GRACEMED HEALTH CLINIC INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: GRACEMED HEALTH CLINIC INC (EIN 48-1159633)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-08-14
IRS object ID: 201302269349301255
Schema version: 2012v2.1
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule G
Schedule L
Schedule M
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-08-14T09:32:59-05:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	481032601	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ALLEN GIBBS & HOULIK LC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	301 N MAIN SUITE 1700	AddressLine1
City	WICHITA	City
State	KS	State
ZIP Code	672024868	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	481159633	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	GRACEMED HEALTH CLINICS INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	GRAC	NameControl
Phone	3168662001	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1122 N TOPEKA	AddressLine1
City	WICHITA	City
State	KS	State
ZIP Code	67214	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	DAVID SANFORD CEO	Name
Title	CEO	Title
Phone	3168662011	Phone
Date Signed	2013-08-13	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	DENISE E HINSON	Name
PTIN	P00287304	PTIN
Phone	3162677231	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	DAVID SANFORD	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	1122 N TOPEKA	AddressLine1
City	WICHITA	City
State	KS	State
ZIP Code	67214	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	10960373	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.GRACEMED.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1979	YearFormation
State Legal Domicile	KS	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE PRIMARY HEALTH AND DENTAL CARE SERVICES TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	13	NbrIndependentVotingMembers
Total Nbr Employees	215	TotalNbrEmployees
Total Nbr Volunteers	50	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	2271684	ContributionsGrantsPriorYear
Contributions Grants Current Year	3916800	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	5197983	ProgramServiceRevenuePriorYear
Program Service Revenue CY	6885367	ProgramServiceRevenueCY
Investment Income Prior Year	30806	InvestmentIncomePriorYear
Investment Income Current Year	45973	InvestmentIncomeCurrentYear
Other Revenue Prior Year	4231	OtherRevenuePriorYear
Other Revenue Current Year	84923	OtherRevenueCurrentYear
Total Revenue Prior Year	7504704	TotalRevenuePriorYear
Total Revenue Current Year	10933063	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	5045156	SalariesEtcPriorYear
Salaries Etc Current Year	6586637	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	18147	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2169537	OtherExpensePriorYear
Other Expenses Current Year	2894484	OtherExpensesCurrentYear
Total Expenses Prior Year	7214693	TotalExpensesPriorYear
Total Expenses Current Year	9481121	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	290011	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1451942	RevenuesLessExpensesCY
Total Assets BOY	4716685	TotalAssetsBOY
Total Assets EOY	6712014	TotalAssetsEOY
Total Liabilities BOY	654625	TotalLiabilitiesBOY
Total Liabilities EOY	1146641	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	4062060	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	5565373	NetAssetsOrFundBalancesEOY
Mission Description	TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS OF SOUTH CENTRAL KANSAS.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	7216930	Expense
Revenue	6953176	Revenue
Description	PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES	Description
Total Program Service Expense	7216930	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	1	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	0	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	1	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	9	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	215	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	13	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	0	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	0	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	0	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	KS	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	SHAROL SULLIVAN	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	3168662049	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1122 N TOPEKA	AddressLine1
City	WICHITA	City
State	KS	State
ZIP Code	67214	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
CARMEN BAKER
BOARD MEMBER	4.00	X	0	0	0
TOM BORREGO
BOARD MEMBER	4.00	X	0	0	0
TERRY BOURLARD
BOARD MEMBER	4.00	X	0	0	0
GARY BROOKS
BOARD MEMBER	4.00	X	0	0	0
SALLY CHESSER
BOARD MEMBER	4.00	X	0	0	0
LOU ANN EWERTT
BOARD MEMBER	4.00	X	0	0	0
MICHAEL GOOD
BOARD MEMBER	4.00	X	0	0	0
LAURIE LABARCA
BOARD MEMBER	4.00	X	0	0	0
GAROLD MINNS
BOARD MEMBER	4.00	X	0	0	0
MARC MINNIS
BOARD MEMBER	4.00	X	0	0	0
BRENDA MOORE
BOARD MEMBER	4.00	X	0	0	0
BARTON PRINCE
BOARD MEMBER	4.00	X	0	0	0
JON ROSELL
BOARD MEMBER	4.00	X	0	0	0
KERIN SMITH
BOARD MEMBER	4.00	X	0	0	0
RUSSELL JOHNSON
CHIEF MEDICAL OFFICER	40.00		141888	0	2128	X
VENUS LEE
CHIEF OPERATING OFFICER	40.00		89449	0	1070	X
DR ROGER NOLTE
CHIEF DENTAL OFFICER	40.00		144068	0	0	X
DAVID SANFORD
CHIEF EXECUTIVE OFFICER	40.00		118518	0	3461	X
SHAROL SULLIVAN
CHIEF FINANCIAL OFFICER	40.00		86090	0	1000	X
DR ANDREA BOOTHE
DENTIST	40.00		112111	0	474		X
DR DEE ANN BRAGG
DOCTOR	40.00		111516	0	0		X
DR PHILLIP BORKINGTON
DENTIST	40.00		126561	0	1041		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	930201	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	9174	TotalOtherCompensation
Number Individuals GT100 K	8	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	0	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
USD #259
201 N WATER	WICHITA	KS	67202	CLINIC CONSTRUCTION	707139
HENRY SCHEIN
5846 W 21ST ST N SUITE 400	WICHITA	KS	67205	DENTAL SUPPLIES	348374
PEARCE TURK DENTAL LABORATORY
201 N EMPORIA	WICHITA	KS	67202	DENTAL LAB	276059
SIMPSON CONSTRUCTION
1831 S ANNA	WICHITA	KS	67277	CLINIC CONSTRUCTION	216020
CONCERGENT
245 N WACO SUITE T-4	WICHITA	KS	67202	IT SUPPORT/EQUIPMENT	166424

