ADAMS COUNTY HEALTH CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ADAMS COUNTY HEALTH CENTER INC (EIN 20-8341138)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-02-09
- IRS object ID
- 201710409349301426
- 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 | 2017-02-09T14:21:29-07:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 200079326 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DINGUS ZARECOR & ASSOCIATES PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12015 E MAIN AVE | AddressLine1Txt |
| City | SPOKANE VALLEY | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 992066130 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208341138 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADAMS COUNTY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ADAM | BusinessNameControlTxt |
| Phone | 2082534242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 428 | AddressLine1Txt |
| City | COUNCIL | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 836120428 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KIM SMITH | PersonNm |
| Person Title | CEO (AS OF 5/2016) | PersonTitleTxt |
| Phone | 2082534242 | PhoneNum |
| Signature | 2017-02-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | THOMAS DINGUS | PreparerPersonNm |
| PTIN | P00951009 | PTIN |
| Phone | 5092420874 | PhoneNum |
| Preparation | 2017-02-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KIM SMITH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 428 | AddressLine1Txt |
| City | COUNCIL | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 836120428 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,583,167 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ACHCID.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2007 | FormationYr |
| Legal Domicile State | ID | LegalDomicileStateCd |
| Activity Or Mission | ADAMS COUNTY HEALTH CENTER PROVIDES HIGH QUALITY HEALTH SERVICES TO RESIDENTS OF ADAMS COUNTY AND THE SURROUNDING AREA, REGARDLESS OF SOCIAL OR ECONOMIC STATUS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 51 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $990,674 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,334,219 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,334,111 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,236,707 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,268 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,427 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,612 | PYOtherRevenueAmt |
| CY Other Revenue | $4,286 | CYOtherRevenueAmt |
| PY Total Revenue | $2,334,665 | PYTotalRevenueAmt |
| CY Total Revenue | $2,578,639 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,474,229 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,946,806 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $669,557 | PYOtherExpensesAmt |
| CY Other Expenses | $622,292 | CYOtherExpensesAmt |
| PY Total Expenses | $2,143,786 | PYTotalExpensesAmt |
| CY Total Expenses | $2,569,098 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $190,879 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,541 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,711,311 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,714,810 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $143,534 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $137,492 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,567,777 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,577,318 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ADAMS COUNTY HEALTH CENTER PROVIDES HIGH QUALITY HEALTH SERVICES TO RESIDENTS OF ADAMS COUNTY AND THE SURROUNDING AREA, REGARDLESS OF SOCIAL OR ECONOMIC STATUS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,800,994 | ExpenseAmt |
| Revenue | $1,236,707 | RevenueAmt |
