CLEMSON HEALTH CENTER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CLEMSON HEALTH CENTER INC (EIN 57-0988736)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-13
- IRS object ID
- 201323179349300227
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-13T08:05:03-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | 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 | 570988736 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLEMSON HEALTH CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CLEM | NameControl |
| Phone | 8646540716 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 885 TIGER BLVD | AddressLine1 |
| City | CLEMSON | City |
| State | SC | State |
| ZIP Code | 29631 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KEVIN HERBERT | Name |
| Title | DIRECTOR/ CO-SEC & TREAS | Title |
| Phone | 8646540716 | Phone |
| Date Signed | 2013-11-13 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | 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 | JERRY PARRISH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 885 TIGER BLVD | AddressLine1 |
| City | CLEMSON | City |
| State | SC | State |
| ZIP Code | 29631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2456570 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CLEMSONHEALTH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1993 | YearFormation |
| State Legal Domicile | SC | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE URGENT, OUTPATIENT DIAGNOSTIC AND PRIMARY HEALTH CARE FOR THE CITIZENS OF CLEMSON, SC. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 4 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 51 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 268478 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2166464 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2150352 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 33979 | OtherRevenuePriorYear |
| Other Revenue Current Year | 34264 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2200443 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2453094 | 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 | 981888 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1347319 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1262118 | OtherExpensePriorYear |
| Other Expenses Current Year | 1127067 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2244006 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2474386 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -43563 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -21292 | RevenuesLessExpensesCY |
| Total Assets BOY | 2190450 | TotalAssetsBOY |
| Total Assets EOY | 2163356 | TotalAssetsEOY |
| Total Liabilities BOY | 125482 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 119680 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2064968 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2043676 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE URGENT, OUTPATIENT DIAGNOSTIC AND PRIMARY HEALTH CARE SERVICES FOR THE CITIZENS OF CLEMSON, SC REGARDLESS OF THEIR ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2372025 | Expense |
| Revenue | 2184616 | Revenue |
| Description | PROVIDED URGENT, OUT PATIENT DIAGNOSTIC AND PRIMARY CARE HEALTH CARE, REGARDLESS OF THE ABILITY TO PAY, TO 31,516 PATIENTS AT THE CLINIC LOCATED IN CLEMSON, SC. | Description |
| Total Program Service Expense | 2372025 | 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 | 0 | 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | 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 | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | 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 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 51 | 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 |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 4 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | SC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JENNIFER SARAFIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8646546800 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 885 TIGER BLVD | AddressLine1 |
| City | CLEMSON | City |
| State | SC | State |
| ZIP Code | 29631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (8 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JEANNE WARD | ||||||||
| DIRECTOR/CO-PRESIDENT | 1.00 | 40.00 | X | X | 0 | 343578 | 68570 | |