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	11	NumberOfContractorsGT100K
Fundraising Events	32042	FundraisingEvents
Government Grants	3222607	GovernmentGrants
All Other Contributions	662151	AllOtherContributions
Noncash Contributions	276512	NoncashContributions
Total Contributions	3916800	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAL & DENTAL SERVI	621110	6545367	6545367
HIT CERT INCENTIVE	621110	340000	340000

Field	Value	IRS element (for citing)
Total Program Service Revenue	6885367	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	45973	TotalRevenueColumn
Exclusion	$45,973	ExclusionAmount

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	44424	GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events	32042	CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses	27310	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	17114	TotalRevenueColumn
Exclusion	$17,114	ExclusionAmount

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	MISC REVENUE	Description
Business Code	900099	BusinessCode
Total Revenue Column	67809	TotalRevenueColumn
Related Or Exempt Function Income	67809	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	67809	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	10933063	TotalRevenueColumn
Related Or Exempt Function Income	6953176	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$63,087	ExclusionAmount

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	X	InfoInScheduleOPartIX

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	580013	Total
Program Services	174086	ProgramServices
Management And General	405927	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	5549444	Total
Program Services	4114370	ProgramServices
Management And General	1433225	ManagementAndGeneral
Fundraising	1849	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	56515	Total
Program Services	49029	ProgramServices
Management And General	7160	ManagementAndGeneral
Fundraising	326	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	400665	Total
Program Services	341410	ProgramServices
Management And General	58213	ManagementAndGeneral
Fundraising	1042	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	33144	Total
Program Services	410	ProgramServices
Management And General	28448	ManagementAndGeneral
Fundraising	4286	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	101898	Total
Program Services	71968	ProgramServices
Management And General	28873	ManagementAndGeneral
Fundraising	1057	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	286996	Total
Program Services	273493	ProgramServices
Management And General	13503	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	19898	Total
Program Services	14814	ProgramServices
Management And General	5084	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	272919	Total
Program Services	254405	ProgramServices
Management And General	18514	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	18971	Total
Program Services	2371	ProgramServices
Management And General	16600	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
MEDICAL SUPPLIES	1107597	1104639	2958
CONSULTING & COMPUTER E	269823	207837	61966	20
PROFESSIONAL & CONTRACT	255485	245878	9607
REPAIRS	182542	168091	14451

