PCC COMMUNITY WELLNESS CENTER: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
PCC COMMUNITY WELLNESS CENTER (EIN 36-3828320)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-02-26
IRS object ID
201340579349300759
Schema version
2011v1.5
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)
Timestamp2013-02-26T10:44:58-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MITCHELL & TITUS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE BATTERY PARK PLAZAAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN363828320EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PCC COMMUNITY WELLNESS CENTERBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% ROBERT URSOInCareOfName
Name ControlPCCCNameControl
Phone7083830113Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line114 WEST LAKE STREETAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60302ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRobert UrsoName
TitlePresident and C.E.O.Title
Date Signed2013-02-25DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKEVIN FULLERName
Phone2127094500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonROBERT URSONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line114 WEST LAKE STREETAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60302ZIPCode
FieldValueIRS element (for citing)
Gross Receipts25356666GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PCCWELLNESS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1980YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTO PROMOTE HEALTH CARE SERVICE PROGRAMS AND COMMUNITY HEALTH CENTERS FOR THE MEDICALLY UNDERSERVED LIVING IN CHICAGO'S WESTSIDE COMMUNITIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees366TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year7674394ContributionsGrantsPriorYear
Contributions Grants Current Year6040675ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16518235ProgramServiceRevenuePriorYear
Program Service Revenue CY18067234ProgramServiceRevenueCY
Investment Income Prior Year56090InvestmentIncomePriorYear
Investment Income Current Year47677InvestmentIncomeCurrentYear
Other Revenue Prior Year145004OtherRevenuePriorYear
Other Revenue Current Year1163978OtherRevenueCurrentYear
Total Revenue Prior Year24393723TotalRevenuePriorYear
Total Revenue Current Year25319564TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year15531912SalariesEtcPriorYear
Salaries Etc Current Year16108182SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year37102TotalFundrsngExpCurrentYear
Other Expense Prior Year6326020OtherExpensePriorYear
Other Expenses Current Year6958668OtherExpensesCurrentYear
Total Expenses Prior Year21857932TotalExpensesPriorYear
Total Expenses Current Year23066850TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2535791RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2252714RevenuesLessExpensesCY
Total Assets BOY24320749TotalAssetsBOY
Total Assets EOY30989004TotalAssetsEOY
Total Liabilities BOY9616171TotalLiabilitiesBOY
Total Liabilities EOY14031712TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY14704578NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY16957292NetAssetsOrFundBalancesEOY
Mission DescriptionThe mission of PCC Community Wellness Center is to improve health outcomes for the medically underserved community through the provision of high quality, affordable, and accessible primary health care and support services. We are committed to serving the needs of men, women, and children in all lifecycles, while we continue to specialize in the delivery of comprehensive maternal and child health services to address this unmet need in our community.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense18321967Expense
Revenue18067234Revenue
DescriptionPCC provides health care services to the community. PCC health care services include: Pediatric and adolescent health care that includes well-child exams, immunizations, sick infant/child exams, school and sports physicals, and lead screenings; Women's health care (OB/GYN) that includes maternity care and delivery, Pap smears, and breast cancer screenings; Adult health care; Senior health care; Diagnosis and treatment of illness; Disease screening and prevention; Family planning (Birth control); Management of chronic illnesses such as asthma, diabetes, and high blood pressure; HIV testing, counseling, and primary care; and dental care and referral.Description
Total Program Service Expense18321967TotalProgramServiceExpense
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 StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109620NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees366NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business 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
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonROBERT URSONamePerson
Telephone Number7083830113TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line114 WEST LAKE STREETAddressLine1
CityOAK PARKCity
StateILState
ZIP Code60302ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Ronald Austin
Chairperson2.0XX000
Carolyn Fitzpatrick MD
Vice Chairperson2.0XX000
Kenneth Blair MD
Treasurer2.0XX000
Melinda Malecki
Secretary2.0XX000
Amanda Canedo
Director2.0X000
Barbara Diggins
Director2.0X000
John M McDonnell
Director2.0X000
Patricia Ford
Director2.0X000
Rhonda Stuart
Director2.0X000
Shawnda Steet
Director2.0X000
Teresa Reyes
Director2.0X000
Barbara Vanek
Director2.0X000
Robert J Urso
President and Chief Executive40.0X23960403511
Paul Luning MD
Chief Medical Officer40.0X21971406219
Lynn Hopkins
Chief Operating Officer40.0X1093960139
Yam-Shun Tong
OB/GYN Physician40.03883490139X
Maureen Ruder
OB/GYN Physician40.021533704675X
Bertha Lopez
OB/GYN Physician40.02191530456X
Karole A Lakota
Family Practice Physician40.020544504173X
Thomas J Staff
Family Practice Physician40.017662104259X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1773619TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation23571TotalOtherCompensation
Number Individuals GT100 K39NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Humana Insurance Company
PO Box 533CAROL STREAMIL60132Health Insurance1139728
Global Insight Solutions
2010 N Harlem AvenueELMWOOD PARKIL60707Billing Services561185
Cardinal Health Med Products Ser
PO Box 70539CHICAGOIL60673Medcial Supplies337620
Norwegian American Hospital
1044 N FranciscoCHICAGOIL60622Hospital/ Healthcare334855
Henry Schein
135 Duryea RoadMELVILLENY11747Medcial Supplies292143
FieldValueIRS element (for citing)
Number Of Contractors GT100 K18NumberOfContractorsGT100K
Fundraising Events44082FundraisingEvents
Government Grants4829364GovernmentGrants
All Other Contributions1167229AllOtherContributions
Total Contributions6040675TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICES REVENUE6241001694499916944999
OTHER SERVICE REVENUE624100887160887160
GRANT REVENUE - WEST SUBURBAN HOSPITAL623000235075235075
FieldValueIRS element (for citing)
Total Program Service Revenue18067234TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column47677TotalRevenueColumn
Exclusion$47,677ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real14783Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real14783Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column14783TotalRevenueColumn
Exclusion$14,783ExclusionAmount

