2013-08-14T09:32:59-05:00 2012-12-31 481032601 ALLEN GIBBS & HOULIK LC 301 N MAIN SUITE 1700 WICHITA KS 672024868 990 2012-01-01 481159633 GRACEMED HEALTH CLINICS INC GRAC 3168662001 1122 N TOPEKA WICHITA KS 67214 DAVID SANFORD CEO 3168662011 2013-08-13 1 DENISE E HINSON P00287304 3162677231 2012 2016-02-25 16:41:14Z DAVID SANFORD 1122 N TOPEKA WICHITA KS 67214 10960373 0 X WWW.GRACEMED.ORG X 1979 KS TO PROVIDE PRIMARY HEALTH AND DENTAL CARE SERVICES TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES. 14 13 215 50 0 0 2271684 3916800 5197983 6885367 30806 45973 4231 84923 7504704 10933063 0 0 0 0 5045156 6586637 0 0 18147 2169537 2894484 7214693 9481121 290011 1451942 4716685 6712014 654625 1146641 4062060 5565373 TO SHOW AND SHARE THE LOVE OF JESUS CHRIST BY PROVIDING COMPASSIONATE, ACCESSIBLE, HIGH-QUALITY HEALTH CARE FOR RESIDENTS OF SOUTH CENTRAL KANSAS. 0 0 7216930 6953176 PROVIDING PRIMARY HEALTH AND DENTAL CARE TO KANSANS WITHOUT HEALTH INSURANCE OR ADEQUATE FINANCIAL RESOURCES TO SECURE TRADITIONAL HEALTH CARE SERVICES 7216930 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 9 0 1 215 1 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 1 0 0 0 KS X SHAROL SULLIVAN 3168662049 1122 N TOPEKA WICHITA KS 67214 CARMEN BAKER 4.00 X 0 0 0 TOM BORREGO 4.00 X 0 0 0 TERRY BOURLARD 4.00 X 0 0 0 GARY BROOKS 4.00 X 0 0 0 SALLY CHESSER 4.00 X 0 0 0 LOU ANN EWERTT 4.00 X 0 0 0 MICHAEL GOOD 4.00 X 0 0 0 LAURIE LABARCA 4.00 X 0 0 0 GAROLD MINNS 4.00 X 0 0 0 MARC MINNIS 4.00 X 0 0 0 BRENDA MOORE 4.00 X 0 0 0 BARTON PRINCE 4.00 X 0 0 0 JON ROSELL 4.00 X 0 0 0 KERIN SMITH 4.00 X 0 0 0 RUSSELL JOHNSON 40.00 X 141888 0 2128 VENUS LEE 40.00 X 89449 0 1070 DR ROGER NOLTE 40.00 X 144068 0 0 DAVID SANFORD 40.00 X 118518 0 3461 SHAROL SULLIVAN 40.00 X 86090 0 1000 DR ANDREA BOOTHE 40.00 X 112111 0 474 DR DEE ANN BRAGG 40.00 X 111516 0 0 DR PHILLIP BORKINGTON 40.00 X 126561 0 1041 930201 0 9174 8 0 0 0 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 11 32042 3222607 662151 276512 3916800 MEDICAL & DENTAL SERVI 621110 6545367 6545367 HIT CERT INCENTIVE 621110 340000 340000 6885367 45973 45973 44424 32042 27310 17114 17114 MISC REVENUE 900099 67809 67809 67809 10933063 6953176 0 63087 X 580013 174086 405927 5549444 4114370 1433225 1849 56515 49029 7160 326 400665 341410 58213 1042 33144 410 28448 4286 101898 71968 28873 1057 286996 273493 13503 19898 14814 5084 272919 254405 18514 18971 2371 16600 MEDICAL SUPPLIES 1107597 1104639 2958 CONSULTING & COMPUTER E 269823 207837 61966 20 PROFESSIONAL & CONTRACT 255485 245878 9607 REPAIRS 182542 168091 14451 345211 194129 141515 9567 9481121 7216930 2246044 18147 460831 354337 341063 1054753 17282 0 561930 382886 5133 4599 15365 41884 4867139 1099565 2302121 3767574 1012960 1103890 0 2091 4716685 6712014 400899 979690 253726 166951 654625 1146641 X 3799567 5546501 262493 18872 4062060 5565373 4716685 6712014 1451942 51371 0 X X 1 X 1 X 1 1 1 X 1758560 2644753 2178498 2025778 3961224 12568813 4099665 3684944 3839861 5181866 6953176 23759512 5858225 6329697 6018359 7207644 10914400 36328325 0 0 0 36328325 8277 12237 16939 31644 45973 115070 8277 12237 16939 31644 45973 115070 5866502 6341934 6035298 7239288 10960373 36443395 0.99680 0.99740 0.00320 0.00260 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 145000 145000 131512 768 130744 2134801 353894 1780907 2455826 744903 1710923 3767574 11048836 51371 37092 27310 115773 10933063 0 10933063 9545523 37092 27310 64402 9481121 0 9481121 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCHEDULE G PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED ON SCHEDULE G 5K RACE 76466 32042 44424 1000 10135 1245 14930 76466 32042 44424 1000 10135 1245 14930 27310 17114 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 X 1 276512 APPRAISED FMV OF PROP 0 0 0 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.