MAPLE CITY HEALTH CARE CENTER INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: MAPLE CITY HEALTH CARE CENTER INC (EIN 35-1749398)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-06-12
IRS object ID: 201721639349300442
Schema version: 2016v3.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule J
Schedule M
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-06-12T15:53:39-05:00	ReturnTs
Tax Period End	2016-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	351307701	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	KRUGGEL LAWTON & COMPANY LLC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	317 W FRANKLIN ST	AddressLine1Txt
City	ELKHART	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46516	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	351749398	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MAPLE CITY HEALTH CARE CENTER INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	MAPL	BusinessNameControlTxt
Phone	5745343300	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	213 MIDDLEBURY ST	AddressLine1Txt
City	GOSHEN	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	465282956	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	KAREN MILLER RUSH	PersonNm
Person Title	OFFICER	PersonTitleTxt
Phone	5745343300	PhoneNum
Signature	2017-05-25	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MARGENE ZINK	PreparerPersonNm
PTIN	P01222961	PTIN
Phone	5742642247	PhoneNum
Preparation	2017-05-25	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	199.58.74.130	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2017-05-25	IPDt
IP Tm	15:15:00	IPTm
IP Timezone	ED	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	D0FBA37929D0EDFF25265DDB8A0581F7BD777E9F	AtSubmissionCreationDeviceId
At Submission Filing Device Id	B72D29DD95174E3B2C867802932991E60C021911	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	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	VISTA COMMUNITY HEALTH CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	KAREN MILLER RUSH	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	213 MIDDLEBURY ST	AddressLine1Txt
City	GOSHEN	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	465282956	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$6,595,981	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.MCHCC.COM	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1988	FormationYr
Legal Domicile State	IN	LegalDomicileStateCd
Activity Or Mission	THE MISSION OF MAPLE CITY HEALTH CARE CENTER IS:I. TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE ANDII. TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	99	TotalEmployeeCnt
Total Volunteers	12	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$2,420,187	PYContributionsGrantsAmt
CY Contributions Grants	$3,968,815	CYContributionsGrantsAmt
PY Program Service Revenue	$1,623,761	PYProgramServiceRevenueAmt
CY Program Service Revenue	$2,616,745	CYProgramServiceRevenueAmt
PY Investment Income	$7,187	PYInvestmentIncomeAmt
CY Investment Income	$8,935	CYInvestmentIncomeAmt
PY Other Revenue	$675	PYOtherRevenueAmt
CY Other Revenue	$1,486	CYOtherRevenueAmt
PY Total Revenue	$4,051,810	PYTotalRevenueAmt
CY Total Revenue	$6,595,981	CYTotalRevenueAmt
PY Grants And Similar Paid	$5,946	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$5,500	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$2,780,069	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$4,367,073	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,298,993	PYOtherExpensesAmt
CY Other Expenses	$1,845,925	CYOtherExpensesAmt
PY Total Expenses	$4,085,008	PYTotalExpensesAmt
CY Total Expenses	$6,218,498	CYTotalExpensesAmt
PY Revenues Less Expenses	-$33,198	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$377,483	CYRevenuesLessExpensesAmt
Total Assets BOY	$3,472,018	TotalAssetsBOYAmt
Total Assets EOY	$3,858,807	TotalAssetsEOYAmt
Total Liabilities BOY	$258,979	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$427,570	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$3,213,039	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$3,431,237	NetAssetsOrFundBalancesEOYAmt
Mission	THE MISSION OF MAPLE CITY HEALTH CARE CENTER IS:I. TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE ANDII. TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$5,453,127	ExpenseAmt
Grant	$5,500	GrantAmt
Revenue	$2,618,231	RevenueAmt
Desc	FOSTERING HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND ARTICULATING AND PROMOTING OUR EXPERIENCE AS A SUSTAINABLE MODEL. WE PROVIDE MEDICAL, BEHAVIOR HEALTH, DENTAL, VISION, AND SOCIAL SERVICES.	Desc
Total Program Service Expenses	$5,453,127	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	Yes (1)	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	99	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
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	11	GoverningBodyVotingMembersCnt
Independent Voting Member	11	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	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	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	Yes (1)	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	IN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	KAREN MILLER RUSH	PersonNm
Phone	5745343300	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	213 MIDDLEBURY ST	AddressLine1Txt
City	GOSHEN	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46528	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 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
ROEL CERVANTES
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
JOHN DRIVER
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
KEVIN FARMWALD
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
DENICE METTERT
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
MIGUEL MILLAN
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
RACHEL MILLER JACOBS
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
IRMA PEREZ
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
LORENZA ROMERO
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
SARAH METZLER
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
FELISA REYES
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
MAX MERTZ
PRESIDENT	1.00	Yes (X)	$0	$0	$0	Yes (X)
JAMES NELSON GINGERICH
GUARDIAN OF VISION	60.00	Yes (X)	$134,248	$0	$16,905	Yes (X)
KAREN MILLER RUSH
DIRECTOR OF FINANCE	40.00		$69,794	$0	$13,208	Yes (X)
ROSE GILLIN
PHYSICIAN	40.00		$114,244	$0	$17,851		Yes (X)
STEPHEN HARMON
GUARDIAN OF MEDICAL SERVICES	50.00		$131,828	$0	$12,797		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$450,114	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$60,761	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	3	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
ABG DENTAL
622 W LINCOLN	GOSHEN	IN	46526	DENTAL SERVICES	$216,754
ELKHART COUNTY CLUBHOUSE
114 S FIFTH ST	GOSHEN	IN	46528	MENTAL HEALTH SERVICES	$112,500

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	2	CntrctRcvdGreaterThan100KCnt
Government Grants	$3,564,069	GovernmentGrantsAmt
All Other Contributions	$404,746	AllOtherContributionsAmt
Noncash Contributions	$312,042	NoncashContributionsAmt
Total Contributions	$3,968,815	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	PROGRAM SERVICES	Desc
Business	621400	BusinessCd
Total Revenue Column	$2,616,745	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,616,745	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$2,616,745	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$8,935	TotalRevenueColumnAmt
Exclusion	$8,935	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	MISCELLANEOUS	Desc
Business	900099	BusinessCd
Total Revenue Column	$1,486	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,486	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$1,486	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$6,595,981	TotalRevenueColumnAmt
Related Or Exempt Func Income	$2,618,231	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$8,935	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$5,500	TotalAmt
Program Services	$5,500	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$238,197	TotalAmt
Program Services	$202,468	ProgramServicesAmt
Management And General	$35,729	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$2,986,279	TotalAmt
Program Services	$2,538,337	ProgramServicesAmt
Management And General	$447,942	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$153,743	TotalAmt
Program Services	$130,682	ProgramServicesAmt
Management And General	$23,061	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$742,727	TotalAmt
Program Services	$631,318	ProgramServicesAmt
Management And General	$111,409	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$246,127	TotalAmt
Program Services	$209,208	ProgramServicesAmt
Management And General	$36,919	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$4,024	TotalAmt
Management And General	$4,024	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$20,500	TotalAmt
Management And General	$20,500	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$20,650	TotalAmt
Program Services	$17,553	ProgramServicesAmt
Management And General	$3,097	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$100,833	TotalAmt
Program Services	$85,708	ProgramServicesAmt
Management And General	$15,125	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$178,940	TotalAmt
Program Services	$152,099	ProgramServicesAmt
Management And General	$26,841	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$156,251	TotalAmt
Program Services	$132,813	ProgramServicesAmt
Management And General	$23,438	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$25,265	TotalAmt
Program Services	$21,872	ProgramServicesAmt
Management And General	$3,393	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,931	TotalAmt
Program Services	$1,931	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$64,904	TotalAmt
Program Services	$55,168	ProgramServicesAmt
Management And General	$9,736	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$59,802	TotalAmt
Program Services	$59,802	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$851,954	$851,954
VACCINES	$312,042	$312,042
PROFESSIONAL DUES	$27,719	$23,562	$4,157
MISCELLANEOUS	$21,110	$21,110

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$6,218,498	TotalAmt
Program Services	$5,453,127	ProgramServicesAmt
Management And General	$765,371	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$78,246	BOYAmt
EOY	$64,482	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$1,742,431	BOYAmt
EOY	$1,600,254	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$337,109	BOYAmt
EOY	$516,519	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$231,443	BOYAmt
EOY	$330,365	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$39,885	BOYAmt
EOY	$50,952	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$1,706,861	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$418,303	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$1,042,904	BOYAmt
EOY	$1,288,558	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$7,677	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,472,018	BOYAmt
EOY	$3,858,807	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$258,979	BOYAmt
EOY	$427,570	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$258,979	BOYAmt
EOY	$427,570	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,529,203	BOYAmt
EOY	$1,896,687	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,683,836	BOYAmt
EOY	$1,534,550	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$3,213,039	BOYAmt
EOY	$3,431,237	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$3,472,018	BOYAmt
EOY	$3,858,807	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$377,483	ReconcilationRevenueExpnssAmt
Donated Services And Use Fclts	-$159,285	DonatedServicesAndUseFcltsAmt
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)
Hospital	Yes (X)	HospitalInd

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	$165,417	OtherCostOrOtherBasisAmt
Book Value	$165,417	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$478,139	OtherCostOrOtherBasisAmt
Depreciation	$50,216	DepreciationAmt
Book Value	$427,923	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$591,398	OtherCostOrOtherBasisAmt
Depreciation	$263,319	DepreciationAmt
Book Value	$328,079	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$168,497	OtherCostOrOtherBasisAmt
Depreciation	$79,078	DepreciationAmt
Book Value	$89,419	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$303,410	OtherCostOrOtherBasisAmt
Depreciation	$25,690	DepreciationAmt
Book Value	$277,720	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$1,288,558	TotalBookValueLandBuildingsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$6,656,121	TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts	$60,140	DonatedServicesAndUseFcltsAmt
Revenue Not Reported	$60,140	RevenueNotReportedAmt
Revenue Subtotal	$6,595,981	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$6,595,981	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$6,437,923	TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts	$219,425	DonatedServicesUseFcltsAmt
Expenses Not Reported	$219,425	ExpensesNotReportedAmt
Expenses Subtotal	$6,218,498	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$6,218,498	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART X, LINE 2:	FormAndLineReferenceDesc
Explanation	THE INCOME TAXES TOPIC, FASB ASC 740, CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. ASC 740 REQUIRES AN ORGANIZATION TO DISCLOSE THE NATURE OF UNCERTAIN TAX POSITIONS TAKEN, IF ANY, WHEN FILING ITS INCOME TAX RETURN UTILIZING A TWO-STEP PROCESS TO RECOGNIZE AND MEASURE ANY UNCERTAIN TAX POSITIONS TAKEN. THE ORGANIZATION RECOGNIZES A TAX BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THE POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. NO TAX BENEFIT WILL BE RECORDED ON TAX POSITIONS NOT MEETING THE MORE LIKELY THAN NOT TEST. INTEREST AND PENALTIES ACCRUED OR INCURRED, IF ANY, AS A RESULT OF APPLYING ASC 740 WILL BE RECORDED TO INTEREST EXPENSE AND OTHER EXPENSE, RESPECTIVELY. BASED ON ITS EVALUATION, THE ORGANIZATION HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS REQUIRING RECOGNITION IN ITS FINANCIAL STATEMENTS. THE ORGANIZATION'S EVALUATION WAS PERFORMED FOR ALL FEDERAL AND STATE TAX PERIODS STILL SUBJECT TO EXAMINATION. THE ORGANIZATION'S 2013 THROUGH 2015 FEDERAL AND STATE EXEMPT ORGANIZATION RETURNS REMAIN SUBJECT TO EXAMINATION BY THE IRS AND STATE TAXING AUTHORITIES.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
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

Field	Value	IRS element (for citing)
Person	JAMES NELSON GINGERICH	PersonNm
Title	GUARDIAN OF VISION	TitleTxt
Base Compensation Filing Org	$134,248	BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs	$0	CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization	$0	BonusFilingOrganizationAmount
Bonus Related Organizations	$0	BonusRelatedOrganizationsAmt
Other Compensation Filing Org	$0	OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs	$0	OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org	$10,940	DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs	$0	DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org	$5,965	NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs	$0	NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org	$151,153	TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs	$0	TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org	$0	CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs	$0	CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 3	FormAndLineReferenceDesc
Explanation	JAMES GINGERICH'S COMPENSATION WAS SET USING THE SAME STANDARD MCHCC / VCHC WAGE SCALE USED FOR ESTABLISHING COMPENSATION FOR ALL OF OUR STAFF. THIS WAGE SCALE FACTORS IN: EDUCATION AND TRAINING, EXPERIENCE, LANGUAGE, CALL (IF APPLICABLE) AND MOST IMPORTANTLY RESPONSIBILITY LEVEL. EACH FACTOR IS ASSIGNED A POINT VALUE WHICH THEN TRANSLATES INTO HOURLY WAGE AMOUNTS. ALL NEW STAFF LEVELS ARE EVALUATED BY TWO STAFF MEMBERS AND A WRITTEN EMPLOYMENT CONTRACT IS ISSUED. IN SUBSEQUENT YEARS, ALL STAFF RECEIVE A LETTER INDICATING THEIR ANNUAL PAY INCREASE. ANNUAL INCREASES ARE BASED ON EXPERIENCE RAISES (THOUGH DR. GINGERICH HAS MAXED OUT THIS CATEGORY) AND ANNUAL COST OF LIVING RAISES.	ExplanationTxt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

Field	Value	IRS element (for citing)
Non Cash Checkbox	Yes (X)	NonCashCheckboxInd
Noncash Contributions Rpt F990	$312,042	NoncashContributionsRptF990Amt
Method Of Determining Revenues	FAIR MARKET VALUE	MethodOfDeterminingRevenuesTxt

Field	Value	IRS element (for citing)
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts	0	ReviewProcessUnusualNCGiftsInd
Third Parties Used	0	ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6	THE ORGANIZATION'S MEMBERSHIP INCLUDES HEALTH CARE CENTER STAFF AND PATIENTS AND IS OPEN TO ANYONE ELSE INTERESTED IN FURTHERING THE PURPOSE OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	MEMBERS ON THE BOARD OF DIRECTORS APPOINT NEW MEMBERS TO THE BOARD OF DIRECTORS AFTER A CONSULTATION PROCESS.
FORM 990, PART VI, SECTION B, LINE 11B	A DRAFT OF THE FORM 990 IS EMAILED TO BOARD MEMBERS BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C	THE BOARD OF DIRECTORS REVIEWS CONFLICTS OF INTEREST ANNUALLY. STAFF IS MADE AWARE OF THE POLICY AND IN RELEVANT SITUATIONS, THE POLICY IS REVIEWED.
FORM 990, PART VI, SECTION B, LINE 15	THE ORGANIZATION HAS A POINT SYSTEM TO DETERMINE SALARY LEVELS FOR ALL STAFF INCLUDING ALL MANAGEMENT PERSONNEL. THE POINT SYSTEM IS BASED ON: EDUCATION, EXPERIENCE, LANGUAGE ABILITY, RESPONSIBILITY LEVEL, AND WHETHER OR NOT THEY HAVE CALL RESPONSIBILITIES.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NORTHSIDE COMMUNITY HEALTH CENTER INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	808 NORTH THIRD STREET	AddressLine1Txt
City	GOSHEN	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46528	ZIPCd

Field	Value	IRS element (for citing)
EIN	473368774	EIN
Primary Activities	TO PROVIDE HEALTH CARE IN THE GOSHEN, INDIANA COMMUNITY	PrimaryActivitiesTxt
Legal Domicile State	IN	LegalDomicileStateCd
Exempt Code Section	501(C)(3)	ExemptCodeSectionTxt
Public Charity Status	LINE 3	PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	MAPLE CITY HEALTH CARE CENTER INC DBA VISTA COMMUNITY HEALTH CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Controlled Organization	0	ControlledOrganizationInd

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	0	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	0	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd