SACRED HEART COMMUNITY CLINIC INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SACRED HEART COMMUNITY CLINIC INC (EIN 27-2901548)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-14
IRS object ID
201312269349303246
Schema version
2012v2.0
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

FieldValueIRS element (for citing)
Timestamp2013-08-14T13:34:50-07:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ALTON D THIELE PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1300 EAST AVENUE C P O BOX 808AddressLine1
CityBELTONCity
StateTXState
ZIP Code76513ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN272901548EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SACRED HEART COMMUNITY CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSACRNameControl
Phone5127163929Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1620 ROUND ROCK WEST DRIVE BLDG 8AddressLine1
CityROUND ROCKCity
StateTXState
ZIP Code78681ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHELLE BURRName
TitlePRESIDENTTitle
Phone5127163929Phone
Date Signed2013-08-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameALTON D THIELE CPAName
Phone2549390701Phone
Date Prepared2013-08-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHELLE BURRNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11132 OAKLANDS DRAddressLine1
CityROUND ROCKCity
StateTXState
ZIP Code78681ZIPCode
FieldValueIRS element (for citing)
Gross Receipts165730GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitesacredheartclinic.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2010YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionTo provide free outpatient health services to the uninsured and underinsured residents of the Round Rock area.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers75TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year355214ContributionsGrantsPriorYear
Contributions Grants Current Year82519ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year57InvestmentIncomePriorYear
Investment Income Current Year277InvestmentIncomeCurrentYear
Other Revenue Current Year63508OtherRevenueCurrentYear
Total Revenue Prior Year355271TotalRevenuePriorYear
Total Revenue Current Year146304TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year178583GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year39005OtherExpensePriorYear
Other Expenses Current Year73034OtherExpensesCurrentYear
Total Expenses Prior Year217588TotalExpensesPriorYear
Total Expenses Current Year73034TotalExpensesCurrentYear
Revenues Less Expenses Prior Year137683RevenuesLessExpensesPriorYear
Revenues Less Expenses CY73270RevenuesLessExpensesCY
Total Assets BOY153129TotalAssetsBOY
Total Assets EOY257530TotalAssetsEOY
Total Liabilities EOY15312TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY153129NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY242218NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide free outpatient health servicesMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense38073Expense
DescriptionPROVIDING FREE OUTPATIENT HEALTH CARE SERVICES TO THE QUALIFYING UNINSURED AND UNDERINSURED RESIDENTS OF THE ROUND ROCK TX AREADescription
Total Program Service Expense38073TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementfalseRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDEACON DENNIS EGANNamePerson
Telephone Number5123889732TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11907 HAMPTON LNAddressLine1
CityROUND ROCKCity
StateTXState
ZIP Code78664ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficer
BRUNET SARAH
Secretary5.00XX
BRUSKEWITZ SANDY
Clinic Supv10.00X
BURR MICHELLE
President15.00XX
BURTON-GARCIA ELIZABETH
Executive Director20.00X
EGAN DENNIS
Treasurer5.00XX
HERNANDEZ TINO
Past President10.00X
OLIVAREZ SANTOS
VP5.00XX
URIEGAS RUDOLFO
Medical Director15.00X
URIEGAS SABRINA
Clinic Ops Chair15.00X
WEST JERRI
IT Manager10.00X
WILHELM FATHER DEAN
Spiritual Director2.00X
KOPPELL DAVE
PastorX
ROCHA RODRIGUEZ NORMA
AttorneyX
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
All Other Contributions82519AllOtherContributions
Noncash Contributions17610NoncashContributions
Total Contributions82519TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column277TotalRevenueColumn
Exclusion$277ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events82934GrossIncomeFundraisingEvents
Fundraising Direct Expenses19426FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column63508TotalRevenueColumn
Exclusion$63,508ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column146304TotalRevenueColumn
Exclusion$63,785ExclusionAmount

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total1400Total
Program Services0ProgramServices
Management And General1400ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total13902Total
Program Services12704ProgramServices
Management And General1198ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total17689Total
Program Services0ProgramServices
Management And General17689ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total8157Total
Program Services0ProgramServices
Management And General8157ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5576Total
Program Services5341ProgramServices
Management And General235ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total34Total
Program Services0ProgramServices
Management And General34ManagementAndGeneral
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1122Total
Program Services0ProgramServices
Management And General1122ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5780Total
Program Services1600ProgramServices
Management And General4180ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Patient Snacks/Misc10591459140
Medical Supplies9079907900
Pharmaceuticals9204920400
Bank Fees320320

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total73034Total
Program Services38073ProgramServices
Management And General34961ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY69883BOY
EOY161521EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY44861BOY
EOY45786EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis41273LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8668LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY38385BOY
EOY32605EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY17618EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY153129BOY
EOY257530EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
EOY11462EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY3850EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY15312EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY153129BOY
EOY242218EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY153129BOY
EOY242218EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY153129BOY
EOY257530EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses73270ReconcilationRevenueExpenses
Reconcilation Other Changes15819ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year355214CurrentTaxYearMinus1Year
Current Tax Year82519CurrentTaxYear
Total437733Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year355214CurrentTaxYearMinus1Year
Current Tax Year82519CurrentTaxYear
Total437733Total
FieldValueIRS element (for citing)
Public Support Total509437733PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year57CurrentTaxYearMinus1Year
Current Tax Year277CurrentTaxYear
Total334Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year57CurrentTaxYearMinus1Year
Current Tax Year277CurrentTaxYear
Total334Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Total438067Total
FieldValueIRS element (for citing)
First5 Years509XFirst5Years509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis32533OtherCostOrOtherBasis
Depreciation7795Depreciation
Book Value24738BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8740OtherCostOrOtherBasis
Depreciation873Depreciation
Book Value7867BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings32605TotalOfBookValueLandBuildings

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1CATHOLIC DIOCESE OF AUSTINBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16225 HWY 295 EASTAddressLine1
CityAUSTINCity
StateTXState
ZIP Code78723ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient741542827EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant178583AmountOfCashGrant
Method Of ValuationCASHMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantCHARITABLEPurposeOfGrant

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 2Medical Directors (M/M Uriegas) are married; Secretary is daughter of Clinic Supv
Pt VI, Line 11bBoard will likely review after filing; Treasurer will review before
Pt XIAddition of Marketable Securities to assets
Form 990, Part IX, Line 24fDUES/MEMBERSHIPS

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