CHOTA COMMUNITY HEALTH SERVICES: Form 990, tax year 2011
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- Organization
- CHOTA COMMUNITY HEALTH SERVICES (EIN 68-0560048)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2012-11-27
- IRS object ID
- 201213329349300206
- 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 | 2012-11-27T08:38:57-08:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TERRY HORNE CPA & ASSOCIATES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 732 WEST MAIN STREET | AddressLine1 |
| City | LEBANON | City |
| State | TN | State |
| ZIP Code | 37087 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680560048 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHOTA COMMUNITY HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHOT | NameControl |
| Phone | 4234427268 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1206 HWY 411 | AddressLine1 |
| City | VONORE | City |
| State | TN | State |
| ZIP Code | 37885 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PUSPA DAS | Name |
| Title | CHIEF EXECUTIVE OFFICER | Title |
| Phone | 4234427268 | Phone |
| Date Signed | 2012-11-01 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRY HORNE | Name |
| Phone | 6154447293 | Phone |
| Date Prepared | 2012-11-27 | 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 | PUSPA DAS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1206 HWY 411 | AddressLine1 |
| City | VONORE | City |
| State | TN | State |
| ZIP Code | 37885 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6318864 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2003 | YearFormation |
| State Legal Domicile | TN | StateLegalDomicile |
| Activity Or Mission Description | THE ORGANIZATION PROVIDES HEALTH CARE TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THIS IS A DIRECT FULFILLMENT OF THEIR TAX EXEMPT PURPOSE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 127 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 1482841 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1446976 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 4941415 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 4863997 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 506 | InvestmentIncomePriorYear |
| Investment Income Current Year | 691 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 20040 | OtherRevenuePriorYear |
| Other Revenue Current Year | 7200 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6444802 | TotalRevenuePriorYear |
| Total Revenue Current Year | 6318864 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4687655 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4616571 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1507076 | OtherExpensePriorYear |
| Other Expenses Current Year | 1510963 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6194731 | TotalExpensesPriorYear |
| Total Expenses Current Year | 6127534 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 250071 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 191330 | RevenuesLessExpensesCY |
| Total Assets BOY | 2176897 | TotalAssetsBOY |
| Total Assets EOY | 1899785 | TotalAssetsEOY |
| Total Liabilities BOY | 1743055 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1274613 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 433842 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 625172 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE ORGANIZATION PROVIDES HEALTH CARE | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 4143603 | Expense |
| Revenue | 4863997 | Revenue |
| Description | THE ORGANIZATION PROVIDES HEALTH CARE REGARDLESS OF THE INDIVIDUALS ABILITY TO PAY. THESE MEDICAL SERVICES ARE PROVIDED IN AREAS THAT HAVE A SHORTAGE OF HEALTH CARE PROVIDERS. THIS IS A DIRECT FULFILLMENT OF THEIR TAX EXEMPT PURPOSE. OVER 50,900 VISITS WERE PROVIDED DURING THE YEAR. | Description |
| Total Program Service Expense | 4143603 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | true | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 18 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 127 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | 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 | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MELISSA COFFELT | NamePerson |
| Telephone Number | 4238847271 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1206 HIGHWAY 411 | AddressLine1 |
| City | VONORE | City |
| State | TN | State |
| ZIP Code | 37855 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|
| PETER ALLIMAN | |||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD BERNSTEIN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRUCE CHRISTOPHER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ART FOWLER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JUDITH LEE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM O'DONNELL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| CRYSTAL RUSSELL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RAY TALLENT | |||||||
| VICE PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| KAY TALLENT | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| WESLEY MCNEAL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BARBARA LEVIN MD | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 238176 | 0 | 16624 | X | ||
| JOSHUA GETTINGER | |||||||
| MEDICAL DIRECTOR | 40.00 | 200281 | 0 | 17120 | X | ||
| LAURA HARRIS | |||||||
| CHIEF OPERATIONAL OFFICER | 40.00 | 62675 | 0 | 1460 | X | ||
| TRACEY BEVERLEY | |||||||
| PHYSICIAN | 40.00 | 200180 | 0 | 7333 | X | ||
| JOEL BURROUGHS | |||||||
| PHYSICIAN | 40 | 157166 | 10785 | X | |||
| THOMAS COX | |||||||
| PHYSICIAN | 40 | 146615 | 9854 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1005093 | TotalReportableCompFromOrg |
| Total Other Compensation | 63176 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Government Grants | 815375 | GovernmentGrants |
| All Other Contributions | 631601 | AllOtherContributions |
| Total Contributions | 1446976 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT FEES | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 4863997 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 4863997 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 691 | TotalRevenueColumn |
| Exclusion | $691 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 7200 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 7200 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7200 | TotalRevenueColumn |
| Exclusion | $7,200 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6318864 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4863997 | RelatedOrExemptFunctionIncome |
| Exclusion | $7,891 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 501132 | Total |
| Program Services | 200281 | ProgramServices |
| Management And General | 300851 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3320409 | Total |
| Program Services | 2465167 | ProgramServices |
| Management And General | 855242 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 121056 | Total |
| Program Services | 84739 | ProgramServices |
| Management And General | 36317 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 439574 | Total |
| Program Services | 307702 | ProgramServices |
| Management And General | 131872 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 234400 | Total |
| Program Services | 164080 | ProgramServices |
| Management And General | 70320 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26051 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 26051 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 254622 | Total |
