SEATTLE ROOTS COMMUNITY HEALTH: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SEATTLE ROOTS COMMUNITY HEALTH (EIN 23-7100868)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201233199349305048
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)
Timestamp2012-11-14T15:05:13-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13000 NORTHUP WAY SUITE 200AddressLine1
CityBELLEVUECity
StateWAState
ZIP Code980041446ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237100868EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COUNTRY DOCTOR COMMUNITY CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOUNNameControl
Phone2062991937Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12101 EAST YESLER WAY NO 210AddressLine1
CitySEATTLECity
StateWAState
ZIP Code981225900ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLINDA MCVEIGHName
TitleEXECUTIVE DIRECTORTitle
Phone2062991937Phone
Date Signed2012-11-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NamePAUL MBAILEYName
PTINP00292653PTIN
Phone4252506100Phone
Date Prepared2012-11-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLINDA MCVEIGHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 19TH AVENUE EASTAddressLine1
CitySEATTLECity
StateWAState
ZIP Code98112ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12350106GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.COUNTRYDOCTOR.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees162TotalNbrEmployees
Total Nbr Volunteers16TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year5556179ContributionsGrantsPriorYear
Contributions Grants Current Year4792780ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5616085ProgramServiceRevenuePriorYear
Program Service Revenue CY5393367ProgramServiceRevenueCY
Investment Income Prior Year60346InvestmentIncomePriorYear
Investment Income Current Year14210InvestmentIncomeCurrentYear
Other Revenue Prior Year136860OtherRevenuePriorYear
Other Revenue Current Year646771OtherRevenueCurrentYear
Total Revenue Prior Year11369470TotalRevenuePriorYear
Total Revenue Current Year10847128TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7969816SalariesEtcPriorYear
Salaries Etc Current Year8070734SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year127074TotalFundrsngExpCurrentYear
Other Expense Prior Year3475088OtherExpensePriorYear
Other Expenses Current Year3098796OtherExpensesCurrentYear
Total Expenses Prior Year11444904TotalExpensesPriorYear
Total Expenses Current Year11169530TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-75434RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-322402RevenuesLessExpensesCY
Total Assets BOY7442954TotalAssetsBOY
Total Assets EOY7032258TotalAssetsEOY
Total Liabilities BOY2998470TotalLiabilitiesBOY
Total Liabilities EOY2898251TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4444484NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4134007NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF COUNTRY DOCTOR COMMUNITY CLINIC IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING HIGH QUALITY, CARING, CULTURALLY APPROPRIATE PRIMARY HEALTH CARE THAT ADDRESSESS THE NEEDS OF PEOPLE REGARDLESS OF THEIR ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8552165Expense
Revenue5393367Revenue
DescriptionIN 2011 COUNTRY DOCTOR COMMUNITY CLINIC PROVIDED 52,984 MEDICAL VISITS. 84% OF THE PATIENTS SEEN IN 2011 HAD INCOME LESS THAN 200% OF THE FEDERAL POVERTY (FPL). ALL UNINSURED PATIENTS (57% OF THE TOTAL PATIENTS SEEN) EARNING LESS THAN 200% OF FPL WERE SEEN ON A SLIDING SCALE DISCOUNT.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense72028Expense
DescriptionDENTAL CARE IS PROVIDED TO COUNTRY DOCTOR COMMUNITY CLINC (CDCC) PATIENTS THROUGH A CONTRACTUAL ARRANGEMENT WITH A COMMUNITY DENTAL PROVIDER. IN 2011, 178 DENTAL VISITS WERE PROVIDED TO LOW INCOME, UNINSURED PATIENTS. THERE IS NO REVENUE GENERATE BY CDCC THROUGH THIS CONTRACT.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1122445Expense
DescriptionTHE OTHER HEALTH SERVICES PROGRAM PROVIDED 15,226 ANCILLARY HEALTH VISITS (EG NUTRITION, MENTAL HEALTH, WIC, ELIGIBILITY) TO LOW INCOME PATIENTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense9746638TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees162NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SUSANA TANTICOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2062991937TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12101 EAST YESLER WAY SUITE 210AddressLine1
CitySEATTLECity
StateWAState
ZIP Code98122ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
AUGUST PIPER
DIRECTOR1.00X000
CHERYL ANDERSON
DIRECTOR1.00X000
COLT DEWOLF
DIRECTOR1.00X000
JERRET SALE
TREASURER1.00X000
JOAN KLEINBERG
SECRETARY1.00X000X
LY SIENG NGO
DIRECTOR1.00X000X
PAMELA DUNN
CHAIRPERSON1.00X000
PATRICK FERGUSON
VICE CHAIRPERSON1.00X000X
RIK WYMAN
DIRECTOR1.00X000
SARA THOMPSON
DIRECTOR1.00X000
WINNIE SPERRY
DIRECTOR1.00X000
ROBERT LESKO
DIRECTOR1.00X000
ROBERT STRAIT
DIRECTOR1.00X000
LINDA MCVEIGH
EXECUTIVE DIRECTOR35.00145175013993X
SUSANA TANTICO
DIRECTOR OF FINANCE40.0091333015063X
RICHARD KOVAR MD
MEDICAL DIRECTOR32.00154864018398X
HAROLD MOORE
PHYSICIAN/SITE DIRECTOR35.00138283014700X
CARRIE RUBENSTEIN MD
