SEATTLE ROOTS COMMUNITY HEALTH: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SEATTLE ROOTS COMMUNITY HEALTH (EIN 23-7100868)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-09
- IRS object ID
- 201723139349304117
- 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 G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-09T19:24:45-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | 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 | 237100868 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COUNTRY DOCTOR COMMUNITY CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COUN | BusinessNameControlTxt |
| Phone | 2062991937 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 EAST YESLER WAY NO 210 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98122 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RALEIGH WATTS | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 2062991937 | PhoneNum |
| Signature | 2017-11-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-08 | IPDt |
| IP Tm | 12:29:05 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 9AD29FA46B8615F2777C89FEDEB19E0AFF07ACA7 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | F7FEC01EC20CA1B5D46E5CE0AEC8EC2B7989BB02 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RALEIGH WATTS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 EAST YESLER WAY NO 210 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98122 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,030,811 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.COUNTRYDOCTOR.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1971 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HEALTH CARE REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 248 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,710,371 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,421,155 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,560,425 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $18,733,063 | CYProgramServiceRevenueAmt |
| PY Investment Income | $366,822 | PYInvestmentIncomeAmt |
| CY Investment Income | $50,349 | CYInvestmentIncomeAmt |
| PY Other Revenue | $82,776 | PYOtherRevenueAmt |
| CY Other Revenue | -$277,802 | CYOtherRevenueAmt |
| PY Total Revenue | $19,720,394 | PYTotalRevenueAmt |
| CY Total Revenue | $24,926,765 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $42,985 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,847,969 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,052,320 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $141,983 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,766,315 | PYOtherExpensesAmt |
| CY Other Expenses | $10,169,333 | CYOtherExpensesAmt |
| PY Total Expenses | $18,614,284 | PYTotalExpensesAmt |
| CY Total Expenses | $22,264,638 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,106,110 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,662,127 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,798,488 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,167,602 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,252,604 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,959,323 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,545,884 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,208,279 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,378,299 | ExpenseAmt |
| Grant | $42,985 | GrantAmt |
| Revenue | $18,733,063 | RevenueAmt |
| Desc | IN 2016, COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 54,326 MEDICAL VISITS. 79% OF THE PATIENTS SEEN IN 2016 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL (FPL). 18% WERE UNINSURED PATIENTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,451,778 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE OTHER HEALTH SERVICES PROGRAMS PROVIDED 13,551 ANCILLARY HEALTH VISITS (EG NUTRITION, WIC, ELIGIBILITY) TO LOW-INCOME PATIENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $19,830,077 | 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 | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | 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 | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 38 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 248 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSANA TANTICO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2062991937 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2101 EAST YESLER WAY SUITE 210 | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98122 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JERRY SALE | |||||||
| CHAIR (THROUGH MARCH 2016) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MORGAN DUTTON | |||||||
| TREASURER & CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RIK WYMAN | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOAN KLEINBERG | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| COLT DE WOLF | |||||||
| DIRECTOR & TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHERYL ANDERSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RAYMOND ANGEL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY BYRD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALEX CURRY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROB ROCHE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GRANT SCULL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LY SIENG NGO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WINNIE SPERRY | |||||||
| DIRECTOR (THROUGH MARCH 2016) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NICK UREN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVE WILKINS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA MCVEIGH | |||||||
| EXECUTIVE DIRECTOR | 35.00 | Yes (X) | $168,562 | $0 | $15,499 | ||
| SUSANA TANTICO | |||||||
| DIRECTOR OF FINANCE | 40.00 | Yes (X) | $114,070 | $0 | $19,869 | ||
| CHRIS SALAZAR | |||||||
| DEPUTY DIRECTOR | 40.00 | Yes (X) | $121,532 | $0 | $13,760 | ||
| RICHARD KOVAR | |||||||
| MEDICAL DIRECTOR | 32.00 | $181,237 | $0 | $20,721 | Yes (X) | ||
