RURAL HEALTH SERVICES INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- RURAL HEALTH SERVICES INC (EIN 23-7085643)
- Tax period
- 2011-06-01 to 2012-05-31
- Filed
- 2012-10-08
- IRS object ID
- 201232839349300103
- 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 | 2012-10-08T15:27:59-07:00 | Timestamp |
| Tax Period End Date | 2012-05-31 | 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 | 2011-06-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237085643 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RURAL HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RURA | NameControl |
| Phone | 8035939283 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 277 | AddressLine1 |
| City | CLEARWATER | City |
| State | SC | State |
| ZIP Code | 29822 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT T REEL JR | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 8035939283 | Phone |
| Date Signed | 2012-09-10 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRY HORNE | Name |
| Phone | 6154447293 | Phone |
| Date Prepared | 2012-10-08 | 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 | ROBERT T REEL JR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 277 | AddressLine1 |
| City | CLEARWATER | City |
| State | SC | State |
| ZIP Code | 298220277 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3729437 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MJWCHC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1970 | YearFormation |
| State Legal Domicile | SC | StateLegalDomicile |
| Activity Or Mission Description | THIS 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 | 53 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 1387600 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1099020 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1922543 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2628317 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 52 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 2100 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3310195 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3729437 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1805747 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2436676 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1471633 | OtherExpensePriorYear |
| Other Expenses Current Year | 1269347 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3277380 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3706023 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 32815 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 23414 | RevenuesLessExpensesCY |
| Total Assets BOY | 778904 | TotalAssetsBOY |
| Total Assets EOY | 1200248 | TotalAssetsEOY |
| Total Liabilities BOY | 1230558 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1628488 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -451654 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -428240 | NetAssetsOrFundBalancesEOY |
| Mission Description | THIS ORGANIZATION PROVIDES HEALTH CARE | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 2945385 | Expense |
| Revenue | 2628317 | Revenue |
| Description | THE ORGANIZATION PROVIDES HEALTH CARE SERVICES TO RESIDENTS OF CLEARWATER, SOUTH CAROLINA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. THESE MEDICAL SERVICES ARE PROVIDED IN AREAS THAT HAVE A SHORTAGE OF HEALTH CARE PROVIDERS. THIS IS A DIRECT FULFILLMENT OF THIER TAX EXEMPT PURPOSE. OVER 26,650 VISITS WERE PROVIDED DURING THE YEAR. | Description |
| Total Program Service Expense | 2945385 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | 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 | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | true | 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 | 13 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 53 | 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 | false | 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 |
| States Where Copy Of Return Is Filed | SC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ROBERT T REEL JR CFO | NamePerson |
| Telephone Number | 8035939283 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 277 | AddressLine1 |
| City | CLEARWATER | City |
| State | SC | State |
| ZIP Code | 29822 | 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 |
|---|---|---|---|---|---|---|---|
| MONA FLANIGAN | |||||||
| BOARD CHAIR | 1.00 | X | 0 | 0 | 0 | ||
| KENNETH BALDWIN | |||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | ||
| DIEGA GARCIA | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LILLIE JUMPP | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SANDY MCCOLLUM | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SHEVONIE MEALER | |||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| ANTOINETTE NOBLE-WEB | |||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | ||
| JASON PRICE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LIZ STEWART | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| HARVEY TOLLISON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| CAROLYN EMANUEL-MCCLAIN | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 125000 | 0 | 3576 | X | ||
| ROBERT T REEL JR | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 75000 | 0 | 3576 | X | ||
| FREDERIC WORIAX | |||||||
| MEDICAL DIRECTOR | 40.00 | 160000 | 0 | 8625 | X | ||
| ERIC M SCHLEUTER | |||||||
| MEDICAL DIRECTOR | 40.00 | 103810 | 0 | 7187 | X | ||
| GARY FISCHBACH | |||||||
| PHYSICIAN | 40 | 128419 | 4312 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 592229 | TotalReportableCompFromOrg |
| Total Other Compensation | 27276 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Government Grants | 885941 | GovernmentGrants |
| All Other Contributions | 213079 | AllOtherContributions |
| Noncash Contributions | 70586 | NoncashContributions |
| Total Contributions | 1099020 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT FEES | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 2628317 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2628317 | TotalProgramServiceRevenue |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2100 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2100 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2100 | TotalRevenueColumn |
| Exclusion | $2,100 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3729437 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2628317 | RelatedOrExemptFunctionIncome |
| Exclusion | $2,100 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 463810 | Total |
| Program Services | 263810 | ProgramServices |
| Management And General | 200000 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1643390 | Total |
| Program Services | 1600321 | ProgramServices |
| Management And General | 43069 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197402 | Total |
| Program Services | 174040 | ProgramServices |
| Management And General | 23362 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 132074 | Total |
| Program Services | 117546 | ProgramServices |
| Management And General | 14528 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16717 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 16717 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20625 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 20625 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 326926 | Total |
| Program Services | 177762 | ProgramServices |
| Management And General | 149164 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 525417 | Total |
| Program Services | 381645 | ProgramServices |
| Management And General | 143772 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62720 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 62720 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 143142 | Total |