| Desc | ADAMS COUNTY HEALTH CENTER (THE HEALTH CENTER) IS A FEDERALLY QUALIFIED HEALTH CENTER, WHICH PROVIDES PRIMARY AND PREVENTATIVE HEALTH AND DENTAL CARE, COUNSELING SERVICES, TELEPHARMACY, AND X-RAY AND LABORATORY SERVICES. THE CENTER PROVIDED HEALTH SERVICES FOR 4,088 PATIENTS, PHYSICAL THERAPY SERVICES FOR 782 PATIENTS, DENTAL SERVICES FOR 2,087 PATIENTS, OPHTHALMIC SERVICES FOR 264 PATIENTS, AND MENTAL HEALTH SERVICES FOR 488 PATIENTS FOR THE YEAR ENDED SEPTEMBER 30, 2016. THE HEALTH CENTER PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 95,878 FOR CHARITY CARE AND SLIDING FEE, 144,350 FOR MEDICARE, AND 126,272 FOR OTHER THIRD-PARTY PAYORS FOR THE YEAR ENDED SEPTEMEBER 30, 2016. THE HEALTH CENTER HAS NUMEROUS INDIVIDUALS ACCESSING SLIDING FEE DISCOUNTS FOR SERVICES RENDERED. A TOTAL OF 401 INDIVIDUALS HAD ACCESS TO THE SLIDING FEE PROGRAM, WITH INCOMES BELOW 200% OF FPL, WHO WERE ELGIBLE FOR ONE OR MORE OF THE THREE FOLLOWING PROGRAMS: PROGRAM CHARITY SLIDING FEE DISCOUNT EXPENDED MEDICAL SERVICES 31,132 DENTAL SERVICES 62,719 MENTAL HEALTH SERVICES 2,027 THE PROGRAMS HIGHLIGHTED ABOVE PROVIDED HEALTH CARE SERVICES TO UNINSURED INDIVIDUALS WHO MAY HAVE OTHERWISE NOT RECEIVED SUCH SERVICES DUE TO FINANCIAL BARRIERS. | Desc |
| Total Program Service Expenses | $1,800,994 | 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 | Yes (true) | 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 | false | 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 | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 51 | 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 |
| 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 |
| States Where Copy Of Return Is Fld | ID | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KIM SMITH | PersonNm |
| Phone | 2082534242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 428 | AddressLine1Txt |
| City | COUNCIL | CityNm |
| State Abbreviation | ID | StateAbbreviationCd |
| ZIP | 83612 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 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 |
|---|---|---|---|---|---|---|---|
| SHIRLEY HALSEY | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MENDY STANFORD | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DORIS CROSSLEY | |||||||
| CHAIR | 10.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| NELLO JENKINS | |||||||
| TREASURER | 6.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KARI DAWN IVESON | |||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LYNN MARQUARD | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DANA HARRY | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KEITH TRAPPETT | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JACK RUBELT | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| GENE FOSTER | |||||||
| VICE CHAIR | 6.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DENISE LANGSTON-GROVES | |||||||
| EXECUTIVE DI | 40.00 | $100,084 | $0 | $17,550 | Yes (X) | ||
| MARY ANN DOMECQ | |||||||
| CFO (AS OF 5 | 40.00 | $56,178 | $0 | $15,771 | Yes (X) | ||
| KIM SMITH | |||||||
| CEO (AS OF 5 | 40.00 | $32,073 | $0 | $9,548 | Yes (X) | ||
| DOUGLAS LINFORD | |||||||
| PHYSICIAN | 36.50 | $113,075 | $0 | $19,675 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $301,410 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $62,544 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $1,330,661 | GovernmentGrantsAmt |
| All Other Contributions | $3,558 | AllOtherContributionsAmt |
| Noncash Contributions | $1,893 | NoncashContributionsAmt |
| Total Contributions | $1,334,219 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE, NET | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $1,236,707 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,236,707 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,236,707 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,955 | TotalRevenueColumnAmt |
| Exclusion | $7,955 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,000 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,000 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,000 | TotalRevenueColumnAmt |
| Exclusion | $3,000 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,528 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$4,528 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,528 | TotalRevenueColumnAmt |
