FURP.ORG / PUBLIC DATA EXPLORER

GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC (EIN 83-0435138)
Tax period
2015-07-01 to 2016-06-30
Filed
2017-05-11
IRS object ID
201711319349301596
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

FieldValueIRS element (for citing)
Return2017-05-11T09:30:10-05:00ReturnTs
Tax Period End2016-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1901 N GLEBE ROAD SUITE 200AddressLine1Txt
CityARLINGTONCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22203ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN830435138EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GREATER PRINCE WILLIAM AREA COMMUNITYBusinessNameLine1Txt
Business Name Line2HEALTH CENTER INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlGREABusinessNameControlTxt
Phone7036807950PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14379 RIDGEWOOD CENTER DRIVE NO 102AddressLine1Txt
CityWOODBRIDGECityNm
State AbbreviationVAStateAbbreviationCd
ZIP22192ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARK MEYEPersonNm
Person TitleEXECUTIVE DIRECTORPersonTitleTxt
Phone7036807950PhoneNum
Signature2017-05-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDAVID TRIMNER CPAPreparerPersonNm
PTINP00444822PTIN
Phone5712279500PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMARK MEYEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14379 RIDGEWOOD CENTER DRIVE NO 102AddressLine1Txt
CityWOODBRIDGECityNm
State AbbreviationVAStateAbbreviationCd
ZIP22192ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$7,691,672GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.GPWHEALTHCENTER.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2007FormationYr
Legal Domicile StateVALegalDomicileStateCd
Activity Or MissionACCESS TO AFFORDABLE HIGH QUALITY HEALTH CARE FOR THE WHOLE FAMILY.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee96TotalEmployeeCnt
Total Volunteers50TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,559,855PYContributionsGrantsAmt
CY Contributions Grants$3,632,529CYContributionsGrantsAmt
PY Program Service Revenue$3,588,207PYProgramServiceRevenueAmt
CY Program Service Revenue$4,049,412CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue-$39,262PYOtherRevenueAmt
CY Other Revenue-$38,496CYOtherRevenueAmt
PY Total Revenue$6,108,800PYTotalRevenueAmt
CY Total Revenue$7,643,445CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,892,650PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,759,559CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$135,467CYTotalFundraisingExpenseAmt
PY Other Expenses$1,988,175PYOtherExpensesAmt
CY Other Expenses$2,370,101CYOtherExpensesAmt
PY Total Expenses$5,880,825PYTotalExpensesAmt
CY Total Expenses$7,129,660CYTotalExpensesAmt
PY Revenues Less Expenses$227,975PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$513,785CYRevenuesLessExpensesAmt
Total Assets BOY$2,052,052TotalAssetsBOYAmt
Total Assets EOY$2,712,416TotalAssetsEOYAmt
Total Liabilities BOY$975,432TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,122,011TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,076,620NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,590,405NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE CENTER'S MISSION IS TO INCREASE ACCESS TO HIGH QUALITY, COMPREHENSIVE AND PREVENTIVE HEALTH CARE THAT IS CULTURALLY SENSITIVE IN ORDER TO IMPROVE THE HEALTH STATUS OF THE UNDER SERVED AND VULNERABLE RESIDENTS OF PRINCE WILLIAM COUNTY AND THE CITIES OF MANASSAS AND MANASSAS PARK.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,680,782ExpenseAmt
Revenue$2,001,368RevenueAmt
DescPRIMARY CARE: THE CENTER PROVIDES HEALTH AND MEDICAL CARE THAT IS CULTURALLY SENSITITVE IN ORDER TO IMPROVE THE HEALTH STATUS OF THE UNDERSERVED AND VULNERABLE RESIDENTS OF PRINCE WILLIAM COUNTY AND THE CITIES OF MANASSAS AND MANASSAS PARK. THE CENTER PROGRAMS ARE DESIGNED TO INCREASE ACCESS TO HIGH QUALITY, COMPREHENSIVE AND PREVENTIVE HEALTH CARE.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,232,109ExpenseAmt
Revenue$814,247RevenueAmt
DescDENTAL CARE: THE CENTER PROVIDES DENTAL CARE THAT IS CULTURALLY SENSITIVE IN ORDER TO IMPROVE THE HEALTH STATUS OF THE UNDERSERVED AND VULNERABLE RESIDENTS OF PRINCE WILLIAM COUNTY AND THE CITIES OF MANASSAS AND MANASSAS PARK.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,159,842ExpenseAmt
