RURAL HEALTH SERVICES INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- RURAL HEALTH SERVICES INC (EIN 23-7085643)
- Tax period
- 2013-06-01 to 2014-05-31
- Filed
- 2014-08-12
- IRS object ID
- 201412249349301276
- Schema version
- 2013v3.1
- 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 | 2014-08-12T10:26:40-07:00 | ReturnTs |
| Tax Period End | 2014-05-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Terry Horne CPA & Associates PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 732 West Main Street | AddressLine1 |
| City | Lebanon | City |
| State | TN | State |
| ZIP Code | 37087 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-06-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237085643 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RURAL HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RURA | BusinessNameControlTxt |
| Phone | 8035939283 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 277 | AddressLine1 |
| City | CLEARWATER | City |
| State | SC | State |
| ZIP Code | 29822 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT T REEL JR | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 8035939283 | PhoneNum |
| Signature | 2014-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRY HORNE | PreparerPersonNm |
| Phone | 6154447293 | PhoneNum |
| Preparation | 2014-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT T REEL JR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 277 | AddressLine1 |
| City | CLEARWATER | City |
| State | SC | State |
| ZIP Code | 298220277 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,083,848 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MJWCHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | SC | LegalDomicileStateCd |
| Activity Or Mission | THIS ORGANIZATION PROVIDES HEALTH CARE TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THIS IS A DIRECT FULFILLMENT OF THEIR TAX EXEMPT PURPOSE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 66 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,294,125 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,803,912 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,441,090 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,276,636 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,600 | PYOtherRevenueAmt |
| CY Other Revenue | $3,300 | CYOtherRevenueAmt |
| PY Total Revenue | $4,738,815 | PYTotalRevenueAmt |
| CY Total Revenue | $6,083,848 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,118,748 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,369,685 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,449,687 | PYOtherExpensesAmt |
| CY Other Expenses | $1,402,510 | CYOtherExpensesAmt |
| PY Total Expenses | $4,568,435 | PYTotalExpensesAmt |
| CY Total Expenses | $4,772,195 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $170,380 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,311,653 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,279,835 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,934,470 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,537,695 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,887,037 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$257,860 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,047,433 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THIS ORGANIZATION PROVIDES HEALTH CARE | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $3,799,956 | ExpenseAmt |
| Revenue | $3,276,636 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES HEALTH CARE SERVICES TO RESIDENTS OF CLEARWATER, SOUTH CAROLINA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. THESE MEDICAL SERVICES ARE PROVIDED IN AREAS THAT HAVE A SHORTAGE OF HEALTH CARE PROVIDERS. THIS IS A DIRECT FULFILLMENT OF THIER TAX EXEMPT PURPOSE. OVER 30,880 VISITS WERE PROVIDED DURING THE YEAR. | Desc |
| Total Program Service Expenses | $3,799,956 | 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 | Yes (true) | 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 | Yes (true) | 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 |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 16 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 66 | 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 |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | SC | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT T REEL JR CFO | PersonNm |
| Phone | 8035939283 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 277 | AddressLine1 |
| City | CLEARWATER | City |
| State | SC | State |
| ZIP Code | 29822 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 |
|---|---|---|---|---|---|---|---|
| KENNETH BALDWIN | |||||||
| BOARD CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JASON PRICE | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT BOWLES | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LILLIE JUMPP | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROSA ISHMAL | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHEVONIE MEALER | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANTOINETTE NOBLE-WEB | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BENJAMIN BROUSSARD | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TODD ETHEREDGE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HARVEY TOLLISON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| NICHOLAS MCCARLEY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CAROLYN EMANUEL-MCCLAIN | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $138,899 | $0 | $4,018 | Yes (X) | ||
