LA CLINICA DE LOS CAMPESINOS INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- LA CLINICA DE LOS CAMPESINOS INC (EIN 39-1181480)
- Tax period
- 2023-04-01 to 2024-03-31
- Filed
- 2025-01-13
- IRS object ID
- 202530159349300618
- Schema version
- 2023v6.0
- 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 | 2025-01-13T14:47:29-06:00 | ReturnTs |
| Tax Period End | 2024-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391181480 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LA CLINICA DE LOS CAMPESINOS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LACL | BusinessNameControlTxt |
| Phone | 9207875514 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 S TOWNLINE ROAD | AddressLine1Txt |
| City | WAUTOMA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54982 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURA WALDVOGEL | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 9207875514 | PhoneNum |
| Signature | 2025-01-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JESSICA NATUS | PreparerPersonNm |
| PTIN | P01799381 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2025-01-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAMILY HEALTH LA CLINICA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LAURA WALDVOGEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 S TOWNLINE ROAD | AddressLine1Txt |
| City | WAUTOMA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54982 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,332,563 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://NOBLECLINICS.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO ENSURE ACCESS TO HIGH QUALITY INTEGRATED HEALTHCARE AND PROMOTE THE WELL-BEING OF OUR PATIENTS, STAFF, AND COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 231 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $7,019,299 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,325,602 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,176,432 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,642,311 | CYProgramServiceRevenueAmt |
| PY Investment Income | $93,997 | PYInvestmentIncomeAmt |
| CY Investment Income | -$549,431 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $31,289,728 | PYTotalRevenueAmt |
| CY Total Revenue | $21,418,482 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,542,304 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,061,562 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,984,725 | PYOtherExpensesAmt |
| CY Other Expenses | $8,263,065 | CYOtherExpensesAmt |
| PY Total Expenses | $21,537,029 | PYTotalExpensesAmt |
| CY Total Expenses | $24,334,627 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $9,752,699 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,916,145 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,538,371 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,244,485 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,353,259 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,944,352 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $18,185,112 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,300,133 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO ENSURE ACCESS TO HIGH QUALITY INTEGRATED HEALTHCARE AND PROMOTE THE WELL-BEING OF OUR PATIENTS, STAFF, AND COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,010,141 | ExpenseAmt |
| Grant | $10,000 | GrantAmt |
| Revenue | $15,642,311 | RevenueAmt |
| Desc | COMMUNITY AND MIGRANT HEALTH CLINIC CENTER THAT PROVIDES PRIMARY MEDICAL, BEHAVIORAL HEALTH, AND DENTAL HEALTH SERVICES TO COMMUNITY RESIDENTS AND MIGRANT PATIENTS. THE WISCONSIN COMMUNITY HEALTH CENTER GRANT ENABLES LA CLINICA TO PROVIDE COMMUNITY AND MIGRANT PATIENTS ACCESS TO MEDICAL AND DENTAL SERVICES. IN ADDITION, BEHAVIORAL HEALTH SERVICES ARE PROVIDED WHICH INCLUDE MEDICATION ASSISTED TREATMENT FOR SUBSTANCE AND ALCOHOL ABUSE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $297,401 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE WOMEN, INFANT, AND CHILDREN'S GRANT ALLOWS LA CLINICA TO PROVIDE SUPPLEMENTAL NUTRITION AND EDUCATION TO CLIENTS IN THE PROGRAM SERVICES AREA. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $18,307,542 | 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 | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | 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 | Yes (1) | 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 | 0 | 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 | 39 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 231 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIAN AHLGREN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207875514 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 S TOWNLINE ROAD | AddressLine1Txt |
