PEDIATRIC SPECIALISTS OF VIRGINIA LLC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PEDIATRIC SPECIALISTS OF VIRGINIA LLC (EIN 46-1851763)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-11
- IRS object ID
- 201613169349300741
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-11T08:29:53-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 221478099 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COHNREZNICK LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7501 WISCONSIN AVE SUITE 400E | AddressLine1Txt |
| City | BETHESDA | CityNm |
| State Abbreviation | MD | StateAbbreviationCd |
| ZIP | 20814 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461851763 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEDIATRIC SPECIALISTS OF VIRGINIA LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PEDI | BusinessNameControlTxt |
| Phone | 7032892433 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8110 GATEHOUSE ROAD SUITE 400W | AddressLine1Txt |
| City | FALLS CHURCH | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22042 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LEON MOORES MD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7032892433 | PhoneNum |
| Signature | 2016-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | FRED HUTCHISON | PreparerPersonNm |
| PTIN | P00640420 | PTIN |
| Phone | 7037446700 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LEON MOORES MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8110 GATEHOUSE ROAD SUITE 400W | AddressLine1Txt |
| City | FALLS CHURCH | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,669,498 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | PSVCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2013 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | To provide a market-leading pediatric specialist physician capacity in Northern Virginia through the joint efforts of the Members, Inova Health Care Services (Inova) and Children's National Medical Center (CNMC). | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 285 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $401,982 | PYContributionsGrantsAmt |
| CY Contributions Grants | $30,209 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,693,583 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,597,942 | CYProgramServiceRevenueAmt |
| PY Investment Income | $25,989 | PYInvestmentIncomeAmt |
| CY Investment Income | $37,278 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | -$22,953 | CYOtherRevenueAmt |
| PY Total Revenue | $10,121,554 | PYTotalRevenueAmt |
| CY Total Revenue | $19,642,476 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,916,214 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,632,454 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $5,002 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,260,879 | PYOtherExpensesAmt |
| CY Other Expenses | $15,375,014 | CYOtherExpensesAmt |
| PY Total Expenses | $24,177,093 | PYTotalExpensesAmt |
| CY Total Expenses | $42,007,468 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$14,055,539 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$22,364,992 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,358,617 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,760,860 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,597,696 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,935,368 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,760,921 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,825,492 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Pediatric Specialists of Virginia's (PSV) charitable mission is to meet the pediatric specialist staffing needs of Inova and CNMC and to provide pediatric specialist consults to pediatric patients as requested by Inova or CNMC. Also to expand outpatient pediatric specialist services in Northern Virginia through the operation of ambulatory care sites, among other vehicles. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $38,226,795 | ExpenseAmt |
| Revenue | $19,597,942 | RevenueAmt |
