SACRED HEART COMMUNITY CLINIC INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SACRED HEART COMMUNITY CLINIC INC (EIN 27-2901548)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-21
IRS object ID
201242349349300204
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)
Timestamp2012-08-21T06:39:04-07:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ALTON D THIELE PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1300 EAST AVENUE C P O BOX 808AddressLine1
CityBELTONCity
StateTXState
ZIP Code76513ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN272901548EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SACRED HEART COMMUNITY CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSACRNameControl
Phone5127163929Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1620 ROUND ROCK WEST DRIVE BLDG 8AddressLine1
CityROUND ROCKCity
StateTXState
ZIP Code78681ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHELLE BURRName
TitlePRESIDENTTitle
Phone5127163929Phone
Date Signed2012-08-20DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameALTON D THIELE CPAName
Phone2549390701Phone
Date Prepared2012-08-21DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHELLE BURRNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11132 OAKLANDS DRAddressLine1
CityROUND ROCKCity
StateTXState
ZIP Code78681ZIPCode
FieldValueIRS element (for citing)
Gross Receipts355271GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitesacredheartclinic.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2010YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionTo provide free outpatient health services to the uninsured and underinsured residents of the Round Rock area.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers125TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year355214ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Current Year57InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Current Year355271TotalRevenueCurrentYear
Grants And Similar Amnts CY178583GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expenses Current Year39005OtherExpensesCurrentYear
Total Expenses Current Year217588TotalExpensesCurrentYear
Revenues Less Expenses CY137683RevenuesLessExpensesCY
Total Assets BOY15446TotalAssetsBOY
Total Assets EOY153129TotalAssetsEOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15446NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY153129NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide free outpatient health servicesMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense199602Expense
Grants178583Grants
DescriptionPROVIDING FREE OUTPATIENT HEALTH CARE SERVICES TO THE QUALIFYING UNINSURED AND UNDERINSURED RESIDENTS OF THE ROUND ROCK TX AREADescription
Total Program Service Expense199602TotalProgramServiceExpense
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 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
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
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
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 Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
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 BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementfalseRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Own WebsiteXOwnWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDEACON DENNIS EGANNamePerson
Telephone Number5123889732TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11907 HAMPTON LNAddressLine1
CityROUND ROCKCity
StateTXState
ZIP Code78664ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
BRUNET SARAH
Secretary5.00XX000
BRUSKEWITZ SANDY
Clinic Supv10.00X000
BURR MICHELLE
President15.00XX000
BURTON-GARCIA ELIZABETH
Executive Director20.00X000
DE HARO RAY
Board Member2.00X000
EGAN DENNIS
Treasurer5.00XX000
HERNANDEZ TINO
Past President10.00X000
OLIVAREZ SANTOS
VP5.00XX000
RODRIGUEZ MELINDA
Fund Raising Chair2.00X000
URIEGAS RUDOLFO
Medical Director15.00X000
URIEGAS SABRINA
Clinic Ops Chair15.00X000
WEST JERRI
IT Manager10.00X000
WILHELM FATHER DEAN
Spiritual Director2.00X000
TORRES JESSICA
Pharmacist in Charge1.00X000
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
All Other Contributions355214AllOtherContributions
Total Contributions355214TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column57TotalRevenueColumn
Exclusion$57ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column355271TotalRevenueColumn
Exclusion$57ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total178583Total
Program Services178583ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1206Total
Program Services229ProgramServices
Management And General977ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9403Total
Program Services0ProgramServices
Management And General9403ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2100Total
Program Services0ProgramServices
Management And General2100ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2670Total
Program Services2670ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total251Total
Program Services0ProgramServices
Management And General251ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2888Total
Program Services800ProgramServices
Management And General2088ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total3053Total
Program Services0ProgramServices
Management And General3053ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
License/Inspection86786700
Medical Supplies104361043600
Pharmaceuticals6017601700
Bank Fees760760

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total38Total
Program Services0ProgramServices
Management And General38ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total217588Total
Program Services199602ProgramServices
Management And General17986ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY15446BOY
EOY69883EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY44861EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis41273LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2888LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
EOY38385EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY15446BOY
EOY153129EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY15446BOY
EOY153129EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15446BOY
EOY153129EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15446BOY
EOY153129EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses137683ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year355214CurrentTaxYear
Total355214Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year355214CurrentTaxYear
Total355214Total
FieldValueIRS element (for citing)
Public Support Total509355214PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year57CurrentTaxYear
Total57Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year57CurrentTaxYear
Total57Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Total355271Total
FieldValueIRS element (for citing)
First5 Years509XFirst5Years509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

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

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis32533OtherCostOrOtherBasis
Depreciation2597Depreciation
Book Value29936BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8740OtherCostOrOtherBasis
Depreciation291Depreciation
Book Value8449BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings38385TotalOfBookValueLandBuildings

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1CATHOLIC DIOCESE OF AUSTINBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16225 HWY 295 EASTAddressLine1
CityAUSTINCity
StateTXState
ZIP Code78723ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient741542827EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant178583AmountOfCashGrant
Method Of ValuationCASHMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantCHARITABLEPurposeOfGrant

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions100NumberOfContributions
Noncash Contribs Rptd F9908000NoncashContribsRptdF990
Method Of Determining RevenuesResale ValueMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionF&EDescription
Number Of Contributions100NumberOfContributions
Noncash Contribs Rptd F99011700NoncashContribsRptdF990
Method Of Determining RevenuesResale ValueMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 2Medical Directors (M/M Uriegas) are married; Secretary is daughter of Clinic Supv
Pt VI, Line 11aBoard will likely review after filing; Treasurer will review before
Form 990, Part IX, Line 24fDUES/MEMBERSHIPS 38. 0. 38. 0. 0.

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