FURP.ORG / PUBLIC DATA EXPLORER

COMMUNITY HEALTH SERVICE AGENCY INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH SERVICE AGENCY INC (EIN 75-1528614)
Tax period
2012-02-01 to 2013-01-31
Filed
2013-12-13
IRS object ID
201333479349300838
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)
Timestamp2013-12-13T14:31:26-08:00Timestamp
Tax Period End Date2013-01-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ScottSingletonFincher & CoBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14815 King Street Suite AAddressLine1
CityGreenvilleCity
StateTXState
ZIP Code75401ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-02-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN751528614EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH SERVICE AGENCY INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone9034555986Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 1908AddressLine1
CityGREENVILLECity
StateTXState
ZIP Code75403ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCAROL ARRINGTONName
TitleCFOTitle
Date Signed2013-12-13DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHannah C NelsonName
PTINP00448733PTIN
Phone9034554765Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11660 GENA DRAddressLine1
CitySULPHER SPRINGSCity
StateTXState
ZIP Code75482ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8537913GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.completemedicalhome.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1976YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionTo provide community oriented primary health care, including, medical & dental care, education, and social services to the residents of Hunt, Fannin, Kaufman, Delta, and Collin counties, with a particular emphasis on those individuals and families that have difficulty accessing health care services because of financial, language, and/or cultural barriers.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees164TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year4479416ContributionsGrantsPriorYear
Contributions Grants Current Year3648686ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5461976ProgramServiceRevenuePriorYear
Program Service Revenue CY4858723ProgramServiceRevenueCY
Investment Income Prior Year5298InvestmentIncomePriorYear
Investment Income Current Year3738InvestmentIncomeCurrentYear
Other Revenue Current Year26766OtherRevenueCurrentYear
Total Revenue Prior Year9946690TotalRevenuePriorYear
Total Revenue Current Year8537913TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5874135SalariesEtcPriorYear
Salaries Etc Current Year5647110SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3766383OtherExpensePriorYear
Other Expenses Current Year2998262OtherExpensesCurrentYear
Total Expenses Prior Year9640518TotalExpensesPriorYear
Total Expenses Current Year8645372TotalExpensesCurrentYear
Revenues Less Expenses Prior Year306172RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-107459RevenuesLessExpensesCY
Total Assets BOY6051588TotalAssetsBOY
Total Assets EOY6001969TotalAssetsEOY
Total Liabilities BOY2344558TotalLiabilitiesBOY
Total Liabilities EOY2402398TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3707030NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3599571NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide community oriented primary health care, including, medical & dental care, education, and social services to the residents of Hunt, Fannin, Kaufman, Delta, and Collin counties, with a particular emphasis on those individuals and families that have difficulty accessing health care services because of financial, language, and/or cultural barriers.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense6673577Expense
Revenue4885489Revenue
DescriptionThe organization provided general health and family planning services to its service area. During the year the Agency provided over 65,000 patient encounters under the Section 330 grant, Medicaid and Medicare.Description
Total Program Service Expense6673577TotalProgramServiceExpense
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 LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
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 OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
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 ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109648NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees164NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
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 BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCAROL ARRINGTONNamePerson
Telephone Number9034555986TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14500 WESLEY STREETAddressLine1
CityGREENVILLECity
StateTXState
ZIP Code75403ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
KEITH WINTERS
Chairman2.000.00X000
JAMES BARR PHD
Director2.000.00X000
STAN MCKEE
Director2.000.00X000
TIFFANY WILLIS
Director2.000.00X000
SHANNON REIMER
Director2.000.00X000
BRENDA SUE GREGG
Treasurer2.000.00X000
PAUL PAINTER