PHYSICIAN/CLINICAL DIRECTOR28.00107424012004X
MEGAN DEBELL MD
PHYSICIAN/CLINICAL DIRECTOR28.00108395011443X
BESSIE CHI
PHARMACIST40.00104909013023X
JUSTIN PAT
IT SPECIALIST40.00102983015597X
FieldValueIRS element (for citing)
Total Reportable Comp From Org953366TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation114221TotalOtherCompensation
Number Individuals GT100 K7NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PTSO OF WASHINGTONBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1710 OLIVE WAY SUITE 300AddressLine1
CitySEATTLECity
StateWAState
ZIP Code98101ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesINFO TECH SUPPORTDescriptionOfServices
Compensation282340Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns111472FederatedCampaigns
Fundraising Events769365FundraisingEvents
Government Grants3911943GovernmentGrants
Noncash Contributions234295NoncashContributions
Total Contributions4792780TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
THIRD PARTY PAYMENTS90009923153422315342
PATIENT FEES62140017256701725670
MEDICARE/MEDICAID PAYM90009913523551352355
FieldValueIRS element (for citing)
Total Program Service Revenue5393367TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column16364TotalRevenueColumn
Exclusion$16,364ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real41008Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real41008Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column41008TotalRevenueColumn
Exclusion$41,008ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1447733Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1449887Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-2154Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-2154TotalRevenueColumn
Exclusion-$2,154ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events133403GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events769365CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses53091FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column80312TotalRevenueColumn
Exclusion$80,312ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column525451TotalRevenueColumn
Related Or Exempt Function Income525451RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue525451TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10847128TotalRevenueColumn
Related Or Exempt Function Income5918818RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$135,530ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total438826Total
Program Services173262ProgramServices
Management And General265564ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5977768Total
Program Services5714398ProgramServices
Management And General182905ManagementAndGeneral
Fundraising80465Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total260210Total
Program Services237335ProgramServices
Management And General18854ManagementAndGeneral
Fundraising4021Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total927204Total
Program Services740754ProgramServices
Management And General178190ManagementAndGeneral
Fundraising8260Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total466726Total
Program Services424330ProgramServices
Management And General36241ManagementAndGeneral
Fundraising6155Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total41010Total
Management And General41010ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total81786Total
Management And General81786ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total735188Total
Program Services681869ProgramServices
Management And General53203ManagementAndGeneral
Fundraising116Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total412698Total
Program Services331650ProgramServices
Management And General56815ManagementAndGeneral
Fundraising24233Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total442406Total
Program Services227112ProgramServices
Management And General212899ManagementAndGeneral
Fundraising2395Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total38359Total
Program Services30091ProgramServices
Management And General8028ManagementAndGeneral
Fundraising240Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total457000Total
Program Services430837ProgramServices
Management And General26133ManagementAndGeneral
Fundraising30Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total76040Total
Program Services36764ProgramServices
Management And General39276ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PHARMACEUTICALS430758430758
BAD DEBT192933192933
MISCELLANEOUS19044294369949141159
FUNDRAISING1761760

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11169530Total
Program Services9746638ProgramServices
Management And General1295818ManagementAndGeneral
Fundraising127074Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY635067BOY
EOY308879EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY91346BOY
EOY91367EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY712067BOY
EOY734297EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY498992BOY
EOY778079EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY342872BOY
EOY460170EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7639542LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4646678LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3261242BOY
