GIRDWOOD HEALTH CLINIC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- GIRDWOOD HEALTH CLINIC (EIN 90-0622646)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201333189349305943
- 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 | 2013-11-14T12:59:53-09:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 920150055 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | White and Associates CPA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 772165 | AddressLine1 |
| City | Eagle River | City |
| State | AK | State |
| ZIP Code | 99577 | 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 | 900622646 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Girdwood Health Clinic Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GIRD | NameControl |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1130 | AddressLine1 |
| City | Girdwood | City |
| State | AK | State |
| ZIP Code | 99587 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mary Jo Thill | Name |
| Title | President | Title |
| Phone | 9077831355 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | false | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sharon K White CPA | Name |
| PTIN | P00100413 | PTIN |
| Phone | 9075619599 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Self Employed | X | SelfEmployed |
| 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) |
|---|---|---|
| Gross Receipts | 494203 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.girdwoodhealthclinic.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2011 | YearFormation |
| State Legal Domicile | AK | StateLegalDomicile |
| Activity Or Mission Description | provide expanded, quality health care to residents and visitors of the area without regard to ability to pay, operation of a sustainable, nonprofit community health clinic | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 5 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 7793 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 67855 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15308 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 425980 | ProgramServiceRevenueCY |
| Investment Income Current Year | 24 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 344 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 23101 | TotalRevenuePriorYear |
| Total Revenue Current Year | 494203 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1950 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 224314 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6097 | OtherExpensePriorYear |
| Other Expenses Current Year | 207178 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 8047 | TotalExpensesPriorYear |
| Total Expenses Current Year | 431492 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 15054 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 62711 | RevenuesLessExpensesCY |
| Total Assets BOY | 151270 | TotalAssetsBOY |
| Total Assets EOY | 217716 | TotalAssetsEOY |
| Total Liabilities BOY | 136216 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 139951 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 15054 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 77765 | NetAssetsOrFundBalancesEOY |
| Mission Description | provide expanded, quality health care to residents and visitors of the area without regard to ability to pay, operation of a sustainable, nonprofit community health clinic | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 31238 | Expense |
| Grants | 31238 | Grants |
| Revenue | 31238 | Revenue |
| Description | Applied for and awarded Grant from State of Alaska for expansion of hours and services at Girdwood, Alaska Clinic and for Start-up of Satellite cinic in Hope, Alaska, a medically underserved area. A building in Hope was identified, leased and renovated. The new clinic opened in January 2013. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 397656 | Expense |
| Revenue | 425980 | Revenue |
| Description | The Girdwood Health Clinic offers primary and urgent health care for permanent and seasonal residents of the Turnagain Arm area, as well as tourists visiting the resort town. The clinic offers x-ray services and is able to provide casting and splinting, wound care including stitches, medications and lab services. A sliding discount fee schedule is offered to those without insurance or who are underinsured. Medicare and Medicaid payments accepted as well as private insurance. Applied to and approved for Alaska Department of Health and Social Services epidemiology vaccine Depot immunization program. Vaccines were recieved and provided to patients in need. Additionally a grant request was submitted and subsequently approved to provided $20,000 in lab equipment, reducing cost and turn around time on routine testing and improve patient care. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 428894 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | false | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 8 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 5 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Steve Bartholomew | NamePerson |
| Telephone Number | 9077831355 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1053 | AddressLine1 |
| City | Girdwood | City |
| State | AK | State |
| ZIP Code | 99587 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|
| Clinton Dow | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Dorinda Carter | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Eugene Bjornstad | |||||||
| Director | 4.00 | X | 0 | 0 | 0 | ||
| Karl Erickson | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Kathy Trautner | |||||||
| Director | 6.00 | X | 0 | 0 | 0 | ||
| Michelle Cosper | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Peter Preis | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Robin Ingram | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Rochelle Morris | |||||||
| Director | 3.00 | X | 0 | 0 | 0 | ||
| Amanda Snitzer | |||||||
| Sectretary | 3.00 | 0 | 0 | 0 | X | ||
| Mary Jo Thill | |||||||
| President | 8.00 | 0 | 0 | 0 | X | ||
| Steve Bartholomew | |||||||
| Treasurer | 3.00 | 0 | 0 | 0 | X | ||
| Theresa Sherwood | |||||||
| Vice President | 6.00 | 0 | 0 | 0 | X | ||
| Kerry Dorius | |||||||
| Key Employee | 60.00 | 104000 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 104000 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Fundraising Events | 5688 | FundraisingEvents |
| Government Grants | 31238 | GovernmentGrants |
| All Other Contributions | 30929 | AllOtherContributions |
| Total Contributions | 67855 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Health Care | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 425980 | TotalRevenueColumn |
| Related Or Exempt Function Income | 425980 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 425980 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24 | TotalRevenueColumn |