| Desc | PSV provides medical care and related services to children who seek diagnosis, treatment, and care without regard to race, color, creed, sex, disability, national origin, sexual orientation, or poverty status. PSV's physicians and allied staff provide services in the following pediatric specialty areas: gastroenterology, orthopedics, nephrology, genetics, hematology/oncology, endocrinology, rheumatology, infectious diseases, psychology, neurology, psychiatry, allergy and immunology, developmental pediatrics, neurosurgery, physical medicine and rehabilitation, and adolescent gynecology to all pediatric patients on a non-discriminatory basis. In addition, PSV operates an outpatient surgery center and provides pediatric anesthesiology services. PSV engages in activities that educate the community with respect to areas of critical health care importance. Through its affiliation with Inova and Children's Hospital, PSV participates in health screenings, health fairs, and health education classes to all residents in the community, whether or not they are patients of PSV. PSV's employed physicians also participate in academic and research programs. PSV physicians serve as faculty for area medical schools, participating in the medical education programs of the affiliated hospitals and instructing students. By engaging in patient care and teaching activities at the Members' hospitals, PSV promotes the health and well being of the communities served and fosters a dynamic and interactive learning environment for future physicians. PSV's employed physicians and allied staff also conduct medical research to advance the study and practice of medicine and to find cures for diseases. Results of the research will be made available to the general public. PSV's physicians provide services to patients at eight distinct locations in Northern Virginia and Maryland. By providing highly-specialized pediatric physician care to all children in the large, diverse, and growing Northern Virginia community, PSV fulfills a valuable community need. PSV will make available to all children, including indigent children who require medical care, the services of its physicians and of its qualified health care professionals consistent with PSV's policies for providing needed medical services to patients regardless of their ability to pay. | Desc |
| Total Program Service Expenses | $38,226,795 | 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 | Yes (1) | 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 | 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 | 0 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 285 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | 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 | 0 | 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 | VA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEDIACTRIC SPECIALISTS OF VIRGINIA LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7038486630 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3023 HAMAKER COURT | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22031 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| RICHARD MAGENHEIMER | ||||||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $1,886,593 | $495,017 | ||||
| PATRICK CHRISTIANSEN | ||||||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $931,698 | $160,822 | ||||
| LORING FLINT | ||||||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $941,132 | $171,016 | ||||
| DAVID WESSEL | ||||||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $1,070,322 | $169,126 | ||||
| DOUG MYERS | ||||||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $1,017,798 | $161,315 | ||||
| ELIZABETH FLURY | ||||||||||
| TRUSTEE | 1.00 | 49.00 | Yes (X) | $0 | $923,287 | $174,898 | ||||
| ROBERT FILDES | ||||||||||
| TRUSTEE | 37.00 | Yes (X) | $276,424 | $0 | $40,375 | |||||
| CARLY VARELA | ||||||||||
| TRUSTEE | 38.00 | Yes (X) | $193,013 | $0 | $49,654 | |||||
| WILLIAM JUDD | ||||||||||
| COO | 40.00 | $195,277 | $0 | $12,774 | Yes (X) | |||||
| LEON MOORES MD | ||||||||||
| CEO | 40.00 | $465,728 | $147,026 | $25,150 | Yes (X) | |||||
| MARGARET HARRIS | ||||||||||
| SENIOR DIRECTOR, FINANCE | 40.00 | $108,005 | $0 | $9,431 | Yes (X) | |||||
| JEFFREY HANWAY | ||||||||||
| CHIEF SURGICAL OFFICER | 40.00 | $618,266 | $0 | $18,276 | Yes (X) | |||||
| IAN LEIBOWITZ | ||||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $341,065 | $0 | $54,300 | Yes (X) | |||||
| SADHNA SHANKAR | ||||||||||
| MEDICAL DIRECTOR | 40.00 | $294,339 | $0 | $25,687 | Yes (X) | |||||
| CATHERINE CHAO | ||||||||||
| PHYSICIAN | 40.00 | $317,258 | $0 | $27,270 | Yes (X) | |||||
| MARSHALL SCHORIN | ||||||||||
| PHYSICIAN | 40.00 | $314,525 | $0 | $40,628 | Yes (X) | |||||
| OTTO LOUIS-JACQUES | ||||||||||
| PHYSICIAN | 40.00 | $311,902 | $0 | $16,700 | Yes (X) | |||||
| GEORGE GANTSOUDES | ||||||||||
| PHYSICIAN | 40.00 | $307,038 | $0 | $55,977 | Yes (X) | |||||
| RAMESH PATEL | ||||||||||
| MEDICAL DIRECTOR | 40.00 | $369,721 | $0 | $59,427 | Yes (X) | |||||
| GREG FLORENTIN | ||||||||||
| FORMER COO | 40.00 | $121,571 | $0 | $17,218 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,234,132 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,917,856 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,785,061 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 56 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LIBERTY LANGUAGE SERVICE LLC | |||||
| 1604 SPRING HILL ROAD SUITE 262 | VIENNA | VA | 22182 | TRANSLATION SERVICES | $286,100 |
| OASIS OUTSOURCING | |||||
| 2054 VISTA PARKWAY SUITE 300 | WEST PALM BEACH | FL | 33411 | HUMAN RESOURCES OUTSOURCING | $184,299 |
| ECG MANAGEMENT CONSULTANTS | |||||
| 11512 EL CAMINO REAL 200 | SAN DIEGO | CA | 92130 | HEALTHCARE ADVISORY SERVICES | $128,277 |
| PERFECTIONIST CLEANING SERVICES INC | |||||
| PO BOX 230353 | CENTREVILLE | VA | 20120 | JANITORIAL SERVICES | $120,838 |
| MILLENNIUM HEALTH CONSULTING LLC | |||||
| PO BOX 1658 | ISSAQUAH | WA | 98027 | HEALTHCARE ADVISORY SERVICES | $119,169 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $28,379 | FundraisingAmt |
| All Other Contributions | $1,830 | AllOtherContributionsAmt |
| Total Contributions | $30,209 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $19,597,942 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,597,942 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,597,942 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,278 | TotalRevenueColumnAmt |
| Exclusion | $37,278 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $4,069 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $28,379 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $27,022 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$22,953 | TotalRevenueColumnAmt |
| Exclusion | -$22,953 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,642,476 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,597,942 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $14,325 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,144,250 | TotalAmt |
| Program Services | $2,144,250 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,331,709 | TotalAmt |
| Program Services | $17,398,873 | ProgramServicesAmt |
| Management And General | $1,932,836 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $799,490 | TotalAmt |
| Program Services | $727,536 | ProgramServicesAmt |
| Management And General | $71,954 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,046,906 | TotalAmt |
| Program Services | $2,772,684 | ProgramServicesAmt |
| Management And General | $274,222 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,310,099 | TotalAmt |
| Program Services | $1,192,190 | ProgramServicesAmt |
| Management And General | $117,909 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $571,618 | TotalAmt |
| Program Services | $520,172 | ProgramServicesAmt |
| Management And General | $51,446 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,241 | TotalAmt |
| Program Services | $6,589 | ProgramServicesAmt |
| Management And General | $652 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,099 | TotalAmt |
| Program Services | $51,960 | ProgramServicesAmt |
| Management And General | $5,139 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,655,489 | TotalAmt |
| Program Services | $2,416,495 | ProgramServicesAmt |
| Management And General | $238,994 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,367 | TotalAmt |
| Program Services | $14,894 | ProgramServicesAmt |
| Management And General | $1,473 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,945 | TotalAmt |
| Program Services | $212,890 | ProgramServicesAmt |
| Management And General | $16,475 | ManagementAndGeneralAmt |
| Fundraising | $4,580 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,504 | TotalAmt |
| Program Services | $211,579 | ProgramServicesAmt |
| Management And General | $20,925 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,511,643 | TotalAmt |
| Program Services | $2,285,595 | ProgramServicesAmt |
| Management And General | $226,048 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,100 | TotalAmt |
| Program Services | $88,361 | ProgramServicesAmt |
| Management And General | $8,722 | ManagementAndGeneralAmt |
| Fundraising | $17 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,191 | TotalAmt |
| Program Services | $52,954 | ProgramServicesAmt |
| Management And General | $4,832 | ManagementAndGeneralAmt |
| Fundraising | $405 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,596,734 | TotalAmt |
| Program Services | $1,453,028 | ProgramServicesAmt |
| Management And General | $143,706 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,056,600 | TotalAmt |
| Program Services | $961,506 | ProgramServicesAmt |
| Management And General | $95,094 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $5,311,517 | $4,833,480 | $478,037 |
| REPAIRS AND MAINTENANCE | $314,513 | $286,207 | $28,306 |
| BAD DEBT | $304,000 | $276,640 | $27,360 |
| TAXES AND LICENSES | $172,775 | $157,225 | $15,550 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,678 | TotalAmt |
| Program Services | $161,687 | ProgramServicesAmt |