EOY2992864EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1887283BOY
EOY1653174EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY14085BOY
EOY13428EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7442954BOY
EOY7032258EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY959032BOY
EOY878509EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1724290BOY
EOY1697853EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY315148BOY
EOY321889EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2998470BOY
EOY2898251EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4361429BOY
EOY4050952EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY83055BOY
EOY83055EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4444484BOY
EOY4134007EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7442954BOY
EOY7032258EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-322402ReconcilationRevenueExpenses
Reconcilation Other Changes11925ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3939346CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4565967CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4928394CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5556179CurrentTaxYearMinus1Year
Current Tax Year4792780CurrentTaxYear
Total23782666Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3939346CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4565967CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4928394CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5556179CurrentTaxYearMinus1Year
Current Tax Year4792780CurrentTaxYear
Total23782666Total
FieldValueIRS element (for citing)
Public Support Total17023782666PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years171525CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years134216CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years95365CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year84668CurrentTaxYearMinus1Year
Current Tax Year57372CurrentTaxYear
Total543146Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years140611CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years94785CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years74227CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year30685CurrentTaxYearMinus1Year
Current Tax Year78158CurrentTaxYear
Total418466Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3939CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1882CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3841CurrentTaxYearMinus2Years
Total9662Total
FieldValueIRS element (for citing)
Total Support24753940TotalSupport
Public Support Pertcentage1700.96080PublicSupportPertcentage170
Public Support Pertcent Prior Year0.95900PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance83055BeginningOfYearBalance
End Of Year Balance83055EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance83055BeginningOfYearBalance
End Of Year Balance83055EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance83055BeginningOfYearBalance
End Of Year Balance83055EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance83055BeginningOfYearBalance
End Of Year Balance83055EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis184000OtherCostOrOtherBasis
Book Value184000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5377881OtherCostOrOtherBasis
Depreciation3038002Depreciation
Book Value2339879BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis182047OtherCostOrOtherBasis
Depreciation171363Depreciation
Book Value10684BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1895614OtherCostOrOtherBasis
Depreciation1437313Depreciation
Book Value458301BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2992864TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
CAPITAL LEASE$21,654
FQHC ENHANCEMENT SETTLEMENT$287,133
OTHER LIABILITIES (DEFERRED RENT)$13,102
FieldValueIRS element (for citing)
Total Of Amounts321889TotalOfAmounts
Total Revenue10847128TotalRevenue
Total Expenses11169530TotalExpenses
Excess Or Deficit For Year-322402ExcessOrDeficitForYear
Net Unrealized GL On Investments11925NetUnrealizedGLOnInvestments
Total Adjustments11925TotalAdjustments
Excess Or Deficit Per FS-310477ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt10974546TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments11925NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities62402DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F99074327RevenueNotRptdF990
Revenue Subtotal10900219RevenueSubtotal
Other Revenues Not Included-53091OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-53091RevenueNotRptdOnFinStmt
Total Revenue Per Form99010847128TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11285023TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities62402DonatedServicesUseOfFacilities
Other Expenses Included53091OtherExpensesIncluded
Expenses Not Rptd F990115493ExpensesNotRptdF990
Expenses Subtotal11169530ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011169530TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE ENDOWMENT FUNDS ARE ASSETS SET ASIDE AND RESTRICTED BY DONORS. THE INCOME GENERATED FROM THESE ASSETS IS USED TO FUND OPERATIONS OF THE ORGANIZATION.
PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT SPECIAL EVENT EXPENSES PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT SPECIAL EVENT EXPENSES
CDCHC HAS RECEIVED A DETERMINATION LETTER FROM THE IRS THAT STATES IT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NO PROVISION FOR INCOME TAXES IS SHOWN IN THE FINANCIAL STATEMENTS BECAUSE CDCHC IS A NOT-FOR-PROFIT ORGANIZATION, EXEMPT FROM INCOME TAXES. MANAGEMENT EVALUATED CDCHCS TAX POSITIONS AND CONCLUDED THAT CDCHC HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPIC 740 OF THE ACCOUNTING STANDARDS CODIFICATION. CDCHC IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2008.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1FUND RAISING DINNERNameOfEvent1
Gross Receipts Event1902768GrossReceiptsEvent1
Charitable Contributions Event1769365CharitableContributionsEvent1
Gross Revenue Event1133403GrossRevenueEvent1
Rent Facility Costs Event135607RentFacilityCostsEvent1
Other Direct Expenses Event117484OtherDirectExpensesEvent1
Gross Receipts Total902768GrossReceiptsTotal
Charitable Contributions Total769365CharitableContributionsTotal
Gross Revenue Total Events133403GrossRevenueTotalEvents
Rent Facility Costs Total Events35607RentFacilityCostsTotalEvents
Other Direct Expenses Total Events17484OtherDirectExpensesTotalEvents
Direct Expense Summary Events53091DirectExpenseSummaryEvents
Net Income Summary80312NetIncomeSummary

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
LINDA MCVEIGH
145067010800000139930159168000
RICHARD KOVAR MD
15476709700000183980173262000
HAROLD MOORE
138175010800000147000152983000

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions12NumberOfContributions
Noncash Contribs Rptd F990234295NoncashContribsRptdF990
Method Of Determining RevenuesCOST OR SELLING PRICEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE BOTH REVIEW A DRAFT OF THE RETURN BEFORE IT IS PRESENTED TO THE FINANCE COMMITTEE FOR FURTHER REVIEW. AFTER REVIEW BY THE FINANCE COMMITTEE AND DISTRIBUTION TO THE FULL BOARD THE FORM 990 IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CCOMPLIANCE AND NON-COMPLIANCE WERE REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED DURING THE MONTHLY MEETINGS. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ANNUALLY. ANY MEMBER WITH A STATED CONFLICT OF INTEREST IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD CHAIRPERSON DETERMINES THE EXTENT OF THE CONFLICT AND WHETHER THE CONFLICTED BOARD MEMBER SHOULD NOT VOTE ON AN ISSUE OR SHOULD RECUSE THEMSELF FROM THE DISCUSSION.
FORM 990, PART VI, SECTION B, LINE 15THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. EVERY TWO YEARS THIS PROCESS IS ASSISTED BY AN INDEPENDENT COMPENSATION CONSULTANT. THE LAST REVIEW PROCESS OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS DONE IN AUGUST 2010. THE DIRECTOR OF FINANCE'S COMPENSATION IS DETERMINED ANNUALLY BY THE BOARD BASED ON A MILLIMAN SURVEY THAT ASSESSES MARKET COMPENSATION. THE REVIEW OF THE DIRECTOR OF FINANCE'S COMPENSATION WAS DONE IN JULY 2010.
FORM 990, PART VI, SECTION C, LINE 19NO DOCUMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 11,925.CHANGES IN NET ASSETS OR FUND BALANCES:

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