressLine1Txt |
| City | ROCK CAVE | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26234 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 |
|---|---|---|---|---|---|---|---|
| JOHN BONAZZO | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOYCE GIBSON | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KAREN GRANT | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DAVID TAYLOR | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RENEE HOFER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| THELMA SAMPLES | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| GREGORY MOORE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM LYNCH | |||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TRAVIS M MILLER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD SIMON | |||||||
| CEO | 40.00 | $138,076 | $0 | $13,800 | Yes (X) | ||
| SARAH CHOUINARD | |||||||
| MEDICAL DIRECTOR | 36.00 | $324,790 | $0 | $21,863 | Yes (X) | ||
| PATRICIA COLLETT | |||||||
| DIR OF MEDICAL OPERATIONS | 40.00 | $131,413 | $0 | $21,940 | Yes (X) | ||
| CONNIE JOHNSTON | |||||||
| CFO | 40.00 | $118,540 | $0 | $17,311 | Yes (X) | ||
| BROCK MALCOLM | |||||||
| COO | 40.00 | $124,588 | $0 | $16,205 | Yes (X) | ||
| MICHAEL SHAFFER | |||||||
| CIO | 40.00 | $84,341 | $0 | $13,493 | Yes (X) | ||
| DENZIL HAWKINBERRY | |||||||
| PHYSICIAN | 40.00 | $227,691 | $0 | $22,183 | Yes (X) | ||
| GREGORY PETERS | |||||||
| PHYSICIAN | 40.00 | $238,654 | $0 | $26,434 | Yes (X) | ||
| WILLIAM GIVEN | |||||||
| PHYSICIAN | 40.00 | $199,415 | $0 | $21,939 | Yes (X) | ||
| KIMBERLY FARRY | |||||||
| PHYSICIAN | 40.00 | $297,007 | $0 | $13,502 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,884,515 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $188,670 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $4,577,851 | GovernmentGrantsAmt |
| All Other Contributions | $770,266 | AllOtherContributionsAmt |
| Total Contributions | $5,348,117 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HEALTH CARE SERVICES | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $21,519,921 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,519,921 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,519,921 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,295 | TotalRevenueColumnAmt |
| Exclusion | $2,295 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $78,475 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $78,475 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $78,475 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,948,808 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,598,396 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,295 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,026,360 | TotalAmt |
| Program Services | $738,633 | ProgramServicesAmt |
| Management And General | $287,727 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,238,833 | TotalAmt |
| Program Services | $12,098,752 | ProgramServicesAmt |
| Management And General | $1,140,081 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,275 | TotalAmt |
| Program Services | $232,058 | ProgramServicesAmt |
| Management And General | $36,217 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $966,823 | TotalAmt |
| Program Services | $836,302 | ProgramServicesAmt |
| Management And General | $130,521 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,108,073 | TotalAmt |
| Program Services | $958,483 | ProgramServicesAmt |
| Management And General | $149,590 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,587 | TotalAmt |
| Program Services | $2,587 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,677 | TotalAmt |
| Program Services | $12,677 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,906 | TotalAmt |
| Management And General | $43,906 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,286,166 | TotalAmt |
| Program Services | $185,006 | ProgramServicesAmt |
| Management And General | $1,101,160 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,528 | TotalAmt |
| Program Services | $8,605 | ProgramServicesAmt |
| Management And General | $31,923 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $760,754 | TotalAmt |
| Program Services | $758,983 | ProgramServicesAmt |
| Management And General | $1,771 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,730 | TotalAmt |
| Program Services | $96,748 | ProgramServicesAmt |
| Management And General | $27,982 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $565,948 | TotalAmt |
| Program Services | $523,555 | ProgramServicesAmt |
| Management And General | $42,393 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,878 | TotalAmt |
| Program Services | $62,278 | ProgramServicesAmt |
| Management And General | $209,600 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $507,750 | TotalAmt |
| Program Services | $334,574 | ProgramServicesAmt |
| Management And General | $173,176 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,165 | TotalAmt |
| Program Services | $37,254 | ProgramServicesAmt |
| Management And General | $68,911 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $4,595,385 | $4,521,616 | $73,769 |
| COMMUNICATION AND UTILI | $873,228 | $738,805 | $134,423 |
| PHARMACEUTICALS | $694,183 | $479,066 | $215,117 |
| REPAIRS AND MAINTENANCE | $222,137 | $220,610 | $1,527 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,770 | TotalAmt |
| Program Services | $14,075 | ProgramServicesAmt |
| Management And General | $47,695 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,778,156 | TotalAmt |
| Program Services | $22,860,667 | ProgramServicesAmt |
| Management And General | $3,917,489 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,483,428 | BOYAmt |