| Related Or Exempt Function Income | 24 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 5688 | CntrbtnsRprtdFundraisingEvents |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Miscellaneous Revenue | Description |
| Business Code | 323100 | BusinessCode |
| Total Revenue Column | 344 | TotalRevenueColumn |
| Related Or Exempt Function Income | 344 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 344 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 494203 | TotalRevenueColumn |
| Related Or Exempt Function Income | 426348 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104000 | Total |
| Program Services | 104000 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101817 | Total |
| Program Services | 101817 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18497 | Total |
| Program Services | 18497 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 860 | Total |
| Management And General | 860 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33913 | Total |
| Program Services | 33013 | ProgramServices |
| Management And General | 900 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38491 | Total |
| Program Services | 38291 | ProgramServices |
| Management And General | 200 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2119 | Total |
| Program Services | 2119 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8025 | Total |
| Program Services | 8025 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68995 | Total |
| Program Services | 68995 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 264 | Total |
| Program Services | 264 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2218 | Total |
| Program Services | 2218 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13757 | Total |
| Program Services | 13757 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4250 | Total |
| Program Services | 4250 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Board and Staff Training | 1603 | 1210 | 393 |
| Licenses and dues | 693 | 448 | 245 |
| Merchant fees | 2784 | 2784 | |
| Medical Supply | 29206 | 29206 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 431492 | Total |
| Program Services | 428894 | ProgramServices |
| Management And General | 2598 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1096 | BOY |
| EOY | 1587 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14575 | BOY |
| EOY | 92650 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1575 | BOY |
| EOY | 2013 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 58199 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9564 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55960 | BOY |
| EOY | 48635 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78064 | BOY |
| EOY | 72831 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151270 | BOY |
| EOY | 217716 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 716 | BOY |
| EOY | 4589 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 7882 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 135500 | BOY |
| EOY | 127480 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136216 | BOY |
| EOY | 139951 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15054 | BOY |
| EOY | 69883 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 7882 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15054 | BOY |
| EOY | 77765 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151270 | BOY |
| EOY | 217716 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 62711 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | false | FSAudited |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
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 Minus1 Year | 7793 | CurrentTaxYearMinus1Year |
| Current Tax Year | 67855 | CurrentTaxYear |
| Total | 75648 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 15308 | CurrentTaxYearMinus1Year |
| Current Tax Year | 426324 | CurrentTaxYear |
| Total | 441632 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 23101 | CurrentTaxYearMinus1Year |
| Current Tax Year | 494179 | CurrentTaxYear |
| Total | 517280 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 31269 | CurrentTaxYear |
| Total | 31269 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 31269 | CurrentTaxYear |
| Total | 31269 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 486011 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 24 | CurrentTaxYear |
| Total | 24 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 24 | CurrentTaxYear |
| Total | 24 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 23101 | CurrentTaxYearMinus1Year |
| Current Tax Year | 494203 | CurrentTaxYear |
| Total | 517304 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | X | First5Years509 |
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
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 10000 | InvestmentCostOrOtherBasis |
| Depreciation | 267 | Depreciation |
| Book Value | 9733 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 48199 | InvestmentCostOrOtherBasis |
| Depreciation | 9297 | Depreciation |
| Book Value | 38902 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 48635 | TotalOfBookValueLandBuildings |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Kerry Dorius | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Key Employee | Relationship |
| Description Of Transaction | Sale of assets | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | L4 | Identifier |
| Return Reference | 990 Schedule L Placeholder 4 | ReturnReference |
| Explanation | Business Transactions Asset Acquisition Statement under section 1060 Purchaser: Girdwood Health Clinic, Inc Seller: Kerry L Dorius Date of Sale: 12-22-2011 Total sales Price: 135,500 Allocation of Sales Price: Class V assets: 57,000 Class VI and VII assets:78,500 A written agreement was signed by both parties which provided for an allocation of the sales price. This sale was done on an installment basis. Payments began in 2012. The remaining balance of the loan at 12-31-12 was $127,480. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| O01 | Form 990 governing body review Part VI line 11 | The Board of Directors recieved a copy of the return, have reviewed and approved the Form 990 in their regular board meeting prior to filing. |
| O02 | Conflict of interest policy compliance Part VI line 12c | The conflict of interest policy is included in the by-laws of the organization. The policy is enforced thru self-monoritoring and is reviewed and discussed regularly at board meetings. |
| O03 | Governing documents etc available to public Part VI line 19 | The organization makes its governing documents, conflict of interest policy and financial statements available to the public by request. |
Comments