| Exclusion | -$4,528 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,286 | TotalRevenueColumnAmt |
| Exclusion | $1,286 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,286 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,578,639 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,236,707 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $7,713 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,815 | TotalAmt |
| Management And General | $166,815 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,380,556 | TotalAmt |
| Program Services | $984,055 | ProgramServicesAmt |
| Management And General | $396,501 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,733 | TotalAmt |
| Program Services | $38,425 | ProgramServicesAmt |
| Management And General | $17,308 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,734 | TotalAmt |
| Program Services | $125,959 | ProgramServicesAmt |
| Management And General | $89,775 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,968 | TotalAmt |
| Program Services | $83,399 | ProgramServicesAmt |
| Management And General | $44,569 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,807 | TotalAmt |
| Management And General | $26,807 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,341 | TotalAmt |
| Program Services | $104,112 | ProgramServicesAmt |
| Management And General | $29,229 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,587 | TotalAmt |
| Program Services | $2,856 | ProgramServicesAmt |
| Management And General | $1,731 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $226,521 | TotalAmt |
| Program Services | $195,058 | ProgramServicesAmt |
| Management And General | $31,463 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,222 | TotalAmt |
| Program Services | $23,420 | ProgramServicesAmt |
| Management And General | $8,802 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,315 | TotalAmt |
| Program Services | $15,706 | ProgramServicesAmt |
| Management And General | $7,609 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,131 | TotalAmt |
| Program Services | $7,924 | ProgramServicesAmt |
| Management And General | $6,207 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,800 | TotalAmt |
| Program Services | $1,403 | ProgramServicesAmt |
| Management And General | $397 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,485 | TotalAmt |
| Program Services | $68,488 | ProgramServicesAmt |
| Management And General | $5,997 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,628 | TotalAmt |
| Management And General | $8,628 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DUES, FEES & LICENSES | $38,494 | $17,846 | $20,648 |
| RECRUITMENT & RETENTION | $35,025 | $35,025 | |
| OTHER EXPENSES | $2,936 | $127 | $2,809 |
| ALLOCATED INDIRECT COSTS | $97,191 | -$97,191 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,569,098 | TotalAmt |
| Program Services | $1,800,994 | ProgramServicesAmt |
| Management And General | $768,104 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,845 | BOYAmt |
| EOY | $224,780 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $907,826 | BOYAmt |
| EOY | $885,765 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,158 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,853 | BOYAmt |
| EOY | $107,476 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,612 | BOYAmt |
| EOY | $23,333 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,051,079 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $584,609 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,017 | BOYAmt |
| EOY | $466,470 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $6,986 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,711,311 | BOYAmt |
| EOY | $1,714,810 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,579 | BOYAmt |
| EOY | $137,203 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,955 | BOYAmt |
| EOY | $289 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,534 | BOYAmt |
| EOY | $137,492 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,567,777 | BOYAmt |
| EOY | $1,577,318 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,567,777 | BOYAmt |