| KEVIN HERBERT | ||||||||
| DIRECTOR/CO-SECRETARY & TREASURER | 1.00 | 40.00 | X | X | 0 | 178836 | 9520 | |
| JERRY A PARRISH | ||||||||
| DIRECTOR/CO-SECRETARY & TREASURER | 1.00 | 40.00 | X | X | 0 | 65 | 3549 | |
| JOHN A MILLER JR | ||||||||
| DIRECTOR/CO-PRESIDENT | 1.00 | 40.00 | X | X | 0 | 4060571 | 70962 | |
| JENNIFER SARAFIN | ||||||||
| OPERATIONAL MANAGER | 40.00 | X | 0 | 59277 | 19726 | |||
| DAVID LIEBMAN MD | ||||||||
| PHYSICIAN | 40.00 | 122786 | 0 | 18780 | X | |||
| ALLISON AUSTIN | ||||||||
| PHYSICIAN | 40.00 | 145961 | 0 | 12671 | X | |||
| EDMOND JORDAN | ||||||||
| PHYSICIAN | 40.00 | 177045 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 445792 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4642327 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 203778 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLSCRIPTS | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 24630 NETWORK PLACE | AddressLine1 |
| City | CHICAGO | City |
| State | IL | State |
| ZIP Code | 60673 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | MEDICAL RECORD SOFTWARE | DescriptionOfServices |
| Compensation | 124401 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Related Organizations | 268478 | RelatedOrganizations |
| Total Contributions | 268478 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 2150352 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2150352 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2150352 | TotalProgramServiceRevenue |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 26738 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 3476 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 23262 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23262 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23262 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 11002 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11002 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 11002 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2453094 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2184616 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1177445 | Total |
| Program Services | 1177445 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83606 | Total |
| Program Services | 83606 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86268 | Total |
| Program Services | 86268 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29277 | Total |
| Management And General | 29277 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7900 | Total |
| Management And General | 7900 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 490907 | Total |
| Program Services | 425723 | ProgramServices |
| Management And General | 65184 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9752 | Total |
| Program Services | 9752 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 124667 | Total |
| Program Services | 124667 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43701 | Total |
| Program Services | 43701 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15859 | Total |
| Program Services | 15859 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1715 | Total |
| Program Services | 1715 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2001 | Total |
| Program Services | 2001 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95620 | Total |
| Program Services | 95620 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70828 | Total |
| Program Services | 70828 | ProgramServices |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MEDICAL SUPPLIES | 117507 | 117507 |
| BAD DEBT EXPENSE | 117333 | 117333 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2474386 | Total |
| Program Services | 2372025 | ProgramServices |
| Management And General | 102361 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8334 | BOY |
| EOY | 7595 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 353189 | BOY |
| EOY | 310446 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31304 | BOY |
| EOY | 34071 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25973 | BOY |
| EOY | 24056 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 3301771 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1515682 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1770551 | BOY |
