PRIMARY CARE OF SOUTHWEST GEORGIA: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
PRIMARY CARE OF SOUTHWEST GEORGIA (EIN 31-1840668)
Tax period
2010-12-01 to 2011-11-30
Filed
2012-04-10
IRS object ID
201201019349300510
Schema version
2010v3.2
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)
Timestamp2012-04-10T11:43:51-07:00Timestamp
Tax Period End Date2011-11-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DENMARK AND BROWN PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1123 N MAIN STAddressLine1
CitySTATESBOROCity
StateGAState
ZIP Code304585700ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-12-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN311840668EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PRIMARY CARE OF SOUTHWEST GEORGIA INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPRIMNameControl
Phone2297232660Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1360 COLLEGE STAddressLine1
CityBLAKELYCity
StateGAState
ZIP Code39823ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEDWIN JAMESName
TitleCFOTitle
Date Signed2012-04-10DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameFRANK DENMARK CPAName
Phone9127644123Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts3071949GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.pcswga.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2005YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionMEDICAL CAREActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees33TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1515363ContributionsGrantsPriorYear
Contributions Grants Current Year1498638ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1351252ProgramServiceRevenuePriorYear
Program Service Revenue CY1511188ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year50215OtherRevenuePriorYear
Other Revenue Current Year62123OtherRevenueCurrentYear
Total Revenue Prior Year2916830TotalRevenuePriorYear
Total Revenue Current Year3071949TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1826321SalariesEtcPriorYear
Salaries Etc Current Year1945840SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year852522OtherExpensePriorYear
Other Expenses Current Year903868OtherExpensesCurrentYear
Total Expenses Prior Year2678843TotalExpensesPriorYear
Total Expenses Current Year2849708TotalExpensesCurrentYear
Revenues Less Expenses Prior Year237987RevenuesLessExpensesPriorYear
Revenues Less Expenses CY222241RevenuesLessExpensesCY
Total Assets BOY760357TotalAssetsBOY
Total Assets EOY965114TotalAssetsEOY
Total Liabilities BOY181607TotalLiabilitiesBOY
Total Liabilities EOY164123TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY578750NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY800991NetAssetsOrFundBalancesEOY
Mission DescriptionMEDICAL CAREMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1820504Expense
DescriptionTHE CLINIC PROVIDES MEDICAL CARE TO THE UNDERSERVED CHILDREN AND ADULTS OF EARLY COUNTY.Description
Total Program Service Expense1820504TotalProgramServiceExpense
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 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To 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 RequiredfalseScheduleORequired
Number Forms Transmitted With10969NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees33NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
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
Form720 FiledfalseForm720Filed
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 BodyfalseMinutesOfGoverningBody
Minutes Of CommitteesfalseMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
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
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonPRIMARY CARE OF SOUTHWEST GANamePerson
Telephone Number2297232660TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1360 COLLEGE STAddressLine1
CityBLAKELYCity
StateGAState
ZIP Code39823ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeKey EmployeeKeyEmployee
WAYNE LAWSON
MEMBER5.00X000
WALLACE O'NEAL
VICE CHAIRMAN5.00000X
REGINA BARRON
MEMBER5.00X000
NORMA HARRIS GREAT
MEMBER5.00X000
MATTIE GRIMES
MEMBER5.00X000
KEVIN TAYLOR
MEMBER5.00X000
KATHERYN MITCHELL
MEMBER5.00X000
JOAN SIMPSON
MEMBER5.00X000
JACK WATSON
MEMBER5.00X000
GREGORY DODSON
PA45.0010964002244X
FRED DANIELS
MEMBER5.00X000
EDWIN JAMES
CFO50.008640504301X
DR LUIS MURRAIN
MEDICAL DIRECTOR50.0023556403413X
DR JOAN M WORTHINGTON
PHYSICIAN36.0010882202700X
DR CATHERINE PETERS-JAMES
PHYSICIAN40.0019500000X
DR BRENDA A ADDISON
CEO50.0013425709870X
CAROLYN WASHINGTON
MEMBER5.00X000
BUCK GRIST
Chairman5.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org869688TotalReportableCompFromOrg
Total Other Compensation22528TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
STATE HEALTH INSURANCE
PO BOX 931550ATLANTAGA31193INSURANCE190364
MCKESSON
PO BOX 740215CINCINNATIOH45274MEDICAL SUPPLIES62874
JOHN D ARCHBOLD
PO BOX 1018THOMASVILLEGA31799LEASE59352
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants827089GovernmentGrants
All Other Contributions671549AllOtherContributions
Noncash Contributions74392NoncashContributions
Total Contributions1498638TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENUE14599861459986
MANAGEMENT FEE INCOME5120251202
FieldValueIRS element (for citing)
Total Program Service Revenue1511188TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