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events14365GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events44082CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses37102FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-22737TotalRevenueColumn
Exclusion-$22,737ExclusionAmount

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 (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEANINGFUL USE INCENTIVE PAYMENT (CMS)900099871250871250
MEDICARE SETTLEMENT PAYMENT9000999311393113
MEMI BONUS PAYMENT (HEALTHCARE FAMILY SERVICES)9000996456064560

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column143009TotalRevenueColumn
Related Or Exempt Function Income143009RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1171932TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column25319564TotalRevenueColumn
Related Or Exempt Function Income19239166RelatedOrExemptFunctionIncome
Exclusion$39,723ExclusionAmount

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)
Total605834Total
Program Services227446ProgramServices
Management And General378388ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total13341715Total
Program Services11247005ProgramServices
Management And General2094710ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1094701Total
Program Services769450ProgramServices
Management And General325251ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1065932Total
Program Services880996ProgramServices
Management And General184936ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total63726Total
Management And General63726ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total278892Total
Management And General278892ManagementAndGeneral

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)
Total2426070Total
Program Services1823759ProgramServices
Management And General602311ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1242975Total
Program Services1085866ProgramServices
Management And General152919ManagementAndGeneral
Fundraising4190Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total592733Total
Program Services578791ProgramServices
Management And General13942ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total122127Total
Program Services89421ProgramServices
Management And General32706ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total62042Total
Program Services12269ProgramServices
Management And General49773ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total131793Total
Program Services35769ProgramServices
Management And General96024ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total734208Total
Program Services536781ProgramServices
Management And General197427ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total52220Total
Management And General52220ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
CONTRACTUAL SERVICES1485541018341380832912
BAD DEBTS500599500599
STIPENDS222906222906
MAINTENANCE&SUPPORT LICENSES131877131877

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total247946Total
Program Services209075ProgramServices
Management And General38871ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23066850Total
Program Services18321967ProgramServices
Management And General4707781ManagementAndGeneral
Fundraising37102Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4530358BOY
EOY5336871EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY1195709EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1058997BOY
EOY1429188EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2239291BOY
EOY3031660EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY4687800BOY
EOY4752307EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY32165BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY167184BOY
EOY273404EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis18359537LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3576217LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11395769BOY
EOY14783320EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY209185BOY
EOY186545EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY24320749BOY
EOY30989004EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY579739BOY
EOY605173EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY152962BOY
EOY2202747EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY7439014BOY
EOY9721257EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1444456BOY
EOY1502535EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9616171BOY
EOY14031712EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY13262478BOY
EOY12567198EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1442100BOY
EOY4390094EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14704578BOY
EOY16957292EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY24320749BOY
EOY30989004EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2252714ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

