CHS Healthcare Foundation Inc: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CHS Healthcare Foundation Inc (EIN 26-0229508)
- Tax period
- 2011-04-01 to 2012-03-31
- Filed
- 2012-11-13
- IRS object ID
- 201233189349300923
- 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 | 2012-11-13T08:15:48-06:00 | Timestamp |
| Tax Period End Date | 2012-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MYERS BRETTHOLTZ & COMPANY PA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12671 WHITEHALL DR | AddressLine1 |
| City | FORT MYERS | City |
| State | FL | State |
| ZIP Code | 339073626 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 260229508 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHS HEALTHCARE FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHSH | NameControl |
| Phone | 2396583000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1454 MADISON AVE | AddressLine1 |
| City | IMMOKALEE | City |
| State | FL | State |
| ZIP Code | 34142 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DENNIS BROWN | Name |
| Title | TREASURER | Title |
| Phone | 2396583000 | Phone |
| Date Signed | 2012-11-01 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN M LOPEZ CPA | Name |
| Phone | 2399395775 | Phone |
| Date Prepared | 2012-11-13 | 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 | DENNIS BROWN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1454 MADISON AVE | AddressLine1 |
| City | IMMOKALEE | City |
| State | FL | State |
| ZIP Code | 34142 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 376851 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHSHEALTHCAREFOUNDATION.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2007 | YearFormation |
| State Legal Domicile | FL | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT THE PROGRAMS AND SERVICES OF COLLIER HEALTH SERVICES, INC. ("CHSI") TO ENABLE CHSI TO MEET ITS MISSION TO PROVIDE A QUALITY HEALTHCARE HOME ACCESSIBLE TO EVERYONE IN ITS COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 21 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 123597 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 376851 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 123597 | TotalRevenuePriorYear |
| Total Revenue Current Year | 376851 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 366391 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 26549 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6814 | OtherExpensePriorYear |
| Other Expenses Current Year | 37772 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6814 | TotalExpensesPriorYear |
| Total Expenses Current Year | 404163 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 116783 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -27312 | RevenuesLessExpensesCY |
| Total Assets BOY | 120424 | TotalAssetsBOY |
| Total Assets EOY | 235023 | TotalAssetsEOY |
| Total Liabilities BOY | 12499 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 154408 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 107925 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 80615 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO SUPPORT THE PROGRAMS AND SERVICES OF COLLIER HEALTH SERVICES, INC. ("CHSI") TO ENABLE CHSI TO MEET ITS MISSION TO PROVIDE A QUALITY HEALTHCARE HOME ACCESSIBLE TO EVERYONE IN ITS COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 366391 | Expense |
| Grants | 366391 | Grants |
| Description | THE FOUNDATION RAISES AWARENESS AND FUNDING FOR THE PROGRAMS AND SERVICES OF CHSI. TO RAISE AWARENESS, THE BOARD OF THE FOUNDATION HAS FORMED A SUBCOMMITTEE TO CREATE NEW BRANDING AND MAREKETING MESSAGES FOR CHSI. CHSI IS A PRIVATE, NOT-FOR-PROFIT "SAFETY NET" HEALTH CARE PROVIDER WITH 12 HEALTH CARE FACILITIES LOCATED THROUGHOUT COLLIER COUNTY, WHICH INCLUDES THE RONALD MCDONALD CARE MOBILE. CHSI PROVIDED PRIMARY MEDICAL AND DENTAL HEALTH CARE TO OVER 43,000 PATIENTS (30,000 CHILDREN) FOR A TOTAL OF 154,500 PATIENT VISITS. RAISING PHILANTHROPIC SUPPORT WILL ALLOW CHSI TO CONTINUE TO GROW TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. | Description |
| Total Program Service Expense | 366391 | 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 | true | 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 | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | false | 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 | 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 |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 21 | 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 | false | WhistleblowerPolicy |
| Document Retention Policy | false | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLLIER HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2396583039 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1454 MADISON AVE | AddressLine1 |
| City | IMMOKALEE | City |
| State | FL | State |
| ZIP Code | 34142 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| EMILY WATT | ||||||
| CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 |
| DOUG CAMBELL | ||||||
| VICE CHAIRM | 1.00 | X | X | 0 | 0 | 0 |
| DENNIS BROWN | ||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 |
| DOTTIE GERRITY | ||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| JOHN MCDONOUGH | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| RICHARD AKIN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JODY ALEXANDER | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| DOLLY BODICK | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| EDWIN COLODNY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| CHARLES JOHNS | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JINNY JOHNSON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| GEORGE MCLAUGHLIN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| SUSAN MORRISON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| EDWARD MORTON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MARSHA MURPHY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| FRED PEZESHKAN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| TOM SCHNEIDER | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| CARLOS TARRA | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JENNIFER WALKER | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| KEN MURRAY | ||||||
| TRUSTEE EMRI | 1.00 | X | 0 | 0 | 0 | |
| CONNSTANCE DILLON | ||||||
| EXECUTIVE DI | 40.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| All Other Contributions | 376851 | AllOtherContributions |
| Total Contributions | 376851 | TotalContributions |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 376851 | TotalRevenueColumn |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 366391 | Total |
| Program Services | 366391 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175 | Total |
| Fundraising | 175 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23443 | Total |
| Management And General | 3270 | ManagementAndGeneral |
