FURP.ORG / PUBLIC DATA EXPLORER

BLUE MOUNTAIN CLINIC INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
BLUE MOUNTAIN CLINIC INC (EIN 81-0365291)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-07-19
IRS object ID
201742009349300214
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 ReturnHeader

FieldValueIRS element (for citing)
Return2017-07-19T08:15:00-07:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Boyle Deveny & Meyer PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1305 South 4th East Suite 200AddressLine1Txt
CityMissoulaCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59801ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN810365291EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUE MOUNTAIN CLINIC INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBLUEBusinessNameControlTxt
Phone4067211646PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1610 N CALIFORNIA STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59802ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonANNIE HANSENPersonNm
Person TitleExecutive Dir.PersonTitleTxt
Signature2017-07-19SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJaime Ward CPAPreparerPersonNm
PTINP00441760PTIN
Phone4067213555PhoneNum
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerANNIE HANSENPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1610 N CALIFORNIA STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59802ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,861,453GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
All Affiliates IncludedfalseAllAffiliatesIncludedInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.bluemountainclinic.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1976FormationYr
Legal Domicile StateMTLegalDomicileStateCd
Activity Or MissionThe mission of Blue Mountain Clinic is to provide individualized, choice-based healthcare that respects the power of personal connection.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee29TotalEmployeeCnt
Total Volunteers50TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$180,234PYContributionsGrantsAmt
CY Contributions Grants$191,239CYContributionsGrantsAmt
PY Program Service Revenue$1,636,874PYProgramServiceRevenueAmt
CY Program Service Revenue$1,644,953CYProgramServiceRevenueAmt
PY Investment Income$46PYInvestmentIncomeAmt
CY Investment Income$98CYInvestmentIncomeAmt
PY Other Revenue$15,344PYOtherRevenueAmt
CY Other Revenue$17,560CYOtherRevenueAmt
PY Total Revenue$1,832,498PYTotalRevenueAmt
CY Total Revenue$1,853,850CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$992,105PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,097,635CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$67,555CYTotalFundraisingExpenseAmt
PY Other Expenses$724,051PYOtherExpensesAmt
CY Other Expenses$834,487CYOtherExpensesAmt
PY Total Expenses$1,716,156PYTotalExpensesAmt
CY Total Expenses$1,932,122CYTotalExpensesAmt
PY Revenues Less Expenses$116,342PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$78,272CYRevenuesLessExpensesAmt
Total Assets BOY$813,960TotalAssetsBOYAmt
Total Assets EOY$755,979TotalAssetsEOYAmt
Total Liabilities BOY$143,667TotalLiabilitiesBOYAmt
Total Liabilities EOY$163,958TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$670,293NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$592,021NetAssetsOrFundBalancesEOYAmt
MissionThe mission of Blue Mountain Clinic is to provide individualized, choice-based healthcare that respects the power of personal connection.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$1,637,359ExpenseAmt
DescBlue Mountain Clinic is a mission-driven 501(c)3 non-profit corporation organized in the state of Montana and is governed by a volunteer board of directors. Located at 610 N California Street in Missoula, MT, we are the only independent, non-government funded primary and family medicine clinic in the United States that has fully integrated family medicine, mental health counseling, abortion care, and comprehensive trans* care into our daily practice. We are not subsidized by any government money, are not a title X organization and do not offer a sliding fee scale for services. Because of this we are not eligible for many programs that offer amenities such as discounted birth control, sliding scales and large government grants. While such programs can be beneficial, we have always held the belief that we do not want federal regulations to influence how we care for our patients. This status does allow us to have complete autonomy in how we provide care while staying committed to our mission. BMC directly impacts the lives of over 10,000 patients per year who access a wide range of health services within our choice-based, primary medicine model. This is evidenced by the fact that 25% of our clients are traveling 100 miles or more to receive care at BMC. Since 2013 the demand for our care has increased by almost 30%. Blue Mountain Clinic is called upon daily by those who need care for their families, at an ever-increasing rate. This is a direct reflection of changes in our current healthcare environment; expanded services at BMC, lack of access due to clinic closures both in our region, and across the state, the retirement of several local family medicine doctors, anti-choice legislation, and most recently the expansion of Medicaid programs in Montana.In addition to our primary and reproductive care clients, we have been providing care to transgender patients throughout the Northern Rockies for over 16 years. In 2012, after receiving a grant from the Pride Foundation, we further strengthened our Trans* care through training, advocacy and marketing. Because of these trainings we have more than quadrupled the number of trans* identified patients we care for ranging in age from 9 to 72 years old. Our Medical Director Eric Ravitz, DO has been with the clinic for 17 years, our female MD Dr. Joey Banks 5 years, Kelly Polus PA-C 13 years, Alison Charman, ARNP 6 years, and our mental health counselors have been with us for 10 years. Most of our support staff have been working at Blue Mountain Clinic for over 10 years. Per the US Census Bureau, Montana and the Northern Rockies are home to some of the least populated regions, resulting in a large concentration of rural areas. These sparsely populated areas often result in very limited access to many of lifes necessities, including health care. Reports released by the American Medical Association and the American Academy of Family Physicians indicate that we will continue to experience a critical shortage of family medicine clinicians and clinics. The shortage is due in part to retiring physicians as well as a recent trend emerging where providers are choosing specialty areas of medicine over family medicine because they offer much higher salaries. In a report released by the Montana Office of Rural Health (MORH) a serious shortage of primary care physician services is cited in Montana. The distribution of physicians in Montana is extremely uneven, with 37% of all primary care physicians practicing in only three cities and 40 of Montana's 56 counties are designated health professional shortage areas. As we witness these changes and prepare for great uncertainty in the landscape of our healthcare both regionally and nationally, it is of the utmost importance that we remain a sound presence to ensure access to independent, choice-based health care that respects the power of personal connection.Blue Mountain Clinic