Secretary2.000.00X000
NONA JORDAN
Chairman2.000.00X000
MICHELLE CARTER
CEO40.000.008485708206X
DAN SHEPHERD
CEO40.000.0016199609688X
CAROL ARRINGTON
CFO40.000.006028501892X
RONALD PERON MD
MEDICAL DIRECTOR40.000.0011831106463X
ANN MARIE LEDLEY OB
PHYSICIAN40.000.00212844010906X
RIZWANA KHAN MD
PHYSICIAN40.000.0014850005188X
PRETI LEMO MD
PHYSICIAN40.000.0015506308125X
JACK LEWIS
DENTIST40.000.0011472309075X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1056579TotalReportableCompFromOrg
Total Other Compensation59543TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LABCORPBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1P O BOX 12140AddressLine1
CityBURLINGTONCity
StateNCState
ZIP Code27216ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesLABORATORY SRVCSDescriptionOfServices
Compensation250201Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants3341155GovernmentGrants
All Other Contributions307531AllOtherContributions
Noncash Contributions138516NoncashContributions
Total Contributions3648686TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PRIVATE PATIENT FEES21536752153675
MEDICARE/MEDICAID27050482705048
FieldValueIRS element (for citing)
Total Program Service Revenue4858723TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3738TotalRevenueColumn
Exclusion$3,738ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLAENOUS INCOMEDescription
Total Revenue Column26766TotalRevenueColumn
Related Or Exempt Function Income26766RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue26766TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8537913TotalRevenueColumn
Related Or Exempt Function Income4885489RelatedOrExemptFunctionIncome
Exclusion$3,738ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total451698Total
Program Services70570ProgramServices
Management And General381128ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4194604Total
Program Services3448445ProgramServices
Management And General746159ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total32352Total
Program Services24588ProgramServices
Management And General7764ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total593832Total
Program Services460371ProgramServices
Management And General133461ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total374624Total
Program Services284714ProgramServices
Management And General89910ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total10912Total
Program Services9019ProgramServices
Management And General1893ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total26075Total
Management And General26075ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total608949Total
Program Services596239ProgramServices
Management And General12710ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total8524Total
Program Services7544ProgramServices
Management And General980ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total806667Total
Program Services693443ProgramServices
Management And General113224ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total174553Total
Program Services112598ProgramServices
Management And General61955ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total378103Total
Program Services263908ProgramServices
Management And General114195ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total90005Total
Program Services13478ProgramServices
Management And General76527ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total35373Total
Program Services13266ProgramServices
Management And General22107ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total397445Total
Program Services283284ProgramServices
Management And General114161ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEMBERSHIPS40617454536072
RECRUITMENT & TRAINING588683089627972
DONATED PHARMACY138516138516
BAD DEBT PROVISION193925193925

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total29730Total
Program Services24228ProgramServices
Management And General5502ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8645372Total
Program Services6673577ProgramServices
Management And General1971795ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY133402BOY
EOY232830EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY951715BOY
EOY1055703EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY371968BOY
EOY333738EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY47924BOY
EOY54295EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7228524LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2903121LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4546579BOY
EOY4325403EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6051588BOY
EOY6001969EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY495892BOY
EOY789019EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY209314BOY
EOY103941EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1568035BOY
EOY1453739EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY71317BOY
EOY55699EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2344558BOY
EOY2402398EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3687626BOY