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

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis519000OtherCostOrOtherBasis
Book Value519000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10232806OtherCostOrOtherBasis
Depreciation473276Depreciation
Book Value9759530BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1866584OtherCostOrOtherBasis
Depreciation1355903Depreciation
Book Value510681BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2875424OtherCostOrOtherBasis
Depreciation1747038Depreciation
Book Value1128386BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2865723OtherCostOrOtherBasis
Book Value2865723BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings14783320TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED PAYROLL AND PAYROLL TAXES$786,541
INTEREST PAYABLE$47,004
ACCRUED VACATION$668,990
FieldValueIRS element (for citing)
Total Of Amounts1502535TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierUncertain Tax PositionsIdentifier
ExplanationThe Organization adopted the requirements in Financial Accounting Standards Board (FASB) Accounting Standards Update (ASU) 2009-06 regarding uncertain tax positions. ASU 2009-06 defines how uncertain tax positions should be recognized, measured, presented, and disclosed in the financial statements. The authoritative guidance requires entities to recognize a tax benefit from an uncertain tax position only if it is more-likely-than-not that the position is sustainable based solely on its technical merits and consideration of the relevant taxing authoritys widely understood administrative practices and precedents. The Organization evaluated its tax positions taken or expected to be taken to determine whether the tax positions are more-likely-than-not to be sustained by the applicable taxing authority, and has determined that it currently does not have any uncertain tax positions. The Organizations management believes that the Organization is no longer subject to income tax examinations for the years prior to 2009.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GALANameOfEvent1
Gross Receipts Event158447GrossReceiptsEvent1
Charitable Contributions Event144082CharitableContributionsEvent1
Gross Revenue Event114365GrossRevenueEvent1
Cash Prizes Event1505CashPrizesEvent1
Non Cash Prizes Event11594NonCashPrizesEvent1
Rent Facility Costs Event12900RentFacilityCostsEvent1
Food And Beverage Event118358FoodAndBeverageEvent1
Entertainment Event16150EntertainmentEvent1
Other Direct Expenses Event17595OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total58447GrossReceiptsTotal
Charitable Contributions Total44082CharitableContributionsTotal
Gross Revenue Total Events14365GrossRevenueTotalEvents
Cash Prizes Total Events505CashPrizesTotalEvents
Non Cash Prizes Total Events1594NonCashPrizesTotalEvents
Rent Facility Costs Total Events2900RentFacilityCostsTotalEvents
Food And Beverage Total Events18358FoodAndBeverageTotalEvents
Entertainment Total Events6150EntertainmentTotalEvents
Other Direct Expenses Total Events7595OtherDirectExpensesTotalEvents
Direct Expense Summary Events37102DirectExpenseSummaryEvents
Net Income Summary-22737NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
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

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Robert J Urso
2197580160000384600035110243115000
Paul Luning MD
1937810160000993300062190225933000
Yam-Shun Tong
2298690001584800001390388488000
Maureen Ruder
21100105760376000046750220012000
Bertha Lopez
21521802735012000004560219609000
Karole A Lakota
14383501660404500600041730209618000
Thomas J Staff
1455690775802329400042590180880000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Line 12cAll transactions and processes are reviewed and monitored through policy, executive management, and ratified by the voting members of the board, if necessary.
Form 990, Part VI, Line 15a + 15bThe process of determining compensation for the CEO and other key officers of the organization is done through a review and approval process via the governing body, and subject to ratification of the board.
Form 990, Part VI, Line 19Governing documents, conflict of interest policy statements, and financial statements are made available upon request.
Form 990, Schedule HSince PCC Community Wellness Center does not operate at least one facility that is, or is required to be, licensed, registered, or similarly recognized by a state as a hospital, there is no need to attach schedule H with this form.
Form 990, Part VI, Line 11The Finance Manager and CFO complete the Form 990 information request for a CPA firm to prepare return, and review draft for approval before filing.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1PCC Qalicb LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line114 W LAKE STREETAddressLine1
CityOAK PARKCity
StateILState
ZIP Code60302ZIPCode
FieldValueIRS element (for citing)
EIN273160926EIN
Primary ActivitiesSee Part VIIPrimaryActivities
Legal Domicile StateILLegalDomicileState
Total Income333151TotalIncome
EOY Assets6496136EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1See Part VIIBusinessNameLine1

Form990 Schedule R Part VII Form990ScheduleRPartVII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PCC QALICB, LLCForm 990, Schedule R, Part I, Column (b)Primary activity: To serve as the Qualified Active Low-Income Community Business that provides charitable activities in the distressed community.
PCC QALICB, LLCForm 990, Schedule R, Part I, Column (f)Direct controlling entity: PCC Community Wellness Center.

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