| Program Services | 134295 | ProgramServices |
| Management And General | 120327 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 566546 | Total |
| Program Services | 338307 | ProgramServices |
| Management And General | 228239 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 297519 | Total |
| Program Services | 252892 | ProgramServices |
| Management And General | 44627 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30489 | Total |
| Program Services | 11694 | ProgramServices |
| Management And General | 18795 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40389 | Total |
| Program Services | 34331 | ProgramServices |
| Management And General | 6058 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 234888 | Total |
| Program Services | 105186 | ProgramServices |
| Management And General | 129702 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60459 | Total |
| Program Services | 44929 | ProgramServices |
| Management And General | 15530 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6127534 | Total |
| Program Services | 4143603 | ProgramServices |
| Management And General | 1983931 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 479 | BOY |
| EOY | 510 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 92214 | BOY |
| EOY | 130338 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 605946 | BOY |
| EOY | 463769 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10034 | BOY |
| EOY | 2400 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2031108 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 728340 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1468224 | BOY |
| EOY | 1302768 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2176897 | BOY |
| EOY | 1899785 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1330048 | BOY |
| EOY | 553039 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 413007 | BOY |
| EOY | 721574 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1743055 | BOY |
| EOY | 1274613 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 433842 | BOY |
| EOY | 625172 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 433842 | BOY |
| EOY | 625172 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2176897 | BOY |
| EOY | 1899785 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 191330 | ReconcilationRevenueExpenses |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | 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 | 602629 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 756798 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 968164 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1482841 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1446976 | CurrentTaxYear |
| Total | 5257408 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 602629 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 756798 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 968164 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1482841 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1446976 | CurrentTaxYear |
| Total | 5257408 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 5257408 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1349 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2459 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2364 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 20546 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7891 | CurrentTaxYear |
| Total | 34609 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 5292017 | TotalSupport |
| Gross Receipts From Admissions Etc | 19856280 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.99350 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.99360 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
| Public Support Total509 | 0 | PublicSupportTotal509 |
| Public Support Percentage509 | 0 | PublicSupportPercentage509 |
| Investment Income Percentage | 0 | InvestmentIncomePercentage |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 140192 | InvestmentCostOrOtherBasis |
| Book Value | 140192 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 531988 | InvestmentCostOrOtherBasis |
| Depreciation | 36820 | Depreciation |
| Book Value | 495168 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1358928 | InvestmentCostOrOtherBasis |
| Depreciation | 691520 | Depreciation |
| Book Value | 667408 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1302768 | TotalOfBookValueLandBuildings |
| Total Revenue | 6318864 | TotalRevenue |
| Total Expenses | 6127534 | TotalExpenses |
| Excess Or Deficit For Year | 191330 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 191330 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 6318864 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 6318864 | RevenueSubtotal |
| Total Revenue Per Form990 | 6318864 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 6127534 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 6127534 | ExpensesSubtotal |
| Total Expenses Per Form990 | 6127534 | TotalExpensesPerForm990 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|
| BARBARA LEVIN MD | |||
| 238176 | 8921 | 7703 | 254800 |
| JOSHUA GETTINGER | |||
| 200281 | 8237 | 8883 | 217401 |
| TRACEY BEVERLEY | |||
| 200180 | 7165 | 168 | 207513 |
| JOEL BURROUGHS | |||
| 157166 | 3502 | 7283 | 167951 |
| THOMAS COX | |||
| 146615 | 240 | 9614 | 156469 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DRLEVIN GETTINGER | NamePerson |
| Purpose Of Loan | TO PURCHASE PRACTICE | PurposeOfLoan |
| Loan To Organization | X | LoanToOrganization |
| Original Principal | $380,000 | OriginalPrincipalAmount |
| Balance Due | 62082 | BalanceDue |
| Default | false | Default |
| Approved By Board | true | ApprovedByBoard |
| Written Agreement | true | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 62082 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BJ3 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | CEO & MEDICAL DIRECTOR | Relationship |
| Amount Of Transaction | 192000 | AmountOfTransaction |
| Description Of Transaction | ORGANIZATION RENTS BLDG | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART IV LINE 1 | THE ORGANIZATION RENTS A BUILDING FROM BJ3,LLC FOR $16,000 |
| PER MONTH. BJ3, LLC IS OWNED BY DR. BARBARA LEVIN & DR. JOSHUA GETTINGER | |
| WHO WERE EXECUTIVE DIRECTOR & MEDICAL DIRECTOR FOR FISCAL YEAR END 6/30/12. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Pt VI, Line 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST |
| POLICY AND FORM 990 AVAILABLE UPON WRITTEN REQUEST. | |
| Pt VI, Line 11a | THE CEO AND FINANCE COMMITTEE REVIEWS THE FORM 990 AND THEN PRESENTS TO FULL BOARD. |
| Pt VI, Line 15 | STATE AND NATIONAL SALARY COMPARISONS ARE USED TO ESTABLISH SALARY LIMITS |
| FOR TOP MANAGEMENT OFFICIALS. PERFORMANCE EVALUATION ARE PERFORMED ANNUALLY | |
| AND SALARY INCREASES ARE BOARD APPROVED. | |
| Pt XII, Line 2c | THE CEO OVERSEES FINANCIAL STATEMENT PREPARATION AND AUDIT ENGAGEMENT. |
| Pt VI, Line 12c | ANNUALLY THE CONFLICT OF INTEREST STATEMENT IS SIGNED BY BOARD MEMBERS AND |
| REVIEWED BY THE ENTIRE BOARD. BOARD MEMBERS SHALL EXCUSE THEMSELVES FROM | |
| ISSUES THAT ENHANCE THE PROBABILITY OF THEIR OWN PERSONAL AND PRIVATE GAIN. | |
| Pt VI, Line 2 | DR. LEVIN AND DR. GETTINGER WERE THE CEO AND MEDICAL DIRECTOR |
| FOR A PORTION OF THE FISCAL YEAR AND THEY HAVE A PERSONAL | |
| RELATIONSHIP. |
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