PACKARD HEALTH INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- PACKARD HEALTH INC (EIN 38-2269817)
- Tax period
- 2022-09-01 to 2023-08-31
- Filed
- 2024-03-30
- IRS object ID
- 202420909349300702
- Schema version
- 2022v5.0
- 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) |
|---|---|---|
| Return | 2024-03-30T11:31:46-04:00 | ReturnTs |
| Tax Period End | 2023-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382706146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YEO & YEO PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1450 EISENHOWER PLACE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 481083283 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382269817 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKARD HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PACK | BusinessNameControlTxt |
| Phone | 7349711073 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5200 VENTURE DRIVE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RAYMOND RION | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 7349711073 | PhoneNum |
| Signature | 2024-03-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RAYMOND | PersonFirstNm |
| Person Last | RION | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | false | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRIAN R DIXON | PreparerPersonNm |
| PTIN | P01321580 | PTIN |
| Phone | 7347691331 | PhoneNum |
| Preparation | 2024-03-28 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RAYMOND RION | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5200 VENTURE PARK DRIVE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,601,647 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PACKARDHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 147 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $3,722,288 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,955,787 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,213,115 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,554,470 | CYProgramServiceRevenueAmt |
| PY Investment Income | $247,860 | PYInvestmentIncomeAmt |
| CY Investment Income | $91,220 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,438 | PYOtherRevenueAmt |
| CY Other Revenue | $170 | CYOtherRevenueAmt |
| PY Total Revenue | $12,184,701 | PYTotalRevenueAmt |
| CY Total Revenue | $12,601,647 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,727,949 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,475,556 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $231,037 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,606,683 | PYOtherExpensesAmt |
| CY Other Expenses | $4,095,314 | CYOtherExpensesAmt |
| PY Total Expenses | $11,334,632 | PYTotalExpensesAmt |
| CY Total Expenses | $12,570,870 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $850,069 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $30,777 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $17,769,426 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,440,917 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,719,397 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,254,462 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,050,029 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,186,455 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $9,297,152 | ExpenseAmt |
| Revenue | $8,554,470 | RevenueAmt |
| Desc | PRIMARY HEALTH SERVICES, INCLUDING MENTAL HEALTH CARE AND HEALTH PROMOTION TO PATIENTS IN THE WASHTENAW COUNTY AREA. | Desc |
| Total Program Service Expenses | $9,297,152 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 147 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD MONTRIEF | PersonNm |
| Phone | 7349711073 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5200 VENTURE PARK DRIVE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| RAYMOND RION | ||||||||
| EXECUTIVE DI | 40.00 | Yes (X) | Yes (X) | $273,915 | $0 | $20,935 | ||
| DR ANKOOR SONI | ||||||||
| MEDICAL DIRE | 33.60 | $200,147 | $0 | $14,339 | Yes (X) | |||
| TODD MONTRIEF | ||||||||
| CFO | 40.00 | Yes (X) | $104,220 | $0 | $24,728 | |||
| NEIL B KIRST | ||||||||
| CHIEF MEDICA | 40.00 | $220,824 | $0 | $23,976 | Yes (X) | |||
| RANA SMITH | ||||||||
| BOARD CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DEBORAH VANDENBROEK | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| THOMAS BIGGS | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| NORA MALOY PHD | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GARY BOREN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARGARET CALARCO | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHUCK HOFFMAN | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SHARON MOORE | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| EDD SNYDER | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DOUG STRONG | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BRYAN WAGONER | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MOLLY WELCH-MARAHAR | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| PAULA LANTZ | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JUAN MARQUEZ MD MPH | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RUTH CASSIDY | ||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RAVI VADLAMUDI | ||||||||
