2016-05-12T14:37:36-05:00 2015-06-30 550596200 HERMAN & CORMANY CPAS AC 8 CAPITOL STREET STE 600 CHARLESTON WV 25301 990 2014-07-01 550599096 COMMUNITY CARE OF WEST VIRGINIA INC COMM 3049246262 PO BOX 217 ROCK CAVE WV 26234 RICK SIMON CEO 3049246262 2016-05-12 1 DEREK S GODWIN P00617370 3043452320 2014 2016-08-17 19:52:53Z DBA TRI-COUNTY HEALTH CLINIC INC RICK SIMON PO BOX 217 ROCK CAVE WV 26234 23700177 0 X CCWV.ORG X 1979 WV TO PROVIDE HIGH QUALITY, ACCESSIBLE, COMPREHENSIVE, AND COST-EFFECTIVE HEALTHCARE SERVICES TO THE COMMUNITIES SERVED. 9 9 295 0 0 0 5268758 3511296 12702848 20188451 19854 430 0 0 17991460 23700177 0 0 0 0 10953941 13847602 0 0 0 7076938 8723603 18030879 22571205 -39419 1128972 8346163 8909898 4428375 3863138 3917788 5046760 THE CLINIC WAS DEVELOPED TO PROVIDE PRIMARY CARE HEALTH SERVICES TO THE UNDERSERVED AREAS OF UPSHUR, LEWIS AND WEBSTER COUNTIES OF WEST VIRGINIA. THE CLINIC HAS CONTINUALLY ASSESSED COMMUNITY NEEDS AND RESPONDED WITH EXPANSION AND DEVELOPMENT OF APPROPRIATE SERVICES. 0 0 18778482 19737490 PROVIDING RURAL HEALTH CARE SERVICES TO LOW INCOME FAMILIES OF UPSHUR, WEBSTER, LEWIS, CLAY, POCAHONTAS AND HARRISON COUNTIES OF WEST VIRGINIA. 18778482 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 1 295 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 WV X X RICHARD SIMON 3049246262 PO BOX 217 ROCK CAVE WV 26234 EDDIE WILLIAMS TREASURER 1.00 X X 0 0 0 JOYCE GIBSON VICE PRESIDENT 1.00 X X 0 0 0 KAREN GRANT SECRETARY 1.00 X X 0 0 0 RUTH BLAND BOARD MEMBER 1.00 X 0 0 0 RENEE HOFER BOARD MEMBER 1.00 X 0 0 0 THELMA SAMPLES BOARD MEMBER 1.00 X 0 0 0 GREGORY MOORE BOARD MEMBER 1.00 X 0 0 0 TOM LYNCH PRESIDENT 1.00 X X 0 0 0 TRAVIS M MILLER BOARD MEMBER 1.00 X 0 0 0 RICHARD SIMON CEO 40.00 X 132626 0 13242 PATRICIA COLLETT DIR OF MEDICAL OPERATIONS 40.00 X 110503 0 17726 CONNIE JOHNSTON CFO 40.00 X 79834 0 13623 BROCK MALCOLM COO 40.00 X 83457 0 13821 MICHAEL SHAFFER CIO 40.00 X 38864 0 12855 JENNIFER BEVERAGE PHYSICIAN 40.00 X 167321 0 13555 DENZIL HAWKINBERRY PHYSICIAN 40.00 X 194585 0 13699 GREGORY PETERS PHYSICIAN 40.00 X 219614 0 13646 SARAH CHOUINARD MEDICAL DIRECTOR 36.00 X 238386 0 21659 WILLIAM GIVEN PHYSICIAN 40.00 X 193239 0 214646 IRIS TRINIDAD-CARILLO PHYSICIAN 40.00 X 166197 0 16083 CHRISTINE JONES PHYSICIAN 40.00 X 154922 0 8012 RAYMOND LEONARD PHYSICIAN 40.00 X 185362 0 19368 AIMEE WHITEHAIR PHYSICIAN 40.00 X 203109 0 10077 2168019 0 402012 11 0 1 0 0 3033795 477501 3511296 HEALTH CARE SERVICES 621300 20188451 20188451 20188451 430 430 23700177 20188451 0 430 145868 145868 11677521 10229205 1448316 184362 