| ROBERT T REEL JR | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $74,665 | $0 | $4,018 | Yes (X) | ||
| TYRA TYSON | |||||||
| MEDICAL DIRECTOR | 40.00 | $113,261 | $0 | $7,778 | Yes (X) | ||
| FREDERIC WORIAX | |||||||
| MEDICAL DIRECTOR | 40 | $163,187 | $9,692 | Yes (X) | |||
| DEEPA JAGDALE | |||||||
| PHYSICIAN | 40 | $123,089 | Yes (X) | ||||
| GARY FISCHBACH | |||||||
| PHYSICIAN | 40 | $162,984 | $9,692 | Yes (X) | |||
| JAMES BLAND | |||||||
| PHYSICIAN | 40 | $140,714 | $7,778 | Yes (X) | |||
| LLOYD DANIELS | |||||||
| PHYSICIAN | 40 | $221,023 | $7,778 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,137,822 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $50,754 | 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 |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CONTINENTAL CONSTRUCTION CO | |||||
| 4190 CROSSTOWNE COURT | EVANS | GA | 30809 | CONSTRUCTION | $101,796 |
| PAUL EMANUEL | |||||
| 7300 BEAVER RUN DR | FAYETTEVILLE | NC | 28314 | TECHNICAL SUPPORT | $101,310 |
| MB KAHN CONSTRUCTION CO INC | |||||
| PO BOX 1179 | COLUMBIA | SC | 29202 | CONSTRUCTION | $430,295 |
| HUGHES BEATTIE ONEAL LAW & ASSOCATIES | |||||
| 1075 BROOKHAVEN DRIVE | AIKEN | SC | 29803 | CONSTRUCTION | $130,789 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,463,339 | GovernmentGrantsAmt |
| All Other Contributions | $340,573 | AllOtherContributionsAmt |
| Noncash Contributions | $66,284 | NoncashContributionsAmt |
| Total Contributions | $2,803,912 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT FEES | Desc |
| Business | 621111 | BusinessCd |
| Total Revenue Column | $3,276,636 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,276,636 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,300 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,300 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,300 | TotalRevenueColumnAmt |
| Exclusion | $3,300 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,083,848 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,276,636 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $3,300 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $490,012 | TotalAmt |
| Program Services | $276,448 | ProgramServicesAmt |
| Management And General | $213,564 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,448,910 | TotalAmt |
| Program Services | $2,307,557 | ProgramServicesAmt |
| Management And General | $141,353 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $287,019 | TotalAmt |
| Program Services | $252,576 | ProgramServicesAmt |
| Management And General | $34,443 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,744 | TotalAmt |
| Program Services | $126,495 | ProgramServicesAmt |
| Management And General | $17,249 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,890 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $21,890 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,231 | TotalAmt |
| Program Services | $50,631 | ProgramServicesAmt |
| Management And General | $96,600 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $657,775 | TotalAmt |
| Program Services | $447,984 | ProgramServicesAmt |
| Management And General | $209,791 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,325 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $108,325 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,142 | TotalAmt |
| Program Services | $223,994 | ProgramServicesAmt |
| Management And General | $24,148 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,974 | TotalAmt |
| Program Services | $14,903 | ProgramServicesAmt |
| Management And General | $29,071 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,491 | TotalAmt |
| Program Services | $69,222 | ProgramServicesAmt |
| Management And General | $68,269 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,682 | TotalAmt |
| Program Services | $30,146 | ProgramServicesAmt |
| Management And General | $7,536 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,772,195 | TotalAmt |
| Program Services | $3,799,956 | ProgramServicesAmt |
| Management And General | $972,239 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,272 | BOYAmt |
| EOY | $296,389 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $340,415 | BOYAmt |
| EOY | $338,914 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,841 | BOYAmt |
| EOY | $51,053 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,728,858 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,523,818 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,780,659 | BOYAmt |
| EOY | $3,205,040 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,648 | BOYAmt |
| EOY | $43,074 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,279,835 | BOYAmt |
| EOY | $3,934,470 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $587,240 | BOYAmt |
| EOY | $549,241 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $400,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,950,455 | BOYAmt |
| EOY | $1,937,796 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,537,695 | BOYAmt |
| EOY | $2,887,037 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$265,707 | BOYAmt |
| EOY | $1,042,421 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,847 | BOYAmt |
| EOY | $5,012 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$257,860 | BOYAmt |