| PHYSICIAN | 40.00 | $217,547 | $0 | $25,922 | Yes (X) | |||
| LINDSEY KOTAGAL | ||||||||
| PHYSICIAN | 40.00 | $211,290 | $0 | $10,573 | Yes (X) | |||
| RONALD ROMERO | ||||||||
| PHYSICIAN | 30.80 | $159,721 | $0 | $27,288 | Yes (X) | |||
| DANIEL ORAM | ||||||||
| PHYSICIAN | 32.00 | $153,804 | $0 | $26,824 | Yes (X) | |||
| HOLLY ROSS | ||||||||
| COMPLIANCE O | 26.00 | $151,472 | $0 | $26,955 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,692,940 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $201,540 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Business Name Line2ContractorName/BusinessName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|
| ATHENAHEALTH INC | ||||||
| 315 MADISON AVE STE 1804 | NEW YORK | NY | 10017 | BILLING AND AR | $361,696 | |
| 340BASICS | ||||||
| 311 ARSENAL STREET | WATERTOWN | MA | 02472 | 340B SERVICES | $172,965 | |
| WASHTENAW COUNTY COMMUNITY | ||||||
| 555 TOWNER STREET | YPSILANTI | MI | 48198 | BEHAVIOR HEALTH | $127,063 | MENTAL HEALTH |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,452,497 | GovernmentGrantsAmt |
| All Other Contributions | $1,503,290 | AllOtherContributionsAmt |
| Noncash Contributions | $516,492 | NoncashContributionsAmt |
| Total Contributions | $3,955,787 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT FEES | 624100 | $6,014,787 | $6,014,787 |
| CONTRACT SERVICE FEES | 624100 | $2,063,972 | $2,063,972 |
| CAPITATION FEES | 624100 | $337,200 | $337,200 |
| PHARMACY | 624100 | $138,511 | $138,511 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,554,470 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $91,220 | TotalRevenueColumnAmt |
| Exclusion | $91,220 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $170 | TotalRevenueColumnAmt |
| Exclusion | $170 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $170 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,601,647 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,554,470 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $91,390 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $918,979 | TotalAmt |
| Program Services | $374,486 | ProgramServicesAmt |
| Management And General | $544,493 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,036,055 | TotalAmt |
| Program Services | $4,686,623 | ProgramServicesAmt |
| Management And General | $1,228,511 | ManagementAndGeneralAmt |
| Fundraising | $120,921 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,570 | TotalAmt |
| Program Services | $91,498 | ProgramServicesAmt |
| Management And General | $16,573 | ManagementAndGeneralAmt |
| Fundraising | $2,499 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $896,465 | TotalAmt |
| Program Services | $679,687 | ProgramServicesAmt |
| Management And General | $199,993 | ManagementAndGeneralAmt |
| Fundraising | $16,785 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $513,487 | TotalAmt |
| Program Services | $376,134 | ProgramServicesAmt |
| Management And General | $128,311 | ManagementAndGeneralAmt |
| Fundraising | $9,042 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,270 | TotalAmt |
| Management And General | $140,270 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,274,253 | TotalAmt |
| Program Services | $784,462 | ProgramServicesAmt |
| Management And General | $489,791 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,163 | TotalAmt |
| Fundraising | $75,163 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,776 | TotalAmt |
| Program Services | $142,200 | ProgramServicesAmt |
| Management And General | $15,978 | ManagementAndGeneralAmt |
| Fundraising | $1,598 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,327 | TotalAmt |
| Program Services | $379,894 | ProgramServicesAmt |
| Management And General | $18,621 | ManagementAndGeneralAmt |
| Fundraising | $1,812 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,266 | TotalAmt |
| Program Services | $56,128 | ProgramServicesAmt |
| Management And General | $6,138 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,171 | TotalAmt |
| Program Services | $210,192 | ProgramServicesAmt |
| Management And General | $23,617 | ManagementAndGeneralAmt |
| Fundraising | $2,362 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,374 | TotalAmt |
| Management And General | $28,374 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,343,951 | $1,343,951 | |
| DUES, LICENSES & SUBSCRIP | $107,248 | $88,512 | $18,736 |
| INTEREST | $94,887 | $94,887 | |
| OTHER | $87,142 | $39,725 | $47,417 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,486 | TotalAmt |
| Program Services | $43,660 | ProgramServicesAmt |