| CHINYERE SHEHU | |||||||
| PHYSICIAN, RESIDENCY DIRECTOR | 23.00 | $154,488 | $0 | $12,299 | Yes (X) | ||
| MATT LOGALBO | |||||||
| PHYSICIAN | 35.00 | $127,236 | $0 | $17,867 | Yes (X) | ||
| BESSIE CHI | |||||||
| IT SPECIALIST | 40.00 | $127,236 | $0 | $13,664 | Yes (X) | ||
| SARAH HUFBAUER | |||||||
| PHYSICIAN, CLINICAL SITE DIRECTOR | 21.00 | $134,343 | $0 | $5,322 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,128,704 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $119,001 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | 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 |
|---|---|---|---|---|---|
| PTSO OF WASHINGTON | |||||
| 3101 4TH AVENUE SUITE 320 | SEATTLE | WA | 98101 | I.T. SUPPORT | $384,888 |
| SEATTLE CHILDREN'S | |||||
| 4800 SAND POINT WAY NE | SEATTLE | WA | 98105 | BUILDING MAINTENANCE | $335,849 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $127,561 | FundraisingAmt |
| Government Grants | $5,322,792 | GovernmentGrantsAmt |
| All Other Contributions | $970,802 | AllOtherContributionsAmt |
| Noncash Contributions | $371,174 | NoncashContributionsAmt |
| Total Contributions | $6,421,155 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621400 | $9,826,411 | $9,826,411 |
| PHARMACY | 621400 | $8,906,652 | $8,906,652 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $18,733,063 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,655 | TotalRevenueColumnAmt |
| Exclusion | $10,655 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $96,487 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $96,487 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $96,487 | TotalRevenueColumnAmt |
| Exclusion | $96,487 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $62,039 | SecuritiesAmt |
| Other | $32,320 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $54,665 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,374 | SecuritiesAmt |
| Other | $32,320 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,694 | TotalRevenueColumnAmt |
| Exclusion | $39,694 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $28,550 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $127,561 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $49,381 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$20,831 | TotalRevenueColumnAmt |
| Exclusion | -$20,831 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $7,000 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,000 | TotalRevenueColumnAmt |
| Exclusion | $7,000 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| OTHER REVENUE | 900099 | $97,806 | $97,806 |
| RISK POOL | 900099 | -$458,264 | -$458,264 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$360,458 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,926,765 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,733,063 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$227,453 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,985 | TotalAmt |
| Program Services | $42,985 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $453,292 | TotalAmt |
| Management And General | $453,292 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,370,310 | TotalAmt |
| Program Services | $8,745,278 | ProgramServicesAmt |
| Management And General | $536,615 | ManagementAndGeneralAmt |
| Fundraising | $88,417 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $365,419 | TotalAmt |
| Program Services | $317,538 | ProgramServicesAmt |
| Management And General | $44,047 | ManagementAndGeneralAmt |
| Fundraising | $3,834 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,143,159 | TotalAmt |
| Program Services | $1,044,973 | ProgramServicesAmt |
| Management And General | $85,568 | ManagementAndGeneralAmt |
| Fundraising | $12,618 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $720,140 | TotalAmt |
| Program Services | $616,866 | ProgramServicesAmt |
| Management And General | $95,825 | ManagementAndGeneralAmt |
| Fundraising | $7,449 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,573 | TotalAmt |
| Management And General | $5,573 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,333 | TotalAmt |
| Management And General | $93,333 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,644,547 | TotalAmt |
| Program Services | $2,460,227 | ProgramServicesAmt |
| Management And General | $178,803 | ManagementAndGeneralAmt |
| Fundraising | $5,517 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,390 | TotalAmt |
| Program Services | $3,889 | ProgramServicesAmt |
| Management And General | $22,332 | ManagementAndGeneralAmt |
| Fundraising | $169 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,677 | TotalAmt |
| Program Services | $176,945 | ProgramServicesAmt |
| Management And General | $54,112 | ManagementAndGeneralAmt |
| Fundraising | $11,620 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $622,057 | TotalAmt |
| Program Services | $341,554 | ProgramServicesAmt |
| Management And General | $273,980 | ManagementAndGeneralAmt |
| Fundraising | $6,523 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,788 | TotalAmt |
| Program Services | $41,882 | ProgramServicesAmt |
| Management And General | $20,687 | ManagementAndGeneralAmt |
| Fundraising | $219 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,705 | TotalAmt |
| Program Services | $399 | ProgramServicesAmt |
| Management And General | $2,289 | ManagementAndGeneralAmt |
| Fundraising | $17 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $373,540 | TotalAmt |
| Program Services | $342,032 | ProgramServicesAmt |
| Management And General | $28,528 | ManagementAndGeneralAmt |
| Fundraising | $2,980 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,676 | TotalAmt |
| Program Services | $10,495 | ProgramServicesAmt |
| Management And General | $108,181 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| PHARMACEUTICALS | $5,304,559 | $5,304,559 | ||
| MISCELLANEOUS | $320,823 | $47,279 | $271,493 | $2,051 |
| OTHER HEALTHCARE SUPPLI | $165,597 | $165,597 | ||
| BAD DEBT | $116,863 | $116,863 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,205 | TotalAmt |
| Program Services | $50,716 | ProgramServicesAmt |
| Management And General | $17,920 | ManagementAndGeneralAmt |
| Fundraising | $569 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,264,638 | TotalAmt |
| Program Services | $19,830,077 | ProgramServicesAmt |
| Management And General | $2,292,578 | ManagementAndGeneralAmt |
| Fundraising | $141,983 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $412,676 | BOYAmt |
| EOY | $1,968,470 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $413,665 | BOYAmt |
| EOY | $426,259 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,237,171 | BOYAmt |
| EOY | $1,660,778 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,057,716 | BOYAmt |
| EOY | $4,439,773 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $319,851 | BOYAmt |
| EOY | $379,275 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,884,196 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,591,149 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,357,409 | BOYAmt |
| EOY | $3,293,047 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,798,488 | BOYAmt |
| EOY | $12,167,602 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,397,055 | BOYAmt |
| EOY | $2,108,030 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,855,549 | BOYAmt |
| EOY | $1,851,293 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,252,604 | BOYAmt |
| EOY | $3,959,323 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,462,829 | BOYAmt |
| EOY | $8,125,224 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,055 | BOYAmt |
| EOY | $83,055 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,545,884 | BOYAmt |
| EOY | $8,208,279 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,798,488 | BOYAmt |
| EOY | $12,167,602 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,662,127 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $268 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,856,236 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,785,356 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,043,959 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,710,371 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,421,155 | CurrentTaxYearAmt |
| Total | $25,817,077 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,856,236 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,785,356 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,043,959 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,710,371 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,421,155 | CurrentTaxYearAmt |
| Total | $25,817,077 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $25,817,077 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $96,147 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $113,859 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $108,335 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $90,336 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $107,142 | CurrentTaxYearAmt |
| Total | $515,819 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $220,307 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $312,659 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,012,271 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $61,194 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $133,356 | CurrentTaxYearAmt |
| Total | $1,739,787 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $28,072,683 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $59,827,771 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.91970 | PublicSupportCY170Pct |
| Public Support PY170 | 0.90300 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER REVENUE RISK POOL REVENUE DEBT FORGIVENESS SPECIAL FUNDRAISING EVENTS CHARITABLE GAMING EVENTS | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $83,055 | BeginningYearBalanceAmt |
| End Year Balance | $83,055 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $83,055 | BeginningYearBalanceAmt |
| End Year Balance | $83,055 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $83,055 | BeginningYearBalanceAmt |
| End Year Balance | $83,055 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $83,055 | BeginningYearBalanceAmt |
| End Year Balance | $83,055 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $83,055 | BeginningYearBalanceAmt |
| End Year Balance | $83,055 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $184,000 | OtherCostOrOtherBasisAmt |
| Book Value | $184,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,780,574 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,318,573 | DepreciationAmt |
| Book Value | $2,462,001 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $182,047 | OtherCostOrOtherBasisAmt |
| Depreciation | $172,581 | DepreciationAmt |
| Book Value | $9,466 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,468,572 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,099,995 | DepreciationAmt |
| Book Value | $368,577 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $269,003 | OtherCostOrOtherBasisAmt |
| Book Value | $269,003 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,293,047 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $24,738,215 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $507,645 | OtherRevenueAmt |
| Revenue Not Reported | $507,645 | RevenueNotReportedAmt |
| Revenue Subtotal | $24,230,570 | RevenueSubtotalAmt |
| Other Revenues Not Included | $696,195 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $696,195 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $24,926,765 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,314,019 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $49,381 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $49,381 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,264,638 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $22,264,638 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS ARE ASSETS SET ASIDE AND RESTRICTED BY DONORS. THE INCOME GENERATED FROM THESE ASSETS IS USED TO FUND OPERATIONS OF THE ORGANIZATION. |