| EOY | $1,047,433 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,279,835 | BOYAmt |
| EOY | $3,934,470 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,311,653 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$6,360 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,461,937 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,387,600 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,099,020 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,294,125 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,803,912 | CurrentTaxYearAmt |
| Total | $8,046,594 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,461,937 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,387,600 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,099,020 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,294,125 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,803,912 | CurrentTaxYearAmt |
| Total | $8,046,594 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $8,046,594 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $335 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $52 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,100 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,600 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,300 | CurrentTaxYearAmt |
| Total | $9,387 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $8,055,981 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $13,070,874 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99880 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99890 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
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) |
|---|---|---|
| Investment Cost Or Other Basis | $184,543 | InvestmentCostOrOtherBasisAmt |
| Book Value | $184,543 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $3,713,515 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $925,976 | DepreciationAmt |
| Book Value | $2,787,539 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $830,800 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $597,842 | DepreciationAmt |
| Book Value | $232,958 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,205,040 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| CAPITALIZED LOAN COSTS | $27,512 |
| DEPOSITS | $10,550 |
| CASH RESTRICTED-USDA ESCROW | $3,525 |
| DONATED PHARMACY INVENTORY | $1,487 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $43,074 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $6,083,848 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $6,083,848 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $6,083,848 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,772,195 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $4,772,195 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $4,772,195 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| FREDERIC WORIAX | ||
| $163,187 | $9,692 | $172,879 |
| GARY FISCHBACH | ||
| $162,984 | $9,692 | $172,676 |
| LLOYD DANIELS | ||
| $221,023 | $7,778 | $228,801 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PAUL EMANUEL | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | NEPHEW TO CEO | RelationshipDescriptionTxt |
| Transaction | $69,932 | TransactionAmt |
| Transaction | MIS TECHNICAL SUPPORT | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 1 | THE ORGANIZATION EXECUTED A CONTRACT WITH THE NEPHEW OF THE CEO |
| 1 | TO PROVIDE MIS TECHNICAL SUPPORT WHICH WAS SIGNED BY BOARD. |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 893 | ContributionCnt |
| Noncash Contributions Rpt F990 | $44,645 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | # OF CONTRIBUTIONS ARE ESTIMATED @FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | LAB SERVICES | Desc |
| Contribution | 435 | ContributionCnt |
| Noncash Contributions Rpt F990 | $21,739 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | # OF CONTRIBUTIONS ARE ESTIMATED @FMV | 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 (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 11b | MANAGEMENT AND THE BOARD REVIEW AND APPROVE THE FORM 990 BEFORE |
| Pt VI, Line 11b | IT IS FILED WITH THE IRS. |
| Pt VI, Line 12c | ANNUALLY, THE BOARD IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST |
| Pt VI, Line 12c | STATEMENT THAT COMPLIES WIH THE CONFLICT OF INTEREST POLICY. |
| Pt VI, Line 15a | THE ORGANIZATION IS A MEMBER OF THE NATIONAL ASSOCIATION OF COMMUNITY |
| Pt VI, Line 15b | HEALTH CENTERS, AND WITH THIS MEMBERSHIP IS ABLE TO RECEIVE COMPLETED |
| Pt VI, Line 15b | COMPENSATION SURVEYS THAT LIST COMPENSATION BY FUNCTION AND REGION |
| Pt VI, Line 15b | OF EMPLOYMENT. USING THIS SURVEY IS THE INITIAL STATE OF COMPENSATION |
| Pt VI, Line 15b | EVAULATION. THE ORGANIZATION ALSO WILL REVIEW THE APPLICANT'S REQUESTED |
| Pt VI, Line 15b | COMPENSATION RANGE AND DETERMINE IF THIS MEETS PREVIOUSLY |
| Pt VI, Line 15b | BUDGETED BASELINES AS APPROVED BY THE BOARD. THESE DOCUMENTS ARE |
| Pt VI, Line 15b | AVAILABLE IN COMPLIANCE WITH THE FREEDOM OF INFORMATION ACT |
| Pt VI, Line 15b | THROUGH HRSA. |
| Pt VI, Line 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT |
| Pt VI, Line 19 | OF INTEREST POLICY AND FORM 990 AVAILABLE UPON WRITTEN REQUEST. |
| Pt XI | THE USE OF TEMPORARILY RESTRICTED NET ASSETS (DONATED SERVICES) FOR |
| Pt XI | THEIR INTENDED PURPOSE. |
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