| City | WAUTOMA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54982 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ALMA DELIA TORRES | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| AARON WILLIAMS | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHEILA SHAW | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HEIDI DELGADILLO | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LORA BLASIUS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PETER GIERACH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRENDA HENKE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROSEANNE HENNING | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| FRED JOHANNES | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL MOTT | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JUANITA 'TERRY' OLIVAS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDA SHELLEY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL THEYEL | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAMARIS THOME | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LAURA WALDVOGEL | |||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $249,663 | $0 | $63,913 | ||
| THOMAS KAMINSKI | |||||||
| CFO | 40.00 | Yes (X) | $198,951 | $0 | $53,535 | ||
| KEVIN THAO | |||||||
| PHYSICIAN | 28.00 | $215,234 | $0 | $50,388 | Yes (X) | ||
| JAVIER RINCON | |||||||
| PHYSICIAN | 28.00 | $205,974 | $0 | $25,046 | Yes (X) | ||
| SAVITA BIMARTHI | |||||||
| CDO/DENTIST | 40.00 | $172,248 | $0 | $47,343 | Yes (X) | ||
| NATHAN DAILY | |||||||
| DENTIST | 32.00 | $182,740 | $0 | $46,149 | Yes (X) | ||
| SAMANTHA SEILER | |||||||
| PHYSICIAN | 40.00 | $231,556 | $0 | $50,523 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,456,366 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $336,897 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | 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 |
|---|---|---|---|---|---|
| BARTON ASSOCIATES INC | |||||
| PO BOX 417844 | BOSTON | MA | 022417844 | LOCUM DENTIST SERVICES | $737,433 |
| UTSCHIG INC | |||||
| N1040 CRAFTSMEN DRIVE | GREENVILLE | WI | 54942 | CONSTRUCTION SERVICES | $692,070 |
| SOMERVILLE INC | |||||
| 2100 RIVERSIDE DR | GREEN BAY | WI | 54301 | CONSTRUCTION SERVICES | $347,590 |
| OCHIN INC | |||||
| PO BOX 5426 | PORTLAND | OR | 972285426 | SOFTWARE AND CONSULTING | $330,455 |
| WIPFLI CPAS AND CONSULTANTS | |||||
| PO BOX 3160 | MILWAUKEE | WI | 532013160 | ACCOUNTING | $185,544 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,054,247 | GovernmentGrantsAmt |
| All Other Contributions | $271,355 | AllOtherContributionsAmt |
| Total Contributions | $6,325,602 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $15,254,096 | $15,254,096 |
| 340B PROGRAM REVENUE | 900099 | $100,431 | $100,431 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $287,784 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $287,784 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,642,311 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $364,650 | TotalRevenueColumnAmt |
| Exclusion | $364,650 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $914,081 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$914,081 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$914,081 | TotalRevenueColumnAmt |
| Exclusion | -$914,081 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,418,482 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,642,311 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$549,431 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,000 | TotalAmt |
| Program Services | $10,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $590,880 | TotalAmt |
| Management And General | $590,880 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,814,059 | TotalAmt |
| Program Services | $9,938,004 | ProgramServicesAmt |
| Management And General | $1,876,055 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $426,939 | TotalAmt |
| Program Services | $354,378 | ProgramServicesAmt |
| Management And General | $72,561 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,324,099 | TotalAmt |
| Program Services | $1,901,689 | ProgramServicesAmt |
| Management And General | $422,410 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $905,585 | TotalAmt |
| Program Services | $712,243 | ProgramServicesAmt |
| Management And General | $193,342 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,034 | TotalAmt |
| Management And General | $12,034 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,939 | TotalAmt |
| Management And General | $45,939 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,080 | TotalAmt |
| Management And General | $9,080 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,279,451 | TotalAmt |
| Program Services | $1,586,657 | ProgramServicesAmt |
| Management And General | $692,794 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,215 | TotalAmt |
