THUNDER BAY COMMUNITY HEALTH SERVICE INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- THUNDER BAY COMMUNITY HEALTH SERVICE INC (EIN 38-2290337)
- Tax period
- 2014-03-01 to 2015-02-28
- Filed
- 2015-09-24
- IRS object ID
- 201532679349300103
- Schema version
- 2014v5.0
- 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 | 2015-09-24T06:59:26-05:00 | ReturnTs |
| Tax Period End | 2015-02-28 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382963463 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | QUAST JANKE & CO CPA'S PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1010 N JOHNSON | AddressLine1Txt |
| City | BAY CITY | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48708 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-03-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382290337 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THUNDER BAY COMMUNITY HEALTH SERVIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | THUN | BusinessNameControlTxt |
| Phone | 9897424583 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15774 STATE ST PO BOX 427 | AddressLine1Txt |
| City | HILLMAN | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49746 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHELLE STYMA | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9897424583 | PhoneNum |
| Signature | 2015-08-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID G GWIZDALA CPA | PreparerPersonNm |
| PTIN | P00234130 | PTIN |
| Phone | 9898924549 | PhoneNum |
| Preparation | 2015-09-04 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHELLE STYMA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15774 STATE STREET PO BOX 427 | AddressLine1Txt |
| City | HILLMAN | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49746 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,810,161 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TBCHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1981 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | THE ORGANIZATION COMMITS ITS RESOURCES AND PASSION TO PROVIDE COMPREHENSIVE PRIMARY HEALTH CARE SERVICES FOR PEOPLE OF ALL AGES | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 149 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $4,005,315 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,072,942 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,187,868 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,735,296 | CYProgramServiceRevenueAmt |
| PY Investment Income | $23,090 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,923 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $13,216,273 | PYTotalRevenueAmt |
| CY Total Revenue | $14,810,161 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,714,885 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,490,011 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,232,691 | PYOtherExpensesAmt |
| CY Other Expenses | $7,012,991 | CYOtherExpensesAmt |
| PY Total Expenses | $12,947,576 | PYTotalExpensesAmt |
| CY Total Expenses | $14,503,002 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $268,697 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $307,159 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,222,825 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,163,785 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,072,043 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,705,844 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,150,782 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,457,941 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE ORGANIZATION COMMITS ITS RESOURCES AND PASSION TO PROVIDE COMPREHENSIVE PRIMARY HEALTH CARE SERVICES FOR PEOPLE OF ALL AGES | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $10,719,043 | ExpenseAmt |
| Desc | THIS FEDEERALLY QUALIFIED COMMUNITY HELATH CENTER HAS APPROXIMATELY 12,950 PATIENTS AND PROVIDED MORE THAN 48,000 CLINICAL VISITS INCLUDING MEDICAL, DENTAL AND MENTAL HEALTH SERVICES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $76,020 | ExpenseAmt |
| Desc | THIS FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER HAS APPROXIMATELY 12,600 PATIENTS AND PROVIDED MORE THAN 46,000 CLINICAL VISITS INCLUDING MEDICAL, DENTAL AND MENTAL HEALTH SERVICES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $76,020 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $10,795,063 | 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 | false | 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 | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 149 | 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 |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LEIGHANN VIERS | PersonNm |
| Phone | 9893542197 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 N RIPLEY SUITE E | AddressLine1Txt |
