PROVIDENCE SPEECH & HEARING CENTER: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- PROVIDENCE SPEECH & HEARING CENTER (EIN 95-6154473)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-13
- IRS object ID
- 202441349349302854
- 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 | 2024-05-13T09:14:05-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 550 SOUTH HOPE STREET SUITE 1500 | AddressLine1Txt |
| City | LOS ANGELES | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90071 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 956154473 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROVIDENCE SPEECH AND HEARING CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PROV | BusinessNameControlTxt |
| Phone | 7146394990 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 W LA VETA AVENUE | AddressLine1Txt |
| City | ORANGE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92868 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KERRI RUPPERT SCHILLER | PersonNm |
| Person Title | DIRECTOR/TREASURER | PersonTitleTxt |
| Phone | 7146394990 | PhoneNum |
| Signature | 2024-05-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KERRI | PersonFirstNm |
| Person Last | RUPPERT SCHILLER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HOLLY MOEN | PreparerPersonNm |
| PTIN | P01800653 | PTIN |
| Phone | 2139724000 | PhoneNum |
| Preparation | 2024-05-07 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| 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 | PAUL VAN DOLAH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 W LA VETA AVENUE | AddressLine1Txt |
| City | ORANGE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92868 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,335,868 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PSHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | ENRICHING LIFE THROUGH THE GIFTS OF SPEECH AND HEARING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 4 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 175 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $259,888 | PYContributionsGrantsAmt |
| CY Contributions Grants | $253,804 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,408,596 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,930,526 | CYProgramServiceRevenueAmt |
| PY Investment Income | $82,092 | PYInvestmentIncomeAmt |
| CY Investment Income | $16,522 | CYInvestmentIncomeAmt |
| PY Other Revenue | $56,141 | PYOtherRevenueAmt |
| CY Other Revenue | $38,020 | CYOtherRevenueAmt |
| PY Total Revenue | $8,806,717 | PYTotalRevenueAmt |
| CY Total Revenue | $12,238,872 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,958,664 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,014,912 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,810,997 | PYOtherExpensesAmt |
| CY Other Expenses | $3,271,183 | CYOtherExpensesAmt |
| PY Total Expenses | $13,769,661 | PYTotalExpensesAmt |
| CY Total Expenses | $16,286,095 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,962,944 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,047,223 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,859,501 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,888,798 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,764,314 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,878,922 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$904,813 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$4,990,124 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO CONTINUALLY PROVIDE THE HIGHEST STANDARDS OF SERVICES IN THE IDENTIFICATION, DIAGNOSIS, TREATMENT AND PREVENTION OF SPEECH, LANGUAGE AND HEARING DISORDERS FOR PERSONS OF ALL AGES, RACES AND SOCIO-ECONOMIC BACKGROUNDS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,657,420 | ExpenseAmt |