| Program Services | $59,998 | ProgramServicesAmt |
| Management And General | $152,217 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,025,204 | TotalAmt |
| Program Services | $432,551 | ProgramServicesAmt |
| Management And General | $592,653 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $631,924 | TotalAmt |
| Program Services | $497,009 | ProgramServicesAmt |
| Management And General | $134,915 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $748,619 | TotalAmt |
| Program Services | $299,644 | ProgramServicesAmt |
| Management And General | $448,975 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,664 | TotalAmt |
| Program Services | $150,430 | ProgramServicesAmt |
| Management And General | $56,234 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,630 | TotalAmt |
| Program Services | $28,023 | ProgramServicesAmt |
| Management And General | $7,607 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,340 | TotalAmt |
| Program Services | $14,322 | ProgramServicesAmt |
| Management And General | $163,018 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $730,329 | TotalAmt |
| Program Services | $432,617 | ProgramServicesAmt |
| Management And General | $297,712 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,007 | TotalAmt |
| Program Services | $37,198 | ProgramServicesAmt |
| Management And General | $137,809 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $954,980 | $954,980 | |
| BAD DEBT EXPENSE | $698,155 | $698,155 | |
| REPAIRS & MAINTENANCE | $136,115 | $82,904 | $53,211 |
| DUES, PUBLICATIONS & ME | $91,488 | $31,498 | $59,990 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,891 | TotalAmt |
| Program Services | $85,242 | ProgramServicesAmt |
| Management And General | $7,649 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,334,627 | TotalAmt |
| Program Services | $18,307,542 | ProgramServicesAmt |
| Management And General | $6,027,085 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,984,785 | BOYAmt |
| EOY | $3,683,761 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $277,853 | BOYAmt |
| EOY | $278,508 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $237,702 | BOYAmt |
| EOY | $109,209 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,120,692 | BOYAmt |
| EOY | $1,133,399 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $93,611 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $56,693 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,059 | BOYAmt |
| EOY | $231,455 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,722,982 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,775,116 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,255,735 | BOYAmt |
| EOY | $9,947,866 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $5,213,309 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $492,545 | BOYAmt |
| EOY | $496,674 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,538,371 | BOYAmt |
| EOY | $21,244,485 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,513,308 | BOYAmt |
| EOY | $1,857,468 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $395,294 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,577,961 | BOYAmt |
| EOY | $3,450,889 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $261,990 | BOYAmt |
| EOY | $240,701 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,353,259 | BOYAmt |
| EOY | $5,944,352 | 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 | $17,813,246 | BOYAmt |
| EOY | $14,922,389 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $371,866 | BOYAmt |
| EOY | $377,744 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,185,112 | BOYAmt |
| EOY | $15,300,133 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,538,371 | BOYAmt |
| EOY | $21,244,485 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,916,145 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $31,166 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | LA CLINICA DE LOS CAMPESINOS IS A NOT-FOR-PROFIT CORPORATION THAT PROVIDES HEALTHCARE SERVICES THROUGH MEDICAL, BEHAVIORAL AND DENTAL CLINICS. IT IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL AND THEREFORE IS NOT REQUIRED TO COMPLETE SCHEDULE H. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $725,004 | OtherCostOrOtherBasisAmt |
| Book Value | $725,004 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,425,121 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,267,868 | DepreciationAmt |
| Book Value | $7,157,253 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $463,534 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,620 | DepreciationAmt |
| Book Value | $438,914 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,026,640 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,420,333 | DepreciationAmt |