EOY3570590EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY19404BOY
EOY28981EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3707030BOY
EOY3599571EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6051588BOY
EOY6001969EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-107459ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2961541CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3372022CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3655853CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4479416CurrentTaxYearMinus1Year
Current Tax Year3648686CurrentTaxYear
Total18117518Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2961541CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3372022CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3655853CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4479416CurrentTaxYearMinus1Year
Current Tax Year3648686CurrentTaxYear
Total18117518Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total17018117518PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years29222CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years15311CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8048CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5298CurrentTaxYearMinus1Year
Current Tax Year3738CurrentTaxYear
Total61617Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years8463CurrentTaxYearMinus3Years
Current Tax Year26766CurrentTaxYear
Total35229Total
FieldValueIRS element (for citing)
Total Support18214364TotalSupport
Public Support Pertcentage1700.99470PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99170PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis237668OtherCostOrOtherBasis
Book Value237668BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4337850OtherCostOrOtherBasis
Depreciation956661Depreciation
Book Value3381189BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2173371OtherCostOrOtherBasis
Depreciation1626796Depreciation
Book Value546575BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis479635OtherCostOrOtherBasis
Depreciation319664Depreciation
Book Value159971BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4325403TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCAPITAL LEASES PAYABLEDescription
Amount$55,699Amount
FieldValueIRS element (for citing)
Total Of Amounts55699TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt8537913TotRevenueEtcAuditedFinclStmt
Revenue Subtotal8537913RevenueSubtotal
Total Revenue Per Form9908537913TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8645372TotExpensesEtcAuditedFinclStmt
Expenses Subtotal8645372ExpensesSubtotal
Total Expenses Per Form9908645372TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierPart XIdentifier
Return ReferencePart X : FIN48 FootnoteReturnReference
ExplanationTHE AGENCY ADOPTED THE PROVISIONS OF FASB ASC TOPIC 740-10, INCOME TAXES (PREVIOUSLY KNOW AS FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES). MANAGEMENT BELIEVES IT HAS NO UNCERTAIN TAX POSITIONS, AND ACCORDINGLY THERE IS NO LIABILITY RECORDED FOR UNRECOGNIZED TAX BENEFITS AT JANUARY 31, 2013 AND 2012.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrg
RIZWANA KHAN MD
PHYSICIAN1485005188153688
PRETI LEMO MD
PHYSICIAN15506357251631882400
DAN SHEPHERD
CEO16199657251716843963
ANN MARIE LEDLEY OB
PHYSICIAN21284457252237505181

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions2NumberOfContributions
Noncash Contribs Rptd F990138516NoncashContribsRptdF990
Method Of Determining RevenuesFAIR MKT VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableTHE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesSALARY COMPARISONS FOR KEY EMPLOYEES ARE COMPARED TO LOCAL SERVICE AREA PAY RATES IN ORDER TO REMAIN COMPETITIVE. KEY EMPLOYEES' COMPENSATION IS DETERMINED BY THE CEO AND REVIEWED WITH THE BOARD OF DIRECTORS.
Form 990, Part VI, Line 15aForm 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top ManagementCOMPENSATION FOR KEY MANAGEMENT, INCLUDING THE CEO AND CFO, IS COMPARED TO REGIONAL & STATE SALARY SURVEYS BASED ON BUDGET, ANNUAL ENCOUNTERS, AND YEARS OF SERVICE. THIS SALARY SURVEY IS SPECIFIC TO COMMUNITY HEALTH CENTERS. SALARY COMPARISONS FOR KEY EMPLOYEES ARE ALSO COMPARED TO LOCAL SERVICE AREA PAY RATES IN ORDER TO REMAIN COMPETITIVE. THE CEO'S COMPENSATION PACKAGE IS DETERMINED, REVIEWED, AND APPROVED BY THE BOARD OF DIRECTORS. ALL OTHER KEY EMPLOYEES' COMPENSATION IS DETERMINED BY THE CEO AND REVIEWED WITH THE BOARD OF DIRECTORS.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsTHIS POLICY IS PART OF A CODE OF CONDUCT THAT ALL EMPLOYEES AND THE BOARD OF DIRECTORS SIGN. IT IS ALSO PART OF THE BYLAWS OF THE AGENCY AND INCLUDED IN THE BOARD OF DIRECTORS ORIENTATION. THIS POLICY IS REVIEWED AT ANNUAL BOARD TRAININGS.
Form 990, Part VI, Line 11bForm 990, Part VI, Line 11b: Form 990 Review ProcessTHE CEO AND CFO OF THE AGENCY WILL PARTICIPATE IN COMPLETING THE FORM 990 AS WELL AS REVIEWING THE 990 BEFORE SUBMISSION. THE AGENCY'S CFO WILL REVIEW THE FORM 990 WITH THE BOARD OF DIRECTORS BEFORE SUBMISSION.