Revenue$1,072,683RevenueAmt
DescPRENATAL CARE: THE CENTER PROVIDES OB-GYN CARE THAT IS CULTURALLY SENSITIVE IN ORDER TO IMPROVE THE HEALTH STATUS OF THE UNDERSERVED AND VULNERABLE RESIDENTS OF PRINCE WILLIAM COUNTY AND THE CITIES OF MANASSAS AND MANASSAS PARK.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$442,637ExpenseAmt
Revenue$161,114RevenueAmt
DescBEHAVIORAL HEALTH: THE CENTER PROVIDES BEHAVIORAL HEALTH AND OTHER HEALTH CARE THAT IS CULTURALLY SENSITIVE IN ORDER TO IMPROVE THE HEALTH STATUS OF THE UNDERSERVED AND VULNERABLE RESIDENTS OF PRINCE WILLIAM COUNTY AND THE CITIES OF MANASSAS AND MANASSAS PARK.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$442,637TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$161,114TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$5,515,370TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document32IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee96EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMARK MEYEPersonNm
Phone7036807950PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14379 RIDGEWOOD CENTER DRIVE SUITEAddressLine1Txt
CityWOODBRIDGECityNm
State AbbreviationVAStateAbbreviationCd
ZIP22192ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
LUIS LOU FERRARO
PRESIDENT3.00Yes (X)Yes (X)$0$0$0
DAVID B WILKS
VICE PRESIDENT3.00Yes (X)Yes (X)$0$0$0
JOHN S GRAY
TREASURER3.00Yes (X)Yes (X)$0$0$0
VALERIE E KEENE
SECRETARY3.00Yes (X)Yes (X)$0$0$0
ROSE GONZALEZ
MEMBER3.00Yes (X)$0$0$0
ABRA HOGARTH
MEMBER1.50Yes (X)$0$0$0
ADDIE RAY WHITAKER
MEMBER1.50Yes (X)$0$0$0
EVELYN MARR
MEMBER1.50Yes (X)$0$0$0
JENNY PORTILLO
MEMBER1.50Yes (X)$0$0$0
JULIO ALEX CORREA
MEMBER1.50Yes (X)$0$0$0
LASHEECO GRAHAMAN
MEMBER1.50Yes (X)$0$0$0
LAURA C POSEY
MEMBER1.50Yes (X)$0$0$0
RONALD KING 070115-0216
MEMBER1.50Yes (X)$0$0$0
GEORGE BARKER
EXECUTIVE DIRECTOR40.00Yes (X)$102,879$0$0
MARK MEYE
DIRECTOR OF FINANCE40.00Yes (X)$127,938$0$8,645
RASHID MOHIUDDIN
MEDICAL DIRECTOR40.00$205,713$0$11,561Yes (X)
SYED MAHBOOB
PHYSICIAN40.00$172,132$0$6,656Yes (X)
SHEETAL RAY
DENTAL DIRECTOR40.00$120,892$0$3,619Yes (X)
LISA WIENER
OB-GYN DIRECTOR40.00$115,863$0$3,188Yes (X)
AMBER HASAN
DENTIST40.00$115,303$0$5,170Yes (X)
MI-YON CHOI
DENTIST40.00$107,338$0$6,947Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,068,058TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$45,786TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K10IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CA CONSTRUCTION
4078 DUNCAN LANEGOLDVEINVA22720REVOVATION$453,368
COMMUNITY CARE NETWORK OF VIRGINIA
3831 WESTERRE PARKWAYHENRICOVA23233BILLING/CREDENTIALING$164,411
LABCORP
PO BOX 12140BURLINGTONNC27216LABORATORY$123,474
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Fundraising$45,171FundraisingAmt
Government Grants$2,544,638GovernmentGrantsAmt
All Other Contributions$1,042,720AllOtherContributionsAmt
Noncash Contributions$137,867NoncashContributionsAmt
Total Contributions$3,632,529TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVENUDesc
Business624110BusinessCd
Total Revenue Column$4,049,412TotalRevenueColumnAmt
Related Or Exempt Func Income$4,049,412RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$4,049,412TotalProgramServiceRevenueAmt
Fundraising Gross Income$7,821FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$45,171ContriRptFundraisingEventAmt
Fundraising Direct Expenses$48,227FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$40,406TotalRevenueColumnAmt
Exclusion-$40,406ExclusionAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,910TotalRevenueColumnAmt
Exclusion$1,910ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,910OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,643,445TotalRevenueColumnAmt
Related Or Exempt Func Income$4,049,412RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$38,496ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$474,197TotalAmt
Program Services$46,631ProgramServicesAmt
Management And General$409,390ManagementAndGeneralAmt
Fundraising$18,176FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,671,349TotalAmt
Program Services$3,397,875ProgramServicesAmt
Management And General$263,611ManagementAndGeneralAmt