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	345211	Total
Program Services	194129	ProgramServices
Management And General	141515	ManagementAndGeneral
Fundraising	9567	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	9481121	Total
Program Services	7216930	ProgramServices
Management And General	2246044	ManagementAndGeneral
Fundraising	18147	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	460831	BOY
EOY	354337	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	341063	BOY
EOY	1054753	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	17282	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	561930	BOY
EOY	382886	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	5133	BOY
EOY	4599	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	15365	BOY
EOY	41884	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	4867139	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	1099565	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2302121	BOY
EOY	3767574	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	1012960	BOY
EOY	1103890	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	2091	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4716685	BOY
EOY	6712014	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	400899	BOY
EOY	979690	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	253726	BOY
EOY	166951	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	654625	BOY
EOY	1146641	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	3799567	BOY
EOY	5546501	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	262493	BOY
EOY	18872	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4062060	BOY
EOY	5565373	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4716685	BOY
EOY	6712014	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	1451942	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	51371	ReconciliationUnrealizedInvest
Reconcilation Other Changes	0	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	1	AccountantCompileOrReview

Accountant Compile Or Review Basis AccountantCompileOrReviewBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1758560	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2644753	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	2178498	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2025778	CurrentTaxYearMinus1Year
Current Tax Year	3961224	CurrentTaxYear
Total	12568813	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4099665	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3684944	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	3839861	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	5181866	CurrentTaxYearMinus1Year
Current Tax Year	6953176	CurrentTaxYear
Total	23759512	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	5858225	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	6329697	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	6018359	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	7207644	CurrentTaxYearMinus1Year
Current Tax Year	10914400	CurrentTaxYear
Total	36328325	Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Amts From Subst Contributors AmtsFromSubstContributors

Field	Value	IRS element (for citing)
Total	0	Total

Support From DQ Ps Etc SupportFromDQPsEtc

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Public Support Total509	36328325	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	8277	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	12237	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	16939	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	31644	CurrentTaxYearMinus1Year
Current Tax Year	45973	CurrentTaxYear
Total	115070	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	8277	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	12237	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	16939	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	31644	CurrentTaxYearMinus1Year
Current Tax Year	45973	CurrentTaxYear
Total	115070	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	5866502	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	6341934	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	6035298	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	7239288	CurrentTaxYearMinus1Year
Current Tax Year	10960373	CurrentTaxYear
Total	36443395	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99680	PublicSupportPercentage509
Prior Year Support Percentage	0.99740	PriorYearSupportPercentage
Investment Income Percentage	0.00320	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00260	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	145000	InvestmentCostOrOtherBasis
Book Value	145000	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	131512	InvestmentCostOrOtherBasis
Depreciation	768	Depreciation
Book Value	130744	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	2134801	InvestmentCostOrOtherBasis
Depreciation	353894	Depreciation
Book Value	1780907	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	2455826	InvestmentCostOrOtherBasis
Depreciation	744903	Depreciation
Book Value	1710923	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3767574	TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt	11048836	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	51371	NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities	37092	DonatedSrvcAndUseOfFacilities
Other Revenues	27310	OtherRevenues
Revenue Not Rptd F990	115773	RevenueNotRptdF990
Revenue Subtotal	10933063	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	10933063	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	9545523	TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities	37092	DonatedServicesUseOfFacilities
Other Expenses Included	27310	OtherExpensesIncluded
Expenses Not Rptd F990	64402	ExpensesNotRptdF990
Expenses Subtotal	9481121	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	9481121	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifier	ExplanationExplanation
PART XI, LINE 2D - OTHER ADJUSTMENTS:	EXPENSES REPORTED ON SCHEDULE G
PART XII, LINE 2D - OTHER ADJUSTMENTS:	EXPENSES REPORTED ON SCHEDULE G

Schedule G IRS990ScheduleG

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	5K RACE	NameOfEvent1
Gross Receipts Event1	76466	GrossReceiptsEvent1
Charitable Contributions Event1	32042	CharitableContributionsEvent1
Gross Revenue Event1	44424	GrossRevenueEvent1
Cash Prizes Event1	1000	CashPrizesEvent1
Non Cash Prizes Event1	10135	NonCashPrizesEvent1
Rent Facility Costs Event1	1245	RentFacilityCostsEvent1
Other Direct Expenses Event1	14930	OtherDirectExpensesEvent1
Gross Receipts Total	76466	GrossReceiptsTotal
Charitable Contributions Total	32042	CharitableContributionsTotal
Gross Revenue Total Events	44424	GrossRevenueTotalEvents
Cash Prizes Total Events	1000	CashPrizesTotalEvents
Non Cash Prizes Total Events	10135	NonCashPrizesTotalEvents
Rent Facility Costs Total Events	1245	RentFacilityCostsTotalEvents
Other Direct Expenses Total Events	14930	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	27310	DirectExpenseSummaryEvents
Net Income Summary	17114	NetIncomeSummary

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
SALLY CHESSER
BOARD MEMBER	0	GRACEMED HEALTH CLINIC, INC. HOLDS AN INVESTMENT ACCOUNT WITH SALLY CHESSER AT TD AMERITRADE. SALLY DOES NOT CHARGE A FEE FOR HER SERVICES.	0
CHAD SANFORD
SON OF CEO	41737	CHAD SANFORD IS THE SON OF DAVID SANFORD, CEO OF GRACEMED. CHAD IS AN EMPLOYEE OF GRACEMED.	0
JOHN BORREGO
SON OF BOARD MEMBER	27860	JOHN BORREGO IS THE SON OF TOM BORREGO, THE PRESIDENT OF THE BOARD OF DIRECTORS. JOHN BORREGO IS AN EMPLOYEE OF GRACEMED	0
SARA BAYLESS
DAUGHTER OF OFFICER	50777	SARA BAYLESS IS THE DAUGHTER OF ROGER NOLTE, GRACEMED'S CHIEF DENTAL OFFICER. SARA BAYLESS IS AN EMPLOYEE OF GRACEMED.	0

Schedule M IRS990ScheduleM

Real Estate Commercial RealEstateCommercial

Field	Value	IRS element (for citing)
Non Cash Checkbox	X	NonCashCheckbox
Number Of Contributions	1	NumberOfContributions
Noncash Contribs Rptd F990	276512	NoncashContribsRptdF990
Method Of Determining Revenues	APPRAISED FMV OF PROP	MethodOfDeterminingRevenues

Field	Value	IRS element (for citing)
Any Property That Must Be Held	0	AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts	0	ReviewProcessUnusualNCGifts
Third Parties Used	0	ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

Return ReferenceReturnReference	ExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11	THE ORGANIZATION HIRES AN OUTSIDE CPA TO PREPARE THE FINANCIAL STATEMENT AUDIT AND THE FORM 990 EACH YEAR. AFTER THE CPA HAS COMPLETED BOTH THE AUDIT AND FORM 990, THE CFO FOR THE ORGANIZATION AND THE CPA REVIEW THE INITIAL DRAFT OF THE RETURN TO ENSURE ITS COMPLETENESS AND ACCURACY. FOLLOWING THE REVIEW, THE FORM 990 IS COMPLETED AND THE ORGANIZATION FILES THE RETURN.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICIES, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C	THIS POLICY HAS NOT CHANGED SINCE THE PRIOR YEAR.