PACKARD HEALTH INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- PACKARD HEALTH INC (EIN 38-2269817)
- Tax period
- 2009-09-01 to 2010-08-31
- Filed
- 2011-07-13
- IRS object ID
- 201101949349301255
- Schema version
- 2009v1.7
- 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 | 2011-07-13T17:49:06-05:00 | Timestamp |
| Tax Period End Date | 2010-08-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BENNETT & ASSOCIATES CPA'S PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 HURONVIEW BLVD STE 200 | AddressLine1 |
| City | ANN ARBOR | City |
| State | MI | State |
| ZIP Code | 481032946 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-09-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382269817 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKARD HEALTH INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PACK | NameControl |
| Phone | 7349711073 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD RD | AddressLine1 |
| City | ANN ARBOR | City |
| State | MI | State |
| ZIP Code | 48108 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RAYMOND RION | Name |
| Title | MEDICAL DIRECTOR | Title |
| Phone | 7349711073 | Phone |
| Date Signed | 2011-07-13 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES H BENNETT CPA | Name |
| Phone | 7346227000 | Phone |
| Date Prepared | 2011-07-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RAYMOND RION MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD RD | AddressLine1 |
| City | ANN ARBOR | City |
| State | MI | State |
| ZIP Code | 48108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2499709 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.PACKARDHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Activity Or Mission Description | TO PROVIDE HIGH QUALITY, COMPREHENSIVE MEDICAL CARE ON A VERY PERSONAL LEVEL TO PATIENTS IN THE WASHTENAW COUNTY COMMUNITY, REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 43 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 696685 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 683870 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1252245 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1501673 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -99602 | InvestmentIncomePriorYear |
| Investment Income Current Year | 11845 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 56402 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1849328 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2253790 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1442103 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1783738 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 145576 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 646743 | OtherExpensePriorYear |
| Other Expenses Current Year | 833082 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2088846 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2616820 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -239518 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -363030 | RevenuesLessExpensesCY |
| Total Assets BOY | 804213 | TotalAssetsBOY |
| Total Assets EOY | 743890 | TotalAssetsEOY |
| Total Liabilities BOY | 140688 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 438382 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 663525 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 305508 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE HIGH QUALITY, COMPREHENSIVE MEDICAL CARE ON A VERY PERSONAL LEVEL TO PATIENTS IN THE WASHTENAW COUNTY COMMUNITY, REGARDLESS OF ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 2209941 | Expense |
| Revenue | 1722634 | Revenue |
| Description | PACKARD HEALTH, INC. PROVIDES PRIMARY HEALTH CARE SERVICES, INCLUDING MENTAL HEALTH CARE AND HEALTH PROMOTION, TO PATIENTS IN THE WASHTENAW COUNTY AREA. 18,003 APPOINTMENTS WERE TAKEN, WHICH ACCOUNTS FOR APPROXIMATELY 7,000 PATIENTS SEEN IN THE 8/31/09 FISCAL YEAR. | Description |
| Total Program Service Expense | 2209941 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| 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 | false | 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 |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 43 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 43 | 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 |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | 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 | false | 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 | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MI | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | RAYMOND RION MD | NamePerson |
| Telephone Number | 7349711073 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3174 PACKARD ROAD | AddressLine1 |
| City | ANN ARBOR | City |
| State | MI | State |
| ZIP Code | 48108 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| DUANE NEWLAND | |||||||
| CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| NICOLE APPLEBERRY | |||||||
| VICE-CHAIR | 2.00 | X | X | 0 | 0 | 0 | |
| ANNE BROWN | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BARBARA CAMPBELL | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JUDITH CAWHORN | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MICHELLE DEBBINK | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JPAUL DIXON | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| NATALLE EDMUNDS | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LAKSHMI HALASYAMANI | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN MARTIN | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| NORMA MCCULSTON | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT MOYAD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| TISHA O'MALLEY | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JAMES F PEGGS | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| KIM D WALSH | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| CHARLES WILSON | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RAYMOND RION | |||||||
| MEDICAL DIR | 46.00 | X | 180688 | 0 | 11957 | ||
| KIMBERLY KRATZ | |||||||
| EXEC DIR | 46.00 | X | 101113 | 0 | 15450 | ||
| HOLLY ROSS | |||||||
| DOCTOR | 36.00 | 119455 | 0 | 18253 | X | ||
| MIRA P SINHA | |||||||
| DOCTOR | 36.00 | 117641 | 0 | 17976 | X | ||
| ALICE PENROSE | |||||||
| DOCTOR | 35.00 | 105714 | 0 | 16153 | X | ||
| ELLEEN KUET | |||||||
| DOCTOR | 40.00 | 100293 | 0 | 15325 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 724904 | TotalReportableCompFromOrg |
| Total Other Compensation | 95114 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Federated Campaigns | 51603 | FederatedCampaigns |
| Government Grants | 220961 | GovernmentGrants |
| All Other Contributions | 411306 | AllOtherContributions |
| Noncash Contributions | 155458 | NoncashContributions |
| Total Contributions | 683870 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| PATIENT FEES | 1260196 | 1260196 |
| CAPITATION | 241477 | 241477 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1501673 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7316 | TotalRevenueColumn |
| Exclusion | $7,316 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 250448 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 245919 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4529 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4529 | TotalRevenueColumn |
| Exclusion | $4,529 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| ADVISORY BOARD FEES | 52750 | 52750 |
