ANDEAN HEALTH AND DEVELOPMENT INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ANDEAN HEALTH AND DEVELOPMENT INC (EIN 39-1809174)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201613199349306086
- 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 | 2016-11-14T12:53:35-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 392043144 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LULLOFF & TAYLOR LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3333 N MAYFAIR RD STE 203 | AddressLine1Txt |
| City | WAUWATOSA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53222 | 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 | 391809174 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDEAN HEALTH AND DEVELOPMENT INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ANDE | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 DELAPLAINE COURT | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53715 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID P GAUS MD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Signature | 2016-04-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID A TAYLOR | PreparerPersonNm |
| PTIN | P00003270 | PTIN |
| Phone | 4147770700 | PhoneNum |
| Preparation | 2016-11-14 | PreparationDt |
| 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 | DAVID P GAUS MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4722 LAFAYETTE DRIVE | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53705 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,331,284 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ANDEANHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | PROVIDING FUNDING FOR PRIMARY HEALTH CARE | ActivityOrMissionDesc |
| Voting Members Governing Body | 27 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,501,487 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,278,780 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $56,748 | PYInvestmentIncomeAmt |
| CY Investment Income | $22,858 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,850 | PYOtherRevenueAmt |
| CY Other Revenue | $29,646 | CYOtherRevenueAmt |
| PY Total Revenue | $1,561,085 | PYTotalRevenueAmt |
| CY Total Revenue | $1,331,284 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,390,479 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $931,019 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $227,802 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $320,075 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $64,095 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $239,239 | PYOtherExpensesAmt |
| CY Other Expenses | $222,820 | CYOtherExpensesAmt |
| PY Total Expenses | $2,857,520 | PYTotalExpensesAmt |
| CY Total Expenses | $1,473,914 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,296,435 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$142,630 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $914,170 | TotalAssetsBOYAmt |
| Total Assets EOY | $651,619 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,345,483 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,225,799 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$431,313 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$574,180 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDING FUNDING FOR PRIMARY HEALTH CARE | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $1,390,269 | ExpenseAmt |
| Grant | $931,019 | GrantAmt |
| Desc | IMPLEMENTATION OF PRIMARY HEALTH CARE SERVICES IN RURAL ECUADOR BENEFITING OVER 50,000 PEOPLE SINCE MARCH 2001 | Desc |
| Total Program Service Expenses | $1,390,269 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | Yes (true) | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | Yes (true) | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 2 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 27 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDEAN HEALTH & DEVELOPMENT INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6197886833 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1100 DELAPLANE COURT | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53715 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)
| TitleTitleTxt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| MICHAEL HEISLER MD | ||||||
| SECRETARY | Yes (X) | $0 | $0 | $0 | ||
| JOHN BURCHETT | ||||||
| VICE PRESIDE | Yes (X) | $0 | $0 | $0 | ||
| LAURIE MCKEON | ||||||
| TREASURER | Yes (X) | $0 | $0 | $0 | ||
| DAVID P GAUS MD | ||||||
| PRESIDENT | $173,350 | $0 | $0 | 40.00 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $173,350 | TotalReportableCompFromOrgAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $1,278,780 | AllOtherContributionsAmt |
| Noncash Contributions | $11,787 | NoncashContributionsAmt |
| Total Contributions | $1,278,780 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,858 | TotalRevenueColumnAmt |
| Exclusion | $22,858 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Total Revenue Column | $29,646 | TotalRevenueColumnAmt |
| Exclusion | $29,646 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $29,646 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,331,284 | TotalRevenueColumnAmt |
| Exclusion | $52,504 | ExclusionAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $931,019 | TotalAmt |
| Program Services | $931,019 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,350 | TotalAmt |
| Program Services | $173,350 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,640 | TotalAmt |
| Program Services | $51,640 | ProgramServicesAmt |
| Management And General | $10,000 | ManagementAndGeneralAmt |
| Fundraising | $10,000 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,247 | TotalAmt |
| Program Services | $61,247 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,838 | TotalAmt |
| Program Services | $12,146 | ProgramServicesAmt |
| Management And General | $846 | ManagementAndGeneralAmt |
| Fundraising | $846 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,254 | TotalAmt |
| Management And General | $5,254 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,969 | TotalAmt |
| Program Services | $21,969 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,900 | TotalAmt |
| Program Services | $30,900 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34 | TotalAmt |
| Program Services | $34 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,514 | TotalAmt |
| Program Services | $38,064 | ProgramServicesAmt |
| Management And General | $3,450 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| OUTSIDE SERVICES | $72,042 | $18,793 | $53,249 |
| BAD DEBT-ACCRUED INTEREST | $22,024 | $22,024 | |
| VOLUNTEERS | $11,787 | $11,787 | |
| MEETING EXPENSES | $8,203 | $8,203 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,093 | TotalAmt |