| PART X, LINE 2: | CDCHC'S ACTIVITIES ARE GENERALLY EXEMPT FROM FEDERAL INCOMES TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; HOWEVER, UNRELATED BUSINESS ACTIVITIES WOULD BE SUBJECT TO INCOME TAX. SINCE CDCHC IS EXEMPT FROM FEDERAL INCOME TAX LIABILITY, NO PROVISION IS MADE FOR CURRENT OR DEFERRED INCOME TAX EXPENSE. FOR THE YEARS ENDED DECEMBER 31, 2016 AND 2015, MANAGEMENT EVALUATED CDCHC'S TAX POSITIONS AND CONCLUDED THAT CDCHC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS. ALL TAX-EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE, AND OTHER APPLICABLE STATE STATUTES, USUALLY FOR THREE YEARS SUBSEQUENT TO THE DATE THE RETURN WAS FILED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSES 49,381. RISK POOL 458,264. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL INCOME 96,487. REALIZED GAIN ON INVESTMENTS 7,374. CAPITAL CAMPAIGN CONTRIBUTIONS 592,334. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSES 49,381. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | FUNDRAISING DINNER | Event1Nm |
| Gross Receipts Event1 | $156,111 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $127,561 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $28,550 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $6,040 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $28,604 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $5,075 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $9,662 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $156,111 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $127,561 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $28,550 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $6,040 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $28,604 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $5,075 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $9,662 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $49,381 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$20,831 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YWCA SEATTLE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1118 5TH AVENUE | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 910482890 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $42,985 | CashGrantAmt |
| Purpose Of Grant | FEDERAL RYAN WHITE PROGRAM DISTRIBUTION TO SUB-RECIPIENT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | COUNTRY DOCTOR MONITORS THE USE OF FUNDS DISTRIBUTED TO SUB-RECIPIENTS THROUGH FEDERAL GRANT PROGRAMS IN ACCORDANCE WITH THE REQUIREMENTS FOR THOSE PROGRAMS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | 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 (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LINDA MCVEIGH | ||||||||||||||
| EXECUTIVE DIRECTOR | $168,462 | $0 | $100 | $0 | $0 | $0 | $0 | $0 | $15,499 | $0 | $184,061 | $0 | $0 | $0 |
| RICHARD KOVAR | ||||||||||||||
| MEDICAL DIRECTOR | $181,147 | $0 | $90 | $0 | $0 | $0 | $0 | $0 | $20,721 | $0 | $201,958 | $0 | $0 | $0 |
| CHINYERE SHEHU | ||||||||||||||
| PHYSICIAN, RESIDENCY DIRECTOR | $154,422 | $0 | $66 | $0 | $0 | $0 | $0 | $0 | $12,299 | $0 | $166,787 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 6 | FormAndLineReferenceDesc |
| Explanation | ALL EMPLOYEES RECEIVE A SMALL END-OF-YEAR BONUS BASED ON THE ORGANIZATION'S PERFORMANCE, INCLUDING FINANCIAL PERFORMANCE. | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 12 | ContributionCnt |
| Noncash Contributions Rpt F990 | $371,174 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST/SELLING PRICE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | 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 1 | THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD CHAIR AND AT LEAST THREE OTHER BOARD MEMBERS. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY AS EXPRESSLY DELEGATED TO IT BY RESOLUTION OF THE BOARD IN THE GOVERNANCE OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE BOTH REVIEWED A DRAFT OF THE RETURN BEFORE IT WAS PRESENTED TO THE FINANCE COMMITTEE FOR FURTHER REVIEW. AFTER REVIEW BY THE FINANCE COMMITTEE AND DISTRIBUTION TO THE FULL BOARD THE FORM 990 WAS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | COMPLIANCE AND NON-COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY WERE REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED DURING THE MONTHLY MEETINGS. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ANNUALLY. ANY MEMBER WITH A STATED CONFLICT OF INTEREST IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD CHAIRPERSON DETERMINES THE EXTENT OF THE CONFLICT AND WHETHER THE CONFLICTED BOARD MEMBER SHOULD NOT VOTE ON AN ISSUE OR SHOULD RECUSE HIM OR HERSELF FROM THE DISCUSSION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. EVERY TWO YEARS, THIS PROCESS IS ASSISTED BY AN INDEPENDENT COMPENSATION CONSULTANT AS WELL AS A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE LAST REVIEW PROCESS OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS DONE IN 2014. THE DIRECTOR OF FINANCE'S COMPENSATION IS REVIEWED BY THE EXECUTIVE DIRECTOR BASED ON A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE BOARD THEN REVIEWS IT ALONG WITH ALL OTHER EMPLOYEES AS A GROUP. THE REVIEW OF THE DIRECTOR OF FINANCE'S COMPENSATION WAS DONE IN 2014. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | I.T. SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 119,485. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 119,485. INTERPRETIVE SERVICES: PROGRAM SERVICE EXPENSES 73,569. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,569. HEALTHCARE SERVICES: PROGRAM SERVICE EXPENSES 2,332,007. MANAGEMENT AND GENERAL EXPENSES 11,381. FUNDRAISING EXPENSES 5,517. TOTAL EXPENSES 2,348,905. OTHER SERVICES: PROGRAM SERVICE EXPENSES 54,651. MANAGEMENT AND GENERAL EXPENSES 47,937. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,588. |
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