| OTHER REVENUE | 3652 | 3652 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 56402 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2253790 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1558075 | RelatedOrExemptFunctionIncome |
| Exclusion | $11,845 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 309208 | Total |
| Program Services | 266038 | ProgramServices |
| Management And General | 18759 | ManagementAndGeneral |
| Fundraising | 24411 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1259392 | Total |
| Program Services | 1083561 | ProgramServices |
| Management And General | 76404 | ManagementAndGeneral |
| Fundraising | 99427 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92396 | Total |
| Program Services | 79496 | ProgramServices |
| Management And General | 5605 | ManagementAndGeneral |
| Fundraising | 7295 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122742 | Total |
| Program Services | 105606 | ProgramServices |
| Management And General | 7446 | ManagementAndGeneral |
| Fundraising | 9690 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48042 | Total |
| Management And General | 48042 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 107673 | Total |
| Program Services | 96906 | ProgramServices |
| Management And General | 10767 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29474 | Total |
| Program Services | 26527 | ProgramServices |
| Management And General | 2947 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 333816 | Total |
| Program Services | 274675 | ProgramServices |
| Management And General | 54388 | ManagementAndGeneral |
| Fundraising | 4753 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12947 | Total |
| Program Services | 11652 | ProgramServices |
| Management And General | 1295 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52492 | Total |
| Program Services | 47242 | ProgramServices |
| Management And General | 5250 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1344 | Total |
| Program Services | 1210 | ProgramServices |
| Management And General | 134 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18557 | Total |
| Program Services | 15878 | ProgramServices |
| Management And General | 2679 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23344 | Total |
| Program Services | 21010 | ProgramServices |
| Management And General | 2334 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40431 | Total |
| Program Services | 38122 | ProgramServices |
| Management And General | 2309 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 128290 | 128290 | |
| DUES AND SUBSCRIPTIONS | 9416 | 9416 | |
| MISCELLANEOUS | 9037 | 8135 | 902 |
| ORGNAIZATIONAL DEVELOPMEN | 6842 | 6842 | |
| LICENSES AND PERMITS | 5228 | 5228 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6149 | Total |
| Program Services | 5593 | ProgramServices |
| Management And General | 556 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2616820 | Total |
| Program Services | 2209941 | ProgramServices |
| Management And General | 261303 | ManagementAndGeneral |
| Fundraising | 145576 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -12877 | BOY |
| EOY | 11801 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 306559 | BOY |
| EOY | 23320 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51124 | BOY |
| EOY | 45833 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128674 | BOY |
| EOY | 144843 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6028 | BOY |
| EOY | 11395 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 664143 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 368519 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 277205 | BOY |
| EOY | 295624 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47500 | BOY |
| EOY | 211074 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 804213 | BOY |
| EOY | 743890 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 140688 | BOY |
| EOY | 138690 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 299692 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 140688 | BOY |
| EOY | 438382 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 616025 | BOY |
| EOY | 208408 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47500 | BOY |
| EOY | 97100 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 663525 | BOY |
| EOY | 305508 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 804213 | BOY |
| EOY | 743890 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15000 | OtherCostOrOtherBasis |
| Book Value | 15000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 506020 | OtherCostOrOtherBasis |
| Depreciation | 272944 | Depreciation |
| Book Value | 233076 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29345 | OtherCostOrOtherBasis |
| Depreciation | 4224 | Depreciation |
| Book Value | 25121 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 113778 | OtherCostOrOtherBasis |
| Depreciation | 91351 | Depreciation |
| Book Value | 22427 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 295624 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CONDITIONAL CONTRIBUTION - SJMHS | $299,692 |
| RETIREMENT PAYABLE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 299692 | TotalOfAmounts |
| Total Revenue | 2253790 | TotalRevenue |
| Total Expenses | 2616820 | TotalExpenses |
| Excess Or Deficit For Year | -363030 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 5013 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 5013 | TotalAdjustments |
| Excess Or Deficit Per FS | -358017 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 2258803 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 5013 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 5013 | RevenueNotRptdF990 |
| Revenue Subtotal | 2253790 | RevenueSubtotal |
| Total Revenue Per Form990 | 2253790 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2616820 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 2616820 | ExpensesSubtotal |
| Total Expenses Per Form990 | 2616820 | TotalExpensesPerForm990 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 | RAYMOND RION | NamePerson |
| Base Compensation Filing Org | 180688 | BaseCompensationFilingOrg |
| Nontaxable Benefits Filing Org | 11957 | NontaxableBenefitsFilingOrg |
| Total Compensation Filing Org | 192645 | TotalCompensationFilingOrg |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 17244 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | MARKET VALUE | MethodOfDeterminingRevenues |
Food Inventory FoodInventory
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 3 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 33914 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | MARKET VALUE | MethodOfDeterminingRevenues |
Drugs And Medical Supplies DrugsAndMedicalSupplies
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 3 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 104300 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | MARKET VALUE | 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 (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11 | A REPRESENTATIVE OF THE FINANCE COMMITTEE WILL REVIEW THE 990. THE 990 WILL BE MADE AVAILABE TO THE ENTIRE BOARD. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD RE-CERTIFIES THE CONFLICT OF INTEREST DOCUMENTATION ON AN ANNUAL BASIS. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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