159504 24858 1023056 885114 137942 816795 706664 110131 9429 9429 19869 19869 55115 55115 1117186 150068 967118 163445 4051 159394 607845 604634 3211 151694 59141 92553 120453 91242 29211 218820 13861 204959 394100 341360 52740 118522 115938 2584 SUPPLIES 4181894 4086264 95630 COMMUNICATION AND UTILI 718018 686043 31975 PHARMACEUTICALS 517716 382939 134777 REPAIRS AND MAINTENANCE 203781 202772 1009 125716 30384 95332 22571205 18778482 3792723 0 10923 1483428 1008405 0 175153 337732 1862493 2028571 510910 523162 0 79990 6895044 2704579 4511729 4190465 250000 250000 16550 16550 8346163 8909898 1946133 1768598 2482242 2094540 4428375 3863138 X 3917788 5046760 3917788 5046760 8346163 8909898 1128972 0 X 0 1 X 1 1 1 X 4200040 5784538 5877126 5268758 3511296 24641758 4200040 5784538 5877126 5268758 3511296 24641758 24641758 212 10233 995 19854 430 31724 24673482 0.99870 0.99870 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 352025 352025 5139951 1759470 3380481 1403068 945109 457959 4190465 X 23700177 0 23700177 0 23700177 22571205 0 22571205 0 22571205 PART X, LINE 2: MANAGEMENT BELIEVES THE ORGANIZATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION FOR YEARS PRIOR TO 2012. X 0 0 0 0 0 0 0 0 0 JENNIFER BEVERAGE PHYSICIAN 167321 0 0 0 0 0 0 0 13555 0 180876 0 0 0 DENZIL HAWKINBERRY PHYSICIAN 194585 0 0 0 0 0 0 0 13699 0 208284 0 0 0 GREGORY PETERS PHYSICIAN 219614 0 0 0 0 0 0 0 13646 0 233260 0 0 0 SARAH CHOUINARD MEDICAL DIRECTOR 238386 0 0 0 0 0 0 0 21659 0 260045 0 0 0 WILLIAM GIVEN PHYSICIAN 193239 0 0 0 0 0 0 0 214646 0 407885 0 0 0 IRIS TRINIDAD-CARILLO PHYSICIAN 166197 0 0 0 0 0 0 0 16083 0 182280 0 0 0 CHRISTINE JONES PHYSICIAN 154922 0 0 0 0 0 0 0 8012 0 162934 0 0 0 RAYMOND LEONARD PHYSICIAN 185362 0 0 0 0 0 0 0 19368 0 204730 0 0 0 AIMEE WHITEHAIR PHYSICIAN 203109 0 0 0 0 0 0 0 10077 0 213186 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE GOVERNING BOARD REVIEWS THE ANNUAL AUDIT OF THE ORGANIZATION AND THE FORM 990 IS COMPLETED EACH YEAR CONSISTENTLY IN ACCORDANCE WITH THE AMOUNTS REPORTED ON THE AUDIT. THE 990 IS REVIEWED AT A BOARD MEETING AFTER ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY IS IN PLACE. POSSIBLE ISSUES ARE REPORTED TO SENIOR MANAGEMENT AND TO GOVERNING BOARD IF APPLICABLE. GOVERNING BOARD AND SENIOR MANAGEMENT ADDRESS ANY ISSUES AND MONITOR. FORM 990, PART VI, SECTION B, LINE 15 DETERMINED BY THE GOVERNING BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 18 DOCUMENTS ARE ON FILE AND AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE ON FILE AND AVAILABLE TO THE GENERAL PUBLIC ON REQUEST.