advocates for its clients, community and region in the following areas:We are starting our 6th year providing critical gynecological training to residents in the Western Montana Family Medicine Residency Program. We train 10 residents a year preparing them to provide comprehensive reproductive and family medicine through our choice based lens. We are striving to ensure these residents will continue to practice and provide care filling the need for healthcare in our rural areas, many of which Blue Mountain Clinic currently serves. Dr. Eric Ravitz has served as the Medical Director for the Missoula Youth Homes for the past 10 years. The Youth Homes provide transitional and long-term housing and services to Montanas youth- from all over the state. Having Dr. Ravitz as their medical director enables them to offer a mental health component ensuring the whole health and safety of our most vulnerable populations.Dr. Joey Banks is currently serving as the Medical Director for Open Aid Alliance, a free clinic, located in Missoula, MT that strives to prevent HIV, hepatitis C and sexually transmitted infections through testing, education and outreach. Blue Mountain Clinic serves as one of the treatment sites for positive STI results when necessary. In anticipation of being defunded, Planned Parenthood has decided not to renew their youth education program, and therefore Blue Mountain Clinic will be absorbing this, in addition to our own current program. While we have always provided education and outreach within our schools, from topics as simple has healthy sexuality, to more sensitive topics including consent, by-stander intervention and teen suicide, this will more than double anything that we have ever done in the past. After an informal statewide survey completed in the summer of 2016, it was discovered that Blue Mountain Clinic is one of the only clinics in the state of Montana that provides:a.Comprehensive Trans* care that includes family medicine, hormone replacement, mental health counseling, and support and advocacy for reassignment surgery.b.Is one of the only remaining clinics not limiting or capping the amount of Medicaid patients. c.Is one of a handful of clinics left that continues to serve our Medicare population. Even locally, we see many clients who have been with their same doctor for 40 years or more, and are suddenly finding themselves discharged from the practice simply because they have termed onto Medicare. Can you imagine what it would be like to be with the same clinician for decades, only to find you healthcare displaced, simply because your insurance has changed? d.Is the only clinic of its kind where one can receive a full spectrum of family medicine, mental health counseling, reproductive and Trans*care all under one roof, without receiving any government funding, grants or designations.Desc
Total Program Service Expenses$1,637,359TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document15IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee29EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Form990 T FiledfalseForm990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Form8282 Filed0Form8282FiledCnt
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
DAF Excess Business HoldingsfalseDAFExcessBusinessHoldingsInd
Taxable DistributionsfalseTaxableDistributionsInd
Distribution To DonorfalseDistributionToDonorInd
Org Filed In Lieu Of Form1041falseOrgFiledInLieuOfForm1041Ind
Licensed More Than One StatefalseLicensedMoreThanOneStateInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonBLUE MOUNTAIN CLINICPersonNm
Phone4067211646PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1610 N CALIFORNIA STAddressLine1Txt
CityMISSOULACityNm
State AbbreviationMTStateAbbreviationCd
ZIP59802ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Christine Littig
Director2.000.00Yes (X)Yes (X)$0$0$0
JULIANNA CROWLEY
Vice President5.000.00Yes (X)Yes (X)$0$0$0
ERIN STEUER
President5.000.00Yes (X)Yes (X)$0$0$0
BETH HUBBLE
Director2.000.00Yes (X)$0$0$0
ERIN ROBERTS
Director2.000.00Yes (X)$0$0$0
LUKE LAUGHLIN
Director2.000.00Yes (X)$0$0$0
DEANNA JENNESS
Treasurer2.000.00Yes (X)$0$0$0
SUNDI HAMILTON
Director40.000.00Yes (X)$0$0$0
VICKI THUESEN
Director2.000.00Yes (X)$0$0$0
FRANK SHEEHY
Director2.000.00Yes (X)$0$0$0
ANNIE HANSEN
Executive Dir.40.000.00Yes (X)$55,312$0$0
ERIC A RAVITZ
STAFF40.000.00$137,104$0$0Yes (X)
JOEY BANKS
STAFF40.000.00$137,895$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$330,311TotalReportableCompFromOrgAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$191,239AllOtherContributionsAmt
Total Contributions$191,239TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHEALTH CARE DELIVERYDesc
Business621110BusinessCd
Total Revenue Column$1,644,953TotalRevenueColumnAmt
Related Or Exempt Func Income$1,644,953RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$1,644,953TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$98TotalRevenueColumnAmt
Exclusion$98ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$25,163FundraisingGrossIncomeAmt
Fundraising Direct Expenses$7,603FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,560TotalRevenueColumnAmt
Exclusion$17,560ExclusionAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,853,850TotalRevenueColumnAmt
Related Or Exempt Func Income$1,644,953RelatedOrExemptFuncIncomeAmt
Exclusion$17,658ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$55,312TotalAmt
Management And General$41,484ManagementAndGeneralAmt
Fundraising$13,828FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$903,384TotalAmt
Program Services$767,877ProgramServicesAmt
Management And General$90,338ManagementAndGeneralAmt
Fundraising$45,169FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$33,349TotalAmt
Program Services$25,012ProgramServicesAmt
Management And General$8,337ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$34,963TotalAmt
Program Services$26,222ProgramServicesAmt
Management And General$8,741ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$70,627TotalAmt
Program Services$52,970ProgramServicesAmt
Management And General$17,657ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$27,281TotalAmt
Management And General$27,281ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$23,555TotalAmt
Program Services$23,555ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$10,362TotalAmt
Program Services$6,735ProgramServicesAmt
Management And General$3,109ManagementAndGeneralAmt
Fundraising$518FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$11,317TotalAmt
Program Services$9,619ProgramServicesAmt
Management And General$1,132ManagementAndGeneralAmt
Fundraising$566FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$15,318TotalAmt
Program Services$12,254ProgramServicesAmt
Management And General$2,298ManagementAndGeneralAmt
Fundraising$766FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$239TotalAmt
Program Services$239ProgramServicesAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$5,728TotalAmt
Program Services$5,728ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$29,603TotalAmt
Program Services$25,163ProgramServicesAmt
Management And General$2,960ManagementAndGeneralAmt
Fundraising$1,480FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$54,871TotalAmt
Program Services$44,511ProgramServicesAmt
Management And General$10,360ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$363,287$363,287
CONTRACT LABOR$91,882$91,882
LAB SUPPLIES$34,768$34,768
OUTSIDE SERVICES$29,167$24,792$4,375

