NORTHERN HEALTH CENTERS INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN HEALTH CENTERS INC (EIN 39-1550213)
- Tax period
- 2011-02-01 to 2012-01-31
- Filed
- 2012-09-13
- IRS object ID
- 201202579349300910
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-09-13T13:38:35-05:00 | Timestamp |
| Tax Period End Date | 2012-01-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 43A W DAVENPORT ST | AddressLine1 |
| City | RHINELANDER | City |
| State | WI | State |
| ZIP Code | 54501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-02-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391550213 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN HEALTH CENTERS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 7152766321 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 179 | AddressLine1 |
| City | LAKEWOOD | City |
| State | WI | State |
| ZIP Code | 54138 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHELLE WHITE | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 7152766321 | Phone |
| Date Signed | 2012-09-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RANDALL H BEARD CPA | Name |
| PTIN | P00023289 | PTIN |
| Phone | 7153691040 | Phone |
| Date Prepared | 2012-09-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHELLE WHITE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 179 | AddressLine1 |
| City | LAKEWOOD | City |
| State | WI | State |
| ZIP Code | 54138 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3643939 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NHCMEDDEN.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1986 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE OUR COMMUNITY HEALTH BY PROVIDING ALL PERSONS A COMPREHENSIVE PROGRAM OF QUALITY FAMILY ORIENTED PRIMARY HEALTH CARE SERVICES REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 59 | TotalNbrEmployees |
| Total Nbr Volunteers | 15 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1168946 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 770457 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 2500628 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2860208 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 502 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 43396 | OtherRevenuePriorYear |
| Other Revenue Current Year | 8820 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3713472 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3639485 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2112597 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2300923 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1104952 | OtherExpensePriorYear |
| Other Expenses Current Year | 1239879 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3217549 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3540802 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 495923 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 98683 | RevenuesLessExpensesCY |
| Total Assets BOY | 2806806 | TotalAssetsBOY |
| Total Assets EOY | 2646157 | TotalAssetsEOY |
| Total Liabilities BOY | 1053116 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 793784 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1753690 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1852373 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO IMPROVE OUR COMMUNITY HEALTH BY PROVIDING ALL PERSONS A COMPREHENSIVE PROGRAM OF QUALITY FAMILY ORIENTED PRIMARY HEALTH CARE SERVICES REGARDLESS OF THEIR ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2609516 | Expense |
| Revenue | 2827073 | Revenue |
| Description | NORTHERN HEALTH CENTERS, INC. IS A FEDERALLY QUALIFIED HEALTH CENTER LOCATED IN NORTHEAST WISCONSIN. WE ARE A COMMUNITY HEALTH CENTER SERVING A MEDICALLY UNDERSERVED POPULATION WITHIN A FIVE COUNTY RADIUS. THE SERVICES PROVIDED TO OUR PATIENT POPULATION ARE MEDICAL, DENTAL, BEHAVIORAL HEALTH CARE AND ENABLING SERVICES. NHC CONTINUES TO PROVIDE PREVENTIVE DENTAL SERVICES TO THE UNDERSERVED CHILDREN THROUGH OUR SEAL-A-SMILE PROGRAM WHICH WAS IMPLEMENTED IN 2010; WE HAVE INCREASED THE NUMBER OF SCHOOLS WE PROVIDE SEALANTS TO FROM 15 TO 24 SCHOOLS IN THREE COUNTIES. | Description |
| Total Program Service Expense | 2609516 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 59 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAURAL WALDVOGEL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7152766321 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15397 HWY 32 | AddressLine1 |
| City | LAKEWOOD | City |
| State | WI | State |
| ZIP Code | 54138 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| TED BARTELS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BETTY MACINTOSH | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| GARY DONALDSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BETH HARTMAN | |||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | X | |
| MIKE HESS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DEBBIE KRUGER | |||||||
| SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | X | |
| CHRIS BERRY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| PAAL HANSEN | |||||||
| VICE PRESIDENT | 1.00 | X | 0 | 0 | 0 | X | |
| GAIL NELSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DICK KENDALL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ANN KROLL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LAURA WALDVOGEL | |||||||
| EXECUTIVE DIRECTOR | 41.00 | 105167 | 0 | 0 | X | ||
| TED JUNG | |||||||
| DENTIST | 40.00 | 121289 | 0 | 0 | X | ||
| LANCE ORLINSKI | |||||||
| DENTIST | 40.00 | 101700 | 0 | 0 | X | ||
| JOE WINEGAR | |||||||
| DENTIST | 40.00 | 103856 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 432012 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WPS INSURANCE | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1717 W BROADWAY | AddressLine1 |
| City | MADISON | City |
| State | WI | State |
| ZIP Code | 53708 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | HEALTH INSURANCE FOR EMPLOYEES | DescriptionOfServices |
| Compensation | 135960 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 693826 | GovernmentGrants |
| All Other Contributions | 76631 | AllOtherContributions |
| Total Contributions | 770457 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICAL & DENTAL SERVI | 621110 | 1591777 | 1591777 |
| FQHC REIMBURSEMENTS | 621110 | 1235296 | 1235296 |
| SCHOOL NURSE OUTSOURCI | 621399 | 33135 | 33135 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2860208 | TotalProgramServiceRevenue |
| Gross Income Fundraising Events | 13274 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 4454 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8820 | TotalRevenueColumn |
| Exclusion | $8,820 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3639485 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2860208 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $8,820 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1939309 | Total |
| Program Services | 1442052 | ProgramServices |
| Management And General | 497257 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 361614 | Total |
| Program Services | 261522 | ProgramServices |
| Management And General | 100092 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37908 | Total |
| Program Services | 6591 | ProgramServices |
| Management And General | 31317 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 474807 | Total |
| Program Services | 352724 | ProgramServices |
| Management And General | 122083 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33647 | Total |
| Management And General | 33647 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30374 | Total |
| Program Services | 4686 | ProgramServices |
| Management And General | 25688 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24463 | Total |
| Program Services | 22017 | ProgramServices |
| Management And General | 2446 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28116 | Total |
| Program Services | 17309 | ProgramServices |
| Management And General | 10807 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25310 | Total |
| Management And General | 25310 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111503 | Total |
| Program Services | 100353 | ProgramServices |
| Management And General | 11150 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32346 | Total |
| Management And General | 32346 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL & DENTAL SUPPLI | 187956 | 187956 | |
| BAD DEBT EXPENSE | 98648 | 98648 | |
| REPAIRS AND MAINTENANCE | 54705 | 54521 | 184 |
| SMALL EQUIPMENT PURCHAS | 48768 | 29505 | 19263 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51328 | Total |
| Program Services | 31632 | ProgramServices |
| Management And General | 19696 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3540802 | Total |
| Program Services | 2609516 | ProgramServices |
| Management And General | 931286 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24993 | BOY |
| EOY | 52420 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5817 | BOY |
| EOY | 5337 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 842371 | BOY |
| EOY | 645580 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200222 | BOY |
| EOY | 277814 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55964 | BOY |
| EOY | 56012 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23364 | BOY |
| EOY | 21788 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2426527 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 881706 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1650425 | BOY |
| EOY | 1544821 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3650 | BOY |
| EOY | 42385 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2806806 | BOY |
| EOY | 2646157 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 246734 | BOY |
| EOY | 133187 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 785532 | BOY |
| EOY | 643940 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20850 | BOY |
| EOY | 16657 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1053116 | BOY |
| EOY | 793784 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1753690 | BOY |
| EOY | 1852373 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1753690 | BOY |
| EOY | 1852373 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2806806 | BOY |
| EOY | 2646157 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 98683 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 611249 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 622584 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1028394 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1168946 | CurrentTaxYearMinus1Year |
| Current Tax Year | 768802 | CurrentTaxYear |
| Total | 4199975 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 611249 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 622584 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1028394 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1168946 | CurrentTaxYearMinus1Year |
| Current Tax Year | 768802 | CurrentTaxYear |
| Total | 4199975 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 4199975 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 4058 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3422 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3883 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 502 | CurrentTaxYearMinus1Year |
| Current Tax Year | 403 | CurrentTaxYear |
| Total | 12268 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | -4761 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5203 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 10613 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 43396 | CurrentTaxYearMinus1Year |
| Current Tax Year | 10065 | CurrentTaxYear |
| Total | 64516 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 4276759 | TotalSupport |
| Gross Receipts From Admissions Etc | 10242457 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.98200 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.98040 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 84293 | OtherCostOrOtherBasis |
| Book Value | 84293 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 861149 | OtherCostOrOtherBasis |
| Depreciation | 299163 | Depreciation |
| Book Value | 561986 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 659355 | OtherCostOrOtherBasis |
| Depreciation | 54096 | Depreciation |
| Book Value | 605259 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 821730 | OtherCostOrOtherBasis |
| Depreciation | 528447 | Depreciation |
| Book Value | 293283 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1544821 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAPITAL LEASE OBLIGATIONS | Description |
| Amount | $16,657 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 16657 | TotalOfAmounts |
| Total Revenue | 3639485 | TotalRevenue |
| Total Expenses | 3540802 | TotalExpenses |
| Excess Or Deficit For Year | 98683 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 98683 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 3639485 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 3639485 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 3639485 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3540802 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 3540802 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 3540802 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE ORGANIZATION IS A NON-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES. THE ORGANIZATION ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OR THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. FEDERAL RETURNS FOR THE YEARS ENDED 2008 AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GARY DONALDSON NICOLET PHARMACY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD OF DIRECTOR | Relationship |
| Description Of Transaction | 340B PHARMACY | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY WAS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. THE AUDITING FIRM ALSO PRESENTED COMPREHENSIVE AUDIT INFORMATION DIRECTLY TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOTH STAFF AND BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT IDENTIFYING ANY CONFLICTS ON AN ANNUAL BASIS. STAFF HAS RECEIVED REQUIRED TRAINING ON THE POLICY AND IT IS MONITORED ON A MONTHLY BASIS. THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING ANY CONFLICTS OF INTEREST AND ADDRESSING ANY ISSUES AS A RESULT OF THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS DETERMINED BY PERFORMANCE COUPLED WITH PREVAILING INDUSTRY STANDARDS AND THE CURRENT NACHC COMPENSATION REPORT. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL STAFF AND BOARD OF DIRECTORS MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. STAFF RECEIVES REQUIRED TRAINING UPON HIRE AND AT LEAST ANNUALLY THEREAFTER. THERE ARE ESTABLISHED POLICIES FOR REPORTING AND RESPONDING TO VIOLATIONS OF THE CONFLICT OF INTEREST POLICY WHICH IS PART OF THE LARGER NHC CORPORATE COMPLIANT POLICY. NHCS CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING ANY CONFLICTS OF INTEREST AND FOLLOWING ESTABLISHED POLICY TO ADDRESS AND REPORTS OF VIOLATIONS. |
| FORM 990, PART XII, LINE 2C: | AN RFP PROCESS IS UTILIZED FOR THE SELECTION OF AUDITING FIRM. THE BOD AS A WHOLE APPROVES THE SELECTION OF THE AUDITING FIRM. THE FINANCE COMMITTEE AND BOD AS A WHOLE IS RESPONSIBLE FOR THE OVERSIGHT AND APPROVAL OF THE ANNUAL AUDIT. |
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