NORTH SHORE COMMUNITY HEALTH INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- NORTH SHORE COMMUNITY HEALTH INC (EIN 04-2610447)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-02-10
- IRS object ID
- 201120419349300037
- 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 | 2011-02-10T16:04:43-06:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEXANDER ARONSON FINNING & CO PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 21 EAST MAIN STREET | AddressLine1 |
| City | WESTBORO | City |
| State | MA | State |
| ZIP Code | 01581 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042610447 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH SHORE COMMUNITY HEALTH INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 9787448388 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 CONGRESS STREET No 103 | AddressLine1 |
| City | SALEM | City |
| State | MA | State |
| ZIP Code | 01970 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GLORIA RILEY | Name |
| Title | executive director | Title |
| Phone | 9787448388 | Phone |
| Date Signed | 2011-02-08 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANA J MARKS CPA | Name |
| Phone | 5083669100 | Phone |
| Date Prepared | 2011-02-08 | 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 | dr robert hendershott | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 CONGRESS STREET | AddressLine1 |
| City | SALEM | City |
| State | MA | State |
| ZIP Code | 01970 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8490803 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.NSCHI.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1977 | YearFormation |
| State Legal Domicile | MA | StateLegalDomicile |
| Activity Or Mission Description | provides primary and preventative health care, including related health care services such as dental services to the residents of Salem, Peabody and Gloucester, Massachusetts, and the surrounding areas. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 89 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1692982 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2707564 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 4512763 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5640210 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 13988 | InvestmentIncomePriorYear |
| Investment Income Current Year | 12855 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 123881 | OtherRevenuePriorYear |
| Other Revenue Current Year | 130174 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6343614 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8490803 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3700225 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4490839 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2725098 | OtherExpensePriorYear |
| Other Expenses Current Year | 2953014 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6425323 | TotalExpensesPriorYear |
| Total Expenses Current Year | 7443853 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -81709 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1046950 | RevenuesLessExpensesCY |
| Total Assets BOY | 5116876 | TotalAssetsBOY |
| Total Assets EOY | 5884992 | TotalAssetsEOY |
| Total Liabilities BOY | 1994315 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1715481 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3122561 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4169511 | NetAssetsOrFundBalancesEOY |
| Mission Description | to develop and operate a primary care health center to serve the residents of Salem, MAssachusetts and the surrounding communities. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4717384 | Expense |
| Revenue | 3796226 | Revenue |
| Description | MEDICAL SERVICES - MEDICAL SERVICES PROVIDED TO THE RESIDENTS OF SALEM, PEABODY, gloucester AND SURROUNDING COMMUNITIES. SERVICES INCLUDE MEDICAL SERVICES TO ADULTS AND CHILDREN, HIV COUNSELING AND OTHER. (31,603 VISITS) | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1191429 | Expense |
| Revenue | 1103556 | Revenue |
| Description | DENTAL SERVICES - DENTAL SERVICES PROVIDED TO THE ADULTS & CHILDREN RESIDENTS OF SALEM, PEABODY, gloucester AND SURROUNDING COMMUNITIES. (11,598 VISITS) | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 492978 | Expense |
| Revenue | 530414 | Revenue |
| Description | PHARMACEUTICAL SERVICES - PROVIDE PHARMACY SERVICES TO PATIENTS OF THE HEALTH CENTER, INCLUDING BUT NOT LIMITED TO UNDER AND UNINSURED PATIENTS. (26,757 Prescriptions) | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 164356 | Expense |
| Revenue | 340188 | Revenue |
| Description | school based health center and other - health services provided to students at salem high school. (750 visits) | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 164356 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 340188 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 6566147 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 89 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MA | StatesWhereCopyOfReturnIsFiled |
| 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 | john hildreth | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9787448388 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 CONGRESS STREET | AddressLine1 |
| City | SALEM | City |
| State | MA | State |
| ZIP Code | 01970 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 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 |
|---|---|---|---|---|---|---|---|
| marion winfrey | |||||||
| president | 2.00 | X | X | 0 | 0 | 0 | |
| beverly white | |||||||
| vice president | 1.00 | X | X | 0 | 0 | 0 | |
| paul o'shea | |||||||
