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MAPLE CITY HEALTH CARE CENTER INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
MAPLE CITY HEALTH CARE CENTER INC (EIN 35-1749398)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-06-30
IRS object ID
201601829349300245
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

FieldValueIRS element (for citing)
Return2016-06-30T14:26:20-05:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN351307701PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KRUGGEL LAWTON & COMPANY LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1317 W FRANKLIN STAddressLine1Txt
CityELKHARTCityNm
State AbbreviationINStateAbbreviationCd
ZIP46516ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351749398EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MAPLE CITY HEALTH CARE CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMAPLBusinessNameControlTxt
Phone5745343300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP465282956ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKAREN MILLER RUSHPersonNm
Person TitleOFFICERPersonTitleTxt
Phone5745343300PhoneNum
Signature2016-06-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARGENE ZINKPreparerPersonNm
PTINP01222961PTIN
Phone5742642247PhoneNum
Preparation2016-06-13PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2016-09-27 15:27:22ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1VISTA COMMUNITY HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerKAREN MILLER RUSHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP465282956ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,051,810GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MCHCC.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1988FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTHE PURPOSE OF MAPLE CITY HEALTH CARE CENTER IS:I. TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE ANDII. TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee67TotalEmployeeCnt
Total Volunteers14TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,591,914PYContributionsGrantsAmt
CY Contributions Grants$2,420,187CYContributionsGrantsAmt
PY Program Service Revenue$1,379,176PYProgramServiceRevenueAmt
CY Program Service Revenue$1,623,761CYProgramServiceRevenueAmt
PY Investment Income-$3,896PYInvestmentIncomeAmt
CY Investment Income$7,187CYInvestmentIncomeAmt
PY Other Revenue$175PYOtherRevenueAmt
CY Other Revenue$675CYOtherRevenueAmt
PY Total Revenue$2,967,369PYTotalRevenueAmt
CY Total Revenue$4,051,810CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$5,946CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,114,412PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,780,069CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$971,484PYOtherExpensesAmt
CY Other Expenses$1,298,993CYOtherExpensesAmt
PY Total Expenses$3,085,896PYTotalExpensesAmt
CY Total Expenses$4,085,008CYTotalExpensesAmt
PY Revenues Less Expenses-$118,527PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$33,198CYRevenuesLessExpensesAmt
Total Assets BOY$3,462,430TotalAssetsBOYAmt
Total Assets EOY$3,472,018TotalAssetsEOYAmt
Total Liabilities BOY$216,193TotalLiabilitiesBOYAmt
Total Liabilities EOY$258,979TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,246,237NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,213,039NetAssetsOrFundBalancesEOYAmt
MissionTHE PURPOSE OF MAPLE CITY HEALTH CARE CENTER IS:I. TO FOSTER HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE ANDII. TO ARTICULATE AND PROMOTE OUR EXPERIENCE AS A SUSTAINABLE MODEL.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$3,596,830ExpenseAmt
Grant$5,946GrantAmt
Revenue$1,624,436RevenueAmt
DescFOSTERING HEALTHY COMMUNITY IN OUR NEIGHBORHOODS BY PROVIDING AND PROMOTING AFFORDABLE, ACCESSIBLE, AND INTEGRATED QUALITY CARE, AND ARTICULATING AND PROMOTING OUR EXPERIENCE AS A SUSTAINABLE MODEL. WE PROVIDE MEDICAL, BEHAVIOR HEALTH, DENTAL, VISION, AND SOCIAL SERVICES.Desc
Total Program Service Expenses$3,596,830TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee67EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKAREN MILLER RUSHPersonNm
Phone5745343300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1213 MIDDLEBURY STAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP46528ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
ROEL CERVANTES
BOARD MEMBER1.00Yes (X)$0$0$0
JOHN DRIVER
BOARD MEMBER1.00Yes (X)$0$0$0
KEVIN FARMWALD
BOARD MEMBER1.00Yes (X)$0$0$0
DENICE METTERT
BOARD MEMBER1.00Yes (X)$0$0$0
MIGUEL MILLAN
BOARD MEMBER1.00Yes (X)$0$0$0
RACHEL MILLER JACOBS
BOARD MEMBER1.00Yes (X)$0$0$0
IRMA PEREZ
BOARD MEMBER1.00Yes (X)$0$0$0
LORENZA ROMERO
BOARD MEMBER1.00Yes (X)$0$0$0
SARAH METZLER
BOARD MEMBER1.00Yes (X)$0$0$0
JENNIFER HIRE
BOARD MEMBER1.00Yes (X)$0$0$0
ADRIANA ORTIZ
BOARD MEMBER1.00Yes (X)$0$0$0
MAX MERTZ
PRESIDENT1.00Yes (X)$0$0$0Yes (X)
JAMES NELSON GINGERICH
GUARDIAN OF VISION60.00Yes (X)$126,328$0$16,721Yes (X)
KAREN MILLER RUSH
DIRECTOR OF FINANCE40.00$61,150$0$9,541Yes (X)
ROSE GILLIN
GUARDIAN OF MEDICAL SERVICES40.00$110,046$0$23,037Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$297,524TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$49,299TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ELKHART COUNTY CLUBHOUSE
114 S FIFTH STGOSHENIN46528MENTAL HEALTH SERVICES$175,000
ABG DENTAL
622 W LINCOLNGOSHENIN46526DENTAL SERVICES$117,282
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Government Grants$2,145,081GovernmentGrantsAmt
All Other Contributions$275,106AllOtherContributionsAmt
Noncash Contributions$147,603NoncashContributionsAmt
Total Contributions$2,420,187TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPROGRAM SERVICESDesc
Business621400BusinessCd
Total Revenue Column$1,623,761TotalRevenueColumnAmt
Related Or Exempt Func Income$1,623,761RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$1,623,761TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,187TotalRevenueColumnAmt
Exclusion$7,187ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business900099BusinessCd
Total Revenue Column$675TotalRevenueColumnAmt
Related Or Exempt Func Income$675RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$675OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,051,810TotalRevenueColumnAmt
Related Or Exempt Func Income$1,624,436RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$7,187ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,946TotalAmt
Program Services$5,946ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$213,740TotalAmt
Program Services$187,478ProgramServicesAmt
Management And General$26,262ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,876,702TotalAmt
Program Services$1,613,964ProgramServicesAmt
Management And General$262,738ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$103,586TotalAmt
Program Services$89,084ProgramServicesAmt
Management And General$14,502ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$431,198TotalAmt
Program Services$370,830ProgramServicesAmt
Management And General$60,368ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$154,843TotalAmt
Program Services$133,165ProgramServicesAmt
Management And General$21,678ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$3,580TotalAmt
Management And General$3,580ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$20,968TotalAmt
Management And General$20,968ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,077TotalAmt
Program Services$1,023ProgramServicesAmt
Management And General$54ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$69,181TotalAmt
Program Services$59,496ProgramServicesAmt
Management And General$9,685ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$182,262TotalAmt
Program Services$156,745ProgramServicesAmt
Management And General$25,517ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$243,998TotalAmt
Program Services$209,838ProgramServicesAmt
Management And General$34,160ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$18,717TotalAmt
Program Services$16,771ProgramServicesAmt
Management And General$1,946ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$13,653TotalAmt
Program Services$11,741ProgramServicesAmt
Management And General$1,912ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$44,387TotalAmt
Program Services$41,281ProgramServicesAmt
Management And General$3,106ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$506,503$506,503
VACCINES$147,603$147,603
PROFESSIONAL DUES$24,804$24,804
MISCELLANEOUS$22,260$20,558$1,702