| EOY | 1786089 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1099 | BOY |
| EOY | 1099 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2190450 | BOY |
| EOY | 2163356 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94708 | BOY |
| EOY | 111467 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30774 | BOY |
| EOY | 8213 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 125482 | BOY |
| EOY | 119680 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2064968 | BOY |
| EOY | 2043676 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2064968 | BOY |
| EOY | 2043676 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2190450 | BOY |
| EOY | 2163356 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -21292 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | AmountAmount |
|---|---|---|---|
| ANMED HEALTH | |||
| 570359174 | 3 | 1 | $0 |
| OCONEE MEDICAL CENTER | |||
| 570357963 | 3 | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
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) |
|---|---|---|
| Other Cost Or Other Basis | 861945 | OtherCostOrOtherBasis |
| Book Value | 861945 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1438912 | OtherCostOrOtherBasis |
| Depreciation | 893889 | Depreciation |
| Book Value | 545023 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 60820 | OtherCostOrOtherBasis |
| Depreciation | 37783 | Depreciation |
| Book Value | 23037 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 940094 | OtherCostOrOtherBasis |
| Depreciation | 584010 | Depreciation |
| Book Value | 356084 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1786089 | TotalOfBookValueLandBuildings |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEANNE WARD | ||||||||||||||
| DIRECTOR/CO-PRESIDENT | 0 | 341966 | 0 | 0 | 0 | 1612 | 0 | 57858 | 0 | 10712 | 0 | 412148 | 0 | 0 |
| KEVIN HERBERT | ||||||||||||||
| DIRECTOR/CO-SECRETARY & TREASURER | 0 | 177224 | 0 | 0 | 0 | 1612 | 0 | 6307 | 0 | 3213 | 0 | 188356 | 0 | 0 |
| JOHN A MILLER JR | ||||||||||||||
| DIRECTOR/CO-PRESIDENT | 0 | 141764 | 0 | 0 | 0 | 3918807 | 0 | 0 | 0 | 70962 | 0 | 4131533 | 0 | 1432244 |
| ALLISON AUSTIN | ||||||||||||||
| PHYSICIAN | 145961 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 12671 | 0 | 158632 | 0 | 0 | 0 |
| EDMOND JORDAN | ||||||||||||||
| PHYSICIAN | 177045 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 177045 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | THE FOLLOWING OFFICER RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDED BY OCONEE MEDICAL CENTER, A RELATED ORGANIZATION: JEANNE WARD - 49,922 THE PURPOSE OF THE OCONEE MEDICAL CENTER EXECUTIVE DEFERRED COMPENSATION PLAN IS TO PROVIDE RETIREMENT BENEFITS FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES IN ADDITION TO THE BENEFITS PROVIDED THROUGH THE OTHER RETIREMENT PLANS THAT ARE SPONSORED BY THE COMPANY. ELIGIBILITY TO PARTICIPATE IN THE PLAN IS CURRENTLY LIMITED TO THE CEO, JEANNE WARD. EMPLOYER CONTRIBUTIONS SHALL BECOME FULLY VESTED ON THE PARTICIPANT'S VESTING DATE AS LONG AS THE PARTICIPANT IS EMPLOYED WITH THE EMPLOYER ON THE VESTING DATE AND SATISFIES THE REQUIREMENTS OF THE PLAN. THE DEFERRED VESTING DATE IS SUBJECT TO A VESTING SCHEDULE THAT REQUIRES A MINIMUM DEFERRAL OF 2 YEARS TO BECOME VESTED. THERE ARE NO LIMITS ON CONTRIBUTIONS TO THE PLAN. IF THE PARTICIPANT'S EMPLOYMENT WITH THE ORGANIZATION IS TERMINATED "WITHOUT CAUSE," THE FULL VALUE OF HIS ACCOUNT SHALL BECOME FULLY VESTED. IN THE CASE OF A VOLUNTARY TERMINATION OF EMPLOYMENT BY THE EXECUTIVE OR INVOLUNTARY TERMINATION OF EMPLOYMENT FOR CAUSE BY THE COMPANY, THE NON-VESTED FUNDS ARE FORFEITED. | |
| PART III | PART I, LINE 3: COMPENSATION OF BOARD MEMBERS JEANNE WARD AND KEVIN HERBERT IS PAID BY OCONEE MEDICAL CENTER (OMC), A RELATED ORGANIZATION. ALL COMPENSATION RECEIVED BY THESE BOARD MEMBERS IS FOR THEIR SERVICES RENDERED TO OMC AS OFFICERS OF THAT ORGANIZATION. THE BOARD OF DIRECTORS OF OMC UTILIZED THE FOLLOWING METHODS TO DETERMINE APPROPRIATE COMPENSATION FOR THE INDIVIDUALS THAT HAD INFLUENCE OVER THE ORGANIZATION'S ACTIVITIES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE COMPENSATION OF BOARD MEMBERS JOHN A. MILLER AND JERRY A. PARRISH, AND OFFICER JENNIFER SARAFIN IS PAID BY ANMED HEALTH, A RELATED ORGANIZATION. ALL COMPENSATION RECEIVED BY THESE TWO BOARD MEMBERS IS FOR THEIR SERVICES RENDERED TO