| EOY | $1,577,318 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,711,311 | BOYAmt |
| EOY | $1,714,810 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $9,541 | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,431 | OtherCostOrOtherBasisAmt |
| Book Value | $22,431 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,679 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,086 | DepreciationAmt |
| Book Value | $53,593 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $351,783 | OtherCostOrOtherBasisAmt |
| Depreciation | $172,160 | DepreciationAmt |
| Book Value | $179,623 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $599,598 | OtherCostOrOtherBasisAmt |
| Depreciation | $408,363 | DepreciationAmt |
| Book Value | $191,235 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,588 | OtherCostOrOtherBasisAmt |
| Book Value | $19,588 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $466,470 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASE OBLIGATIONS | Desc |
| Amt | $289 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $289 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,578,639 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $2,578,639 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $2,578,639 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,569,098 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $2,569,098 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $2,569,098 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE CENTER EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONBLY ESTIMABLE. AS OF SEPTEMBER 30, 2016 AND 2015, THE CENTER HAD NO UNCERTAIN TAX POSITONS REQUIRING ACCRUAL. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 | ACHC ACHIEVED LEVEL 2 PATIENT CENTERED MEDICAL HOME (PCMH) RECOGNITION STATUS BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE EFFECTIVE SEPTEMBER 22, 2014. WE CONTINUE TO WORK TOWARD LEVEL 3 RECOGNITION BY PARTICIPATING IN IDAHO'S STATEWIDE HEALTHCARE INNOVATION PLAN (SHIP) WHICH IS AIMED AT PROMOTING THE PCMH MODEL WHILE REDUCING THE COST OF CARE AND INTEGRATING THE MEDICAL-HEALTH NEIGHBORHOOD AND BY WORKING WITH BOTH FEDERAL AND STATE LEVEL PCMH COACHES. STAFF PARTICIPATED IN FACE-TO-FACE MEETINGS, MONTHLY ASSISTANCE CALLS AND WEBINARS THROUGHOUT THE YEAR. WE PLAN TO SUBMIT FOR LEVEL 3 PCMH RECOGNITION STATUS IN SEPTEMBER 2017. THE TECHNICAL COMPONENT OF THE SHIP PROGRAM IS THE IDAHO HEALTH DATA EXCHANGE (IHDE) PROGRAM. THE PURPOSE OF IHDE IS TO FACILITATE ACCESS TO KEY CLINICAL INFORMATION BETWEEN HEALTHCARE PROVIDERS AND HOSPITALS. ACHC SUCCESSFULLY TRANSMITTED TEST PATIENT DATA TO THE IHDE BEGINNING IN NOVEMBER 2016. ACHC WENT "LIVE" WITH IHDE AT THE END OF DECEMBER 2016. ACHC HAS WORKED IN COLLABORATION WITH THE CRITICAL ACCESS HOSPITAL IN MCCALL, IDAHO FOR THE PAST FOUR YEARS IN A DENTAL GRANT PROJECT WHICH HAS BEEN NAMED THE "BRIGHTER SMILES" GRANT. FOR THIS FUNDING CYCLE THE CRITICAL ACCESS HOSPITAL REFERRED PATIENTS WITH INCOME LEVELS BELOW 150% OF THE FEDERAL POVERTY LEVEL TO ACHC FOR CARE. EACH QUALIFIED INDIVIDUAL COULD RECEIVE UP TO 500 IN DENTAL CARE AT ACHC THROUGH THIS GRANT PROJECT. ACHC CONTINUES TO COLLABORATE WITH THE CRITICAL ACCESS HOSPITAL IN MCCALL, ID ON THE "VALLEY ADAMS HEALTH IMPROVEMENT COALITION" PROJECT. IN ADDITION TO THE TARGET AREAS FROM LAST YEAR (TOBACCO USE REDUCTION IN YOUTH, VIOLENCE- INCLUDING SEXUAL VIOLENCE AND ABUSE- AGAINST WOMEN, AND MENTAL HEALTH NEEDS) TWO MORE TARGET AREAS HAVE BEEN IDENTIFIED: EXERCISE (WALK- ABILITY) AND ACCESS TO FOOD/FOOD DISTRIBUTION PROGRAMS. AS PART OF THE RURAL OUTPATIENT CARE COORDINATION COLLABORATIVE (ROCCC) PROJECT WHICH IS FUNDED BY A GRANT AWARD THROUGH THE HRSA, ACHC WORKS CLOSELY WITH THE ST. LUKE'S HEALTHCARE SYSTEM TO COORDINATE CARE FOR ITS PATIENTS WHO ARE DISCHARGED FROM ANY OF THE ST. LUKE'S HOSPITAL FACILITIES. A ST. LUKE'S CARE COORDINATOR CONTACTS ACHC'S CARE COORDINATOR WHEN ANY ACHC PATIENT IS DISCHARGED FROM ONE OF THE ST. LUKE'S FACILITIES SO THAT ACHC CAN FOLLOW UP WITH THAT PATIENT TO ENSURE THAT THEY RECEIVE THE CARE AND