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 (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RENT2400024000
OTHER INCOME3549235492
INTEREST INCOME26312631
FieldValueIRS element (for citing)
Total Other Revenue62123TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3071949TotalRevenueColumn
Related Or Exempt Function Income1573311RelatedOrExemptFunctionIncome

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)
Total283364Total
Management And General283364ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1301959Total
Program Services1066405ProgramServices
Management And General235554ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total360517Total
Program Services241226ProgramServices
Management And General119291ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

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)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total11576Total
Management And General11576ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total14412Total
Management And General14412ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total65016Total
Program Services32508ProgramServices
Management And General32508ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total108908Total
Program Services81681ProgramServices
Management And General27227ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total76929Total
Program Services36793ProgramServices
Management And General40136ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total70038Total
Management And General70038ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total45428Total
Program Services39594ProgramServices
Management And General5834ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
TELEPHONE AND COMMUNICATIONS43515870334812
MISCELLANEOUS3697536975
MEDICAL SUPPLIES125342125342
MEDICAL AND DENTAL CONTRACTS7519375193
CONSULTING & PROFESSIONAL1308087900151807

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total99728Total
Program Services34058ProgramServices
Management And General65670ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2849708Total
Program Services1820504ProgramServices
Management And General1029204ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY130080BOY
EOY332292EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY142112BOY
EOY168627EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY96216BOY
EOY76785EOY

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)
BOY3969BOY
EOY8435EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis592308LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec223357LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY385979BOY
EOY368951EOY

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)
BOY2001BOY
EOY10024EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY760357BOY
EOY965114EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY166771BOY
EOY156192EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY5610BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY9226BOY
EOY7931EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY181607BOY
EOY164123EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY578750BOY
EOY800991EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY578750BOY
EOY800991EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY760357BOY
EOY965114EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses222241ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteefalseAuditCommittee
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 Years856876CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1219308CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1292975CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1515363CurrentTaxYearMinus1Year
Current Tax Year1498638CurrentTaxYear
Total6383160Total

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 Years856876CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1219308CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1292975CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1515363CurrentTaxYearMinus1Year
Current Tax Year1498638CurrentTaxYear
Total6383160Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total1706383160PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years42236CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years112720CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years98326CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year104455CurrentTaxYearMinus1Year
Current Tax Year113325CurrentTaxYear
Total471062Total
FieldValueIRS element (for citing)
Total Support6854222TotalSupport
Gross Receipts From Admissions Etc5078155GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.93130PublicSupportPertcentage170
Public Support Pertcent Prior Year0.93730PublicSupportPertcentPriorYear
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

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis203946OtherCostOrOtherBasis
Depreciation19723Depreciation
Book Value184223BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis25019OtherCostOrOtherBasis
Depreciation20015Depreciation
Book Value5004BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis363343OtherCostOrOtherBasis
Depreciation183619Depreciation
Book Value179724BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings368951TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Rounding$1
LEASE PAYABLE$7,930
FieldValueIRS element (for citing)
Total Of Amounts7931TotalOfAmounts

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
DR LUIS MURRAIN
2355643413238977
DR CATHERINE PETERS-JAMES
195000195000

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableNo documents available to the public.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesTHE HEALTH CENTER UTILIZES COMPARABLE COMPENSATION DATA FROM THE NACHC SALARY SURVEY AS WELL AS THE GAPHC SALARY SURVEY.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsEVERY YEAR, DURING THE ANNUAL BOARD STRATEGIC MEETING, THE BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessREVIEWED BY CEO & CFO & PRESENTED TO BOARD OF DIRECTORS BEFORE FILING.

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