ANMED HEALTH AS OFFICERS OF THAT ORGANIZATION. THE BOARD OF DIRECTORS OF ANMED HEALTH UTILIZED THE FOLLOWING METHODS TO DETERMINE APPROPRIATE COMPENSATION FOR THE INDIVIDUALS THAT HAD INFLUENCE OVER THE ORGANIZATION'S ACTIVITIES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACTS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART II, COLUMN (B)(III): THE FOLLOWING INDIVIDUAL RECEIVED A PAYOUT FROM A DEFERRED COMPENSATION PLAN BY A RELATED ORGANIZATION THAT IS TAXABLE IN THE CURRENT PERIOD: JOHN A. MILLER - $ 3,871,706 THE PAYOUT LISTED ABOVE IS COMPRISED OF $ 1,194,980 OF DEFERRED COMPENSATION REPORTED ON A PRIOR FORM 990 AND $2,676,726 OF MARKET ADJUSTMENTS AND AMOUNTS ACCRUED PRIOR TO THE REVISED REPORTING REQUIREMENTS OF 990 SCHEDULE J. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE ORGANIZATION IS MANAGED BY A TWO PERSON EXECUTIVE COMMITTEE CONSISITNG OF THE CEO OR OTHER EXECUTIVE OFFICER OF EACH MEMBER. THE FOLLOWING ACTIONS BY THE ORGANIZATION SHALL REQUIRE APPROVAL OF BOTH MEMBERS OF THE EXECUTIVE COMMITEE: -ADOPTION OF AN ANNUAL OPERATING BUDGET -CAPITAL EXPENDITURES IN EXCESS OF $5,000 -DEVELOPMENT OF ANY NEW SERVICES OR INCURRING ANY EXPENDITURE WHICH REQUIRES A CONTRACT -DECISION TO SELL ALL OR SUBSTANTIALLY ALL OF THE ASSETS -DISSOLUTION OR LIQUIDATION -AMENDING OR MODIFYING THE BYLAWS -ADOPTION OF CLINICAL AND MEDICAL PRIVILEGE AND GUIDELINE POLICIES. | |
| FORM 990, PART VI, SECTION A, LINE 3 | ON MARCH 1, 2002, CLEMSON HEALTH CENTER ENTERED INTO A MANAGEMNT SERVICES AGREEMNT WITH ANMED HEALTH PLAN, INC. A SOUTH CAROLINA CORPORATION. AS PART OF THE AGREEMENT, CLEMSON HEALTH CENTER GRANTS ANMED HEALTH PLAN THE RESPONSABILITY FOR PRACTICE MANAGEMENT SERVICES, SUBJECT TO THE GENERAL APPROVAL OF THE BOARD OF DIRECTORS OF CLEMSON HEALTH CENTER. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS TWO MEMBERS: ANMED HEALTH, AND OCONEE MEDICAL CENTER. BOTH OF THE MEMBERS ARE SOUTH CAROLINA 501(C)(3) ORGANIZATIONS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION AND REVIEW BY MANAGEMENT, THE FORM 990 IS REVIEWED BY THE GOVERNING BODY AT A SCHEDULED MEETING PRIOR TO ITS FILING. IF NO MEETING IS SCHEDULED, THE FORM 990 IS EMAILED TO THE GOVERNING BODY FOR REVIEW. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD ANNUALLY REVIEWS THE CONFLICT OF INTEREST POLICY AND COMPLIANCE WITH THE POLICY. | |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION SHOWN FOR OFFICERS OF CLEMSON HEALTH CENTER IS FOR SERVICES PERFORMED FOR RELATED ORGANIZATIONS. THE COMPENSATION IS DETERMINED BY METHODS EMPLOYED BY THE RELATED ORGANIZATIONS WHICH INCLUDES UTILIZING AN OUTSIDE COMPENSATION CONSULTANT, USE OF COMPENSATION STUDIES, AND APPROVAL BY COMPENSATION COMMITTEE OR BOARD. MANAGEMENT IS PROVIDED AND COMPENSATED IN ACCORDANCE WITH THE MANAGEMENT AGREEMENT BETWEEN THE ORGANIZATION AND ANMED HEALTH, A SUPPORTED ORGANIZATION. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CORPORATION'S ARTICLES OF INCORPORATION ARE AVAILABLE FROM THE SC SECRETARY OF STATE. OTHER GOVERNING DOCUMENTS INCLUDING THE BY-LAWS AND OPERATING POLICIES, SUCH AS THE CONFLICT OF INTEREST POLICY, ARE BY STATE LAW NOT SUBJECT TO PUBLIC DISCLOSURE. THIS FORM 990 CONSTITUTES THE CORPORATION'S PUBLIC DISCLOSURE OF ITS FINANCIAL STATEMENTS. | |
| FORM 990 PART VII, SECTION A, LINE 1A, COLUMN E AND F: | COMPENSATION INCLUDED FOR DIRECTORS OF CLEMSON HEALTH CENTER IS FOR SERVICES PERFORMED TO RELATED ORGANIZATIONS. IN ADHERENCE TO A SERVICES AFFILIATION AGREEMENT BETWEEN RELATED ORGANIZATION ANMED HEALTH AND UNRELATED ORGANIZATION CAROLINAS HEALTH SYSTEM, DIRECTORS JOHN A. MILLER AND JERRY A. PARRISH RECEIVED COMPENSATION FROM THE UNRELATED ORGANIZATION FOR THEIR SERVICES AS OFFICERS OF ANMED HEALTH WHICH IS NOT REPORTED ON THIS FORM 990. | COMPENSATION FOR DIRECTORS: |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 425,723. MANAGEMENT AND GENERAL EXPENSES 65,184. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 490,907. | OTHER FEES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ANMED HEALTH | |||||||||||
| 800 NORTH FANT STREET | ANDERSON | SC | 29621 | 570359174 | HOSPITAL | SC | 501(C)(3) | LINE 3 | ANMED HEALTH SYSTEM | 0 | |
| OCONEE MEDICAL CENTER | |||||||||||
| 298 MEMORIAL DRIVE | SENECA | SC | 29672 | 570357963 | HOSPITAL | SC | 501(C)(3) | LINE 3 | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |