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PETALUMA HEALTH CENTER: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
PETALUMA HEALTH CENTER (EIN 68-0437840)
Tax period
2022-07-01 to 2023-06-30
Filed
2024-05-02
IRS object ID
202411239349301681
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

FieldValueIRS element (for citing)
Return2024-05-02T12:40:23-05:00ReturnTs
Tax Period End2023-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN910189318PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1101 SECOND STREET SUITE 900AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94105ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN680437840EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PETALUMA HEALTH CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPETABusinessNameControlTxt
Phone7075597500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11179 NORTH MCDOWELL BLVDAddressLine1Txt
CityPETALUMACityNm
State AbbreviationCAStateAbbreviationCd
ZIP94954ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMOLLY JOUANEHPersonNm
Person TitleCFOPersonTitleTxt
Phone7075597500PhoneNum
Signature2024-05-02SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMOLLYPersonFirstNm
Person LastJOUANEHPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL LUMSDENPreparerPersonNm
PTINP01262236PTIN
Phone4159561500PhoneNum
Preparation2024-05-01PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerPEDRO TOLEDO JD MA MHSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11455 N MCDOWELL BLVDAddressLine1Txt
CityPETALUMACityNm
State AbbreviationCAStateAbbreviationCd
ZIP94954ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$73,522,685GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PHEALTHCENTER.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1999FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionTO ENSURE ACCESS & PROVIDE HIGH QUALITY PREVENTION-FOCUSED HEALTH CARE FOR THE COMMUNITIES WE SERVE.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee650TotalEmployeeCnt
Total Volunteers57TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$12,319,234PYContributionsGrantsAmt
CY Contributions Grants$18,644,349CYContributionsGrantsAmt
PY Program Service Revenue$51,090,204PYProgramServiceRevenueAmt
CY Program Service Revenue$54,761,399CYProgramServiceRevenueAmt
PY Investment Income$26,992PYInvestmentIncomeAmt
CY Investment Income$76,779CYInvestmentIncomeAmt
PY Other Revenue$107,856PYOtherRevenueAmt
CY Other Revenue$40,158CYOtherRevenueAmt
PY Total Revenue$63,544,286PYTotalRevenueAmt
CY Total Revenue$73,522,685CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$44,727,434PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$50,796,973CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$15,281,353PYOtherExpensesAmt
CY Other Expenses$20,453,178CYOtherExpensesAmt
PY Total Expenses$60,008,787PYTotalExpensesAmt
CY Total Expenses$71,250,151CYTotalExpensesAmt
PY Revenues Less Expenses$3,535,499PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,272,534CYRevenuesLessExpensesAmt
Total Assets BOY$54,279,302TotalAssetsBOYAmt
Total Assets EOY$57,279,151TotalAssetsEOYAmt
Total Liabilities BOY$25,093,010TotalLiabilitiesBOYAmt
Total Liabilities EOY$25,686,938TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$29,186,292NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$31,592,213NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPETALUMA HEALTH CENTER'S MISSION IS TO ENSURE ACCESS TO HIGH-QUALITY HEALTH CARE AND ACHIEVE HEALTH EQUITY FOR THE COMMUNITIES WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$32,185,204ExpenseAmt
Grant$0GrantAmt
Revenue$33,975,843RevenueAmt
DescFAMILY PRACTICE SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF FAMILY PRACTICE VISITS DURING FISCAL YEAR 2023 WAS 104,789.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$8,141,623ExpenseAmt
Grant$0GrantAmt
Revenue$11,103,247RevenueAmt
DescGENERAL DENTISTRY AND FLUORIDE VARNISHING SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF DENTAL VISITS DURING FISCAL YEAR 2023 WAS 24,951.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$4,298,328ExpenseAmt
Grant$0GrantAmt
Revenue$5,425,813RevenueAmt