| Management And General | $40,971 | ManagementAndGeneralAmt |
| Fundraising | $855 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,570,870 | TotalAmt |
| Program Services | $9,297,152 | ProgramServicesAmt |
| Management And General | $3,042,681 | ManagementAndGeneralAmt |
| Fundraising | $231,037 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,679 | BOYAmt |
| EOY | $4,067 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,340,400 | BOYAmt |
| EOY | $1,057,462 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $380,605 | BOYAmt |
| EOY | $195,328 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,451,038 | BOYAmt |
| EOY | $1,346,311 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $125,434 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,063 | BOYAmt |
| EOY | $197,349 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,698,377 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $707,323 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,268,984 | BOYAmt |
| EOY | $8,991,054 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,025,657 | BOYAmt |
| EOY | $5,904,367 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $619,545 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,769,426 | BOYAmt |
| EOY | $18,440,917 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $637,496 | BOYAmt |
| EOY | $617,225 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $50,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,031,901 | BOYAmt |
| EOY | $1,960,313 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $626,924 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,719,397 | BOYAmt |
| EOY | $3,254,462 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,467,892 | BOYAmt |
| EOY | $14,704,108 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $582,137 | BOYAmt |
| EOY | $482,347 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,050,029 | BOYAmt |
| EOY | $15,186,455 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,769,426 | BOYAmt |
| EOY | $18,440,917 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $30,777 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $105,649 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,295,809 | OtherCostOrOtherBasisAmt |
| Book Value | $1,295,809 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,359,328 | OtherCostOrOtherBasisAmt |
| Depreciation | $476,591 | DepreciationAmt |
| Book Value | $6,882,737 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $258,383 | OtherCostOrOtherBasisAmt |
| Depreciation | $140,139 | DepreciationAmt |
| Book Value | $118,244 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $312,775 | OtherCostOrOtherBasisAmt |
| Depreciation | $90,593 | DepreciationAmt |
| Book Value | $222,182 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $472,082 | OtherCostOrOtherBasisAmt |
| Book Value | $472,082 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,991,054 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE | Desc |
| Amt | $626,924 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $626,924 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $12,707,296 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $105,649 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $105,649 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,601,647 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $12,601,647 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,570,870 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $12,570,870 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $12,570,870 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| RAYMOND RION | ||||
| EXECUTIVE DIRECTOR | $273,915 | $10,973 | $9,962 | $294,850 |
| DR ANKOOR SONI | ||||
| MEDICAL DIRECTOR | $200,147 | $6,428 | $7,911 | $214,486 |
| NEIL B KIRST | ||||
| CHIEF MEDICAL OFFICE | $220,824 | $3,078 | $20,898 | $244,800 |
| RAVI VADLAMUDI | ||||
| PHYSICIAN | $217,547 | $5,627 | $20,295 | $243,469 |
| LINDSEY KOTAGAL | ||||
| PHYSICIAN | $211,290 | $8,449 | $2,124 | $221,863 |
| RONALD ROMERO | ||||
| PHYSICIAN | $159,721 | $6,391 | $20,897 | $187,009 |
| DANIEL ORAM | ||||
| PHYSICIAN | $153,804 | $6,015 | $20,809 | $180,628 |
| HOLLY ROSS | ||||
| COMPLIANCE OFFICER | $151,472 | $6,057 | $20,898 | $178,427 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 2985 | ContributionCnt |
| Noncash Contributions Rpt F990 | $516,492 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE CFO AND TREASURER IN DETAIL, THE 990 IS ALSO PROVIDED TO THE EXECUTIVE DIRECTOR AND BOARD PRIOR TO FILING FOR REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD REVISITS THE CONFLICTS OF INTEREST POLICY ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD DETERMINES THE COMPENSATION OF THE EXECUTIVE DIRECTOR BASED ON PERFORMANCE AND OTHER FACTORS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE DIRECTOR DETERMINES THE COMPENSATION FOR OFFICERS & KEY EMPLOYEES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES 784,462 489,791 0 |