| City | ALPENA | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49707 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| MIKE WURTSMITH | |||||||
| BOARD CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NANCY DEXTROM | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TARRY DEO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| AL MOE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHANNA JOHNSON | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROD FULLERTON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NINA KENNARD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BEACH HALL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BEN BOLSER | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ELEANOR LUTZE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY FITZGERALD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JACQUELYN MCINTIRE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARION HAUTEA | |||||||
| CMO | 40.00 | $227,100 | $0 | $21,269 | Yes (X) | ||
| MICHELLE STYMA | |||||||
| CEO | 40.00 | $177,126 | $0 | $19,834 | Yes (X) | ||
| SHARRON GALLOP | |||||||
| CFO | 20.00 | $76,020 | $0 | $4,595 | Yes (X) | ||
| ANTHONY VANHORN | |||||||
| CIO | 40.00 | $75,108 | $0 | $15,401 | Yes (X) | ||
| JEMELLEE JACALA-TADIAN | |||||||
| PHYSICIAN | 40.00 | $190,750 | $0 | $20,242 | Yes (X) | ||
| DONALD HILLMAN | |||||||
| PHYSICIAN | 40.00 | $170,500 | $0 | $16,479 | Yes (X) | ||
| TIMOTHY HAYES | |||||||
| PHYSICIAN | 40.00 | $160,500 | $0 | $11,522 | Yes (X) | ||
| LORI WINEMAN | |||||||
| PHARMACY DIR | 40.00 | $133,265 | $0 | $18,236 | Yes (X) | ||
| WAYNE MCEWEN | |||||||
| MEDICAL DIRE | 40.00 | $128,144 | $0 | $18,002 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,338,513 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $145,580 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Government Grants | $2,370,653 | GovernmentGrantsAmt |
| All Other Contributions | $1,702,289 | AllOtherContributionsAmt |
| Noncash Contributions | $1,623,387 | NoncashContributionsAmt |
| Total Contributions | $4,072,942 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| PATIENT FEES | $5,411,249 | $5,411,249 |
| PHARMACY SALES | $4,964,501 | $4,964,501 |
| MEDICAID MEANINGFUL USE | $195,500 | $195,500 |
| INCENTIVE | $127,374 | $127,374 |
| RENTAL INCOME | $36,672 | $36,672 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,735,296 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,923 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,923 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,810,161 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,737,219 | RelatedOrExemptFuncIncomeAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $555,354 | TotalAmt |
| Program Services | $303,120 | ProgramServicesAmt |
| Management And General | $252,234 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,283,161 | TotalAmt |
| Program Services | $3,808,668 | ProgramServicesAmt |
| Management And General | $1,474,493 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,169,074 | TotalAmt |
| Program Services | $590,945 | ProgramServicesAmt |
| Management And General | $578,129 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $482,422 | TotalAmt |
| Program Services | $330,266 | ProgramServicesAmt |
| Management And General | $152,156 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $615,748 | TotalAmt |
| Program Services | $318,103 | ProgramServicesAmt |
| Management And General | $297,645 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,182 | TotalAmt |
| Program Services | $56,430 | ProgramServicesAmt |
| Management And General | $22,752 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,361 | TotalAmt |
| Program Services | $113,598 | ProgramServicesAmt |
| Management And General | $76,763 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,177 | TotalAmt |
| Program Services | $165,796 | ProgramServicesAmt |
| Management And General | $177,381 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,024 | TotalAmt |
| Program Services | $70,233 | ProgramServicesAmt |
| Management And General | $90,791 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,438 | TotalAmt |
| Management And General | $134,438 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $353,922 | TotalAmt |
| Program Services | $63,396 | ProgramServicesAmt |
| Management And General | $290,526 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,524 | TotalAmt |
| Program Services | $4,360 | ProgramServicesAmt |
| Management And General | $26,164 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $4,836,383 | $4,836,383 | |
| REPAIR AND MAINT | $150,334 | $87,688 | $62,646 |
| DUES AND LICENSES | $66,467 | $24,300 | $42,167 |
| OTHER | $51,431 | $21,777 | $29,654 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,503,002 | TotalAmt |
| Program Services | $10,795,063 | ProgramServicesAmt |
