MAPLE CITY HEALTH CARE CENTER INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MAPLE CITY HEALTH CARE CENTER INC (EIN 35-1749398)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-05-14
- IRS object ID
- 201421349349302072
- Schema version
- 2013v3.0
- 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 | 2014-05-14T09:50:21-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351640896 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JURGONSKI & FREDLAKE CPAS | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 418 W JEFFERSON BLVD | AddressLine1 |
| City | SOUTH BEND | City |
| State | IN | State |
| ZIP Code | 46601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351749398 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAPLE CITY HEALTH CARE CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MAPL | BusinessNameControlTxt |
| Phone | 5745343300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 MIDDLEBURY STREET | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 465282956 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MAX MERTZ | PersonNm |
| Person Title | OFFICER | PersonTitleTxt |
| Phone | 5745343300 | PhoneNum |
| Signature | 2014-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN A FREDLAKE CPA | PreparerPersonNm |
| PTIN | P00071521 | PTIN |
| Phone | 5742511414 | PhoneNum |
| Preparation | 2014-05-14 | 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 | KAREN MILLER RUSH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 MIDDLEBURY STREET | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 465282956 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,814,535 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MCHCC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1988 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | HEALTH CARE SERVICES; PROVIDES NEIGHBORHOOD PATIENTS WITH MEDICAL, COUNSELING, EDUCATIONAL, AND SOCIAL SERVICES THROUGH THE HEALTH CARE CENTER, IMPROVING THEIR PRACTICAL LIVES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 38 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $868,009 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,513,013 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,125,502 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $1,296,819 | CYProgramServiceRevenueAmt |
| PY Investment Income | $213 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $99,837 | PYOtherRevenueAmt |
| CY Other Revenue | $4,703 | CYOtherRevenueAmt |
| PY Total Revenue | $2,093,561 | PYTotalRevenueAmt |
| CY Total Revenue | $4,814,535 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,053,873 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,732,931 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $25,778 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $518,570 | PYOtherExpensesAmt |
| CY Other Expenses | $941,257 | CYOtherExpensesAmt |
| PY Total Expenses | $1,572,443 | PYTotalExpensesAmt |
| CY Total Expenses | $2,674,188 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $521,118 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,140,347 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,363,959 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,533,305 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $139,543 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $168,541 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,224,416 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,364,764 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HEALTH CARE SERVICES; PROVIDES NEIGHBORHOOD PATIENTS WITH MEDICAL, COUNSELING, EDUCATIONAL, AND SOCIAL SERVICES THROUGH THE HEALTH CARE CENTER, IMPROVING THEIR PRACTICAL LIVES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,391,482 | ExpenseAmt |
| Revenue | $1,301,522 | RevenueAmt |
| Desc | VISITS BY PATIENTS WITH MEDICAL, COUNSELING, EDUCATIONAL, AND SOCIAL SERVICES THROUGH THE HEALTH CARE CENTER, IMPROVING THEIR PRACTICAL LIVES. | Desc |
| Total Program Service Expenses | $2,391,482 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 38 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KAREN MILLER RUSH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5745343300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 213 MIDDLEBURY STREET | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 465282956 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| MAX MERTZ | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN DRIVER | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KEVIN FARMWALD | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JENNIFER HIRE | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KELLY JOHNSON | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DENISE METTERT | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MIGUEL MILLAN | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ADRIANA ORTIZ | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JAMES NELSON GINGERICH | ||||||
| EXECUTIVE DIRECTOR | 60.00 | Yes (X) | $116,580 | $0 | $10,366 | Yes (X) |
| RACHEL MILLER-JACOBS | ||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $116,580 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $10,366 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ABG DENTAL | |||||
| 622 W LINCOLN | GOSHEN | IN | 46526 | DENTAL SERVICES | $227,191 |
| CLUBHOUSE OF ELKHART CO | |||||
| 114 S FIFTH ST | GOSHEN | IN | 46528 | MENTAL HEALTH SERVICES | $200,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,347,268 | GovernmentGrantsAmt |
| All Other Contributions | $2,165,745 | AllOtherContributionsAmt |
| Noncash Contributions | $96,295 | NoncashContributionsAmt |
| Total Contributions | $3,513,013 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $1,296,819 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,296,819 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $1,296,819 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $4,703 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,703 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,703 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,814,535 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,301,522 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,421 | TotalAmt |
| Program Services | $168,733 | ProgramServicesAmt |
| Management And General | $14,834 | ManagementAndGeneralAmt |
| Fundraising | $1,854 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,070,518 | TotalAmt |
| Program Services | $974,172 | ProgramServicesAmt |
| Management And General | $85,641 | ManagementAndGeneralAmt |
| Fundraising | $10,705 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,305 | TotalAmt |
| Program Services | $68,528 | ProgramServicesAmt |
| Management And General | $6,024 | ManagementAndGeneralAmt |
| Fundraising | $753 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $307,095 | TotalAmt |
| Program Services | $279,456 | ProgramServicesAmt |
| Management And General | $24,568 | ManagementAndGeneralAmt |