| EOY | $1,320,053 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $337,732 | BOYAmt |
| EOY | $10,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,028,571 | BOYAmt |
| EOY | $2,319,726 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $523,162 | BOYAmt |
| EOY | $616,952 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,990 | BOYAmt |
| EOY | $206,159 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,272,698 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,212,329 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,190,465 | BOYAmt |
| EOY | $5,060,369 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,000 | BOYAmt |
| EOY | $222,500 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,550 | BOYAmt |
| EOY | $17,977 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,909,898 | BOYAmt |
| EOY | $9,773,736 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,768,598 | BOYAmt |
| EOY | $1,825,211 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,094,540 | BOYAmt |
| EOY | $2,731,113 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,863,138 | BOYAmt |
| EOY | $4,556,324 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,046,760 | BOYAmt |
| EOY | $5,217,412 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,046,760 | BOYAmt |
| EOY | $5,217,412 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,909,898 | BOYAmt |
| EOY | $9,773,736 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $170,652 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,784,538 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,877,126 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,268,758 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,511,296 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,348,117 | CurrentTaxYearAmt |
| Total | $25,789,835 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,784,538 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,877,126 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,268,758 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,511,296 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,348,117 | CurrentTaxYearAmt |
| Total | $25,789,835 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $25,789,835 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,233 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $995 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $19,854 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $430 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,295 | CurrentTaxYearAmt |
| Total | $33,807 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $25,823,642 | TotalSupportAmt |
| Public Support CY170 | 0.99870 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99870 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $352,025 | OtherCostOrOtherBasisAmt |
| Book Value | $352,025 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,815,809 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,994,822 | DepreciationAmt |
| Book Value | $3,820,987 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,104,864 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,217,507 | DepreciationAmt |
| Book Value | $887,357 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,060,369 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $26,948,808 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $26,948,808 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $26,948,808 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,778,156 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,778,156 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,778,156 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT BELIEVES THE ORGANIZATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION FOR YEARS PRIOR TO 2012. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RICHARD SIMON | ||||||||||||||
| CEO | $138,076 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,800 | $0 | $151,876 | $0 | $0 | $0 |
| SARAH CHOUINARD | ||||||||||||||
| MEDICAL DIRECTOR | $324,790 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $21,863 | $0 | $346,653 | $0 | $0 | $0 |
| PATRICIA COLLETT | ||||||||||||||
| DIR OF MEDICAL OPERATIONS | $131,413 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $21,940 | $0 | $153,353 | $0 | $0 | $0 |
| DENZIL HAWKINBERRY | ||||||||||||||
| PHYSICIAN | $227,691 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,183 | $0 | $249,874 | $0 | $0 | $0 |
| GREGORY PETERS | ||||||||||||||
| PHYSICIAN | $238,654 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $26,434 | $0 | $265,088 | $0 | $0 | $0 |
| WILLIAM GIVEN | ||||||||||||||
| PHYSICIAN | $199,415 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $21,939 | $0 | $221,354 | $0 | $0 | $0 |
| KIMBERLY FARRY | ||||||||||||||
| PHYSICIAN | $297,007 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,502 | $0 | $310,509 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE GOVERNING BOARD REVIEWS THE ANNUAL AUDIT OF THE ORGANIZATION AND THE FORM 990 IS COMPLETED EACH YEAR CONSISTENTLY IN ACCORDANCE WITH THE AMOUNTS REPORTED ON THE AUDIT. THE 990 IS REVIEWED AT A BOARD MEETING AFTER ITS SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY IS IN PLACE. POSSIBLE ISSUES ARE REPORTED TO SENIOR MANAGEMENT AND TO GOVERNING BOARD IF APPLICABLE. GOVERNING BOARD AND SENIOR MANAGEMENT ADDRESS ANY ISSUES AND MONITOR. |
| FORM 990, PART VI, SECTION B, LINE 15 | DETERMINED BY THE GOVERNING BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 18 | DOCUMENTS ARE ON FILE AND AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE ON FILE AND AVAILABLE TO THE GENERAL PUBLIC ON REQUEST. |
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