Fundraising$9,863FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$56,917TotalAmt
Program Services$43,146ProgramServicesAmt
Management And General$13,225ManagementAndGeneralAmt
Fundraising$546FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$238,766TotalAmt
Program Services$180,996ProgramServicesAmt
Management And General$55,480ManagementAndGeneralAmt
Fundraising$2,290FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$318,330TotalAmt
Program Services$241,309ProgramServicesAmt
Management And General$73,967ManagementAndGeneralAmt
Fundraising$3,054FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$38,005TotalAmt
Management And General$38,005ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$27,051TotalAmt
Management And General$27,051ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$307,243TotalAmt
Program Services$236,976ProgramServicesAmt
Management And General$8,099ManagementAndGeneralAmt
Fundraising$62,168FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$2,584TotalAmt
Program Services$2,584ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$189,203TotalAmt
Program Services$130,521ProgramServicesAmt
Management And General$54,116ManagementAndGeneralAmt
Fundraising$4,566FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$48,915TotalAmt
Program Services$28,410ProgramServicesAmt
Management And General$18,548ManagementAndGeneralAmt
Fundraising$1,957FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$821,184TotalAmt
Program Services$476,944ProgramServicesAmt
Management And General$311,393ManagementAndGeneralAmt
Fundraising$32,847FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,525TotalAmt
Program Services$1,131ProgramServicesAmt
Management And General$394ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$24,655TotalAmt
Program Services$4,354ProgramServicesAmt
Management And General$20,301ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$13,742TotalAmt
Management And General$13,742ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$165,522TotalAmt
Program Services$63,955ProgramServicesAmt
Management And General$101,567ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$21,515TotalAmt
Program Services$14,082ProgramServicesAmt
Management And General$7,433ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CLINICAL SUPPLIES$595,515$595,515
BAD DEBT EXPENSE$57,233$57,233
AGENCY MEMBERSHIP FEES$24,634$24,634
COMMUNITY OUTREACH$21,398$21,398

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$10,177TotalAmt
Program Services$4,909ProgramServicesAmt
Management And General$5,268ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$7,129,660TotalAmt
Program Services$5,515,370ProgramServicesAmt
Management And General$1,478,823ManagementAndGeneralAmt
Fundraising$135,467FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$741,961BOYAmt
EOY$661,300EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$127,598BOYAmt
EOY$173,789EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$325,856BOYAmt
EOY$624,083EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$30,652BOYAmt
EOY$36,916EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$41,830BOYAmt
EOY$34,450EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,789,259LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$746,741LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$670,549BOYAmt
EOY$1,042,518EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$9,984BOYAmt
EOY$8,903EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$15,127BOYAmt
EOY$16,081EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$88,495BOYAmt
EOY$114,376EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,052,052BOYAmt
EOY$2,712,416EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$318,638BOYAmt
EOY$450,966EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
EOY$2,351EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$257,364BOYAmt
EOY$198,623EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$399,430BOYAmt
EOY$470,071EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$975,432BOYAmt
EOY$1,122,011EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$966,620BOYAmt
EOY$1,450,405EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$110,000BOYAmt
EOY$140,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,076,620BOYAmt