| Management And General | $15,991 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,007,468 | TotalAmt |
| Program Services | $38,226,795 | ProgramServicesAmt |
| Management And General | $3,775,671 | ManagementAndGeneralAmt |
| Fundraising | $5,002 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $921,430 | BOYAmt |
| EOY | $1,832,550 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,057,078 | BOYAmt |
| EOY | $1,863,329 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $175,534 | BOYAmt |
| EOY | $335,846 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,808 | BOYAmt |
| EOY | $31,755 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,752,103 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,932,607 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,903,026 | BOYAmt |
| EOY | $8,819,496 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,412,571 | BOYAmt |
| EOY | $1,929,507 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,224,220 | BOYAmt |
| EOY | $941,708 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $597,950 | BOYAmt |
| EOY | $6,669 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,358,617 | BOYAmt |
| EOY | $15,760,860 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,042,277 | BOYAmt |
| EOY | $4,425,843 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $555,419 | BOYAmt |
| EOY | $3,509,525 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,597,696 | BOYAmt |
| EOY | $7,935,368 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,760,921 | BOYAmt |
| EOY | $7,825,492 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,760,921 | BOYAmt |
| EOY | $7,825,492 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,358,617 | BOYAmt |
| EOY | $15,760,860 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$22,364,992 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$43,537 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $19,473,100 | 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 | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $401,982 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $34,278 | CurrentTaxYearAmt |
| Total | $436,260 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $1,557,548 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,693,583 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,597,942 | CurrentTaxYearAmt |
| Total | $30,849,073 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $25,989 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $37,278 | CurrentTaxYearAmt |
| Total | $63,267 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $1,557,548 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,121,554 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,669,498 | CurrentTaxYearAmt |
| Total | $31,348,600 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $31,348,600 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $1,557,548 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,121,554 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,669,498 | CurrentTaxYearAmt |
| Total | $31,348,600 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | Yes (X) | First5Years509Ind |
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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,184,652 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,521,927 | DepreciationAmt |
| Book Value | $6,662,725 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,227,614 | OtherCostOrOtherBasisAmt |
| Depreciation | $410,680 | DepreciationAmt |
| Book Value | $1,816,934 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $339,837 | OtherCostOrOtherBasisAmt |
| Book Value | $339,837 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,819,496 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| PROFESSIONAL LIABILITY | $1,239,934 |
| DEFERRED RENT | $2,064,105 |
| DUE TO RELATED PARTIES | $205,486 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,509,525 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $19,316,716 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$43,537 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$309,245 | OtherRevenueAmt |
| Revenue Not Reported | -$352,782 | RevenueNotReportedAmt |
| Revenue Subtotal | $19,669,498 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$27,022 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$27,022 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $19,642,476 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $41,725,245 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $27,022 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $27,022 | ExpensesNotReportedAmt |
