Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 45,250 | 27,907 | 111,008 | 68,171 | 1,269,864 | 1,522,200 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 45,250 | 27,907 | 111,008 | 68,171 | 1,269,864 | 1,522,200 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | 228,574 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,293,626 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 45,250 | 27,907 | 111,008 | 68,171 | 1,269,864 | 1,522,200 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 174 | 70 | 21 | 36 | 57 | 358 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 3,983 | 3,987 | 3,095 | 2,036 | 13,101 | |
| 11 | Total support Add lines 7 through 10. | 1,535,659 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 2 | CHANGE IN PROGRAM SERVICE: THE ORGANIZATION BEGAN OPERATIONS AS A FEDERALLY QUALIFIED HEALTH CENTER IN THE CURRENT YEAR, PROVIDING PATIENTS WITH CLINICAL, DENTAL, AND BEHAVIORAL SERVICES. |
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACHIEVEMENT #1: THE BOARD OF DIRECTORS WORKED TO ASSURE THAT YCHC WOULD BE READY TO PROVIDE QUALITY HEALTH SERVICES TO THE COMMUNITY. EMPLOYEES WERE HIRED, A LOCATION WAS DONATED BY PHELPS COUNTY REGIONAL MEDICAL CENTER, AND THE DOORS OPENED ON FEBRUARY 27, 2014. DURING THE NEXT TEN MONTHS YCHC PROVIDED 1,146 PRIMARY MEDICAL, DENTAL, AND MENTAL HEALTH VISITS TO PATIENTS. AS A COMMUNITY HEALTH CENTER, YCHC IS ABLE TO OFFER QUALITY HEALTH CARE TO ALL PATIENTS BY PROVIDING PATIENTS WHO EARN INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL A SLIDING FEE DISCOUNT ON HEALTH CARE SERVICES AND PATIENTS WHO EARN LESS THAN 100% OF FEDERAL POVERTY LEVEL ONLY PAY A NOMINAL FEE. OF THE 1,146 PATIENTS YCHC SERVED: -74% HAD NO HEALTH INSURANCE AND USED THE SLIDING FEE SCALE TO ACCESS SERVICES -2% OF PATIENTS USED MEDICAID -6% OF PATIENTS USED MEDICARE -8% OF PATIENTS USED PRIVATE HEALTH INSURANCE |
| FORM 990, PART III, LINE 4B | PROGRAM SERVICE ACHIEVEMENT #2: PCRMC'S BOARD OF DIRECTORS DONATED A 2004 MOBILE DENTAL UNIT, THE SMILE MOBILE, TO YCHC. SINCE THE UNIT HAD NOT BEEN USED FOR SEVERAL YEARS THE SMILE MOBILE, A FORTY-FOOT CONVERTED RV, NEEDED A SIGNIFICANT AMOUNT OF WORK AND THE DENTAL EQUIPMENT NEEDED TO BE UPDATED. A PRIVATE DONOR SUPPLIED THE NEEDED FUNDS TO REHAB THE RV, A MEMBER OF THE COMMUNITY SUPPLIED NEW TIRES, AND THE MISSOURI FOUNDATION FOR HEALTH PROVIDED THE NEEDED FUNDS FOR NEW DENTAL EQUIPMENT. YCHC'S SMILE MOBILE BEGAN SERVING PUBLIC SCHOOL STUDENTS IN SEPTEMBER 2014 WITH CONTRACTED DENTISTS AND IN NOVEMBER 2014 WE WERE ABLE TO HIRE OUR FIRST DENTIST, DR. AREZO HESARAKI. DR. HESARAKI AND HER STAFF PROVIDE FULL DENTAL SERVICES TO CHILDREN WHO DO NOT HAVE ACCESS TO A DENTIST. THESE SERVICES INCLUDE TREATMENT PLANS, CLEANING, SEALANTS, FILLINGS, AND EXTRACTIONS. THIS COOPERATIVE ARRANGEMENT WITH FAMILIES, SCHOOLS, AND YCHC RESULTED IN CHILDREN BEING ABLE TO ACHIEVE BETTER HEALTH THROUGH TREATMENT, EDUCATION, AND PREVENTION OF ORAL DISEASE. IN 2014, 110 DENTAL ENCOUNTERS WERE PROVIDED. |
| FORM 990, PART III, LINE 4C | PROGRAM ACHIEVEMENT #3: THE EXTREME NEED OF OUR PATIENTS RESULTED IN THE RECOGNITION THAT OUR PRIMARY CARE PROVIDERS NEEDED EXTRA HELP. THIS REALIZATION RESULTED IN RESEARCHING BEST PRACTICES AND FUNDING TO IMPLEMENT THESE PRACTICES. A NEW PROGRAM, YOUR BEST HEALTH, WAS CREATED TO MEET THIS NEED AND A STATE GRANT AND A PRIVATE DONOR ALLOWED US TO HIRE NEEDED STAFF. THIS INCLUDED A PART-TIME PSYCHIATRIC NURSE PRACTITIONER AND A CLINICAL PHARMACIST. YOUR BEST HEALTH ALLOWED PATIENTS TO GET THE CARE THEY NEEDED AND TO MAKE CHANGES WHICH RESULTED IN POSITIVE OUTCOMES, INCLUDING LOWERED BLOOD PRESSURE AND LOWERED GLUCOSE LEVELS. PSYCHIATRIC PATIENTS WERE ALSO ABLE TO OBTAIN IMPORTANT MEDICATIONS. WITHIN SIX MONTHS OF OPERATING THE PROGRAM: -OF THE 32 PARTICIPANTS WITH AT LEAST TWO A1C MEASUREMENTS, 20(63%) LOWERED THEIR A1C AND 38% LOWERED THEIR A1C BY AT LEAST ONE PERCENTAGE POINT. FOR SOME, THIS REPRESENTED A VERY MODEST DECREASE BUT SEVERAL REGISTERED SIGNIFICANT DECREASES -OF THE 48 PATIENTS WITH AT LEAST TWO BLOOD PRESSURE READINGS, 27(56%) LOWERED THEIR HIGH BLOOD PRESSURE AND 25% OF PATIENTS LOWERED THEIR BLOOD PRESSURE TO WITHIN NORMAL RANGES |
| FORM 990, PART VI, SECTION A, LINE 1A | EXECUTIVE COMMITTEE AUTHORITY THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS AS MAY BE NECESSARY AND APPROPRIATE FOR THE OPERATION OF THE HEALTH CENTER BETWEEN REGULAR OR SPECIAL MEETINGS OF THE FULL BOARD. THE EXECUTIVE COMMITTEE SHALL BE AUTHORIZED TO ACT ON BEHALF OF THE BOARD, CONSISTENT WITH ESTABLISHED BOARD POLICIES AND DIRECTION, AT ANY SUCH MEETINGS HELD BY THE EXECUTIVE COMMITTEE IN ALL RESPECTS, WITH THE EXCEPTION OF THE FOLLOWING AREAS OF AUTHORITY WHICH REQUIRE THE ACTION OF THE FULL BOARD: THE HIRING AND TERMINATION OF THE EXECUTIVE DIRECTOR; THE DISSOLUTION OF THE CORPORATION; THE ACQUISITION OR DISPOSITION OF REAL PROPERTY; APPROVAL OR AMENDMENT TO THE BUDGET; AND THE EXECUTION OF LOANS OR INCURRENCE OF INDEBTEDNESS AS REFERENCED IN ARTICLE IX, SECTION 1. THE EXECUTIVE COMMITTEE SHALL REPORT ITS ACTIONS AT THE NEXT MEETING OF THE FULL BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | REVIEW OF THE FORM 990 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FULL BOARD OF DIRECTORS REVIEWS THE PUBLIC DISCLOSURE COPY OF THE FORM 990 AT THE BOARD MEETING BEFORE FILING. THE PUBLIC DISCLOSURE COPY DOES NOT LIST THE NAMES OR ADDRESSES OF THE DONORS TO RESPECT THE CONFIDENTIALITY OF THE DONORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY YOUR COMMUNITY HEALTH CENTER REQUIRES FULL DISCLOSURE IN WRITING BY ANY INTERESTED PARTIES TO THE FULL BOARD OF DIRECTORS IN ALL CONFLICTS OF INTEREST, INCLUDING BUT NOT LIMITED TO THE FOLLOWING: - A BOARD MEMBER IS RELATED TO ANOTHER BOARD MEMBER OR STAFF MEMBER BY BLOOD, MARRIAGE OR DOMESTIC PARTNERSHIP. - A STAFF MEMBER IN A SUPERVISORY CAPACITY IS RELATED TO ANOTHER STAFF MEMBER WHOM SHE/HE SUPERVISES. - A BOARD MEMBER OR THEIR ORGANIZATION STANDS TO BENEFIT FROM A TRANSACTION OR STAFF MEMBER OF SUCH ORGANIZATION RECEIVES PAYMENT FROM YOUR COMMUNITY HEALTH CENTER FOR ANY SUBCONTRACT, GOODS, OR SERVICES OTHER THAN AS PART OF HER/HIS REGULAR JOB RESPONSIBILITIES OR AS REIMBURSEMENT FOR REASONABLE EXPENSES INCURRED AS PROVIDED IN THE BYLAWS AND BOARD POLICY. - A BOARD MEMBER'S ORGANIZATION RECEIVES GRANT FUNDING FROM YOUR COMMUNITY HEALTH CENTER. - A BOARD MEMBER OR STAFF MEMBER IS A MEMBER OF THE GOVERNING BODY OF A CONTRIBUTOR TO YOUR COMMUNITY HEALTH CENTER. - A VOLUNTEER WORKING ON BEHALF OF YOUR COMMUNITY HEALTH CENTER WHO MEETS ANY OF THE SITUATIONS OR CRITERIA LISTED ABOVE. FOLLOWING FULL DISCLOSURE OF A POSSIBLE CONFLICT OF INTEREST OR ANY CONDITION LISTED ABOVE, THE BOARD SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO THE BOARD SHALL VOTE TO AUTHORIZE OR REJECT THE TRANSACTION OR TAKE ANY OTHER ACTION DEEMED NECESSARY TO ADDRESS THE CONFLICT AND PROTECT THE PARTNERSHIP'S BEST INTERESTS. BOTH VOTES SHALL BE BY A MAJORITY VOTE WITHOUT COUNTING THE VOTE OF ANY INTERESTED DIRECTOR, EVEN IF THE DISINTERESTED DIRECTORS ARE LESS THAN A QUORUM PROVIDED THAT AT LEAST ONE CONSENTING DIRECTOR IS DISINTERESTED. A BOARD MEMBER OR COMMITTEE MEMBER WHO IS FORMALLY CONSIDERING EMPLOYMENT WITH YOUR COMMUNITY HEALTH CENTER MUST TAKE A TEMPORARY LEAVE OF ABSENCE UNTIL THE POSITION IS FILLED. SUCH A LEAVE WILL BE TAKEN WITHIN THE BOARD MEMBER'S ELECTED TERM, WHICH WILL NOT BE EXTENDED BECAUSE OF THE LEAVE. A BOARD MEMBER OR COMMITTEE MEMBER WHO IS FORMALLY CONSIDERING EMPLOYMENT WITH YOUR COMMUNITY HEALTH CENTER MUST SUBMIT A WRITTEN REQUEST FOR A TEMPORARY LEAVE OF ABSENCE TO THE SECRETARY OF THE BOARD INDICATING THE TIME PERIOD OF THE LEAVE. THE SECRETARY OF YOUR COMMUNITY HEALTH CENTER WILL INFORM THE CHAIR OF THE BOARD OF SUCH A REQUEST. THE CHAIR WILL BRING THE REQUEST TO THE BOARD FOR ACTION. THE REQUEST AND ANY ACTION TAKEN SHALL BE REFLECTED IN THE OFFICIAL MINUTES OF THE BOARD MEETING. AN INTERESTED BOARD MEMBER, OFFICER, OR STAFF MEMBER SHALL NOT PARTICIPATE IN ANY DISCUSSION OR DEBATE OF THE BOARD OR OF ANY COMMITTEE OR SUBCOMMITTEE THEREOF IN WHICH THE SUBJECT OF DISCUSSION IS A CONTRACT, TRANSACTION, OR SITUATION IN WHICH THERE MAY BE A PERCEIVED OR ACTUAL CONFLICT OF INTEREST. HOWEVER, THEY MAY BE PRESENT TO PROVIDE CLARIFYING INFORMATION IN SUCH A DISCUSSION OR DEBATE UNLESS OBJECTED TO BY ANY PRESENT BOARD OR COMMITTEE MEMBER. ANYONE IN A POSITION TO MAKE DECISIONS ABOUT SPENDING THE PARTNERSHIP'S RESOURCES (I.E., TRANSACTIONS SUCH AS PURCHASES CONTRACTS)-WHO ALSO STANDS TO BENEFIT FROM THAT DECISION-HAS A DUTY TO DISCLOSE THAT CONFLICT AS SOON AS IT ARISES (OR BECOMES APPARENT); S/HE SHOULD NOT PARTICIPATE IN ANY FINAL DECISIONS. A COPY OF THIS POLICY SHALL BE GIVEN TO ALL BOARD MEMBERS, STAFF MEMBERS, VOLUNTEERS OR OTHER KEY STAKEHOLDERS UPON COMMENCEMENT OF SUCH PERSON'S RELATIONSHIP WITH YOUR COMMUNITY HEALTH CENTER OR AT THE OFFICIAL ADOPTION OF STATED POLICY. EACH BOARD MEMBER, OFFICER, STAFF MEMBER AND VOLUNTEER SHALL SIGN AND DATE THE POLICY AT THE BEGINNING OF HER/HIS TERM OF SERVICE OR EMPLOYMENT AND EACH YEAR THEREAFTER. FAILURE TO SIGN DOES NOT NULLIFY THE POLICY. THIS POLICY AND DISCLOSURE FORM MUST BE FILED ANNUALLY BY ALL SPECIFIED PARTIES. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | COMPENSATION REVIEW YOUR COMMUNITY HEALTH CENTER USES MPCA DATA FOR COMPARISON WHEN DETERMINING THE CEO'S COMPENSATION. THE COMPENSATION IS THEN REVIEWED BY THE BOARD, HOWEVER THERE IS NO INDEPENDENT REVIEW. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENT DISCLOSURE YOUR COMMUNITY HEALTH CENTER MAKES ITS CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE ON THE ORGANIZATION'S WEBSITE AND UPON REQUEST. |
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