| Revenue | $11,968,546 | RevenueAmt |
| Desc | PROVIDENCE PROVIDES AUDIOLOGY AND HEARING CARE AND SPEECH-LANGUAGE PATHOLOGY TO ALL THOSE IN NEED, REGARDLESS OF THEIR ABILITY TO PAY. PROVIDENCE STRIVES TO ACHIEVE ITS MISSION BY CONTINUALLY PROVIDING THE HIGHEST QUALITY SERVICES IN THE IDENTIFICATION, DIAGNOSIS, TREATMENT AND PREVENTION OF SPEECH, LANGUAGE AND HEARING DISORDERS FOR PERSONS OF ALL AGES, RACES AND SOCIO-ECONOMIC BACKGROUNDS. PROVIDENCE IS A LEADING SERVICE PROVIDER TO THE SPEECH AND HEARING IMPAIRED OF ORANGE COUNTY, PROVIDING MORE THAN 114,431 PATIENT VISITS EACH YEAR. MORE THAN HALF OF THE WORK IS DEDICATED TO LOW-INCOME PATIENTS, ALL OF WHOM ARE UNINSURED OR UNDERINSURED. | Desc |
| Total Program Service Expenses | $14,657,420 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 175 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 4 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARY NGUYEN | PersonNm |
| Phone | 7145094124 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 WEST LA VETA AVENUE | AddressLine1Txt |
| City | ORANGE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92868 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| JAY GABRIEL | ||||||||||
| DIRECTOR/SECRETARY | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $771,599 | $79,346 | |||
| KERRI RUPPERT SCHILLER | ||||||||||
| DIRECTOR/TREASURER | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $924,633 | $75,580 | |||
| MARY ZIMMER | ||||||||||
| DIRECTOR | 2.00 | 38.00 | Yes (X) | $0 | $488,057 | $61,951 | ||||
| PAUL VAN DOLAH | ||||||||||
| PRESIDENT/CHAIR | 0.50 | 39.50 | Yes (X) | Yes (X) | $0 | $896,478 | $30,198 | |||
| LUCIA MORIZIO | ||||||||||
| EXECUTIVE DIR, SPEECH & HEARING | 40.00 | 0.00 | $270,370 | $0 | $17,165 | Yes (X) | ||||
| SAMANTHA MCCOMB | ||||||||||
| MANAGER, SPEECH & LANGUAGE | 40.00 | 0.00 | $146,484 | $0 | $16,488 | Yes (X) | ||||
| ROBYN BELZ | ||||||||||
| SPEECH LANGUAGE PATHOLOGIST | 40.00 | 0.00 | $146,500 | $0 | $8,499 | Yes (X) | ||||
| AMY MARSHALL | ||||||||||
| MANAGER, SPEECH & LANGUAGE | 40.00 | 0.00 | $142,385 | $0 | $7,205 | Yes (X) | ||||
| KYM ASAHARA | ||||||||||
| SPEECH LANGUAGE PATHOLOGIST | 40.00 | 0.00 | $129,080 | $0 | $0 | Yes (X) | ||||
| HAGAR MADNICK | ||||||||||
| SPEECH LANGUAGE PATHOLOGIST | 40.00 | 0.00 | $123,666 | $0 | $20,083 | Yes (X) | ||||
| SHAHAB DADJOU | ||||||||||
| SVP, STRATEGY & INTEGRATION/CSO | 0.00 | 0.00 | $0 | $392,881 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $958,485 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,473,648 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $316,515 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 18 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| OTICON INC | |||||
| PO BOX 347996 | PITTSBURGH | PA | 152514996 | HEARING AID DEVICES | $357,557 |
| WIDEX USA INC | |||||
| PO BOX 200138 | DALLAS | TX | 753200138 | HEARING AID DEVICES | $318,956 |
| OTICON MEDICAL LLC | |||||
| 580 HOWARD | SOMERSET | NJ | 08873 | BONE CONDUCTION MANUFACTURE | $267,604 |
| COCHLEAR AMERICAS | |||||
| PO BOX 910811 | DENVER | CO | 802910811 | BONE CONDUCTION MANUFACTURE | $140,551 |
| EPLUS TECHNOLOGY INC | |||||
| 13595 DULLES TECHNOLOGY DR | HERNDON | VA | 20171 | TECHNOLOGY SOLUTIONS | $108,838 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $253,804 | AllOtherContributionsAmt |
| Total Contributions | $253,804 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $11,930,526 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,930,526 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,930,526 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,028 | TotalRevenueColumnAmt |
| Exclusion | $15,028 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $98,490 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $96,996 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,494 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,494 | TotalRevenueColumnAmt |