| treasurer | 2.00 | X | X | 0 | 0 | 0 | |
| pamela paine | |||||||
| secretary | 1.00 | X | X | 0 | 0 | 0 | |
| george kaplan | |||||||
| board member | 1.00 | X | 0 | 0 | 0 | ||
| jack vondras | |||||||
| board member | 1.00 | X | 0 | 0 | 0 | ||
| lucy corchado | |||||||
| board member | 1.00 | X | 0 | 0 | 0 | ||
| calvin young | |||||||
| board member | 1.00 | X | 0 | 0 | 0 | ||
| Paul Passeri | |||||||
| board member | 1.00 | X | 0 | 0 | 0 | ||
| DR ROBERT HENDERSHOTT | |||||||
| EXEC. DIR. | 40.00 | X | 169897 | 0 | 20488 | X | |
| gloria riley | |||||||
| COO | 40.00 | X | 89527 | 0 | 11000 | ||
| dr Azra Ali | |||||||
| MD | 40.00 | 122628 | 0 | 13000 | X | ||
| dr Katarzyna Gilek-seib | |||||||
| MD | 40.00 | 123783 | 0 | 6500 | X | ||
| dr gabrille demille | |||||||
| dentist | 40.00 | 115409 | 0 | 4622 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 621244 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 55610 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| North shore physicians group inc | |||||
| 61 elm st | danvers | MA | 01923 | OB/GYN Services | 171762 |
| RC Griffin | |||||
| 49 Central St | Peabody | MA | 01960 | Construction | 153723 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Government Grants | 2216128 | GovernmentGrants |
| All Other Contributions | 491436 | AllOtherContributions |
| Total Contributions | 2707564 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE Fees | 621110 | 3506453 | 3506453 |
| Medicare/Medicaid Paym | 621110 | 2133757 | 2133757 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5640210 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12855 | TotalRevenueColumn |
| Exclusion | $12,855 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| debt forgiveness | 621110 | 79167 | 79167 |
| Miscellaneous Revenue | 621110 | 51007 | 51007 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 130174 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8490803 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5770384 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $12,855 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 314055 | Total |
| Management And General | 314055 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3441531 | Total |
| Program Services | 3271493 | ProgramServices |
| Management And General | 170038 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 454047 | Total |
| Program Services | 428218 | ProgramServices |
| Management And General | 25829 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 281206 | Total |
| Program Services | 251552 | ProgramServices |
| Management And General | 29654 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33692 | Total |
| Program Services | 475 | ProgramServices |
| Management And General | 33217 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64808 | Total |
| Management And General | 64808 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25435 | Total |
| Management And General | 25435 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 323255 | Total |
| Program Services | 312667 | ProgramServices |
| Management And General | 10588 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139906 | Total |
| Program Services | 99591 | ProgramServices |
| Management And General | 40315 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310251 | Total |
| Program Services | 290920 | ProgramServices |
| Management And General | 19331 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41247 | Total |
| Program Services | 4327 | ProgramServices |
| Management And General | 36920 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64104 | Total |
| Program Services | 48719 | ProgramServices |
| Management And General | 15385 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 232437 | Total |
| Program Services | 205425 | ProgramServices |
| Management And General | 27012 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75175 | Total |
| Program Services | 64263 | ProgramServices |
| Management And General | 10912 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 653489 | 653489 | |
| Contracted Services | 373156 | 368156 | 5000 |
| Bad Debts | 240685 | 240685 | |
| Dispensing Fees | 211099 | 211099 | |
| dues and subscriptions | 66105 | 41385 | 24720 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98170 | Total |
| Program Services | 73683 | ProgramServices |
| Management And General | 24487 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7443853 | Total |
| Program Services | 6566147 | ProgramServices |
| Management And General | 877706 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 391401 | BOY |
| EOY | 723958 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 580947 | BOY |
| EOY | 824808 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 782865 | BOY |
| EOY | 838688 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 880638 | BOY |
| EOY | 1136295 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69045 | BOY |
| EOY | 19095 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113783 | BOY |
| EOY | 81603 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 3758918 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1498373 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1938116 | BOY |
| EOY | 2260545 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 360081 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5116876 | BOY |
| EOY | 5884992 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 651833 | BOY |
| EOY | 478170 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1342482 | BOY |
| EOY | 1237311 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1994315 | BOY |
| EOY | 1715481 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2528956 | BOY |
| EOY | 3595041 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 593605 | BOY |
| EOY | 574470 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3122561 | BOY |
| EOY | 4169511 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5116876 | BOY |
| EOY | 5884992 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 869761 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1197957 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1344767 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1692982 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2707564 | CurrentTaxYear |
| Total | 7813031 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 869761 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1197957 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1344767 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1692982 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2707564 | CurrentTaxYear |
| Total | 7813031 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 7813031 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 10170 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 32434 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 26850 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 13988 | CurrentTaxYearMinus1Year |
| Current Tax Year | 12855 | CurrentTaxYear |
| Total | 96297 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 11391 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2286 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4990 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 44714 | CurrentTaxYearMinus1Year |
| Current Tax Year | 130174 | CurrentTaxYear |
| Total | 193555 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 8102883 | TotalSupport |
| Gross Receipts From Admissions Etc | 21752038 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.96420 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.97510 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
| General Explanation | Schedule A, Part II, Line 10, Explanation of Other Income: rental income, debt forgiveness & miscellaneous revenue | GeneralExplanation |
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
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1409274 | OtherCostOrOtherBasis |
| Depreciation | 35678 | Depreciation |
| Book Value | 1373596 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1691348 | OtherCostOrOtherBasis |
| Depreciation | 981644 | Depreciation |
| Book Value | 709704 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 658296 | OtherCostOrOtherBasis |
| Depreciation | 481051 | Depreciation |
| Book Value | 177245 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2260545 | TotalOfBookValueLandBuildings |
| Total Revenue | 8490803 | TotalRevenue |
| Total Expenses | 7443853 | TotalExpenses |
| Excess Or Deficit For Year | 1046950 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 1046950 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 8759186 | TotRevenueEtcAuditedFinclStmt |
| Donated Srvc And Use Of Facilities | 268383 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 268383 | RevenueNotRptdF990 |
| Revenue Subtotal | 8490803 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 8490803 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 7712236 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 268383 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 268383 | ExpensesNotRptdF990 |
| Expenses Subtotal | 7443853 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 7443853 | TotalExpensesPerForm990 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DR ROBERT HENDERSHOTT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Base Compensation Filing Org | 169897 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 20488 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 190385 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | paul o'shea | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | board treasurer | Relationship |
| Amount Of Transaction | 27206 | AmountOfTransaction |
| Description Of Transaction | paul o'shea is the president of an organization that is engaged by north shore community health in the provision of clinical consultant services. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section B, line 11 | The form 990 initial completion is done by our Auditors. the form 990 is then sent to North Shore Community Health management team and then forwarded to the members of the Board of Directors, who are given a week to submit any questions, comments, or observations that they have. Then management discusses any changes they are going to make to the 990 form. If changes are deemed necessary, they are made immediately. The form 990 is then approved for submission by the Board of Directors. |
| Form 990, Part VI, Section B, line 12c | Each employee, volunteer, and board member will acknowledge that they have read and understand North Shore Community Health's conflict of interest policy upon beginning their employment or tenure with North shore community health by signing an acknowledgement form. This is updated on a yearly basis. |
| Form 990, Part VI, Section B, line 15 | the compensation of the health center's officers and key employees is approved by the board of directors utilizing a salary survey. the executive director and finance committee set the other employee's salary based on a salary survey in accordance with the health center's budget parameters. |
| Form 990, Part VI, Section C, line 19 | North Shore Community Health, Inc. makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. the form 990 is available to the general public through www.guidestar.org. |
Comments