| Program Services | 128827 | ProgramServices |
| Management And General | 14315 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52143 | Total |
| Program Services | 14145 | ProgramServices |
| Management And General | 37998 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23187 | Total |
| Program Services | 20868 | ProgramServices |
| Management And General | 2319 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97118 | Total |
| Program Services | 65069 | ProgramServices |
| Management And General | 32049 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1352 | Total |
| Program Services | 1352 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3706023 | Total |
| Program Services | 2945385 | ProgramServices |
| Management And General | 760638 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66584 | BOY |
| EOY | 21715 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 273650 | BOY |
| EOY | 376720 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17601 | BOY |
| EOY | 58987 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1978819 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1278057 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 421069 | BOY |
| EOY | 700762 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 42064 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 778904 | BOY |
| EOY | 1200248 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1001863 | BOY |
| EOY | 608159 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28568 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200127 | BOY |
| EOY | 1020329 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1230558 | BOY |
| EOY | 1628488 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -454469 | BOY |
| EOY | -433265 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2815 | BOY |
| EOY | 5025 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -451654 | BOY |
| EOY | -428240 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 778904 | BOY |
| EOY | 1200248 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 23414 | ReconcilationRevenueExpenses |
| 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 | 720961 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1024603 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1461937 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1387600 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1099020 | CurrentTaxYear |
| Total | 5694121 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 720961 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1024603 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1461937 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1387600 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1099020 | CurrentTaxYear |
| Total | 5694121 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 5694121 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 2143 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 854 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 335 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 52 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2100 | CurrentTaxYear |
| Total | 5484 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 5699605 | TotalSupport |
| Gross Receipts From Admissions Etc | 8349338 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.99900 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.99900 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
| Public Support Total509 | 0 | PublicSupportTotal509 |
| Public Support Percentage509 | 0 | PublicSupportPercentage509 |
| Investment Income Percentage | 0 | InvestmentIncomePercentage |
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) |
|---|---|---|
| Investment Cost Or Other Basis | 51068 | InvestmentCostOrOtherBasis |
| Book Value | 51068 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1258491 | InvestmentCostOrOtherBasis |
| Depreciation | 864997 | Depreciation |
| Book Value | 393494 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 669260 | InvestmentCostOrOtherBasis |
| Depreciation | 413060 | Depreciation |
| Book Value | 256200 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 700762 | TotalOfBookValueLandBuildings |
| Total Revenue | 3729437 | TotalRevenue |
| Total Expenses | 3706023 | TotalExpenses |
| Excess Or Deficit For Year | 23414 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 23414 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 3729437 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 3729437 | RevenueSubtotal |
| Total Revenue Per Form990 | 3729437 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 3706023 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 3706023 | ExpensesSubtotal |
| Total Expenses Per Form990 | 3706023 | TotalExpensesPerForm990 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | FREDERIC WORIAX | NamePerson |
| Base Compensation Filing Org | 160000 | BaseCompensationFilingOrg |
| Nontaxable Benefits Filing Org | 8625 | NontaxableBenefitsFilingOrg |
| Total Compensation Filing Org | 168625 | TotalCompensationFilingOrg |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PAUL EMANUEL | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | NEPHEW TO CEO | Relationship |
| Amount Of Transaction | 122530 | AmountOfTransaction |
| Description Of Transaction | MIS TECHNICAL SUPPORT | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| 1 | THE ORGANIZATION EXECUTED A CONTRACT WITH THE NEPHEW OF THE CEO |
| TO PROVIDE MIS TECHNICAL SUPPORT WHICH WAS SIGNED BY BOARD. |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSupplies
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1106 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 55305 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | # OF CONTRIBUTIONS ARE EST @ FMV | MethodOfDeterminingRevenues |
Other Non Cash Contributions Table OtherNonCashContributionsTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Description | LAB SERVICES | Description |
| Number Of Contributions | 3056 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 15281 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | # OF CONTRIBUTIONS ARE EST @ FMV | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGifts |
| Third Parties Used | false | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (15 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Pt VI, Line 11a | MANAGEMENT AND THE BOARD REVIEW AND APPROVE THE FORM 990 BEFORE |
| Pt VI, Line 11a | IT IS FILED WITH THE IRS. |
| Pt VI, Line 12c | ANNUALLY, THE BOARD IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST |
| Pt VI, Line 12c | STATEMENT THAT COMPLIES WIH THE CONFLICT OF INTEREST POLICY. |
| Pt VI, Line 15 | THE ORGANIZATION IS A MEMBER OF THE NATIONAL ASSOCIATION OF COMMUNITY |
| Pt VI, Line 15 | HEALTH CENTERS, AND WITH THIS MEMBERSHIP IS ABLE TO RECEIVE COMPLETED |
| Pt VI, Line 15 | COMPENSATION SURVEYS THAT LIST COMPENSATION BY FUNCTION AND REGION |
| Pt VI, Line 15 | OF EMPLOYMENT. USING THIS SURVEY IS THE INITIAL STATE OF COMPENSATION |
| Pt VI, Line 15 | EVAULATION. THE ORGANIZATION ALSO WILL REVIEW THE APPLICANT'S REQUESTED |
| Pt VI, Line 15 | COMPENSATION RANGE AND DETERMINE IF THIS MEETS PREVIOUSLY |
| Pt VI, Line 15 | BUDGETED BASELINES AS APPROVED BY THE BOARD. THESE DOCUMENTS ARE |
| Pt VI, Line 15 | AVAILABLE IN COMPLIANCE WITH THE FREEDOM OF INFORMATION ACT |
| Pt VI, Line 15 | THROUGH HRSA. |
| Pt VI, Line 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT |
| Pt VI, Line 19 | OF INTEREST POLICY AND FORM 990 AVAILABLE UPON WRITTEN REQUEST. |
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