| Exclusion | $1,494 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $38,020 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,020 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $38,020 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,238,872 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,968,546 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $16,522 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,790,409 | TotalAmt |
| Program Services | $9,711,368 | ProgramServicesAmt |
| Management And General | $1,079,041 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,858 | TotalAmt |
| Program Services | $131,272 | ProgramServicesAmt |
| Management And General | $14,586 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,279,188 | TotalAmt |
| Program Services | $1,151,269 | ProgramServicesAmt |
| Management And General | $127,919 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $799,457 | TotalAmt |
| Program Services | $719,511 | ProgramServicesAmt |
| Management And General | $79,946 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71 | TotalAmt |
| Management And General | $71 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,386 | TotalAmt |
| Program Services | $1,247 | ProgramServicesAmt |
| Management And General | $139 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,471 | TotalAmt |
| Program Services | $184,924 | ProgramServicesAmt |
| Management And General | $20,547 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,130 | TotalAmt |
| Program Services | $4,617 | ProgramServicesAmt |
| Management And General | $513 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $975,028 | TotalAmt |
| Program Services | $877,525 | ProgramServicesAmt |
| Management And General | $97,503 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79 | TotalAmt |
| Program Services | $71 | ProgramServicesAmt |
| Management And General | $8 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,493 | TotalAmt |
| Program Services | $9,444 | ProgramServicesAmt |
| Management And General | $1,049 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $583,013 | TotalAmt |
| Program Services | $524,712 | ProgramServicesAmt |
| Management And General | $58,301 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,357 | TotalAmt |
| Program Services | $10,221 | ProgramServicesAmt |
| Management And General | $1,136 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,464,687 | $1,318,218 | $146,469 |
| LICENSES & TAXES | $13,772 | $12,395 | $1,377 |
| CONSULTANT | $696 | $626 | $70 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,286,095 | TotalAmt |
| Program Services | $14,657,420 | ProgramServicesAmt |
| Management And General | $1,628,675 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,331,180 | BOYAmt |
| EOY | $170,687 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $871,860 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,262 | BOYAmt |
| EOY | $1,772,531 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,404 | BOYAmt |
| EOY | $44,640 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,619 | BOYAmt |
| EOY | $91,498 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,713,927 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,537,402 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,031,536 | BOYAmt |
| EOY | $10,176,525 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $41,104 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,320,500 | BOYAmt |
| EOY | $719,953 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,859,501 | BOYAmt |
| EOY | $13,888,798 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,983,885 | BOYAmt |