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$4,085,008TotalAmt
Program Services$3,596,830ProgramServicesAmt
Management And General$488,178ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$351,717BOYAmt
EOY$78,246EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$199,700BOYAmt
EOY$1,742,431EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$223,990BOYAmt
EOY$337,109EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$227,630BOYAmt
EOY$231,443EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$29,118BOYAmt
EOY$39,885EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,396,303LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$353,399LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$661,347BOYAmt
EOY$1,042,904EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,768,928BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,462,430BOYAmt
EOY$3,472,018EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$216,193BOYAmt
EOY$258,979EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$216,193BOYAmt
EOY$258,979EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,262,609BOYAmt
EOY$1,529,203EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,983,628BOYAmt
EOY$1,683,836EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,246,237BOYAmt
EOY$3,213,039EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,462,430BOYAmt
EOY$3,472,018EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$33,198ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

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$187,104OtherCostOrOtherBasisAmt
Book Value$187,104BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$478,139OtherCostOrOtherBasisAmt
Depreciation$37,480DepreciationAmt
Book Value$440,659BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$576,282OtherCostOrOtherBasisAmt
Depreciation$251,769DepreciationAmt
Book Value$324,513BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$154,778OtherCostOrOtherBasisAmt
Depreciation$64,150DepreciationAmt
Book Value$90,628BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,042,904TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$4,072,863TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts$21,053DonatedServicesAndUseFcltsAmt
Revenue Not Reported$21,053RevenueNotReportedAmt
Revenue Subtotal$4,051,810RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$4,051,810TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$4,106,061TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$21,053DonatedServicesUseFcltsAmt
Expenses Not Reported$21,053ExpensesNotReportedAmt
Expenses Subtotal$4,085,008ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$4,085,008TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE INCOME TAXES TOPIC, FASB ASC 740, CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. ASC 740 REQUIRES AN ORGANIZATION TO DISCLOSE THE NATURE OF UNCERTAIN TAX POSITIONS TAKEN, IF ANY, WHEN FILING ITS INCOME TAX RETURN UTILIZING A TWO-STEP PROCESS TO RECOGNIZE AND MEASURE ANY UNCERTAIN TAX POSITIONS TAKEN. THE ORGANIZATION RECOGNIZES A TAX BENEFIT ONLY IF IT IS MORE LIKELY THAN NOT THE POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. NO TAX BENEFIT WILL BE RECORDED ON TAX POSITIONS NOT MEETING THE MORE LIKELY THAN NOT TEST. INTEREST AND PENALTIES ACCRUED OR INCURRED, IF ANY, AS A RESULT OF APPLYING ASC 740 WILL BE RECORDED TO INTEREST EXPENSE AND OTHER EXPENSE, RESPECTIVELY. BASED ON ITS EVALUATION, THE ORGANIZATION HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS REQUIRING RECOGNITION IN ITS FINANCIAL STATEMENTS. THE ORGANIZATION'S EVALUATION WAS PERFORMED FOR ALL FEDERAL AND STATE TAX PERIODS STILL SUBJECT TO EXAMINATION. THE ORGANIZATION'S 2012 THROUGH 2014 FEDERAL AND STATE EXEMPT ORGANIZATION RETURNS REMAIN SUBJECT TO EXAMINATION BY THE IRS AND STATE TAXING AUTHORITIES.ExplanationTxt

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Noncash Contributions Rpt F990$147,603NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

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

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTHSIDE COMMUNITY HEALTH CENTER INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1808 NORTH THIRD STREETAddressLine1Txt
CityGOSHENCityNm
State AbbreviationINStateAbbreviationCd
ZIP46528ZIPCd
FieldValueIRS element (for citing)
EIN473368774EIN
Primary ActivitiesTO PROVIDE HEALTH CARE IN THE GOSHEN, INDIANA COMMUNITYPrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MAPLE CITY HEALTH CARE CENTER INC DBA VISTA COMMUNITY HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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