DescOBSTETRIC AND GYNECOLOGY SERVICES PROVIDED TO PATIENTS, INCLUDING BIRTHING AND PREGNANCY SERVICES. THE TOTAL NUMBER OF OB/GYN VISITS DURING FISCAL YEAR 2023 WERE 13,926.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$14,800,971ExpenseAmt
Grant$0GrantAmt
Revenue$4,256,496RevenueAmt
DescOTHER PROGRAM SERVICES INCLUDE INTEGRATED BEHAVIORAL HEALTH, VISION, WELLNESS, AND NUTRITION PROGRAMS FOR PATIENTS; ADDITIONALLY, THE ORGANIZATION OPERATES A NURSE PRACTITIONER AND PHYSICIAN'S ASSISTANT RESIDENCY PROGRAM TO TRAIN NEW NP/PA'S IN THE COMMUNITY MEDICINE MODEL OF CARE.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$14,800,971TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant$0TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue$4,256,496TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$59,426,126TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntYes (1)BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document62IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee650EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMOLLY JOUANEHPersonNm
Phone7075597578PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11455 N MCDOWELL BLVDAddressLine1Txt
CityPETALUMACityNm
State AbbreviationCAStateAbbreviationCd
ZIP94954ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
ROBERT RAMIREZ
PRESIDENT2.00Yes (X)Yes (X)$0$0$0
ELISA VELASQUEZ-ANDRADE MA PHD
VP THROUGH 1/2023 / BOARD MEMBER2.00Yes (X)Yes (X)$0$0$0
TOM ISAAK BS
VICE PRESIDENT START 1/20232.00Yes (X)Yes (X)$0$0$0
VANESSA LUNA SHANNON
SECRETARY THROUGH 10/20222.00Yes (X)Yes (X)$0$0$0
PHOEBE ELLIS JDMSW BS
SECRETARY START 10/20222.00Yes (X)Yes (X)$0$0$0
MARC POUNDS CPA
TREASURER THROUGH 5/20232.00Yes (X)Yes (X)$0$0$0
ELIZABETH LIZA GOLDBLATT PHD MPA
INTERIM TREASURER START 5/20232.00Yes (X)Yes (X)$0$0$0
WILLIAM BARRETT
BOARD MEMBER2.00Yes (X)$0$0$0
FERNANDO CARRILLO BA CPFA
BOARD MEMBER2.00Yes (X)$0$0$0
CECILIA CASTANEDA BA LCSW
BOARD MEMBER2.00Yes (X)$0$0$0
SILVIA RODRIGUEZ
BOARD MEMBER2.00Yes (X)$0$0$0
TERESA TAYLOR-KING MPA
BOARD MEMBER2.00Yes (X)$0$0$0
CATHERINE WEST MD DRPH
BOARD MEMBER2.00Yes (X)$0$0$0
KATHRYN POWELL MHA MA
CHIEF EXECUTIVE OFFICER40.00Yes (X)$434,511$0$51,060
RAMONA ENGLISH DMD
CHIEF DENTAL OFFICER40.00Yes (X)$319,419$0$23,101
NURIT LICHT MD
CHIEF MEDICAL OFFICER40.00Yes (X)$318,847$0$41,934
MOLLY JOUANEH CMA
CHIEF FINANCIAL OFFICER40.00Yes (X)$308,373$0$11,753
PEDRO TOLEDO JD MA MHSA
CHIEF ADMINISTRATIVE OFFICER40.00Yes (X)$286,447$0$41,657
TIFFANY JIMENEZ RN
CHIEF OPERATING OFFICER40.00Yes (X)$205,322$0$38,532
MICHELLE GLANCY MBA
CHRO THROUGH 10/202240.00Yes (X)$131,642$0$11,893
DANIELLE ORYN DO MPH
CHIEF MEDICAL INFORMATICS OFFICER40.00Yes (X)$253,744$0$31,236
KEN WEINSTOCK MD
DIR. OF BEHAVIORAL HEALTH SERVICES40.00$326,470$0$39,479Yes (X)
REBECCA KATZ MD
PRIMARY CARE SITE DIRECTOR36.00$233,256$0$40,918Yes (X)
CARLIN CHI MD
MEDICAL DIRECTOR, PRIMARY CARE40.00$242,016$0$33,702Yes (X)
JONATHAN CHOE MD
ASSOC. MEDICAL DIR., WOMEN'S HEALTH34.00$248,562$0$12,401Yes (X)
JOHN PENDLETON MD
ASSOC. MEDICAL DIRECTOR, OPERATIONS34.00$220,768$0$30,104Yes (X)
FIONA REDWOOD MD
CLINICAL SERV. DIR. - WOMEN'S HEALTH32.00$239,108$0$31,506Yes (X)
SCOTT HOLMES DO
ASSOC. MEDICAL DIR., PRIMARY CARE40.00$234,411$0$16,507Yes (X)
CHRISTINA GOMEZ-MIRA MD
LEAD PHYS, RURAL PRIMARY CARE SERV36.00$201,615$0$12,159Yes (X)
IUN-LU AILEEN CHEN DO
ASSOC. MEDICAL DIR., PRIMARY CARE38.00$217,258$0$18,584Yes (X)
PHILIPPE EDOUARD MD FACP
FAMILY PHYSICIAN40.00$295,086$0$23,846Yes (X)
KARL GREER MD
FAMILY PHYSICIAN40.00$273,980$0$23,663Yes (X)
SHANNON MENTOCK MD
FAMILY PHYSICIAN40.00$270,787$0$7,717Yes (X)
CASSIE IUTZI MD MPH
FAMILY PHYSICIAN40.00$245,201$0$34,753Yes (X)
ANDREW ASCHROFT MD MPH
FAMILY PHYSICIAN36.00$226,912$0$40,268Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$5,733,735TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$616,773TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K106IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
SCANSTAT TECHNOLOGIES LLC
PO BOX 791522BALTIMOREMD212791522DOCUMENT MANAGEMENT$724,077
ECLINICALWORKS LLC
TWO TECHNOLOGY DRIVEWESTBOROUGHMA01581IT SUPPORT SERVICES$530,895