| Program Services | $9,093 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,473,914 | TotalAmt |
| Program Services | $1,390,269 | ProgramServicesAmt |
| Management And General | $19,550 | ManagementAndGeneralAmt |
| Fundraising | $64,095 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,402 | BOYAmt |
| EOY | $184,923 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $284,673 | BOYAmt |
| EOY | $111,050 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $557,699 | BOYAmt |
| EOY | $338,806 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,806 | BOYAmt |
| EOY | $16,521 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,154 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,835 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $590 | BOYAmt |
| EOY | $319 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $914,170 | BOYAmt |
| EOY | $651,619 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,570 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,275,000 | BOYAmt |
| EOY | $1,161,872 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,913 | BOYAmt |
| EOY | $63,927 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,345,483 | BOYAmt |
| EOY | $1,225,799 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$431,313 | BOYAmt |
| EOY | -$574,180 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$431,313 | BOYAmt |
| EOY | -$574,180 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $914,170 | BOYAmt |
| EOY | $651,619 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$142,630 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$237 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 Minus4 Years | $1,539,859 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,021,699 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,360,058 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,501,487 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,278,780 | CurrentTaxYearAmt |
| Total | $7,701,883 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $2,850 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $29,646 | CurrentTaxYearAmt |
| Total | $32,496 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,539,859 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,021,699 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,360,058 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,504,337 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,308,426 | CurrentTaxYearAmt |
| Total | $7,734,379 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $7,734,379 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $694 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $550 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $28,379 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $56,748 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $22,858 | CurrentTaxYearAmt |
| Total | $109,229 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $694 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $550 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $28,379 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $56,748 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $22,858 | CurrentTaxYearAmt |
| Total | $109,229 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,540,553 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,022,249 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,388,437 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,561,085 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,331,284 | CurrentTaxYearAmt |
| Total | $7,843,608 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98610 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98730 | PublicSupportPY509Pct |
| Investment Income CY | 0.01000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,154 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,835 | DepreciationAmt |
| Book Value | $319 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $319 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PENSION PAYABLE | $61,247 |
| ACCRUED INTEREST | $1,512 |
| ACCRUED PAYROLL LIABILITIES | $1,168 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $63,927 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $1,331,284 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $1,331,284 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $1,331,284 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,474,151 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $237 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $237 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,473,914 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $1,473,914 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 4, PART XII, LINE 2D | FormAndLineReferenceDesc |
| Explanation | BOOK / TAX DEPRECIATION DIFFERENCE 237 | ExplanationTxt |
Schedule F IRS990ScheduleF
Grants To Org Outside US GrantsToOrgOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Purpose Of Grant | HOSPITAL OPERATIONS | PurposeOfGrantTxt |
| Cash Grant | $931,019 | CashGrantAmt |
| Manner Of Cash Disbursement | BANK TRANSFERS | MannerOfCashDisbursementTxt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transfer To Foreign Corp | false | TransferToForeignCorpInd |
| Interest In Foreign Trust | false | InterestInForeignTrustInd |
| Foreign Corp Ownership | false | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | false | PassiveForeignInvestmestCoInd |
| Foreign Partnership | false | ForeignPartnershipInd |
| Boycott Countries | false | BoycottCountriesInd |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID P GAUS MD | PersonNm |
| Title | PRESIDENT | TitleTxt |
| Base Compensation Filing Org | $173,350 | BaseCompensationFilingOrgAmt |
| Total Compensation Filing Org | $173,350 | TotalCompensationFilingOrgAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | BOARD MEMBERS RECEIVE A COPY OF THE FORM 990 FOR REVIEW PRIOR TO MAILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ALL OFFICERS, DIRECTORS AND EMPLOYEES ARE INFORMED OF THE ORGANZATIONS CONFLICT OF INTEREST POLICY AND ARE INSTRUCTED TO NOTIFY THE BOARD OF DIRECTORS IF THEY HAVE ANY CONCERNS. THE BOARD OF DIRECTORS REVIEWS AND MONITORS ANY CONCERNS RELATED TO CONFLICT OR INTERESTS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | MEMBERS OF THE BOARD OF DIRECTORS ANNUALLY REVIEW THE COMPENSATION FOR THE EXECUTIVE DIRECTOR AND BASED UPON PRIOR SALARIES AND ANTICIPATED REVENUE THE BOARD MEMBERS OFFER THE EXECUTIVE DIRECTOR A COMPENSATION PACKAGE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL FINANCIAL RECORDS ARE MAINTAINED BY THE TREASURER AND ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | BOOK / TAX DEPRECIATION DIFFERENCE -237 TOTAL -237 |
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