| Fundraising | 20173 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153 | Total |
| Management And General | 153 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8221 | Total |
| Management And General | 3006 | ManagementAndGeneral |
| Fundraising | 5215 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 425 | Total |
| Management And General | 425 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209 | Total |
| Management And General | 209 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|
| CELL PHONE | 1957 | 1957 | |
| SMALL EQUIPMENT | 1350 | 1350 | |
| DUES AND PUBLICATIONS | 991 | 396 | 595 |
| OTHER | 848 | 457 | 391 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 404163 | Total |
| Program Services | 366391 | ProgramServices |
| Management And General | 11223 | ManagementAndGeneral |
| Fundraising | 26549 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 119131 | BOY |
| EOY | 234239 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300 | BOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1463 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 679 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 993 | BOY |
| EOY | 784 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 120424 | BOY |
| EOY | 235023 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12499 | BOY |
| EOY | 1805 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 152603 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12499 | BOY |
| EOY | 154408 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107925 | BOY |
| EOY | 80615 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107925 | BOY |
| EOY | 80615 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 120424 | BOY |
| EOY | 235023 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -27312 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 2 | ReconcilationOtherChanges |
| 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 | false | FederalGrantAuditRequired |
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 | 10000 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 60960 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 79032 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 123597 | CurrentTaxYearMinus1Year |
| Current Tax Year | 376851 | CurrentTaxYear |
| Total | 650440 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 10000 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 60960 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 79032 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 123597 | CurrentTaxYearMinus1Year |
| Current Tax Year | 376851 | CurrentTaxYear |
| Total | 650440 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 173646 | AmountsSubstContributorsTotal |
| Public Support Total170 | 476794 | PublicSupportTotal170 |
| Total Support | 650440 | TotalSupport |
| Public Support Pertcentage170 | 0.73300 | PublicSupportPertcentage170 |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1463 | OtherCostOrOtherBasis |
| Depreciation | 679 | Depreciation |
| Book Value | 784 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 784 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | AGENCY TRANSACTIONS | Description |
| Amount | $152,603 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 152603 | TotalOfAmounts |
| Total Revenue | 376851 | TotalRevenue |
| Total Expenses | 404163 | TotalExpenses |
| Excess Or Deficit For Year | -27312 | ExcessOrDeficitForYear |
| Other | $7,530,815 | OtherAmount |
| Total Adjustments | 7530815 | TotalAdjustments |
| Excess Or Deficit Per FS | 7503503 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 69899351 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 69843892 | OtherRevenues |
| Revenue Not Rptd F990 | 69843892 | RevenueNotRptdF990 |
| Revenue Subtotal | 55459 | RevenueSubtotal |
| Other Revenues Not Included | 321392 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 321392 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 376851 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 62395848 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 62313077 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 62313077 | ExpensesNotRptdF990 |
| Expenses Subtotal | 82771 | ExpensesSubtotal |
| Other Expenses Not Included | 321392 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 321392 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 404163 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RECONCILIATION OF CHANGES - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 8 | COLLIER HEALTH SERVICES, INC. REVENUE 31,142,595 INTEGRAL HEALTH PLAN, INC. REVENUE 42,168,904 INTERCOMPANY ELIMINATIONS -3,467,607 AGENCY TRANSACTIONS -321,392 COLLIER HEALTH SERVCIES, INC. EXPENSES -25,725,857 INTEGRAL HEALTH PLAN, INC. EXPENSES -40,054,827 INTERCOMPANY ELIMINATIONS 3,467,607 AGENCY TRANSACTIONS 321,392 |
| REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 2D | COLLIER HEALTH SERVICES, INC. REVENUE 31,142,595 INTEGRAL HEALTH PLAN, INC. REVENUE 42,168,904 INTERCOMPANY ELIMINATIONS -3,467,607 |
| REVENUE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 4B | AGENCY TRANSACTIONS 321,392 |
| EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 2D | COLLIER HEALTH SERVCIES, INC. EXPENSES 25,725,857 INTEGRAL HEALTH PLAN, INC. EXPENSES 40,054,827 INTERCOMPANY ELIMINATIONS -3,467,607 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 4B | AGENCY TRANSACTIONS 321,392 |
| SUPPLEMENTAL FINANCIAL INFORMATION | SCHEDULE D, PAGE 4, PART XIV | THE AUDITED FINANCIAL STATEMENTS OF THE FOUNDATION WERE BASED ON THE CONSOLIDATED FINANCIAL STATEMENTS OF COLLIER HEALTH SERVICES, INC. ("CHSI"), INTEGRAL HEALTH PLAN, INC. ("IHP") AND CHS HEALTHCARE FOUNDATION, INC. ("FOUNDATION"). FORM 990 ONLY INCLUDES THE ACTIVITY OF THE FOUNDATION. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| CHS HEALTHCARE | |||||||
| 1454 MADISON AVENUE | IMMOKALEE | FL | 34142 | 591741277 | 501 | 45000 | HEALTHCARE |
| CHS HEALTHCARE | |||||||
| 1454 MADISON AVENUE | IMMOKALEE | FL | 34142 | 591741277 | 501 | 321391 | AGENCY TRANSACTIONS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Sharing Of RevenuesSharingOfRevenues |
|---|---|
| CONNIE DILLON | |
| CHSI EMPLOYEE | false |
| DENNIS BROWN | |
| CHSI BRD MEMBER | false |
| DOUG CAMPBELL | |
| CHSI BRD MEMBER | false |
| RICHARD AKIN | |
| CHSI - CEO | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | THE FOUNDATION GRANTED 45000 TO CHSI AND COLLECTED FUNDS IN THE AMOUNT OF 321391 ON CHSIS BEHALF | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | A DRAFT OF THE TAX RETURN IS REVIEWED BY THE BOARD FOR ACCURACY AND COMPLETENESS PRIOR TO SIGNING AND FILING THE RETURN. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICTS OF INTEREST ARE DISCUSSED AND DISCLOSED AT BOARD MEETINGS, PRIMARLIY ON AN ISSUE BY ISSUE BASIS. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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