| Expenses Subtotal | $41,698,223 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $309,245 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $309,245 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $42,007,468 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Company was recognized as a public charity, not a foundation, generally exempt from federal income taxation under 501(c)(3) of the Internal Revenue Code pursuant to a determination letter issued by the IRS in January 2015 effective September 30, 2013. The Company is entitled to rely on this determination as long asthere are no substantial changes in its character, purposes, or methods of operation. Management has concluded that there have been no such changes and therefore the Company's status as a public charity exempt from federal income taxation remains in effect. The state in which the Company operates also provides general exemption from state income taxation for organizations that are exempt from federal income taxation. However, the Company is subject to both federal and state income taxation at corporate tax rates on its unrelated business income. Exemption from other state taxes, such as real and personal property taxes, is separately determined. The Company had no unrecognized tax benefits or such amounts were immaterial during the periods presented. For tax periods with respect to which no unrelated business income was recognized, the Company was not required to file any income tax returns. |
| Part XI, Line 2d - Other Adjustments: | Bad debt -304,000. Investment Expense -5,245. |
| Part XI, Line 4b - Other Adjustments: | Special Events Expense -27,022. |
| Part XII, Line 2d - Other Adjustments: | Special Events Expense 27,022. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense 304,000. Investment Expense 5,245. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | STRIDE FORWARD 5K | Event1Nm |
| Gross Receipts Event1 | $32,448 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $28,379 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $4,069 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $4,427 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $78 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $700 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $21,817 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $32,448 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $28,379 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $4,069 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,427 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $78 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $700 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $21,817 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $27,022 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$22,953 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 (19 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RICHARD MAGENHEIMER | ||||||||||||||
| TRUSTEE | $0 | $686,647 | $0 | $455,969 | $0 | $743,977 | $0 | $478,579 | $0 | $16,438 | $0 | $2,381,610 | $0 | $603,000 |
| PATRICK CHRISTIANSEN | ||||||||||||||
| TRUSTEE | $0 | $628,958 | $0 | $265,216 | $0 | $37,524 | $0 | $145,096 | $0 | $15,726 | $0 | $1,092,520 | $0 | $0 |
| LORING FLINT | ||||||||||||||
| TRUSTEE | $0 | $607,509 | $0 | $296,099 | $0 | $37,524 | $0 | $151,048 | $0 | $19,968 | $0 | $1,112,148 | $0 | $0 |
| DAVID WESSEL | ||||||||||||||
| TRUSTEE | $0 | $528,999 | $0 | $475,919 | $0 | $65,404 | $0 | $95,752 | $0 | $73,374 | $0 | $1,239,448 | $0 | $0 |
| DOUG MYERS | ||||||||||||||
| TRUSTEE | $0 | $504,053 | $0 | $467,784 | $0 | $45,961 | $0 | $92,751 | $0 | $68,564 | $0 | $1,179,113 | $0 | $0 |
| ELIZABETH FLURY | ||||||||||||||
| TRUSTEE | $0 | $490,436 | $0 | $430,061 | $0 | $2,790 | $0 | $88,252 | $0 | $86,646 | $0 | $1,098,185 | $0 | $0 |
| ROBERT FILDES | ||||||||||||||
| TRUSTEE | $232,511 | $0 | $38,250 | $0 | $5,663 | $0 | $14,733 | $0 | $25,642 | $0 | $316,799 | $0 | $0 | $0 |
| CARLY VARELA | ||||||||||||||
| TRUSTEE | $160,653 | $0 | $31,000 | $0 | $1,360 | $0 | $7,372 | $0 | $42,282 | $0 | $242,667 | $0 | $0 | $0 |
| WILLIAM JUDD | ||||||||||||||
| COO | $193,832 | $0 | $0 | $0 | $1,445 | $0 | $11,124 | $0 | $1,650 | $0 | $208,051 | $0 | $0 | $0 |
| LEON MOORES MD | ||||||||||||||
| CEO | $463,751 | $147,026 | $0 | $0 | $1,977 | $0 | $15,900 | $0 | $9,250 | $0 | $490,878 | $147,026 | $0 | $0 |
| JEFFREY HANWAY | ||||||||||||||
| CHIEF SURGICAL OFFICER | $479,184 | $0 | $136,800 | $0 | $2,282 | $0 | $15,900 | $0 | $2,376 | $0 | $636,542 | $0 | $0 | $0 |
| IAN LEIBOWITZ | ||||||||||||||
| CHIEF MEDICAL OFFICER | $292,703 | $0 | $45,000 | $0 | $3,362 | $0 | $15,900 | $0 | $38,400 | $0 | $395,365 | $0 | $0 | $0 |
| SADHNA SHANKAR | ||||||||||||||
| MEDICAL DIRECTOR | $233,791 | $0 | $58,750 | $0 | $1,798 | $0 | $14,452 | $0 | $11,235 | $0 | $320,026 | $0 | $0 | $0 |
| CATHERINE CHAO | ||||||||||||||
| PHYSICIAN | $273,726 | $0 | $41,250 | $0 | $2,282 | $0 | $15,900 | $0 | $11,370 | $0 | $344,528 | $0 | $0 | $0 |
| MARSHALL SCHORIN | ||||||||||||||
| PHYSICIAN | $277,630 | $0 | $30,000 | $0 | $6,895 | $0 | $15,900 | $0 | $24,728 | $0 | $355,153 | $0 | $0 | $0 |
| OTTO LOUIS-JACQUES | ||||||||||||||
| PHYSICIAN | $269,200 | $0 | $40,500 | $0 | $2,202 | $0 | $15,900 | $0 | $800 | $0 | $328,602 | $0 | $0 | $0 |
| GEORGE GANTSOUDES | ||||||||||||||
| PHYSICIAN | $305,912 | $0 | $0 | $0 | $1,126 | $0 | $31,900 | $0 | $24,077 | $0 | $363,015 | $0 | $0 | $0 |
| RAMESH PATEL | ||||||||||||||
| MEDICAL DIRECTOR | $319,830 | $0 | $45,144 | $0 | $4,747 | $0 | $33,900 | $0 | $25,527 | $0 | $429,148 | $0 | $0 | $0 |
| GREG FLORENTIN | ||||||||||||||
| FORMER COO | $96,583 | $0 | $24,749 | $0 | $239 | $0 | $2,484 | $0 | $14,734 | $0 | $138,789 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4b | FormAndLineReferenceDesc |
| Explanation | INOVA SERP Plan Payments Richard Magenheimer $101,665 CNMC SERP Plan Payments Douglas Myers $79,501 David Wessel, MD $82,502 Elizabeth Flury $75,002 Inova SERP Description The Supplemental Executive Retirement Plan (SERP Plan) is a nonqualified retirement plan. Employees eligible to participate are Executive Directors, Assistant Vice Presidents, Vice Presidents, Senior Vice Presidents, Executive Vice Presidents, CFO, COO, and CEO. Each year, a certain percentage of each participant's base salary is contributed to the SERP Plan. This amount ranges from 5% to 20%, depending on position. After three years of continuous participation, participants vest in 50% of their balance at that time and are paid out the vested balance as a taxable event. After a total of six years participation and after attaining age 45, participants are 100% vested and are paid out their remaining balance as a taxable event. Vesting then reverts to a three-year rolling schedule until year 12. Thereafter, the annual contribution is paid out to the participant each year as a taxable event. CNMC Deferred Compensation Plan The Children's National Medical Center Deferred Compensation Plan is a nonqualified deferred compensation plan. Employees eligible to participate are a select group of management or highly compensated employees. Each year, a certain percentage of each participant's base salary is contributed to the SERP Plan. This amount ranges from 5% to 15%, depending on position. Contributions vest after a minimum of two years of continuous participation, and are paid out as a taxable event. Participants may elect a minimum deferral period between 2 and 5 years. After attaining age 65, participants are 100% vested and are paid out their remaining balance as a taxable event. Thereafter, the annual contribution is paid out to the participant each year as a taxable event. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The organization was formed as a limited liability company and has two Members: Inova Health Care Services and Children's National Medical Center, both charitable 501(c)(3) tax-exempt organizations, with equal interests. The Members entered into the Amended and Restated Operating Agreement dated September 30, 2013 to establish and operate the organization. |
| Form 990, Part VI, Section A, line 7a | As described in the Operating Agreement, the governing body of the organization is the Management Committee. The Management Committee is comprised of eight representatives. Three of the Management Committee representatives are designated and appointed by each of the Members. The remaining two Management Committee representatives are physicians employed by the organization and mutually agreed upon by the Members. |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared by a third party and initially provided to the Sr. Director of Finance, the Chief Operating Officer, and external tax consultants for review. The Form 990 is finally presented to the full Management Committee for review prior to filing. |
| Form 990, Part VI, Section B, line 12c | PSV has a written conflict of interest policy which is provided to and reviewed with all employees during their new employee orientation. The policy requires the employee to disclose real or potential conflicts of interest, and also to report suspected violations of the policy to management or human resources. The Employee Code of Conduct also includes a section discussing Conflicts of Interest and all employees are required to acknowledge receipt of, and agreement to comply with, the Code of Conduct in writing. |
| Form 990, Part VI, Section B, line 15 | Pediatric Speciallist of Virginia, LLC compensation: Chief Executive Officer determined by regional market analysis for comparable positions. Chief Operating Officer determined by regional market analysis for comparable positions. Chief Medical Officer determined by regional market analysis for comparable positions. Chief Surgical Officer determined by regional market analysis for comparable positions. Compensation for the positions listed above are approved by the Board. |