| EOY | $695,074 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,697 | BOYAmt |
| EOY | -$3,673 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,664,732 | BOYAmt |
| EOY | $18,187,521 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,764,314 | BOYAmt |
| EOY | $18,878,922 | 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 | -$2,125,640 | BOYAmt |
| EOY | -$6,254,466 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,220,827 | BOYAmt |
| EOY | $1,264,342 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$904,813 | BOYAmt |
| EOY | -$4,990,124 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,859,501 | BOYAmt |
| EOY | $13,888,798 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$4,047,223 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $33,327 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | -$71,415 | DonatedServicesAndUseFcltsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,709,973 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,567,254 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $596,177 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,432,319 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $253,804 | CurrentTaxYearAmt |
| Total | $10,559,527 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,709,973 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,567,254 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $596,177 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,432,319 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $253,804 | CurrentTaxYearAmt |
| Total | $10,559,527 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $4,574,886 | SubstantialContributorsTotAmt |
| Public Support Total170 | $5,984,641 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,194 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,080 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $87,719 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,028 | CurrentTaxYearAmt |
| Total | $106,021 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $270,071 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $24,069 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $106,616 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $56,141 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,783 | CurrentTaxYearAmt |
| Total | $461,680 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $11,127,228 | TotalSupportAmt |
| Public Support CY170 | 0.53780 | PublicSupportCY170Pct |
| Public Support PY170 | 0.57340 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $901,366 | BeginningYearBalanceAmt |
| Contributions | $497 | ContributionsAmt |
| Investment Earnings Or Losses | $11,100 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $212,006 | OtherExpendituresAmt |
| End Year Balance | $700,957 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $815,612 | BeginningYearBalanceAmt |
| Contributions | $3,662 | ContributionsAmt |
| Investment Earnings Or Losses | $82,092 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $901,366 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $723,981 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $91,631 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $815,612 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $761,967 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$37,986 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $723,981 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $582,667 | BeginningYearBalanceAmt |
| Contributions | $137,000 | ContributionsAmt |
| Investment Earnings Or Losses | $42,300 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $761,967 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.05558 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.94442 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,850,254 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,162,764 | DepreciationAmt |
