These revenue sources fluctuate significantly over the year, often requiring a rationing of budget for critical supplies. The clinic's budget is one that fluctuations on a quarterly basis depending on funding from the foundation donors and how quickly Medicare, Medicaid and insurance companies reimburse for treatments given. The facility has never had excess revenue and routinely operates unprofitably, continually seeking funding from the foundation to keep the staffing levels up and hire new doctors in the areas of specialization including pediatrics and orthopedics. The most challenging revenue stream is that of the insurance companies, many of which have completely different processes for approving treatment vs. paying for it. At least 50% of the office staff's time is spent going through arbitration calls with insurance companies to make sure the clinic is paid...

The foundation also audits the financial records quarterly and will also interview doctors who go through re-certification to see what they need to continue treatment. The hospital that is affiliated to the clinic is also a not-for-profit, as it also files a Form 990 with the IRS. The hospital however gets the majority of the foundation's financial resources and has created entire treatment centers that are named for key donors who are both individuals and corporations. The clinic benefits from these key philanthropists indirectly as well. The costs of the clinic are also reported monthly and posted on the intranet site.
References

Carlson, J.. (2010, January). Not-for-profits: more scrutiny. Modern Healthcare, 40(1), 28.

Speizman, R.. (2009, February). tax-exempt status for hospitals: where have we been…