| Form 990, Part VI, Section C, line 18 | The Form 1023 and Form 990 are available at the address listed on page 1 of the Form 990 upon request during regular business hours. |
| Form 990, Part VI, Section C, line 19 | Form 990s are disclosed on the Guidestar website. Governing documents and financial statements are not currently publicly available. While the conflict of interest policy is not specifically publicly disclosed, the policy is available to staff and physicians. |
| Part VI, 7b | The business affairs for the organization are managed solely by the Management Committee which has full and complete authority, power and discretion to manage and control the business, affairs and properties of the organization, to make all decisions regarding those matters and to perform any and all other acts or activities customary or incident to the management of the company. No Member, by virtue of having the status of a Member, shall solely have any management power over the business and affairs of the organization or actual or apparent authority to enter into contracts on behalf of, or to otherwise bind, the organization. |
| Form 990, Part XI, line 9: | CONTRIBUTED CAPITAL IHCS AND CNMC 19,473,100. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (18 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| INOVA HEALTH CARE SERVICES | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 540620889 | HOSPITAL SYSTEM | VA | 501(C)(3) | 3 | N/A | 0 |
| CHILDREN'S NATIONAL MEDICAL CENTER | ||||||||||
| 111 MICHIGAN AVE NW | WASHINGTON | DC | 20010 | 521640403 | SUPPORT DELIVERY OF HEALTHCARE | DC | 501(C)(3) | 11, II | N/A | 0 |
| INOVA HEALTH SYSTEM FOUNDATION | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 541071867 | FUNDRAISING | VA | 501(C)(3) | 11, III | N/A | 0 |
| IMANCO INC | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 541340725 | PAYROLL CORPORATION | VA | 501(C)(3) | 11,I | N/A | 0 |
| INOVA VNA HOME CARE | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 541277164 | HOME CARE SERVICES | VA | 501(C)(3) | 9 | N/A | 0 |
| INTOTAL HEALTH LLC | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 201581237 | HMO | VA | 501(C)(3) | 9 | N/A | 0 |
| ALEXANDRIA HOSPITAL FOUNDATION | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 410241913 | FUNDRAISING | VA | 501(C)(3) | 11, I | N/A | 0 |
| LOUDOUN HOSPITAL CENTER | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 540525802 | HOSPITAL | VA | 501(C)(3) | 3 | N/A | 0 |
| LOUDOUN NURSING AND REHABILITATION CENTER | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 541361310 | REHABILITATION SERVICES | VA | 501(C)(3) | 9 | N/A | 0 |
| LOUDOUN HEALTH SERVICES | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 541555489 | SURGERY CENTER | VA | 501(C)(3) | 9 | N/A | 0 |
| LOUDOUN HEALTHCARE FOUNDATION | ||||||||||
| 8110 GATEHOUSE ROAD SUITE 400W | FALLS CHURCH | VA | 22042 | 542011240 | FUNDRAISING | VA | 501(C)(3) | 11, I | N/A | 0 |
| CHILDREN'S RESEACH INSTITUTE | ||||||||||
| 111 MICHIGAN AVE NW | WASHINGTON | DC | 20010 | 521654453 | RESEARCH | DC | 501(C)(3) | 9 | N/A | 0 |
| CHILDREN'S HOSPITAL | ||||||||||
| 111 MICHIGAN AVE NW | WASHINGTON | DC | 20010 | 530196580 | HEALTH CARE | DC | 501(C)(3) | 9 | N/A | 0 |
| SAFE KIDS WORLDWIDE | ||||||||||
| 1301 PENNSYLVANIA AVE NW | WASHINGTON | DC | 20004 | 521627574 | INJURY PREVENTI0N | DC | 501(C)(3) | 11, I | N/A | 0 |
| CHILDREN'S HOSPTIAL SELF INSURANCE TRUST | ||||||||||
| 111 MICHIGAN AVE NW | WASHINGTON | DC | 20010 | 521640399 | INSURANCE | DC | 501(C)(3) | 11, III | N/A | 0 |
| CHILDREN'S HOSPITAL FOUNDATION | ||||||||||
| 111 MICHIGAN AVE NW | WASHINGTON | DC | 20010 | 521640402 | FUNDRAISING | DC | 501(C)(3) | 7 | N/A | 0 |
| BRAINY CAMPS ASSOCIATION | ||||||||||
| 111 MICHIGAN AVE NW | WASHINGTON | DC | 20010 | 271547370 | CHILD CAMPS | DC | 501(C)(3) | 11, I | N/A | 0 |
| CHILDREN'S NATIONAL ADVOC AND PUBLIC POLIC | ||||||||||
| 111 MICHIGAN AVE NW | WASHINGTON | DC | 20010 | 271564354 | ADVOCACY | DC | 501(C)(3) | 11, II | N/A | 0 |
| 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 | Yes (1) | 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 | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| INOVA HEALTH CARE SERVICES | ||
| C | $9,736,550 | FMV |
| CHILDREN'S NATIONAL MEDICAL CENTER | ||
| C | $9,736,550 | FMV |
| INOVA HEALTH CARE SERVICES | ||
| S | $606,793 | GENERAL LEDGER |
| CHILDREN'S NATIONAL MEDICAL CENTER | ||
| S | $189,974 | GENERAL LEDGER |
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