NORTHEASTERN RURAL HEALTH CLINICS: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NORTHEASTERN RURAL HEALTH CLINICS (EIN 94-2492609)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-02-20
IRS object ID
201210619349300426
Schema version
2010v3.4
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)
Timestamp2012-02-20T14:00:56-07:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1M L Reimche CPA MBABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11701 W Manor DriveAddressLine1
CityVisaliaCity
StateCAState
ZIP Code93291ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN942492609EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Northeastern Rural Health Clinics IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone5302575563Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11850 Spring Ridge DriveAddressLine1
CitySusanvilleCity
StateCAState
ZIP Code96130ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJanet LasickName
TitleCEOTitle
Phone5302575563Phone
Date Signed2012-02-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameM L ReimcheName
Phone5593090943Phone
Date Prepared2012-02-15DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPhillip Nowak CFONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11850 Spring Ridge DriveAddressLine1
CitySusanvilleCity
StateCAState
ZIP Code96130ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7192873GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.northeasternhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1977YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTo provide quality health care to rural and low income population regardless of ability to pay. Services include, primary care, pediatric, OB, diagnostic lab testing, pharmacy services and educational services. A total of 49,769 visits were provided in the last year to the population served.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees131TotalNbrEmployees
Total Nbr Volunteers11TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2674990ContributionsGrantsPriorYear
Contributions Grants Current Year1633607ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6119680ProgramServiceRevenuePriorYear
Program Service Revenue CY5500480ProgramServiceRevenueCY
Investment Income Prior Year945InvestmentIncomePriorYear
Investment Income Current Year623InvestmentIncomeCurrentYear
Other Revenue Prior Year90413OtherRevenuePriorYear
Other Revenue Current Year58163OtherRevenueCurrentYear
Total Revenue Prior Year8886028TotalRevenuePriorYear
Total Revenue Current Year7192873TotalRevenueCurrentYear
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 Year4906038SalariesEtcPriorYear
Salaries Etc Current Year5484236SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3525205OtherExpensePriorYear
Other Expenses Current Year3251710OtherExpensesCurrentYear
Total Expenses Prior Year8431243TotalExpensesPriorYear
Total Expenses Current Year8735946TotalExpensesCurrentYear
Revenues Less Expenses Prior Year454785RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1543073RevenuesLessExpensesCY
Total Assets BOY7277822TotalAssetsBOY
Total Assets EOY5924441TotalAssetsEOY
Total Liabilities BOY5679215TotalLiabilitiesBOY
Total Liabilities EOY5868907TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1598607NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY55534NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide quality health care to rural and low income population regardless of ability to pay. Services include, primary care, pediatric, OB, diagnostic lab testing, pharmacy services and educational services. A total of 49,769 visits were provided in the last year to the population served.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6610159Expense
Grants0Grants
Revenue7187258Revenue
DescriptionThe clinic provided care to over 12,400 patients. Services included primary care, pediatric, family planning, dental and pharmacy services.Description
Total Of Other Program Service Exp0TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense6610159TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109670NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees131NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJanet Lasick CEONamePerson
Telephone Number5302575000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11850 Spring Ridge RdAddressLine1
CitySusanvilleCity
StateCAState
ZIP Code96130ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeFormerFormerHighest Compensated EmployeeHighestCompensatedEmployee
Pam Robbins
Board Member2X000
Jean Coye
Board Member2X000
Richard Hrezo
Secretary2X000
Eula Johnson
Board Member2X000
JoAnn Villalovos
Board Member2X000
Mike Stark
Board Member2X000
Carol Montgomery
Vice Chair2X000
Jon Nakanishi
Treasurer2X000
Karen Grosz
Chair2X000
Stephen Taylor
Board Member2X000
Albert Geugenburger
CEO404725100XXX
Dan Zanine
CFO402215500XXX
Janet Lasick
CEO4010758000XX
Linda A Hollingswort
COO/HR Manager401478100XX
Naomi Rea FNP
Medical Director40143348025845XX
Paul Homes MD
Physican40195054019971X
John Dozier MD
Physican40151613023975X
Paul Davainis MD
Physican40175580038798X
Steven Braatz MD
Physician40236659023975X
Istvan Felker Dentis
Dentist40107346023865X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1201367TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation156429TotalOtherCompensation
Number Individuals GT100 K12NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1TriageBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111133 O StreetAddressLine1
CityOmahaCity
StateNEState
ZIP Code68137ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesLocumsDescriptionOfServices
Compensation185061Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns0FederatedCampaigns
Membership Dues0MembershipDues
Fundraising Events0FundraisingEvents
Related Organizations0RelatedOrganizations
Government Grants1603607GovernmentGrants
All Other Contributions30000AllOtherContributions
Noncash Contributions0NoncashContributions
Total Contributions1633607TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient Revenue, netDescription
Business Code621400BusinessCode
Total Revenue Column5500480TotalRevenueColumn
Related Or Exempt Function Income5500480RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue5500480TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column623TotalRevenueColumn
Related Or Exempt Function Income623RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real18155Real
Personal0Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real18155Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column18155TotalRevenueColumn
Related Or Exempt Function Income18155RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other0Other
FieldValueIRS element (for citing)
Cntrbtns Rprtd Fundraising Events0CntrbtnsRprtdFundraisingEvents

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column40008TotalRevenueColumn
Related Or Exempt Function Income40008RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue40008TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7192873TotalRevenueColumn
Related Or Exempt Function Income5559266RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total18600Total
Management And General18600ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3934031Total
Program Services3205860ProgramServices
Management And General728171ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total30700Total
Program Services24805ProgramServices
Management And General5895ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1148728Total
Program Services988866ProgramServices
Management And General159862ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total352177Total
Program Services294408ProgramServices
Management And General57769ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total84291Total
Management And General84291ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total18523Total
Management And General18523ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total28100Total
Management And General28100ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total425393Total
Program Services398360ProgramServices
Management And General27033ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total14027Total
Program Services12550ProgramServices
Management And General1477ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total178254Total
Management And General178254ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total467398Total
Program Services330690ProgramServices
Management And General136708ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total12923Total
Program Services11930ProgramServices
Management And General993ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total186Total
Program Services128ProgramServices
Management And General58ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total207923Total
Program Services2303ProgramServices
Management And General205620ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total603444Total
Program Services248950ProgramServices
Management And General354494ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total148376Total
Program Services125351ProgramServices
Management And General23025ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Supplies645623634451111720
Professional Fees30914303136010
Bad Debt12326212326200
Postage & shipping215357454140810
Equipment rental & maintenance127195102033251620

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total114343Total
Program Services68445ProgramServices
Management And General45898ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8735946Total
Program Services6610159ProgramServices
Management And General2125787ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY200064BOY
EOY150851EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY121120BOY
EOY123611EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY502650BOY
EOY180520EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY422459BOY
EOY238924EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY250887BOY
EOY76383EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY55715BOY
EOY38159EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8435211LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3319218LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5724927BOY
EOY5115993EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7277822BOY
EOY5924441EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY986677BOY
EOY1296941EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY5000BOY
EOY5000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4687538BOY
EOY4566966EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5679215BOY
EOY5868907EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1582388BOY
EOY33700EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY16219BOY
EOY21834EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1598607BOY
EOY55534EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7277822BOY
EOY5924441EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1543073ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
General ExplanationThe organization is a 501(3)(c) non-profit entity and per the IRS designation letter is described in section 509(a)(1) and 170(b)(1)A(iii) of the IRS code.GeneralExplanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis297892InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Book Value297892BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis6516924InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation2259363Depreciation
Book Value4257561BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1620395InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation1059855Depreciation
Book Value560540BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5115993TotalOfBookValueLandBuildings
Total Revenue7192873TotalRevenue
Total Expenses8735946TotalExpenses
Excess Or Deficit For Year-1543073ExcessOrDeficitForYear
Net Unrealized GL On Investments0NetUnrealizedGLOnInvestments
Donated Services And Facilities0DonatedServicesAndFacilities
Investment Expenses0InvestmentExpenses
Prior Period Adjustments0PriorPeriodAdjustments
Other$0OtherAmount
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-1543073ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt7192873TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments0NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities0DonatedSrvcAndUseOfFacilities
Recoveries Of Prior Year Grants0RecoveriesOfPriorYearGrants
Other Revenues0OtherRevenues
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal7192873RevenueSubtotal
Investment Expenses Not Included0InvestmentExpensesNotIncluded
Other Revenues Not Included0OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9907192873TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8735946TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities0DonatedServicesUseOfFacilities
Prior Year Adjustments0PriorYearAdjustments
Losses Reported0LossesReported
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal8735946ExpensesSubtotal
Investment Expenses Not Included20InvestmentExpensesNotIncluded2
Other Expenses Not Included0OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9908735946TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

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
Paul Homes MD
195054000003141016830021502502194470
Steven Braatz MD
23665900000000023665902625620
John Dozier MD
151613000000023975017558801732070
Paul Davainis MD
1755800000014823023975021437802215460
Naomi Rea FNP
143348000008575017270016919301459790
Albert Geugenburger
472510000000004725101012000
Dan Zanine
2215500000000022155000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSchJ_P01_S00_L03Identifier
Return ReferenceSchedule J, Part I, Line 3ReturnReference
ExplanationSalary and compensation schedules of similar organizations are consulted for comparable wage scales. CEO salary is established in a written contract signed by governing board.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
F990_P06_S0B_L11aForm 990, Part VI, Section B, Line 11aE-mailed and/or provide copy at Monthly Meeting.
F990_P06_S0B_L12cForm 990, Part VI, Section B, Line 12cDisclosure completed annually by officers and directors.
F990_P06_S0B_L15Form 990, Part VI, Section B, Line 15Salary and compensation schedules of similar organizations are consulted for comparable wage scales. CEO salary is established in a written contract signed by governing board.
F990_P06_S0C_L19Form 990, Part VI, Section C, Line 19Copy provided for public inspection in administrative office.

Reasonable Cause Explanation ReasonableCauseExplanation

FieldValueIRS element (for citing)
ExplanationReturn in not late an automatic extension was filed and approved by the IRS till February 15, 2012. IRS does not require the return to be filed until March 31, 2012 due to an IRS system update.Explanation

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