SUPPORT THAT THEY NEED DURING THEIR CONVALESCENCE. THE ROCCC RECOGNIZES THAT PATIENTS ARE SHARED BETWEEN PROVIDERS AND CLINIC LOCATIONS AND THAT COMPLEX PATIENTS, SPECIFICALLY THOSE WITH CHRONIC CONDITIONS LIKE DIABETES, CARDIAC DISEASE, PULMONARY CONDITIONS, AND COMORBID BEHAVIORAL HEALTH ISSUES ARE DIFFICULT TO EFFECTIVELY MANAGE AND TRANSITION TO APPROPRIATE LEVELS OF CARE. THESE CHRONIC CONDITIONS ARE HIGHLY PREVALENT, ASSOCIATED WITH HIGH MORBIDITY, AND HAVE A HIGH COST BURDEN FOR BOTH PATIENTS AND THE NATION. THE ROCCC PROJECT IS INTENDED TO TARGET THESE POPULATIONS TO BROADEN THE CLINICAL IMPACT OF THE "HEALTH NEIGHBORHOOD". IN SEPTEMBER 2015 ACHC WAS AWARDED EXPANDED SERVICES GRANT FUNDING FROM HRSA. THIS GRANT FUNDING ALLOWED ACHC TO EXPAND SERVICES TO INCLUDE OPTOMETRY WHICH HAS GIVEN OUR PATIENT POPULATION ACCESS TO AFFORDABLE, QUALITY EYE CARE. OPTOMETRIC EQUIPMENT AND SUPPLIES WERE PURCHASED AND INSTALLED AND THE DEPARTMENT BEGAN OPERATIONS IN EARLY JANUARY 2016. THIS FUNDING ALLOWED ACHC TO ADD AN OPTOMETRIST, OPTOMETRIC ASSISTANT, PATIENT CARE COORDINATOR AND COMMUNITY HEALTH EDUCATION SPECIALIST DURING THE 2016 FISCAL YEAR. IN SEPTEMBER 2016 ACHC WAS AWARDED DELIVERY SYSTEM HEALTH INFORMATION INVESTMENT (DSHII) SUPPLEMENTAL FUNDING IN THE AMOUNT OF 46,869. THESE FUNDS HAVE BEEN USED TO PURCHASE A BACK-UP SERVER FOR THE SELF-HOSTED E.H.R.; PURCHASE AN E.H.R. INTERFACE, BASE SOFTWARE LICENSE W/C.D.I. AND SOFTWARE FOR INSTALLATION, TRAINING AND MAINTENANCE IN ORDER TO UPGRADE AND EXPAND INFORMATION TECHNOLOGY SYSTEMS TO SUPPORT AND SUSTAIN ACHC'S CONTINUED GROWTH TO MEET OUR PATIENTS' NEEDS. |
| FORM 990, PAGE 2, PART III, LINE 4A | SEPTEMEBER 30, 2016. THE HEALTH CENTER HAS NUMEROUS INDIVIDUALS ACCESSING SLIDING FEE DISCOUNTS FOR SERVICES RENDERED. A TOTAL OF 401 INDIVIDUALS HAD ACCESS TO THE SLIDING FEE PROGRAM, WITH INCOMES BELOW 200% OF FPL, WHO WERE ELGIBLE FOR ONE OR MORE OF THE THREE FOLLOWING PROGRAMS: PROGRAM CHARITY SLIDING FEE DISCOUNT EXPENDED MEDICAL SERVICES 31,132 DENTAL SERVICES 62,719 MENTAL HEALTH SERVICES 2,027 THE PROGRAMS HIGHLIGHTED ABOVE PROVIDED HEALTH CARE SERVICES TO UNINSURED INDIVIDUALS WHO MAY HAVE OTHERWISE NOT RECEIVED SUCH SERVICES DUE TO FINANCIAL BARRIERS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE 990 IS PROVIDED TO THE CEO AND CFO WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PRESENTED TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CFO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PARTY MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE EXECUTIVE TEAM AND/OR BOARD OF TRUSTEES DESCRIBING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS AND AFTER ANY DISCUSSION WITH THE INTERESTED PARTY THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL DETERMINE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THEN THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL DETERMINE WHETHER THE HEALTH CENTER CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE EXECUTIVE TEAM AND/OR THE BOARD OF TRUSTEES SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HEALTH CENTER'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IT SHALL BE CONCLUDED. VIOLATIONS OF THE CONFLICT OF INTEREST POLICY CAN RESULT IN DISCIPLINARY AND CORRECTIVE ACTION BEING TAKEN UP TO AND INCLUDING TERMINATION. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF TRUSTEES EVALUATES THE EXECUTIVE TEAM'S PERFORMANCE AND COMPENSATION ANNUALLY. SOURCES UTILIZED BY THE BOARD WHEN DETERMINING COMPENSATION INCLUDE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND STATE OF IDAHO SALARY SURVEYS AS WELL AS PERSONAL CONTACT WITH IDAHO COMMUNITY HEALTH CENTERS. SALARY CHANGES ARE DISCUSSED AND APPROVED BY MAJORITY VOTE OF THE BOARD OF TRUSTEES AND ARE INCLUDED IN THE MINUTES OF THE MEETING AT WHICH THE ACTION IS TAKEN. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE TEAM ARE THE ONLY OFFICERS OR KEY EMPLOYEES. SEE 990, PART VI, LINE 15A. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE HEALTH CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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