2015-09-03T17:01:20-05:00 2014-12-31 481032601 ALLEN GIBBS & HOULIK LC 301 N MAIN SUITE 1700 WICHITA KS 672024868 990 2014-01-01 481159633 GRACEMED HEALTH CLINIC INC GRAC 3168662001 1122 N TOPEKA WICHITA KS 67214 DAVID SANFORD CEO 3168662011 2015-08-26 1 JENNIFER A ALLEN P01338336 3162677231 2014 2016-02-25 16:41:14Z DAVID SANFORD 1122 N TOPEKA WICHITA KS 67214 13951919 0 X WWW.GRACEMED.ORG X 1979 KS TO PROVIDE PRIMARY HEALTH AND DENTAL CARE SERVICES TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES. 15 15 247 60 0 1613 3163301 4046603 8646990 9463142 -58447 49909 31562 33809 11783406 13593463 0 0 0 0 7754946 8417337 0 0 66529 3056963 3290600 10811909 11707937 971497 1885526 7535112 9901441 899515 1303094 6635597 8598347 X TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS OF SOUTH CENTRAL KANSAS. 0 1 9217011 9477409 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 9217011 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 14 0 1 247 1 1 1 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 KS X SHAROL SULLIVAN 3168662049 1122 N TOPEKA WICHITA KS 67214 ABE RODRIGUEZ BOARD MEMBER 4.00 X 0 0 0 BARTON PRINCE VICE - PRESIDENT 4.00 X X 0 0 0 DENISE WREN BOARD MEMBER 4.00 X 0 0 0 FRED ERVIN BOARD MEMBER 4.00 X 0 0 0 GAROLD MINNS BOARD MEMBER 4.00 X 0 0 0 JEFFREY TOWNE BOARD MEMBER 4.00 X 0 0 0 JON ROSELL BOARD MEMBER 4.00 X 0 0 0 LAURIE LABARCA BOARD MEMBER 4.00 X 0 0 0 MARC MINNIS PRESIDENT 4.00 X X 0 0 0 MICHAEL GOOD BOARD MEMBER 4.00 X 0 0 0 RICK JUST BOARD MEMBER 4.00 X 0 0 0 ROB DAKIN BOARD MEMBER 4.00 X 0 0 0 SALLY CHESSER TREASURER 4.00 X X 0 0 0 SUSAN HOWEY BOARD MEMBER 4.00 X 0 0 0 TERRY BOURLARD BOARD MEMBER 4.00 X 0 0 0 DAVID SANFORD CHIEF EXECUTIVE OFFICER 40.00 X 146987 0 10001 GAIL FINNEY SECRETARY 4.00 X 0 0 0 JULIE A ELDER OFFICER 40.00 X 155542 0 9480 VENUS L LEE OFFICER 40.00 X 111568 0 2863 ROGER G NOLTE OFFICER 40.00 X 144029 0 5591 PAMELA A STANBERRY OFFICER 40.00 X 101926 0 8649 SHAROL A SULLIVAN OFFICER 40.00 X 100376 0 3374 DR ANDREA BOOTHE DENTIST 40.00 X 114491 0 8176 DR MARTA E HANTKE DOCTOR 40.00 X 100452 0 7841 DR GIAO A PHAM DOCTOR 40.00 X 115380 0 7441 1090751 0 63416 9 0 1 0 USD #259 201 N WATER WICHITA KS 67202 CLINIC CONSTRUCTION 724600 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 60055 DENTAL SUPPLIES 465283 MCKESSON DRUG PO BOX 409521 ATLANTA GA 30384 PHARMACY SUPPLIES 219440 GREATER WICHITA YMCA 402 N MARKET WICHITA KS 67202 CONSTRUCTION 189000 PEARCE TURK DENTAL LABORATORY 5775 WAYZATA BLVD SUITE 890 MINNEAPOLIS MN 55416 DENTAL LAB 143605 5 37570 2686787 1322246 4046603 MEDICAL & DENTAL SERVICES 621110 9174142 9174142 HIT CERT INCENTIVE 621110 289000 289000 9463142 45155 45155 333415 328661 4754 4754 4754 49337 37570 29795 19542 19542 MISC REVENUE 900099 14267 14267 14267 13593463 9477409 0 69451 760429 608821 151608 6976546 5550471 1382174 43901 