SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
MOUNTAINLANDS COMMUNITY
HEALTH CENTER
Employer identification number

87-0515716
Return Reference Explanation
FORM 990, PAGE 2, PART III, LINE 4D PROVIDED MENTAL HEALTH CARE ON A SLIDING FEE SCALE FOR PATIENTS.
FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO ITS SUBMISSION. THE FORM 990 IS AVAILABLE TO BOARD MEMBERS FOR THEIR REVIEW SUBSEQUENT TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12C CONFLICT OF INTEREST POLICY IS MONITORED BY THE JOINT COMMISSION (FORMERLY JCHAO) AN INDEPENDENT ACCREDITATION BODY FOR HOSPITAL AND AMBULATORY CARE ORGANIZATIONS
FORM 990, PAGE 6, PART VI, LINE 15A EXECUTIVE DIRECTOR'S COMPENSATION IS APPROVED BY THE BOARD, BASED ON MEDIAN SALARY LEVELS FOR THE AREA AND EXPERIENCE.
FORM 990, PAGE 6, PART VI, LINE 15B PHYSICIANS' SALARIES ARE RECOMMENDED BY EXECUTIVE DIRECTOR, USING COMPENSATION SURVEYS TO DETERMINE SALARY LEVELS BASED ON LOCATION AND EXPERIENCE. THESE RECOMMENDATIONS ARE THEN APPROVED BY THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST JUST AS THE FORM 990 IS AVAILABLE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

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