BARBIER SECURITY GROUP
369-B THIRD STREET 440SAN RAFAELCA94901SECURITY SERVICES$316,583
MOSS ADAMS LLP
PO BOX 101822PASADENACA911891822AUDITING & TAX SERVICES$121,486
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Government Grants$16,128,905GovernmentGrantsAmt
All Other Contributions$2,515,444AllOtherContributionsAmt
Noncash Contributions$1,618,939NoncashContributionsAmt
Total Contributions$18,644,349TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE621400$43,503,373$43,503,373
PHARMACY REVENUE621400$3,960,075$3,960,075
QIP REVENUE621400$2,805,865$2,805,865
PIP REVENUE621400$2,714,350$2,714,350
CAPITATION REVENUE621400$713,960$713,960

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,063,776TotalRevenueColumnAmt
Related Or Exempt Func Income$1,063,776RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$54,761,399TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$65,924TotalRevenueColumnAmt
Exclusion$65,924ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,855TotalRevenueColumnAmt
Exclusion$10,855ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business561000BusinessCd
Total Revenue Column$40,158TotalRevenueColumnAmt
Exclusion$40,158ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$40,158OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$73,522,685TotalRevenueColumnAmt
Related Or Exempt Func Income$54,761,399RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$116,937ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$4,479,664TotalAmt
Program Services$2,737,092ProgramServicesAmt
Management And General$1,742,572ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$34,522,811TotalAmt
Program Services$30,574,628ProgramServicesAmt
Management And General$3,948,183ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,487,481TotalAmt
Program Services$1,349,962ProgramServicesAmt
Management And General$137,519ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$7,340,274TotalAmt
Program Services$6,141,274ProgramServicesAmt
Management And General$1,199,000ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,966,743TotalAmt
Program Services$2,526,121ProgramServicesAmt
Management And General$440,622ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$45,091TotalAmt
Management And General$45,091ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$164,067TotalAmt
Management And General$164,067ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$5,537,086TotalAmt
Program Services$4,857,082ProgramServicesAmt
Management And General$680,004ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$40,121TotalAmt
Program Services$485ProgramServicesAmt
Management And General$39,636ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,053,423TotalAmt
Program Services$797,420ProgramServicesAmt
Management And General$256,003ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$129,329TotalAmt
Program Services$103,944ProgramServicesAmt
Management And General$25,385ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,934,392TotalAmt
Program Services$2,406,252ProgramServicesAmt
Management And General$528,140ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$180,254TotalAmt
Program Services$145,640ProgramServicesAmt
Management And General$34,614ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$363,275TotalAmt
Program Services$281,967ProgramServicesAmt
Management And General$81,308ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$142,597TotalAmt
Management And General$142,597ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,704,834TotalAmt
Program Services$1,212,430ProgramServicesAmt
Management And General$492,404ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$169,542TotalAmt
Program Services$88,493ProgramServicesAmt
Management And General$81,049ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES/DRUGS$3,905,142$3,905,142
MINOR EQUIPMENT$737,978$621,197$116,781
IN-KIND FOOD$657,100$657,100
DUES AND SUBSCRIPTIONS$122,562$95,902$26,660

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,566,385TotalAmt
Program Services$923,995ProgramServicesAmt
Management And General$1,642,390ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$71,250,151TotalAmt
