2015-05-13T16:38:48-05:00 2014-06-30 550596200 HERMAN & CORMANY CPAS AC 8 CAPITOL STREET STE 600 CHARLESTON WV 25301 990 2013-07-01 550599096 COMMUNITY CARE OF WEST VIRGINIA INC COMM 3049246262 PO BOX 217 ROCK CAVE WV 26234 RICK SIMON CEO 3049246262 2015-05-13 1 DEREK S GODWIN P00617370 3043452320 2013 2016-02-25 16:41:14Z DBA TRI-COUNTY HEALTH CLINIC INC RICK SIMON PO BOX 217 ROCK CAVE WV 26234 17991460 0 X CCWV.ORG X 1979 WV TO HELP OUR COMMUNITIES LIVE THE HEALTHIEST LIVES POSSIBLE BY MEETING THEIR IMMEDIATE AND LONG-TERM HEALTHCARE NEEDS. 9 9 246 0 0 0 5877126 5268758 10785140 12702848 995 19854 0 0 16663261 17991460 0 0 0 0 9666180 10953941 0 0 0 6156940 7076938 15823120 18030879 840141 -39419 7252130 8346163 3265199 4428375 3986931 3917788 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 15096935 12702848 PROVIDEING RURAL HEALTH CARE SERVICES TO LOW INCOME FAMILIES OF UPSHUR, WEBSTER, LEWIS, CLAY, POCAHONTAS AND HARRISON COUNTIES OF WEST VIRGINIA. 15096935 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 26 0 1 246 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WV 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 TOM HEFNER 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 115342 0 0 JENNIFER BEVERAGE PHYSICIAN 40.00 X 173247 0 0 DENZIL HAWKINBERRY PHYSICIAN 40.00 X 227824 0 0 GREGORY PETERS PHYSICIAN 40.00 X 214474 0 0 SARAH CHOUINARD MEDICAL DIRECTOR 36.00 X 238386 0 0 WILLIAM GIVEN PHYSICIAN 40.00 X 179309 0 0 IRIS TRINIDAD-CARILLO PHYSICIAN 40.00 X 164594 0 0 AIMEE WHITEHAIR PHYSICIAN 40.00 X 168000 0 0 1481176 0 0 13 0 1 0 0 4681742 587016 5268758 HEALTH CARE SERVICES 621300 12702848 12702848 12702848 19854 19854 17991460 12702848 0 19854 115342 115342 8874935 7591710 1283225 185213 117101 68112 997205 865431 131774 781246 678857 102389 28910 28910 11888 11888 11580 11580 793114 168749 624365 74232 18595 55637 436092 431814 4278 131058 77403 53655 67989 58721 9268 189248 18332 170916 382128 318866 63262 98602 70469 28133 SUPPLIES 3510149 3418437 91712 PHARMACEUTICALS 605450 605450 COMMUNICATION AND UTILI 430282 415471 14811 REPAIRS AND MAINTENANCE 122243 121740 503 183973 78991 104982 18030879 15096935 2933944 0 9694 10923 1088172 1008405 107049 175153 1514470 1862493 455731 510910 7200 16550 7340307 2828578 4069814 4511729 250000 7252130 8346163 1119098 1946133 2146101 2482242 3265199 4428375 X 3986931 3917788 3986931 3917788 7252130 8346163 -39419 -29724 0 X X 0 1 X 1 1 1 X 3090326 4200040 5784538 5877126 5268758 24220788 3090326 4200040 5784538 5877126 5268758 24220788 24220788 632 212 10233 995 19854 31926 24252714 0.99870 0.99940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 352025 352025 5126713 1656008 3470705 1861569 1172570 688999 4511729 17991460 0 17991460 0 17991460 18030879 0 18030879 0 18030879 X 0 0 0 0 0 0 0 0 0 JENNIFER BEVERAGE PHYSICIAN 173247 0 0 0 0 0 0 0 0 0 173247 0 0 0 DENZIL HAWKINBERRY PHYSICIAN 227824 0 0 0 0 0 0 0 0 0 227824 0 0 0 GREGORY PETERS PHYSICIAN 214474 0 0 0 0 0 0 0 0 0 214474 0 0 0 SARAH CHOUINARD MEDICAL DIRECTOR 238386 0 0 0 0 0 0 0 0 0 238386 0 0 0 WILLIAM GIVEN PHYSICIAN 179309 0 0 0 0 0 0 0 0 0 179309 0 0 0 IRIS TRINIDAD-CARILLO PHYSICIAN 164594 0 0 0 0 0 0 0 0 0 164594 0 0 0 AIMEE WHITEHAIR PHYSICIAN 168000 0 0 0 0 0 0 0 0 0 168000 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PRESENTED TO THE GOVERNING BOARD OF DIRECTORS ALONG WITH THE ANNUAL AUDIT REPORT FOR REVIEW AND APPROVAL 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. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE TO THE PROCESS FROM THE PRIOR YEAR.