| Fundraising | $3,071 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,592 | TotalAmt |
| Program Services | $86,079 | ProgramServicesAmt |
| Management And General | $7,567 | ManagementAndGeneralAmt |
| Fundraising | $946 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,349 | TotalAmt |
| Program Services | $69,147 | ProgramServicesAmt |
| Management And General | $11,389 | ManagementAndGeneralAmt |
| Fundraising | $813 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,193 | TotalAmt |
| Program Services | $18,014 | ProgramServicesAmt |
| Management And General | $2,967 | ManagementAndGeneralAmt |
| Fundraising | $212 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,647 | TotalAmt |
| Program Services | $23,500 | ProgramServicesAmt |
| Management And General | $3,871 | ManagementAndGeneralAmt |
| Fundraising | $276 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,461 | TotalAmt |
| Program Services | $15,691 | ProgramServicesAmt |
| Management And General | $2,585 | ManagementAndGeneralAmt |
| Fundraising | $185 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,693 | TotalAmt |
| Program Services | $28,639 | ProgramServicesAmt |
| Management And General | $4,717 | ManagementAndGeneralAmt |
| Fundraising | $337 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $522,309 | $443,963 | $73,123 | $5,223 |
| VACCINATIONS | $96,295 | $96,295 | ||
| PROFESSIONAL SERVICES | $54,547 | $46,365 | $7,637 | $545 |
| TELEPHONE | $35,259 | $29,970 | $4,936 | $353 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,504 | TotalAmt |
| Program Services | $42,930 | ProgramServicesAmt |
| Management And General | $7,069 | ManagementAndGeneralAmt |
| Fundraising | $505 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,674,188 | TotalAmt |
| Program Services | $2,391,482 | ProgramServicesAmt |
| Management And General | $256,928 | ManagementAndGeneralAmt |
| Fundraising | $25,778 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,439 | BOYAmt |
| EOY | $498,708 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,264 | BOYAmt |
| EOY | $199,401 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $478,064 | BOYAmt |
| EOY | $257,228 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $170,847 | BOYAmt |
| EOY | $231,432 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,279 | BOYAmt |
| EOY | $23,523 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $904,417 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $308,507 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $583,066 | BOYAmt |
| EOY | $595,910 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,727,103 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,363,959 | BOYAmt |
| EOY | $3,533,305 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,543 | BOYAmt |
| EOY | $168,541 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,543 | BOYAmt |
| EOY | $168,541 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,197,079 | BOYAmt |
| EOY | $1,373,260 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,337 | BOYAmt |
| EOY | $1,991,504 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,224,416 | BOYAmt |
| EOY | $3,364,764 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,363,959 | BOYAmt |
| EOY | $3,533,305 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,140,347 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | 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 | $183,004 | OtherCostOrOtherBasisAmt |
| Book Value | $183,004 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $102,310 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,261 | DepreciationAmt |
| Book Value | $60,049 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $576,282 | OtherCostOrOtherBasisAmt |
| Depreciation | $241,729 | DepreciationAmt |
| Book Value | $334,553 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,021 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,517 | DepreciationAmt |
| Book Value | $7,504 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,800 | OtherCostOrOtherBasisAmt |
| Book Value | $10,800 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $595,910 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CONTRIBUTED RENT RECEIVABLE | Desc |
| Book Value | $1,727,103 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,727,103 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,860,855 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $46,320 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $46,320 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,814,535 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,814,535 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,720,508 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $46,320 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $46,320 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,674,188 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,674,188 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S POLICY IS TO RECORD AN UNRECOGNIZED TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAX AUTHORITIES. INTEREST AND PENALTIES RELATED TO GROSS UNRECOGNIZED TAX BENEFITS WOULD BE INCLUDED WITHIN THE PROVISION FOR INCOME TAXES. TO THE EXTENT ACCRUED INTEREST AND PENALTIES DO NOT ULTIMATELY BECOME PAYABLE, AMOUNTS ACCRUED WOULD BE REDUCED IN THE PERIOD THAT SUCH DETERMINATION IS MADE AND REFLECTED AS A REDUCTION OF THE OVERALL INCOME TAX PROVISION. THE ORGANIZATION FILES A FEDERAL AND AN INDIANA STATE TAX RETURN. THE TAX YEARS THAT REMAIN SUBJECT TO EXAMINATION BY THE FEDERAL AND INDIANA TAX JURISDICTIONS DATE BACK TO THE YEAR ENDING DECEMBER 31, 2010. | ExplanationTxt |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 268 | ContributionCnt |
| Noncash Contributions Rpt F990 | $96,295 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | ONE OF THE BOARD MEMBERS FATHER CONTRACTED WITH THE ORGANIZATION FOR A RENOVATION PROJECT. THE BOARD MEMBER RECUSED HERSELF FROM ANY DISCUSSION AND VOTING CONCERNING THE SELECTION OF THE CONTRACTOR FOR THIS PROJECT. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS MEMBERS OR STOCKHOLDERS |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS ON THE BOARD OF DIRECTORS APPOINT NEW MEMBERS OF THE BOARD AFTER A CONSULTATION PROCESS. |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE FORM 990 IS EMAILED TO BOARD MEMBERS BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD OF DIRECTORS REVIEWS CONFLICTS OF INTEREST ANNUALLY AT THE TIME OF ANNUAL BOARD ELECTIONS. STAFF IS MADE AWARE OF THE POLICY AND IN RELEVANT SITUATIONS, THE POLICY IS REVIEWED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS A POINT SYSTEM TO DETERMINE SALARY LEVELS FOR ALL STAFF INCLUDING ALL MANAGEMENT PERSONNEL. THE POINT SYSTEM IS BASED ON: * EDUCATION, EXPERIENCE, LANGUAGE ABILITY, RESPONSIBILITY LEVEL, AND WHETHER OR NOT THEY HAVE CALL RESPONSIBILITIES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. |
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