| Book Value | $606,307 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,082,683 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,062,295 | DepreciationAmt |
| Book Value | $1,020,388 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,947,866 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (3 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENTS - ASSOCIATED BANKS | $4,951,503 | F |
| GOLDMAN SACHS | $178,174 | F |
| INTEREST RECEIVABLE | $83,632 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $5,213,309 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RIGHT OF USE OBLIGATION - OPERATING LEASE | Desc |
| Amt | $240,701 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $240,701 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $20,663,129 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$777,439 | OtherRevenueAmt |
| Revenue Not Reported | -$777,439 | RevenueNotReportedAmt |
| Revenue Subtotal | $21,440,568 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $9,080 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$31,166 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$22,086 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $21,418,482 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $23,548,108 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $23,548,108 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $9,080 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $777,439 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $786,519 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $24,334,627 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE CLINIC DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE CLINIC HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | 340B EXPENSES -79,284. BAD DEBT EXPENSE -698,155. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CHANGE IN COMMUNITY FUND -31,166. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | 340B EXPENSES 79,284. BAD DEBT EXPENSE 698,155. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIP | GrantTypeTxt |
| Recipient | 1 | RecipientCnt |
| Cash Grant | $10,000 | CashGrantAmt |
| Valuation Method Used | CASH | ValuationMethodUsedDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE SCHOLARSHIPS AWARDED ARE MANAGED BY AN OUTSIDE FOUNDATION. THE FOUNDATION MAINTAINS THE RECORDS AND ENSURES THE RECIPIENTS MEET THE ELIGIBILITY REQUIREMENTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAURA WALDVOGEL | ||||||||||||||
| PRESIDENT & CEO | $249,663 | $0 | $0 | $0 | $0 | $0 | $13,319 | $0 | $50,594 | $0 | $313,576 | $0 | $0 | $0 |
| SAMANTHA SEILER | ||||||||||||||
| PHYSICIAN | $223,320 | $0 | $0 | $0 | $8,236 | $0 | $9,401 | $0 | $41,122 | $0 | $282,079 | $0 | $0 | $0 |
| KEVIN THAO | ||||||||||||||
| PHYSICIAN | $195,210 | $0 | $0 | $0 | $20,024 | $0 | $7,794 | $0 | $42,594 | $0 | $265,622 | $0 | $0 | $0 |
| THOMAS KAMINSKI | ||||||||||||||
| CFO | $198,951 | $0 | $0 | $0 | $0 | $0 | $10,317 | $0 | $43,218 | $0 | $252,486 | $0 | $0 | $0 |
| JAVIER RINCON | ||||||||||||||
| PHYSICIAN | $205,974 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $25,046 | $0 | $231,020 | $0 | $0 | $0 |
| NATHAN DAILY | ||||||||||||||
| DENTIST | $182,740 | $0 | $0 | $0 | $0 | $0 | $9,360 | $0 | $36,789 | $0 | $228,889 | $0 | $0 | $0 |
| SAVITA BIMARTHI | ||||||||||||||
| CDO/DENTIST | $172,248 | $0 | $0 | $0 | $0 | $0 | $8,913 | $0 | $38,430 | $0 | $219,591 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| KEVIN THAO CMO | |||||||
| HIGHEST COMPENATED EMPLOYEE | INCENTIVE PACKAGE | Yes (X) | $150,000 | $70,000 | 0 | 0 | Yes (1) |
| SAMANTHA SEILER | |||||||
| HIGHEST COMPENATED EMPLOYEE | INCENTIVE PACKAGE | Yes (X) | $50,000 | $23,611 | 0 | 0 | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $93,611 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE PREPARED FORM 990 IS REVIEWED BY THE CFO AND CEO AND APPROVED BY THE BOARD OF DIRECTORS BEFORE THE RETURN IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY ALL DIRECTORS AND OFFICERS DISCLOSE ALL INFORMATION REGARDING THEIR INTERESTS AND THOSE OF THEIR FAMILY MEMBERS THAT COULD GIVE RISE TO CONFLICTS THE MEMBERS OF GOVERNING BODY MAKE DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW ACTUAL CONFLICTS. ANY PERSON WITH A CONFLICT IS PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS ANNUALLY DETERMINE THE CEO'S COMPENSATION USING DATA ON COMPENSATION PAID BY COMPARABLE ORGANIZATIONS IN SIMILAR COMMUNITIES FOR SIMILAR SERVICES. IN DETERMINING COMPENSATION FOR OFFICERS AND KEY EMPLOYEES, THE PROCESS INCLUDES REVIEW BY THE DIRECTOR OF HUMAN RESOURCES AND APPROVAL OF THE CEO IN ALIGNMENT WITH BOARD APPROVED SALARY SCHEDULES WHICH ARE CREATED USING COMPARABILITY DATA TO ENSURE ALIGNMENT WITH MARKET STANDARDS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN CASH SURRENDER VALUE OF DEFERRED ANNUITY 31,166. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |