PEDIPLACE: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
PEDIPLACE (EIN 75-2512752)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-27
IRS object ID
201222409349300307
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

FieldValueIRS element (for citing)
Timestamp2012-08-27T09:25:27-00:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Albright Hill and Sumpter PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line112160 N Abrams Road Suite 412AddressLine1
CityDallasCity
StateTXState
ZIP Code75243ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN752512752EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PEDIPLACE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPEDINameControl
Phone9724367962Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1502 S OLD ORCHARD Room No 126AddressLine1
CityLEWISVILLECity
StateTXState
ZIP Code75067ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLARRY ROBINSName
TitlePRESIDENT AND CEOTitle
Date Signed2012-08-27DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJennifer HillName
Phone9722705452Phone
Date Prepared2012-08-27DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLARRY SMITHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1512 S OLD ORCHARD SUITE 126AddressLine1
CityLEWISVILLECity
StateTXState
ZIP Code75067ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2110495GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PEDIPLACE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1993YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionProvide medical services to uninsured and under-insured children living in North Texas. Our mission is making healthcare a reality for every kid.ActivityOrMissionDescription
Nbr Voting Members Governing Body19NbrVotingMembersGoverningBody
Nbr Independent Voting Members19NbrIndependentVotingMembers
Total Nbr Employees34TotalNbrEmployees
Total Nbr Volunteers811TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year887558ContributionsGrantsPriorYear
Contributions Grants Current Year754721ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1352727ProgramServiceRevenuePriorYear
Program Service Revenue CY1328073ProgramServiceRevenueCY
Investment Income Prior Year5338InvestmentIncomePriorYear
Investment Income Current Year5509InvestmentIncomeCurrentYear
Other Revenue Prior Year27871OtherRevenuePriorYear
Other Revenue Current Year-15098OtherRevenueCurrentYear
Total Revenue Prior Year2273494TotalRevenuePriorYear
Total Revenue Current Year2073205TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1252272SalariesEtcPriorYear
Salaries Etc Current Year1441161SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year132707TotalFundrsngExpCurrentYear
Other Expense Prior Year706290OtherExpensePriorYear
Other Expenses Current Year600139OtherExpensesCurrentYear
Total Expenses Prior Year1958562TotalExpensesPriorYear
Total Expenses Current Year2041300TotalExpensesCurrentYear
Revenues Less Expenses Prior Year314932RevenuesLessExpensesPriorYear
Revenues Less Expenses CY31905RevenuesLessExpensesCY
Total Assets BOY1108511TotalAssetsBOY
Total Assets EOY1139405TotalAssetsEOY
Total Liabilities BOY69129TotalLiabilitiesBOY
Total Liabilities EOY68118TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1039382NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1071287NetAssetsOrFundBalancesEOY
Mission DescriptionProvide medical services to uninsured and under-insured children living in North Texas. Our mission is making healthcare a reality for every kid.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1691980Expense
Revenue1312975Revenue
DescriptionThis organization provides medical services to under-insured and uninsured children living throughout North Texas.Description
Total Program Service Expense1691980TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees34NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members19NbrVotingGoverningBodyMembers
Number Independent Voting Members19NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLARRY ROBINSNamePerson
Telephone Number9724367962TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1512 S OLD ORCHARD SUITE 126AddressLine1
CityLEWISVILLECity
StateTXState
ZIP Code75067ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
LARRY SMITH
CHAIR002.00XX000
LYNN BENJAMIN
CHAIR ELECT001.00XX000
JEFF BRANNEN
VICE CHAIR001.00XX000
MELISSA DEWITT
TREASURER002.00XX000
KEVIN ROGERS
SECRETARY001.00XX000
LINDA BURNEY-FUHR
PAST CHAIR001.00XX000
LARRY ROBINS
EX-OFFICIO/PRESIDENT CEO045.00X14880000XX
JOHN ALLEN
DIRECTOR001.00X000
MIKE FRYE
DIRECTOR001.00X000
DOUG KILLOUGH
DIRECTOR001.00X000
DARLA KINCAID
DIRECTOR001.00X000
CAROL LONGACRE
DIRECTOR001.00X000
MATT MCCORMICK
DIRECTOR001.00X000
CARL MENCKHOFF
DIRECTOR001.00X000
S T NEWTON
DIRECTOR001.00X000
JOHN O'NEILL
DIRECTOR001.00X000
CAROL POPE-CODY
DIRECTOR001.00X000
MIKE SCHNITTKER
DIRECTOR001.00X000
HAROLD SHEPARD
DIRECTOR001.00X000
MARK VARGUS
DIRECTOR001.00X000
SHAWN BLACK
EX-OFFICIO001.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org148800TotalReportableCompFromOrg
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonSEE SCHEDULE ONamePerson
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns275000FederatedCampaigns
Fundraising Events40251FundraisingEvents
Government Grants51965GovernmentGrants
All Other Contributions387505AllOtherContributions
Noncash Contributions96776NoncashContributions
Total Contributions754721TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionMEDICAL SERVICESDescription
Total Revenue Column1328073TotalRevenueColumn
Related Or Exempt Function Income1328073RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue1328073TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5509TotalRevenueColumn
Exclusion$5,509ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events22192GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events40251CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses37290FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-15098TotalRevenueColumn
Exclusion-$15,098ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2073205TotalRevenueColumn
Related Or Exempt Function Income1328073RelatedOrExemptFunctionIncome
Exclusion-$9,589ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total148800Total
Program Services122373ProgramServices
Management And General14209ManagementAndGeneral
Fundraising12218Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1036075Total
Program Services852068ProgramServices
Management And General98936ManagementAndGeneral
Fundraising85071Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total24861Total
Program Services21372ProgramServices
Management And General1822ManagementAndGeneral
Fundraising1667Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total141904Total
Program Services132455ProgramServices
Management And General6972ManagementAndGeneral
Fundraising2477Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total89521Total
Program Services75180ProgramServices
Management And General8012ManagementAndGeneral
Fundraising6329Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total119546Total
Program Services94553ProgramServices
Management And General15543ManagementAndGeneral
Fundraising9450Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total6948Total
Program Services427ProgramServices
Management And General4795ManagementAndGeneral
Fundraising1726Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total51288Total
Program Services34915ProgramServices
Management And General10715ManagementAndGeneral
Fundraising5658Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total39050Total
Program Services29467ProgramServices
Management And General6598ManagementAndGeneral
Fundraising2985Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total104324Total
Program Services82620ProgramServices
Management And General21704ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total5486Total
Program Services1864ProgramServices
Management And General3058ManagementAndGeneral
Fundraising564Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total61368Total
Program Services49094ProgramServices
Management And General12274ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total23989Total
Program Services21571ProgramServices
Management And General1915ManagementAndGeneral
Fundraising503Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PHYSICIAN EXPENSES128647128647
LABORATORY EXPENSE2145021450
DRUGS/MEDICAL SUPPLIES/MEDICAL WASTE1386013755105
CONTINUING EDUCATION512837121247169