Program Services$59,426,126ProgramServicesAmt
Management And General$11,824,025ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,800,879BOYAmt
EOY$6,533,960EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$821,961BOYAmt
EOY$4,069,657EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$843,240BOYAmt
EOY$1,003,646EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,838,489BOYAmt
EOY$6,007,881EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$23,973BOYAmt
EOY$6,646EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$198,202BOYAmt
EOY$217,505EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,079,317BOYAmt
EOY$1,060,366EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$36,326,625LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$14,699,332LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$20,340,794BOYAmt
EOY$21,627,293EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,733,756BOYAmt
EOY$3,980,226EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$12,598,691BOYAmt
EOY$12,771,971EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$54,279,302BOYAmt
EOY$57,279,151EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$7,239,295BOYAmt
EOY$8,763,171EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$1,776,888BOYAmt
EOY$1,925,984EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,726,914BOYAmt
EOY$4,528,475EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,349,913BOYAmt
EOY$10,469,308EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$25,093,010BOYAmt
EOY$25,686,938EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$29,126,592BOYAmt
EOY$31,532,513EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$59,700BOYAmt
EOY$59,700EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$29,186,292BOYAmt
EOY$31,592,213EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$54,279,302BOYAmt
EOY$57,279,151EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$2,272,534ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$133,387NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,608,360CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,027,133CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$26,697,201CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,319,234CurrentTaxYearMinus1YearAmt
Current Tax Year$18,644,349CurrentTaxYearAmt
Total$67,296,277TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,608,360CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,027,133CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$26,697,201CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$12,319,234CurrentTaxYearMinus1YearAmt
Current Tax Year$18,644,349CurrentTaxYearAmt
Total$67,296,277TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$27,965SubstantialContributorsTotAmt
Public Support Total170$67,268,312PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$9,966CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,755CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$45,442CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$26,992CurrentTaxYearMinus1YearAmt
Current Tax Year$76,779CurrentTaxYearAmt
Total$165,934TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$785,952CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,288,063CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,008,112CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$107,856CurrentTaxYearMinus1YearAmt
Current Tax Year$40,158CurrentTaxYearAmt
Total$4,230,141TotalAmt
FieldValueIRS element (for citing)
Total Support$71,692,352TotalSupportAmt
Gross Receipts Rltd Activities$221,859,074GrossReceiptsRltdActivitiesAmt
Public Support CY1700.93830PublicSupportCY170Pct
Public Support PY1700.91840PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationOTHER INCOME - 2018 AMOUNT: $ 785,952. 2019 AMOUNT: $ 1,288,063. 2020 AMOUNT: $ 2,008,112. 2021 AMOUNT: $ 107,856. 2022 AMOUNT: $ 40,158.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$7,500OtherActivitiesAmt
Total Lobbying Expenditures$7,500TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION PAYS MEMBERSHIP DUES TO THE CALIFORNIA PRIMARY CARE ASSOCIATION; A PORTION OF THOSE MEMBERSHIP DUES WERE DESIGNATED AS UTILIZED FOR LOBBYING ACTIVITIES FOR LEGISLATION PERTINENT TO THE HEALTH CARE FIELD.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,835,000OtherCostOrOtherBasisAmt