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$137,109TotalAmt
Program Services$122,745ProgramServicesAmt
Management And General$9,136ManagementAndGeneralAmt
Fundraising$5,228FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,932,122TotalAmt
Program Services$1,637,359ProgramServicesAmt
Management And General$227,208ManagementAndGeneralAmt
Fundraising$67,555FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$120,013BOYAmt
EOY$21,255EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$145,264BOYAmt
EOY$167,847EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$48,266BOYAmt
EOY$53,635EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$5,000BOYAmt
EOY$5,000EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,168,807LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$660,565LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$495,417BOYAmt
EOY$508,242EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$813,960BOYAmt
EOY$755,979EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$50,408BOYAmt
EOY$80,439EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$93,259BOYAmt
EOY$83,519EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$143,667BOYAmt
EOY$163,958EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$670,293BOYAmt
EOY$592,021EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$670,293BOYAmt
EOY$592,021EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$813,960BOYAmt
EOY$755,979EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$78,272ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$97,943CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$114,588CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$102,063CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$180,234CurrentTaxYearMinus1YearAmt
Current Tax Year$191,239CurrentTaxYearAmt
Total$686,067TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,203,577CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,308,714CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,480,175CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,636,874CurrentTaxYearMinus1YearAmt
Current Tax Year$1,644,953CurrentTaxYearAmt
Total$7,274,293TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,301,520CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,423,302CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,582,238CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,817,108CurrentTaxYearMinus1YearAmt
Current Tax Year$1,836,192CurrentTaxYearAmt
Total$7,960,360TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69,750CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$78,600CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$72,000CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$151,000CurrentTaxYearMinus1YearAmt
Current Tax Year$118,000CurrentTaxYearAmt
Total$489,350TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$69,750CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$78,600CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$72,000CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$151,000CurrentTaxYearMinus1YearAmt
Current Tax Year$118,000CurrentTaxYearAmt
Total$489,350TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$7,471,010PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$15CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years-$20CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$46CurrentTaxYearMinus1YearAmt
Current Tax Year$98CurrentTaxYearAmt
Total$161TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$15CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years-$20CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$46CurrentTaxYearMinus1YearAmt
Current Tax Year$98CurrentTaxYearAmt
Total$161TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,301,542CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,423,317CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,582,218CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,817,154CurrentTaxYearMinus1YearAmt
Current Tax Year$1,836,290CurrentTaxYearAmt
Total$7,960,521TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.93850PublicSupportCY509Pct
Public Support PY5090.93900PublicSupportPY509Pct
Investment Income CY0.00000InvestmentIncomeCYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