60152 43167 16127 858 620210 518033 98471 3706 95401 95401 295911 287930 7981 162308 690 157334 4284 115005 68609 46396 342550 322983 19567 22557 4926 17631 350282 330146 20136 25881 2696 23185 MEDICAL SUPPLIES 852885 848312 4573 CONSULTING & COMPUTER E 268674 208796 59858 20 REPAIRS 229285 165051 64234 MISCELLANEOUS 223486 4158 219328 0 306375 252222 40393 13760 11707937 9217011 2424397 66529 315808 233459 941064 2314068 250000 457910 473550 527676 4915 11886 28784 25131 6744565 1776797 4277166 4967768 1242330 1361715 1495 1828 7535112 9901441 835083 746984 64432 556110 899515 1303094 X 6375710 7947579 259887 650768 6635597 8598347 7535112 9901441 X 1885526 78724 -1500 X X 0 1 X 1 1 1 X 2178498 2025778 3961224 3211861 4095940 15473301 3839861 5181866 6953176 8661989 9477409 34114301 6018359 7207644 10914400 11873850 13573349 49587602 0 0 0 49587602 16939 31644 45973 -58447 48409 84518 16939 31644 45973 -58447 48409 84518 6035298 7239288 10960373 11815403 13621758 49672120 0.99830 0.99890 0.00170 0.00110 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4080232 613914 3466318 2664333 1162883 1501450 4967768 14355959 78724 655477 29795 763996 13591963 1500 1500 13593463 12393209 655477 29795 685272 11707937 0 11707937 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCHEDULE G 29,795. PART XI, LINE 4B - OTHER ADJUSTMENTS: PTP GAIN NOT ON AUDIT REPORT 1,500. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCHEDULE G 29,795. 5K RACE 86907 37570 49337 1200 10530 0 18065 86907 37570 49337 1200 10530 18065 29795 19542 X X 0 0 0 0 0 0 0 0 0 DAVID SANFORD CHIEF EXECUTIVE OFFICER 146987 0 0 0 0 0 0 0 10001 0 156988 0 0 0 JULIE A ELDER OFFICER 155542 0 0 0 0 0 0 0 9480 0 165022 0 0 0 CHAD SANFORD SON OF CEO 47320 CHAD SANFORD IS THE SON OF DAVID SANFORD, CEO OF GRACEMED. CHAD IS AN EMPLOYEE OF GRACEMED. 0 SARA BAYLESS DAUGHTER OF OFFICER 54437 SARA BAYLESS IS THE DAUGHTER OF ROGER NOLTE, GRACEMED'S CHIEF DENTAL OFFICER. SARA BAYLESS IS AN EMPLOYEE OF GRACEMED. 0 DON CHESSER SPOUSE OF BOARD MEMBER 0 GRACEMED HEALTH CLINIC, INC. HOLDS AN INVESTMENT ACCOUNT WITH DON CHESSER (SPOUSE OF SALLY CHESSER WHO IS THE TREASURER/BOARD MEMBER) AT TD AMERITRADE. HE DOES NOT CHARGE A FEE FOR HIS SERVICES. 0 FORM 990, PART III, LINE 3 CEASED PROVIDING PRE-NATAL CARE SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION HIRES AN OUTSIDE CPA TO PREPARE THE FINANCIAL STATEMENT AUDIT AND THE FORM 990 EACH YEAR. AFTER THE CPA HAS COMPLETED BOTH THE AUDIT AND FORM 990, THE CFO FOR THE ORGANIZATION AND THE CPA REVIEW THE INITIAL DRAFT OF THE RETURN TO ENSURE ITS COMPLETENESS AND ACCURACY. FOLLOWING THE REVIEW, THE FORM 990 IS COMPLETED AND THE ORGANIZATION FILES THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: PTP GAIN NOT ON AUDIT REPORT -1,500. FORM 990, PART XII, LINE 2C THIS POLICY HAS NOT CHANGED SINCE THE PRIOR YEAR.