EOY$1,590,405EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,052,052BOYAmt
EOY$2,712,416EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$513,785ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$751,623OtherCostOrOtherBasisAmt
Depreciation$314,914DepreciationAmt
Book Value$436,709BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,037,636OtherCostOrOtherBasisAmt
Depreciation$431,827DepreciationAmt
Book Value$605,809BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,042,518TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDEFERRED RENT LIABILITYDesc
Amt$470,071Amt
FieldValueIRS element (for citing)
Total Liability$470,071TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$7,677,112TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts$90,900DonatedServicesAndUseFcltsAmt
Other Revenue-$57,233OtherRevenueAmt
Revenue Not Reported$33,667RevenueNotReportedAmt
Revenue Subtotal$7,643,445RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$7,643,445TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$7,163,327TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$90,900DonatedServicesUseFcltsAmt
Expenses Not Reported$90,900ExpensesNotReportedAmt
Expenses Subtotal$7,072,427ExpensesSubtotalAmt
Other Expenses Not Included$57,233OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$57,233ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$7,129,660TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE CENTER HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE CENTER IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CENTER IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE CENTER IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE OFFSET AGAINST EXPENSE ON FINANCIAL STATEMENTS -57,233.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE OFFSET AGAINST EXPENSE ON FINANCIAL STATEMENTS 57,233.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1CHIPS 4 CHARITYEvent1Nm
Gross Receipts Event1$52,992GrossReceiptsEvent1Amt
Charitable Contri Event1$45,171CharitableContriEvent1Amt
Gross Revenue Event1$7,821GrossRevenueEvent1Amt
Cash Prizes Event1$1,947CashPrizesEvent1Amt
Rent Facility Costs Event1$7,545RentFacilityCostsEvent1Amt
Food And Beverage Event1$11,493FoodAndBeverageEvent1Amt
Entertainment Event1$9,755EntertainmentEvent1Amt
Other Direct Expenses Event1$17,487OtherDirectExpensesEvent1Amt
Gross Receipts Total$52,992GrossReceiptsTotalAmt
Charitable Contributions Tot$45,171CharitableContributionsTotAmt
Gross Revenue Total Events$7,821GrossRevenueTotalEventsAmt
Cash Prizes Total Events$1,947CashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$7,545RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$11,493FoodAndBeverageTotalEventsAmt
Entertainment Total Events$9,755EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$17,487OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$48,227DirectExpenseSummaryEventsAmt
Net Income Summary-$40,406NetIncomeSummaryAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
RASHID MOHIUDDIN
MEDICAL DIRECTOR$205,713$0$0$0$0$0$4,742$0$6,819$0$217,274$0$0$0
SYED MAHBOOB
PHYSICIAN$172,132$0$0$0$0$0$1,246$0$5,410$0$178,788$0$0$0

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution1ContributionCnt
Noncash Contributions Rpt F990$132,957NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD AND THE CHAIRMAN OF STANDING COMMITTEES. THE COMMITTEE SHALL HAVE THE POWERS OF THE GOVERNING BOARD WHEN IT IS NOT IN SESSION.
FORM 990, PART VI, SECTION B, LINE 11THE DRAFT 990 IS PROVIDED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CANNUAL CONFLICT OF INTEREST POLICY REVIEW AND SIGNING BY EACH BOARD MEMBER; STAFF WHEN HIRED AND ANNUAL EDUCATION SESSIONS.
FORM 990, PART VI, SECTION B, LINE 15THE COMMITTEE REVIEWS THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S KEY EMPLOYEES BASED ON AN ANNUAL SALARY SURVEY FOR NORTHERN VIRGINIA. THIS WAS LAST PERFORMED IN 2014 IN PROCESS OF CONDUCTING UPDATE FOR BOARD CONSIDERATION BY OCTOBER 2016. SALARY SURVEY BY NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND SURVEY OF VIRGINIA HEALTH CENTERS IN PROCESS OF BEING CONDUCTED BY EXECUTIVE DIRECTOR, GEORGE BAKER AND DIRECTOR OF HR, JOHNNIE THOMPSON. THIS WAS LAST PERFORMED IN 2016.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.