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

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$79,989OtherCostOrOtherBasisAmt
Book Value$79,989BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$837,690OtherCostOrOtherBasisAmt
Depreciation$449,869DepreciationAmt
Book Value$387,821BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$226,495OtherCostOrOtherBasisAmt
Depreciation$204,835DepreciationAmt
Book Value$21,660BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$24,633OtherCostOrOtherBasisAmt
Depreciation$5,861DepreciationAmt
Book Value$18,772BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$508,242TotalBookValueLandBuildingsAmt

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Agrmt Prof Fundraising ActyfalseAgrmtProfFundraisingActyInd

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1OFF THE RACKEvent1Nm
Gross Receipts Event1$25,163GrossReceiptsEvent1Amt
Gross Revenue Event1$25,163GrossRevenueEvent1Amt
Rent Facility Costs Event1$650RentFacilityCostsEvent1Amt
Food And Beverage Event1$882FoodAndBeverageEvent1Amt
Entertainment Event1$3,997EntertainmentEvent1Amt
Other Direct Expenses Event1$2,074OtherDirectExpensesEvent1Amt
Gross Receipts Total$25,163GrossReceiptsTotalAmt
Gross Revenue Total Events$25,163GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$650RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$882FoodAndBeverageTotalEventsAmt
Entertainment Total Events$3,997EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$2,074OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$7,603DirectExpenseSummaryEventsAmt
Net Income Summary$17,560NetIncomeSummaryAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 11b: Form 990 Review ProcessTHE CURRENT BOARD TREASURER REVIEWS THE 990 IN DETAIL WITH THE EXECUTIVE DIRECTOR. A DRAFT OF THE 990 IS THEN PRESENTED TO THE EXECUTIVE COMMITTEE. ANY CHANGES AND/OR SIGNIFICANT INFORMATION THAT IS RELEVANT TO BOARD MEMBERS IS PASSED ON TO THE BOARD FOR DISCUSSION PURPOSES VIA THE TREASURER.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsBOARD MEMBERS AND KEY STAFF MEMBERS ARE ASKED TO DIVULGE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO JOINING THE BOARD OR COMMENCING EMPLOYMENT AT THE CLINIC. BOTH BOARD AND STAFF MEMBERS UNDERGO A THOROUGH APPLICATION PROCESS DESIGNED TO PREVENT AND AVOID ANY POTENTIAL CONFLICTS OF INTEREST.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesCOMPENSATION OF THE EXECUTIVE DIRECTOR AND THE MEDICAL DIRECTOR IS SUBJECT TO ANNUAL REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS. CHANGES TO COMPENSATION BASED ON PERFORMANCE EVALUATIONS, COST OF LIVING INCREASE, OR ANNUAL BUDGET CONSTRAINTS ARE REVIEWED AND VOTED ON BY THE BOARD AS A WHOLE.
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableANY OF THESE DOCUMENTS ARE READILY AVAILIBLE UPON REQUEST.