| Management And General | $3,707,939 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $461,574 | BOYAmt |
| EOY | $868,028 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,621,109 | BOYAmt |
| EOY | $1,480,711 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $547,123 | BOYAmt |
| EOY | $704,943 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $195,267 | BOYAmt |
| EOY | $187,333 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,559 | BOYAmt |
| EOY | $153,434 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,203,274 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,535,683 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,174,464 | BOYAmt |
| EOY | $5,667,591 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,729 | BOYAmt |
| EOY | $101,745 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,222,825 | BOYAmt |
| EOY | $9,163,785 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $636,958 | BOYAmt |
| EOY | $909,401 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,435,085 | BOYAmt |
| EOY | $2,796,443 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,072,043 | BOYAmt |
| EOY | $3,705,844 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,150,782 | BOYAmt |
| EOY | $5,457,941 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,150,782 | BOYAmt |
| EOY | $5,457,941 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,222,825 | BOYAmt |
| EOY | $9,163,785 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $307,159 | ReconcilationRevenueExpnssAmt |
| 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 | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
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 | $363,841 | OtherCostOrOtherBasisAmt |
| Book Value | $363,841 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,464,570 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,755,402 | DepreciationAmt |
| Book Value | $4,709,168 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $75,232 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,846 | DepreciationAmt |
| Book Value | $54,386 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,299,631 | OtherCostOrOtherBasisAmt |
| Depreciation | $759,435 | DepreciationAmt |
| Book Value | $540,196 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,667,591 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $14,961,576 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $151,415 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $151,415 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,810,161 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $14,810,161 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,654,417 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $151,415 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $151,415 | ExpensesNotReportedAmt |
| Expenses Subtotal | $14,503,002 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $14,503,002 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| MARION HAUTEA | ||||
| CMO | $227,100 | $6,813 | $14,456 | $248,369 |
| MICHELLE STYMA | ||||
| CEO | $177,126 | $5,314 | $14,520 | $196,960 |
| JEMELLEE JACALA-TADIAN | ||||
| PHYSICIAN | $190,750 | $5,722 | $14,520 | $210,992 |
| DONALD HILLMAN | ||||
| PHYSICIAN | $170,500 | $5,115 | $11,364 | $186,979 |
| TIMOTHY HAYES | ||||
| PHYSICIAN | $160,500 | $4,815 | $6,707 | $172,022 |
| LORI WINEMAN | ||||
| PHARMACY DIRECTOR | $133,265 | $3,998 | $14,238 | $151,501 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $1,623,387 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE OF DRUG | MethodOfDeterminingRevenuesTxt |
| 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 (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | BOARD MEMBERS ARE ALL VOLUNTEERS IN ADDITION TO COMMUNITY MEMBERS WHO DONATE TIME FOR VARIOUS CENTER ACTIVITIES |
| FORM 990, PAGE 2, PART III, LINE 4D | THIS FEDERALLY QUALIFIED COMMUNITY HEALTH CENTER HAS APPROXIMATELY 12,600 PATIENTS AND PROVIDED MORE THAN 46,000 CLINICAL VISITS INCLUDING MEDICAL, DENTAL AND MENTAL HEALTH SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | AUDITOR REVIEWS RETURN WITH FINANCE COMMITTEE AND PRESENTS REVIEW TO ENTIRE BOARD PRIOR TO SUBMISSION |
| FORM 990, PAGE 6, PART VI, LINE 12C | BOARD MEMBERS SUBMIT WRITTEN STATEMENTS TO EXECUTIVE TEAM FOR REVIEW ON ANY CONFLICT OF INTEREST ISSUES |
| FORM 990, PAGE 6, PART VI, LINE 15A | CEO COMPENSATION IS DETERMINED BY EXECUTIVE COMMITTEE BASED UPON COMPARABILITY DATA FOR SIMILIAR POSTION. ENTIRE BOARD MAKES FINAL APPROVAL OF WAGE DETERMINATION |
| FORM 990, PAGE 6, PART VI, LINE 15B | BOARD APPROVES WAGES OF CEO AND KEY EMPLOYEES BASED UPON BOARD APPROVED WAGE SCALE |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST, PREFERABLY IN WRITING. THE ORGANIZATION MAKES COPIES OF THE REQUESTED DOCUMENTS AND MAKES THEM AVAILABLE FOR PICK UP OR MAIL TO THE REQUESTEE. |