| Book Value | $8,687,490 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,498,836 | OtherCostOrOtherBasisAmt |
| Depreciation | $374,638 | DepreciationAmt |
| Book Value | $1,124,198 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $364,837 | OtherCostOrOtherBasisAmt |
| Book Value | $364,837 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,176,525 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION | $194 |
| LEASED FACILITY AND EQUIPMENT | $719,759 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $719,953 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| PAYABLE TO RELATED ORGANIZATIONS | $17,449,976 |
| LEASE PAYABLE | $737,545 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $18,187,521 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUND IS USED TO SUPPORT PSHC PROGRAMS ADDRESSING THE NEEDS OF THE UNDERSERVED, AND SOCIAL SERVICES TO PATIENTS AND FAMILIES IN NEED. |
| PART X, LINE 2: | U.S. GAAP REQUIRES THE ORGANIZATION'S MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KERRI RUPPERT SCHILLER | ||||||||||||||
| DIRECTOR/TREASURER | $0 | $626,529 | $0 | $146,330 | $0 | $151,774 | $0 | $46,201 | $0 | $29,379 | $0 | $1,000,213 | $0 | $29,032 |
| PAUL VAN DOLAH | ||||||||||||||
| PRESIDENT/CHAIR | $0 | $642,870 | $0 | $147,277 | $0 | $106,331 | $0 | $30,198 | $0 | $0 | $0 | $926,676 | $0 | $29,238 |
| JAY GABRIEL | ||||||||||||||
| DIRECTOR/SECRETARY | $0 | $534,229 | $0 | $114,164 | $0 | $123,206 | $0 | $36,995 | $0 | $42,351 | $0 | $850,945 | $0 | $21,195 |
| MARY ZIMMER | ||||||||||||||
| DIRECTOR | $0 | $358,081 | $0 | $67,948 | $0 | $62,028 | $0 | $19,600 | $0 | $42,351 | $0 | $550,008 | $0 | $14,140 |
| SHAHAB DADJOU | ||||||||||||||
| SVP, STRATEGY & INTEGRATION/CSO | $0 | $0 | $0 | $0 | $0 | $392,881 | $0 | $0 | $0 | $0 | $0 | $392,881 | $0 | $0 |
| LUCIA MORIZIO | ||||||||||||||
| EXECUTIVE DIR, SPEECH & HEARING | $204,515 | $0 | $57,855 | $0 | $8,000 | $0 | $2,400 | $0 | $14,765 | $0 | $287,535 | $0 | $0 | $0 |
| SAMANTHA MCCOMB | ||||||||||||||
| MANAGER, SPEECH & LANGUAGE | $139,626 | $0 | $6,858 | $0 | $0 | $0 | $8,499 | $0 | $7,989 | $0 | $162,972 | $0 | $0 | $0 |
| ROBYN BELZ | ||||||||||||||
| SPEECH LANGUAGE PATHOLOGIST | $141,644 | $0 | $4,856 | $0 | $0 | $0 | $8,499 | $0 | $0 | $0 | $154,999 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINES 4A-B | FormAndLineReferenceDesc |
| Explanation | SEVERANCE ARRANGEMENTS: PART I, LINE 4A SOME OF THE ORGANIZATION'S PERSONNEL LISTED ON FORM 990 PART VII AND SCHEDULE J PARTICIPATE IN A SEPARATION ARRANGEMENT THAT PROVIDES FOR A PORTION OF THE EMPLOYEE'S ANNUAL SALARY BASED ON THEIR POSITION IN THE ORGANIZATION. FOR THE SENIOR EXECUTIVE LEVEL, THE AMOUNT IS BASED ON YEARS OF SERVICE UP TO A MAXIMUM NUMBER OF MONTHS. UNPAID SEVERANCE UNDER THE SEPARATION AGREEMENTS FOR CURRENT KEY EMPLOYEES WERE REPORTED AT THEIR FULL VALUE IN A PREVIOUS TAX YEAR. IN 2022 SHAHAB DADJOU RECEIVED A SEVERANCE PAYMENT OF $392,881. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PART I, LINE 4B CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC OR THE COMPANY) ESTABLISHED A NONQUALIFIED DEFERRED COMPENSATION PLAN EFFECTIVE JANUARY 1, 2010 IN WHICH CERTAIN INDIVIDUALS LISTED ON THE FORM 990, PART VII AND SCHEDULE J ARE PARTICIPANTS. UNDER THE ESTABLISHED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (THE PLAN), OR SERP, FOR EACH PLAN YEAR THAT BEGINS PRIOR TO THE PARTICIPANT'S CASH DATE, CHOC SHALL CREATE A NEW SERP ACCOUNT ON ITS BOOKS FOR THE PARTICIPANT AND SHALL CREDIT TO SUCH ACCOUNT AT TIMES SPECIFIED. THE PARTICIPANTS OF THE PLAN ARE GENERAL CREDITORS OF THE COMPANY. THE PARTICIPANT'S SERP ACCOUNT SHALL BE UTILIZED SOLELY AS A DEVICE FOR THE MEASUREMENT AND DETERMINATION OF THE AMOUNTS TO BE PAID TO THE PARTICIPANT UNDER THIS PLAN. THE PARTICIPANT IS ENTITLED TO HIS/HER SERP BENEFIT AMOUNT UPON THE EARLIEST OF (1) REMAINING EMPLOYED WITH THE COMPANY TO THE THIRD ANNIVERSARY OF THE FIRST DAY OF THE PLAN YEAR FOR WHICH THE SERP ACCOUNT WAS CREATED; (2) REMAINING EMPLOYED WITH THE COMPANY TO THE PARTICIPANT'S 60TH BIRTHDAY; (3) REMAINING EMPLOYED WITH THE COMPANY TO THE DATE THE PARTICIPANT HAS BOTH ATTAINED AT LEAST AGE 55 AND HAS COMPLETED AT LEAST 10 YEARS OF SERVICE; (4) DISABILITY; (5) INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE; (6) VOLUNTARY SEPARATION FROM SERVICE FOR GOOD REASON OR (7) DEATH. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE PLAN DURING CALENDAR YEAR 2022: MS. SCHILLER ($101,580), MR. GABRIEL ($76,697), MS. ZIMMER ($44,669), AND MR. VAN DOLAH ($102,255). THE COMPANY PROVIDES AN INCENTIVE PLAN TO ALL ELIGIBLE MEMBERS OF MANAGEMENT, INCLUDING CERTAIN INDIVIDUALS LISTED IN PART II OF SCHEDULE J. INCENTIVES ARE EARNED BASED ON ACHIEVEMENT OF ORGANIZATION AND INDIVIDUAL GOALS TYPICALLY RELATED TO QUALITY, PATIENT SAFETY, OPERATING, AND FINANCIAL PERFORMANCE AS WELL AS OTHER SIGNIFICANT CLINICAL, QUALITY, AND STRATEGIC ACHIEVEMENTS. THE COMPANY MAINTAINS A CORPORATE MEMBERSHIP IN A SOCIAL CLUB THAT IS UTILIZED FOR BUSINESS PURPOSES BY ITS EXECUTIVES, INCLUDING CERTAIN INDIVIDUALS LISTED IN PART II OF SCHEDULE J. USE OF THE CLUB AND PAYMENTS TO THE CLUB FOR BUSINESS-RELATED EXPENSES ARE SUBJECT TO THE COMPANY'S WRITTEN POLICIES AND PROCEDURES THAT INCLUDE A REQUIREMENT TO DOCUMENT THE PURPOSE AND ATTENDEES OF THE BUSINESS MEETING PRIOR TO PAYMENT. COMPENSATION FROM AN AFFILIATED ORGANIZATION KERRI RUPPERT SCHILLER IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHC, SHE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CHOC FOUNDATION, CRC REAL ESTATE CORPORATION AND CHILDREN'S HOSPITAL AT MISSION (ALL IRC SECTION 501(C)(3) AFFILIATES). MS. SCHILLER DEVOTES APPROXIMATELY 50% OF HER TIME EACH WEEK TO CHILDREN'S HOSPITAL OF ORANGE COUNTY RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. JAY GABRIEL IS COMPENSATED THROUGH CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC), HOWEVER, IN ADDITION TO HIS RESPONSIBILITIES FOR CHOC, HE ALSO SERVES AS AN OFFICER OF CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), CRC REAL ESTATE CORPORATION, CHILDREN'S HOSPITAL AT MISSION (CCMH) AND PROVIDENCE ESTATE CORPORATION, CHILDREN'S HOSPITAL AT MISSION (CCMH) AND PROVIDENCE SPEECH AND HEARING CENTER (PSHC) (ALL IRC SECTION 501(C)(3) AFFILIATES). MR. GABRIEL DEVOTES APPROXIMATELY 44% OF HIS TIME EACH WEEK TO CHOC RESPONSIBILITIES WITH THE BALANCE OF HIS TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. PAUL VAN DOLAH IS COMPENSATED THROUGH CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC), HOWEVER, IN ADDITION TO HIS RESPONSIBILITIES FOR CHC, HE ALSO SERVES AS AN OFFICER OF CHILDREN'S HOSPITAL OF ORANGE COUNTY, CRC REAL ESTATE CORPORATION, CHILDREN'S HOSPITAL AT MISSION AND PROVIDENCE SPEECH AND HEARING CENTER (PSHC) (ALL IRC SECTION 501(C)(3) AFFILIATES). MR. VAN DOLAH DEVOTES APPROXIMATELY 84% OF HIS TIME EACH WEEK TO CHOC RESPONSIBILITIES WITH THE BALANCE OF HIS TIME BEING SPENT ON THE OTHER RELATED ORGANIZATIONS' BUSINESS AFFAIRS. MARY ZIMMER IS COMPENSATED THROUGH CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC), HOWEVER, IN ADDITION TO HER RESPONSIBILITIES FOR CHOC, SHE ALSO SERVES AS DIRECTOR OF PROVIDENCE SPEECH AND HEARING CENTER (PSHC). MS. ZIMMER DEVOTES APPROXIMATELY 95% OF HER TIME EACH WEEK TO CHOC RESPONSIBILITIES WITH THE BALANCE OF HER TIME BEING SPENT ON PSHC BUSINESS AFFAIRS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF PROVIDENCE SPEECH AND HEARING CENTER (PSHC) IS CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC.) THE OFFICERS AND DIRECTORS OF PSHC ARE EMPLOYEES OF CHILDREN'S HEALTHCARE OF CALIFORNIA (CHC) WITH THE EXCEPTION OF 1 DIRECTOR WHO IS EMPLOYED AT CHILDREN'S HOSPITAL OF ORANGE COUNTY (CHOC). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER, CHOC, HAS THE POWERS DETAILED IN LINE 7B. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE APPROVAL OF THE MEMBER SHALL BE REQUIRED WITH RESPECT TO ANY OF THE FOLLOWING ACTIONS: (1) CHANGING THE PURPOSES AND POWERS OF PSHC; (2) OBLIGATING PSHC TO UNDERTAKE ANY CAPITAL EXPENDITURE IN EXCESS OF $5,000,000; (3) ADOPTING PSHC'S ANNUAL OPERATING AND CAPITAL BUDGETS; (4) ADOPTING A LONG-TERM CAPITAL BUDGET; (5) BUYING, SELLING, LEASING, MORTGAGING, PLEDGING, OR OTHERWISE HYPOTHECATING ANY REAL PROPERTY; (6) INCURRING ANY INDEBTEDNESS IN EXCESS OF $5,000,000; (7) OBLIGATING PSHC TO ACT AS GUARANTOR WITH RESPECT TO ANY DEBT OF ANY PERSON OR OTHER ENTITY; (8) ACCEPTING ANY DONATION WHICH IS CONDITIONED UPON PSHC'S UNDERTAKING ANY UNBUDGETED CAPITAL EXPENDITURE IN EXCESS OF $5,000,000 OR ANY UNBUDGETED EXPENDITURE IN EXCESS OF $5,000,000; (9) ENTERING INTO ANY CONTRACT WHICH INVOLVES THE FOLLOWING: (A) ANY FINANCIAL OBLIGATION ON THE PART OF PSHC IN AN AMOUNT IN EXCESS OF $5,000,000 OR (B) ANY PURPOSE OR ACTIVITY WHICH IS OUTSIDE THE SCOPE OF PSHC'S ORDINARY COURSE OF BUSINESS. (10) INVOLVING PSHC IN ANY MERGER, ACQUISITION, CORPORATE RESTRUCTURING, OR FORMAL AFFILIATION; (11) INVOLVING PSHC AS A MEMBER, SHAREHOLDER, OR PARTNER IN ANY NEW CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITY; (12) DISSOLVING PSHC; (13) ENTERING INTO ANY TRANSACTION INVOLVING THE SALE, CONVEYANCE, EXCHANGE, TRANSFER OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF PSHC'S ASSETS; (14) AMENDING PSHC'S ARTICLES OF INCORPORATION; (15) ADOPTING NEW BYLAWS OR AMENDING EXISTING BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE DIRECTORS OF PSHC WILL HAVE REVIEWED THE COMPLETED FORM 990 FOR COMPLETENESS AND ACCURACY PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE. IN ADDITION, A COPY OF THE COMPLETED AND REVIEWED FORM 990 WILL BE SUBMITTED TO EACH BOARD MEMBER PRIOR TO THE SCHEDULED BOARD MEETING FOR REVIEW AND APPROVAL PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING AND ENFORCING COMPLIANCE OF CONFLICT OF INTEREST POLICY THE CHOC COMPLIANCE OFFICER IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THE CONFLICTS OF INTEREST POLICY, AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, AIMED AT DETERMINING ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL COVERED PERSONS (I.E., BOARD MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP). COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE. WHEN AN INDIVIDUAL BECOMES A COVERED PERSON AND ANNUALLY THEREAFTER, EACH COVERED PERSON IS REQUIRED TO SIGN A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY AND UNDERSTANDS SAID POLICY; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE COMPLIANCE OFFICER AND ANY PERSONS WITH ACTUAL OR POTENTIAL CONFLICTS ARE CONTACTED VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST MAY INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD OF DIRECTORS; (2)THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE CONFLICT, THE SUBSTANCE OF THE TRANSACTION OR THE ARRANGEMENT BEING CONSIDERED; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM ANY DISCUSSION OR APPROVAL OF SUCH TRANSACTION; (4) IF APPLICABLE ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; AND (5) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | PROCESS OF DETERMINING COMPENSATION OF THE CEO AND OTHER OFFICERS AN INDEPENDENT BOARD COMMITTEE OF CHC CHARGED WITH THE DUTIES OF THE COMPENSATION COMMITTEE, WHOSE MEMBERS ARE DISINTERESTED AND INDEPENDENT, IS IN PLACE WITH A WRITTEN COMPENSATION COMMITTEE CHARTER. THIS COMMITTEE ANNUALLY RETAINS AN INDEPENDENT HEALTHCARE COMPENSATION CONSULTING FIRM TO PROVIDE RELEVANT COMPARABILITY DATA AND OTHER COMPENSATION STUDIES. THE CEO, OFFICERS AND EXECUTIVE MANAGEMENT SALARIES, INCENTIVES AND BENEFITS, AS WELL AS OVERALL COMPENSATION PHILOSOPHY AND POLICIES, ARE DISCUSSED WITH THE INDEPENDENT CONSULTANT REPRESENTATIVES AND THE COMPENSATION COMMITTEE MEMBERS, IN PERSON, IN CLOSED SESSIONS WITH NO STAFF MEMBERS PRESENT. THIS ANNUAL REVIEW WAS LAST PERFORMED IN OCTOBER 2023. ALL COMPARATIVE MARKET DATA, SUCH AS ANNUAL COMPENSATION SURVEY COMPRISED OF A PEER GROUP OF COMPARABLY SIZED PEDIATRIC HOSPITALS, IS WELL DOCUMENTED AND THERE ARE MINUTES FROM THESE MEETINGS THAT DOCUMENT THE MEMBERS PRESENT AND VOTING, THE COMPARATIVE DATA USED AND HOW IT WAS OBTAINED AND THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE. THE RESULTS AND RECOMMENDATIONS FROM THE COMMITTEE ARE SHARED IN AN EXECUTIVE SESSION WITH THE CHC BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | DISCLOSURE COPY WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FOR PUBLIC INSPECTION, THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
| PART XII, LINE 2 | OVERSIGHT OR SELECTION PROCESS CHC HAS AN AUDIT COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE OVERSIGHT PROCESS OR SELECTION PROCESS HAS NOT CHANGED DURING THE YEAR. BELOW ARE THE DUTIES AND MEMBERSHIP CRITERIA OF THE AUDIT COMMITTEE: DUTIES: - RECOMMENDS ACCOUNTING FIRM RETENTION AND TERMINATION - NEGOTIATES THE ACCOUNTING FIRM'S COMPENSATION - CONFERS WITH THE ACCOUNTING FIRM TO ASSURE FINANCIAL AFFAIRS ARE IN ORDER - DETERMINES WHETHER TO ACCEPT THE AUDIT - APPROVES PERFORMANCE NON-AUDIT SERVICES TO BE PROVIDED BY ACCOUNTING FIRM - REPORTS AUDIT FINDINGS TO BOARD OF DIRECTORS - ENSURES THAT AUDIT RECOMMENDATIONS ARE ADEQUATELY AND TIMELY IMPLEMENTED BY STAFF MEMBERSHIP: - CHAIRPERSON MAY NOT BE A FINANCE COMMITTEE MEMBER - FINANCE COMMITTEE MEMBERS MUST COMPRISE LESS THAN 50% OF MEMBERSHIP - MAY INCLUDE NON BOARD OF DIRECTOR MEMBERS - NO MEMBER OF STAFF, INCLUDING MANAGEMENT - NO PERSON WITH A MATERIAL FINANCIAL INTEREST IN AN ENTITY DOING BUSINESS WITH PROVIDENCE SPEECH AND HEARING CENTER |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEWPORT LANGUAGE SPEECH & AUD | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26137 LA PAZ RD SUITE 104 | AddressLine1Txt |
| City | MISSION VIEJO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92691 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 956154473 | EIN |
| Primary Activities | HEARING ASSISTANCE | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PSHC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CHILDREN'S HOSPITAL OF ORANGE COUNTY | |||||||||||
| 1201 WEST LA VETA AVENUE | ORANGE | CA | 92868 | 952321786 | HEALTHCARE | CA | 501(C)(3) | LINE 3 | CHC | 0 | |
| CHILDREN'S HOSPITAL AT MISSION | |||||||||||
| 1201 WEST LA VETA AVENUE | ORANGE | CA | 92868 | 330528802 | HEALTHCARE | CA | 501(C)(3) | LINE 3 | CHC | 0 | |
| CHOC FOUNDATION | |||||||||||
| 1201 WEST LA VETA AVENUE | ORANGE | CA | 92868 | 956097416 | FUNDRAISING | CA | 501(C)(3) | LINE 7 | CHC | 0 | |
| CRC REAL ESTATE | |||||||||||
| 1201 WEST LA VETA AVENUE | ORANGE | CA | 92868 | 330612565 | REAL ESTATE | CA | 501(C)(3) | LINE 12B, II | CHC | 0 | |
| CHILDREN'S HEALTHCARE OF CALIFORNIA(CHC) | |||||||||||
| 1201 WEST LA VETA AVENUE | ORANGE | CA | 92868 | 330265266 | HEALTHCARE | CA | 501(C)(3) | LINE 12A, I | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ORANGE COUNTY MEDICAL RECIPROCAL INSURANCE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7400 E GAINEY CLUB DR 111 | AddressLine1Txt |
| City | SCOTTSDALE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85258 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201620666 | EIN |
| Primary Activities | INSURANCE | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |