PACKARD HEALTH INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PACKARD HEALTH INC (EIN 38-2269817)
- Tax period
- 2013-09-01 to 2014-08-31
- Filed
- 2015-01-05
- IRS object ID
- 201530099349300448
- Schema version
- 2013v4.0
- 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 | 2015-01-05T07:37:30-06:00 | ReturnTs |
| Tax Period End | 2014-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382706146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YEO & YEO PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3275 | AddressLine1 |
| City | SAGINAW | City |
| State | MI | State |
| ZIP Code | 48605 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382269817 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKARD HEALTH INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PACK | BusinessNameControlTxt |
| Phone | 7349711073 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD RD | AddressLine1 |
| City | ANN ARBOR | City |
| State | MI | State |
| ZIP Code | 48108 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR RAYMOND RION | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 7349711073 | PhoneNum |
| Signature | 2014-12-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRIAN R DIXON | PreparerPersonNm |
| PTIN | P01321580 | PTIN |
| Phone | 9897939830 | PhoneNum |
| Preparation | 2014-12-29 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DR RAYMOND RION | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD RD | AddressLine1 |
| City | ANN ARBOR | City |
| State | MI | State |
| ZIP Code | 48108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,956,216 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PACKARDHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 53 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $585,210 | PYContributionsGrantsAmt |
| CY Contributions Grants | $556,273 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,255,891 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,317,697 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,240 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,898 | CYInvestmentIncomeAmt |
| PY Other Revenue | $106,779 | PYOtherRevenueAmt |
| CY Other Revenue | $73,348 | CYOtherRevenueAmt |
| PY Total Revenue | $2,950,120 | PYTotalRevenueAmt |
| CY Total Revenue | $2,956,216 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,909,757 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,976,414 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $53,594 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $657,398 | PYOtherExpensesAmt |
| CY Other Expenses | $892,916 | CYOtherExpensesAmt |
| PY Total Expenses | $2,567,155 | PYTotalExpensesAmt |
| CY Total Expenses | $2,869,330 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $382,965 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $86,886 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $985,431 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,009,350 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $459,421 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $189,323 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $526,010 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $820,027 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,313,992 | ExpenseAmt |
| Desc | PRIMARY HEALTH SERVICES, INCLUDING MENTAL HEALTH CARE AND HEALTH PROMOTION TO PATIENTS IN THE WASHTENAW COUNTY AREA. | Desc |
| Total Program Service Expenses | $2,313,992 | 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 | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | 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 | Yes (true) | 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 | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 53 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK JACOBY | PersonNm |
| Phone | 7349264934 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD RD | AddressLine1 |
| City | ANN ARBOR | City |
| State | MI | State |
| ZIP Code | 48108 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| JOHN MARTIN | ||||||
| CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BARBARA CAMPBELL | ||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| THOMAS BIGGS | ||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| GARY BOREN | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DUANE NEWLAND | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ANNE BROWN | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ELLEN CLEMENT | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JPAUL DIXON | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LAKSHMI HALASYAMANI | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| CHUCK HOFFMAN | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MONICA LYPSON | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| NORA MALOY | ||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SHARON MOORE | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BRYAN WAGONER | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ELLEN RABINOWITZ | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DEBORAH VANDENBROEK | ||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DR RAYMOND RION | ||||||
| EXECUTIVE DI | 40.00 | $185,449 | $0 | $17,343 | Yes (X) | |
| MARK JACOBY | ||||||
| COO | 40.00 | $29,437 | $0 | $2,971 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $214,886 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $20,314 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| All Other Contributions | $556,273 | AllOtherContributionsAmt |
| Noncash Contributions | $241,294 | NoncashContributionsAmt |
| Total Contributions | $556,273 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT FEES | 624100 | $1,640,764 | $1,640,764 |
| CONTRACT SERVICE FEES | 624100 | $393,140 | $393,140 |
| CAPITATION FEES | 624100 | $283,793 | $283,793 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,317,697 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $317 | TotalRevenueColumnAmt |
| Exclusion | $317 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,581 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,581 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,581 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,581 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $73,348 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $73,348 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $73,348 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,956,216 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,399,626 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $317 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,200 | TotalAmt |
| Program Services | $101,396 | ProgramServicesAmt |
| Management And General | $123,665 | ManagementAndGeneralAmt |
| Fundraising | $10,139 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,436,169 | TotalAmt |
| Program Services | $1,263,593 | ProgramServicesAmt |
| Management And General | $155,872 | ManagementAndGeneralAmt |
| Fundraising | $16,704 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,677 | TotalAmt |
| Program Services | $16,015 | ProgramServicesAmt |
| Management And General | $3,345 | ManagementAndGeneralAmt |
| Fundraising | $317 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,755 | TotalAmt |
| Program Services | $107,235 | ProgramServicesAmt |
| Management And General | $22,399 | ManagementAndGeneralAmt |
| Fundraising | $2,121 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,613 | TotalAmt |
| Program Services | $125,026 | ProgramServicesAmt |
| Management And General | $26,114 | ManagementAndGeneralAmt |
| Fundraising | $2,473 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,811 | TotalAmt |
| Management And General | $36,218 | ManagementAndGeneralAmt |
| Fundraising | $593 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,827 | TotalAmt |
| Program Services | $199,388 | ProgramServicesAmt |
| Management And General | $45,610 | ManagementAndGeneralAmt |
| Fundraising | $1,829 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,383 | TotalAmt |
| Fundraising | $14,383 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,960 | TotalAmt |
| Program Services | $20,625 | ProgramServicesAmt |
| Management And General | $13,618 | ManagementAndGeneralAmt |
| Fundraising | $717 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,717 | TotalAmt |
| Program Services | $58,243 | ProgramServicesAmt |
| Management And General | $38,450 | ManagementAndGeneralAmt |
| Fundraising | $2,024 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,115 | TotalAmt |
| Program Services | $18,623 | ProgramServicesAmt |
| Management And General | $467 | ManagementAndGeneralAmt |
| Fundraising | $25 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $505 | TotalAmt |
| Management And General | $505 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,583 | TotalAmt |
| Program Services | $15,792 | ProgramServicesAmt |
| Management And General | $14,212 | ManagementAndGeneralAmt |
| Fundraising | $1,579 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,792 | TotalAmt |
| Program Services | $31,246 | ProgramServicesAmt |
| Management And General | $5,315 | ManagementAndGeneralAmt |
| Fundraising | $231 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $341,325 | $341,325 | ||
| OTHER | $16,945 | $5,857 | $10,895 | $193 |
| DUES, LICENSES & SUBSCRIP | $11,252 | $7,445 | $3,617 | $190 |
| REPAIRS & MAINTENANCE | $3,701 | $2,183 | $1,442 | $76 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,869,330 | TotalAmt |
| Program Services | $2,313,992 | ProgramServicesAmt |
| Management And General | $501,744 | ManagementAndGeneralAmt |
| Fundraising | $53,594 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,332 | BOYAmt |
| EOY | $5,368 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $449,104 | BOYAmt |
| EOY | $470,277 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,786 | BOYAmt |
| EOY | $11,800 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,993 | BOYAmt |
| EOY | $149,362 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,356 | BOYAmt |
| EOY | $35,572 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $750,074 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $483,243 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $277,916 | BOYAmt |
| EOY | $266,831 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,944 | BOYAmt |
| EOY | $70,140 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $985,431 | BOYAmt |
| EOY | $1,009,350 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,480 | BOYAmt |
| EOY | $81,268 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,161 | BOYAmt |
| EOY | $15,480 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,888 | BOYAmt |
| EOY | $2,683 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $296,892 | BOYAmt |
| EOY | $89,892 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $459,421 | BOYAmt |
| EOY | $189,323 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $478,610 | BOYAmt |
| EOY | $768,227 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,400 | BOYAmt |
| EOY | $51,800 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $526,010 | BOYAmt |
| EOY | $820,027 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $985,431 | BOYAmt |
| EOY | $1,009,350 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $86,886 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $131 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $207,000 | DonatedServicesAndUseFcltsAmt |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,000 | OtherCostOrOtherBasisAmt |
| Book Value | $15,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $526,518 | OtherCostOrOtherBasisAmt |
| Depreciation | $309,208 | DepreciationAmt |
| Book Value | $217,310 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,921 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,001 | DepreciationAmt |
| Book Value | $2,920 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $173,635 | OtherCostOrOtherBasisAmt |
| Depreciation | $142,034 | DepreciationAmt |
| Book Value | $31,601 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $266,831 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amt | $89,892 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $89,892 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $2,956,347 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $131 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $131 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,956,216 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $2,956,216 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,869,330 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $2,869,330 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $2,869,330 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 | DR RAYMOND RION | PersonNm |
| Title | EXECUTIVE DIRECTOR | TitleTxt |
| Base Compensation Filing Org | $185,449 | BaseCompensationFilingOrgAmt |
| Deferred Compensation Flng Org | $12,510 | DeferredCompensationFlngOrgAmt |
| Nontaxable Benefits Filing Org | $4,833 | NontaxableBenefitsFilingOrgAmt |
| Total Compensation Filing Org | $202,792 | TotalCompensationFilingOrgAmt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $241,294 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE COO AND TREASURER IN DETAIL, THE 990 IS ALSO PROVIDED TO THE EXECUTIVE DIRECTOR AND BOARD PRIOR TO FILING FOR REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD REVISITS THE CONFLICTS OF INTEREST POLICY ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD DETERMINES THE COMPENSATION OF THE EXCUTIVE DIRECTOR BASED ON PERFORMANCE AND OTHER FACTORS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE DIRECTOR DETERMINES THE COMPENSATION FOR OFFICERS & KEY EMPLOYEES, SALARIES ARE ALSO APPROVED BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS ARE AVAILABLE UPON REQUEST OR ONLINE AT PUBLIC WEBSITE GUIDESTAR.COM |
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