Book Value$1,835,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,909,519OtherCostOrOtherBasisAmt
Depreciation$6,770,729DepreciationAmt
Book Value$11,138,790BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,334,823OtherCostOrOtherBasisAmt
Depreciation$1,543,534DepreciationAmt
Book Value$2,791,289BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,787,916OtherCostOrOtherBasisAmt
Depreciation$3,880,900DepreciationAmt
Book Value$1,907,016BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,459,367OtherCostOrOtherBasisAmt
Depreciation$2,504,169DepreciationAmt
Book Value$3,955,198BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$21,627,293TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
OTHER RECEIVABLES$1,318,199
DEPOSITS$61,362
ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS$3,610,423
OPERATING LEASE RIGHT-OF-USE ASSETS$7,781,987
FieldValueIRS element (for citing)
Total Book Value Other Assets$12,771,971TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ESTIMATED AMOUNTS DUE TO THIRD-PARTY PAYORS$2,725,126
OPERATING LEASE LIABILITIES$7,744,182
FieldValueIRS element (for citing)
Total Liability$10,469,308TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$73,844,642TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$133,387NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts$188,570DonatedServicesAndUseFcltsAmt
Revenue Not Reported$321,957RevenueNotReportedAmt
Revenue Subtotal$73,522,685RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$73,522,685TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$71,438,721TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$188,570DonatedServicesUseFcltsAmt
Expenses Not Reported$188,570ExpensesNotReportedAmt
Expenses Subtotal$71,250,151ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$71,250,151TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2023 AND 2022, THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (21 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KATHRYN POWELL MHA MA
CHIEF EXECUTIVE OFFICER$391,617$0$36,500$0$6,394$0$37,857$0$13,203$0$485,571$0$0$0
KEN WEINSTOCK MD
DIR. OF BEHAVIORAL HEALTH SERVICES$316,161$0$8,064$0$2,245$0$15,645$0$23,834$0$365,949$0$0$0
NURIT LICHT MD
CHIEF MEDICAL OFFICER$305,053$0$12,807$0$987$0$32,707$0$9,227$0$360,781$0$0$0
RAMONA ENGLISH DMD
CHIEF DENTAL OFFICER$293,842$0$25,000$0$577$0$14,383$0$8,718$0$342,520$0$0$0
PEDRO TOLEDO JD MA MHSA
CHIEF ADMINISTRATIVE OFFICER$275,818$0$10,087$0$542$0$29,608$0$12,049$0$328,104$0$0$0
MOLLY JOUANEH CMA
CHIEF FINANCIAL OFFICER$283,027$0$25,000$0$346$0$9,177$0$2,576$0$320,126$0$0$0
PHILIPPE EDOUARD MD FACP
FAMILY PHYSICIAN$281,541$0$12,189$0$1,356$0$13,361$0$10,485$0$318,932$0$0$0
KARL GREER MD
FAMILY PHYSICIAN$260,571$0$13,135$0$274$0$11,378$0$12,285$0$297,643$0$0$0
DANIELLE ORYN DO MPH
CHIEF MEDICAL INFORMATICS OFFICER$253,170$0$0$0$574$0$11,598$0$19,638$0$284,980$0$0$0
CASSIE IUTZI MD MPH
FAMILY PHYSICIAN$240,132$0$4,791$0$278$0$11,143$0$23,610$0$279,954$0$0$0
SHANNON MENTOCK MD
FAMILY PHYSICIAN$216,374$0$54,191$0$222$0$0$0$7,717$0$278,504$0$0$0
CARLIN CHI MD
MEDICAL DIRECTOR, PRIMARY CARE$235,507$0$5,756$0$753$0$12,660$0$21,042$0$275,718$0$0$0
REBECCA KATZ MD
PRIMARY CARE SITE DIRECTOR$225,903$0$6,860$0$493$0$13,012$0$27,906$0$274,174$0$0$0
FIONA REDWOOD MD
CLINICAL SERV. DIR. - WOMEN'S HEALTH$237,620$0$0$0$1,488$0$11,088$0$20,418$0$270,614$0$0$0
ANDREW ASCHROFT MD MPH
FAMILY PHYSICIAN$220,334$0$5,878$0$700$0$12,262$0$28,006$0$267,180$0$0$0
JONATHAN CHOE MD
ASSOC. MEDICAL DIR., WOMEN'S HEALTH$243,974$0$4,157$0$431$0$11,144$0$1,257$0$260,963$0$0$0
SCOTT HOLMES DO
ASSOC. MEDICAL DIR., PRIMARY CARE$229,570$0$4,572$0$269$0$6,077$0$10,430$0$250,918$0$0$0
JOHN PENDLETON MD
ASSOC. MEDICAL DIRECTOR, OPERATIONS$212,710$0$7,675$0$383$0$11,972$0$18,132$0$250,872$0$0$0
TIFFANY JIMENEZ RN
CHIEF OPERATING OFFICER$186,069$0$19,000$0$253$0$10,527$0$28,005$0$243,854$0$0$0
IUN-LU AILEEN CHEN DO
ASSOC. MEDICAL DIR., PRIMARY CARE$212,744$0$4,270$0$244$0$6,411$0$12,173$0$235,842$0$0$0
CHRISTINA GOMEZ-MIRA MD
LEAD PHYS, RURAL PRIMARY CARE SERV$198,724$0$2,617$0$274$0$10,720$0$1,439$0$213,774$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN521643828BondIssuerEIN
CUSIP13032UET1CUSIPNum
Bond Issued2016-09-13BondIssuedDt
Issue Price$5,955,305IssuePriceAmt
PurposeREFUND OF BONDS ORIGINALLY ISSUED 6/2/2010PurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$1,135,000RetiredAmt
Total Proceeds$5,955,305TotalProceedsAmt
In Reserve Fund$175,378InReserveFundAmt
Issuance Costs From Proceeds$115,500IssuanceCostsFromProceedsAmt
Credit Enhancement$153,716CreditEnhancementAmt
Other Spent Proceeds$5,510,710OtherSpentProceedsAmt
Refunding Tax Exempt Bonds0RefundingTaxExemptBondsInd
Refunding Taxable BondsYes (1)RefundingTaxableBondsInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due Yet0RebateNotDueYetInd
Exception To RebateYes (1)ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonNORTH BAY OFFICE FURNITUREPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionENTITY IS SOLELY OWNED BY BOARD MEMBER ROBERT RAMIREZRelationshipDescriptionTxt
Transaction$30,137TransactionAmt
TransactionTHE ORGANIZATION PURCHASED OFFICE FURNITURE AT FAIR MARKET VALUE FROM NORTH BAY OFFICE FURNITURE, WHICH IS SOLELY OWNED BY BOARD MEMBER ROBERT RAMIREZ.TransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule M IRS990ScheduleM

Food Inventory FoodInventoryGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution1ContributionCnt
Noncash Contributions Rpt F990$657,100NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution1ContributionCnt
Noncash Contributions Rpt F990$961,839NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Form8283 Received0Form8283ReceivedCnt
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsYes (1)ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, COLUMN (B):FormAndLineReferenceDesc
ExplanationTHE NUMBER REPORTED IN PART I, COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN OUTSIDE TAX PREPARER IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING TEAM. THE CEO AND MEMBERS OF THE FINANCE AND ACCOUNTING STAFF OF THE ORGANIZATION THEN REVIEW THE FORM 990 AND, UPON APPROVAL, SUBMITS THE FORM 990 TO THE BOARD FINANCE COMMITTEE FOR REVIEW BEFORE FILING WITH THE IRS; THE FORM 990 IS ALSO MADE AVAILABLE TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION.
FORM 990, PART VI, SECTION B, LINE 12CIT IS THE POLICY OF PETALUMA HEALTH CENTER THAT ALL FULL-TIME AND PART-TIME EMPLOYEES, CONTRACTORS, AND MEMBERS OF THE BOARD OF DIRECTORS AVOID CONFLICTS OF INTEREST, OR APPEARANCE OF CONFLICT, BETWEEN THEIR PERSONAL INTERESTS AND THE INTERESTS OF THE ORGANIZATION WHEN DEALING WITH ANY INDIVIDUAL OR OUTSIDE ORGANIZATION HAVING, OR SEEKING TO HAVE, A BUSINESS RELATIONSHIP WITH PETALUMA HEALTH CENTER. ALL MEMBERS OF THE PETALUMA HEALTH CENTER BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE THE CONFLICT OF INTEREST DISCLOSURE STATEMENT; ALL STAFF MEMBERS, VOLUNTEERS, AND CONTRACTORS ARE REQUIRED TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT OF INTEREST THAT ARISES TO THE HUMAN RESOURCES DEPARTMENT WITHIN 10 BUSINESS DAYS OF LEARNING OF IT. AFTER DISCLOSURE OF A POSSIBLE CONFLICT OF INTEREST, THE CEO AFFORDS THE INTERESTED PERSON WHO MAKES THE DISCLOSURE AN OPPORTUNITY TO EXPLAIN TO THE SENIOR MANAGEMENT TEAM (FOR EMPLOYEES), OR THE EXECUTIVE COMMITTEE OF THE BOARD (FOR BOARD MEMBERS) THE FACTS AND CIRCUMSTANCES OF THE TRANSACTION OR ARRANGEMENT THAT LED TO SUCH DISCLOSURE. THE INTERESTED PERSON LEAVES THE SENIOR MANAGEMENT TEAM OR BOARD EXECUTIVE COMMITTEE MEETING WHILE THE INTEREST IS DISCUSSED AND VOTED UPON IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS AND CANNOT BE MITIGATED BY FURTHER ACTION.
FORM 990, PART VI, SECTION B, LINE 15THE PROCESS FOR DETERMINING THE CHIEF EXECUTIVE OFFICER'S SALARY INCREASE INVOLVES A DISCUSSION AMONGST THE EXECUTIVE COMMITTEE OF THE BOARD, SALARY RESEARCH BY THE CHIEF HR OFFICER, AND RECOMMENDATION OF A NEW SALARY FROM THE EXECUTIVE COMMITTEE TO THE BOARD OF DIRECTORS FOR APPROVAL. THE CEO REVIEWS AND APPROVES THE COMPENSATION OF OTHER OFFICERS AND MANAGERS UTILIZING COMPARABILITY DATA.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.