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total19055Total
Program Services6457ProgramServices
Management And General8708ManagementAndGeneral
Fundraising3890Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2041300Total
Program Services1691980ProgramServices
Management And General216613ManagementAndGeneral
Fundraising132707Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY596274BOY
EOY67193EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY162615BOY
EOY621902EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY225333BOY
EOY164040EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY53795BOY
EOY55804EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2200BOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY15983BOY
EOY4816EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis653658LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec429508LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY50811BOY
EOY224150EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1500BOY
EOY1500EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1108511BOY
EOY1139405EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY69129BOY
EOY45418EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY22700EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY69129BOY
EOY68118EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY816136BOY
EOY991100EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY212746BOY
EOY69687EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY10500BOY
EOY10500EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1039382BOY
EOY1071287EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1108511BOY
EOY1139405EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses31905ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2
Public Support Total1700PublicSupportTotal170
Public Support Pertcentage1700.00000PublicSupportPertcentage170

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years442351CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years515001CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years559888CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year887558CurrentTaxYearMinus1Year
Current Tax Year754721CurrentTaxYear
Total3159519Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1089294CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1166146CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1285229CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1352727CurrentTaxYearMinus1Year
Current Tax Year1328073CurrentTaxYear
Total6221469Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1531645CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1681147CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1845117CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2240285CurrentTaxYearMinus1Year
Current Tax Year2082794CurrentTaxYear
Total9380988Total
FieldValueIRS element (for citing)
Public Support Total5099380988PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years614CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6526CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7235CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5338CurrentTaxYearMinus1Year
Current Tax Year5509CurrentTaxYear
Total25222Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years614CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6526CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7235CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5338CurrentTaxYearMinus1Year
Current Tax Year5509CurrentTaxYear
Total25222Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1532259CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1687673CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1852352CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2245623CurrentTaxYearMinus1Year
Current Tax Year2088303CurrentTaxYear
Total9406210Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99730PublicSupportPercentage509
Prior Year Support Percentage0.99770PriorYearSupportPercentage
Investment Income Percentage0.00270InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00230PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Included On FSfalseIncludedOnFS

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis264589OtherCostOrOtherBasis
Book Value264589BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis389069OtherCostOrOtherBasis
Book Value389069BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Depreciation429508Depreciation
Book Value-429508BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings224150TotalOfBookValueLandBuildings
Total Revenue2073205TotalRevenue
Total Expenses2041300TotalExpenses
Excess Or Deficit For Year31905ExcessOrDeficitForYear
Excess Or Deficit Per FS31905ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2207239TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities134034DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990134034RevenueNotRptdF990
Revenue Subtotal2073205RevenueSubtotal
Total Revenue Per Form9902073205TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2175334TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities134034DonatedServicesUseOfFacilities
Expenses Not Rptd F990134034ExpensesNotRptdF990
Expenses Subtotal2041300ExpensesSubtotal
Total Expenses Per Form9902041300TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
X2The Organization files an annual income tax return. With few exceptions, the Organization is no longer subject to U.S. federal income tax examinations by tax authorities for years before 2008. The Organization has adopted the provisions of FASB ASC 740, Accounting for Uncertainty in Income Taxes. There were no unrecognized tax benefits as of December 31, 2011 and 2010.
X2The Organization recognizes interest accrued related to unrecognized tax benefits in interest expense and penalties in operating expense. There were no such interest and penalties for 2011 and 2010.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GALANameOfEvent1
Gross Receipts Event149260GrossReceiptsEvent1
Charitable Contributions Event130986CharitableContributionsEvent1
Gross Revenue Event118274GrossRevenueEvent1
Other Direct Expenses Event128910OtherDirectExpensesEvent1
Name Of Event2FASHION SHOWNameOfEvent2
Gross Receipts Event213183GrossReceiptsEvent2
Charitable Contributions Event29265CharitableContributionsEvent2
Gross Revenue Event23918GrossRevenueEvent2
Other Direct Expenses Event28380OtherDirectExpensesEvent2
Gross Receipts Total62443GrossReceiptsTotal
Charitable Contributions Total40251CharitableContributionsTotal
Gross Revenue Total Events22192GrossRevenueTotalEvents
Other Direct Expenses Total Events37290OtherDirectExpensesTotalEvents
Direct Expense Summary Events37290DirectExpenseSummaryEvents
Net Income Summary-15098NetIncomeSummary

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionSOFTWAREDescription
Noncash Contribs Rptd F99096776NoncashContribsRptdF990
Method Of Determining RevenuesBOOK VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990 Part VI11bAfter preparation of the Form 990 and before filing of the form, the preparer provided a copy for the finance committee to review. A copy of the tax return was provided to the organization for its files.
Form 990 Part VI12cThe tone for a high level of ethics is set at the top. The board of directors imparts its expectations to all levels of management. In connection therewith, all board members, members of committees who are not board members, officers and employees are required to review the conflict of interest policy and to annually sign a conflict of interest statement. The signed forms are reviewed and the accounting department is advised of any disclosed conflicts. Any individual with a possible conflict, or who perceives or recognizes a conflict of others, is encouraged to discuss the matter with their immediate supervisor. All conflicts are ultimately to be discussed with the board of directors.
Form 990 Part VI15bThe President CEOs compensation is reviewed annually by a committee appointed by the chair of the board of directors. Base salary is compared with similar not-for-profit and for-profit organizations. Staff size, annual budget, market trends and skill level is used to determine comparable salaries. Benchmark information from other employers and summary data compiled from not-for-profit entity surveys presented bi-annually by the Community Council of Greater Dallas is consulted. Annual performance measurements are established to evaluate bonus guidelines.
Form 990 Part VI19Copies of requested governing documents and open pages of Form 990 are made available upon request. No such requests were received during 2011.
Form 990 Part VII1Community Medical Associates, Inc., 385 W Main St., Suite A, Lewisville, Texas 75057, Contract Physician Service, 128,647
Form 990 Part VI Section B Line 11b After preparation of the Form 990 and before filing of the form, the preparer provided a copy for the finance committee to review. A copy of the tax return was provided to the organization for its files. Form 990 Part VI Section B Line 12c The tone for a high level of ethics is set at the top. The board of directors imparts its expectations to all levels of management. In connection therewith, all board members, members of committees who are not board members, officers and employees are required to review the conflict of interest policy and to annually sign a conflict of interest statement. The signed forms are reviewed and the accounting department is advised of any disclosed conflicts. Any individual with a possible conflict, or who perceives or recognizes a conflict of others, is encouraged to discuss the matter with their immediate supervisor. All conflicts are ultimately to be discussed with the board of directors. Form 990 Part VI Section B Line 15b The President CEOs compensation is reviewed annually by a committee appointed by the chair of the board of directors. Base salary is compared with similar not-for-profit and for-profit organizations. Staff size, annual budget, market trends and skill level is used to determine comparable salaries. Benchmark information from other employers and summary data compiled from not-for-profit entity surveys presented bi-annually by the Community Council of Greater Dallas is consulted. Annual performance measurements are established to evaluate bonus guidelines. Form 990 Part VI Section C Line 19 Copies of requested governing documents and open pages of Form 990 are made available upon request. No such requests were received during 2011. Form 990 Part VII Section B Line 1 Community Medical Associates, Inc., 385 W Main St., Suite A, Lewisville, Texas 75057, Contract Physician Service, 128,647

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