PETALUMA HEALTH CENTER: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PETALUMA HEALTH CENTER (EIN 68-0437840)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-04
- IRS object ID
- 202211249349302966
- Schema version
- 2020v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule J
- Schedule K
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-04T18:25:10-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SECOND STREET SUITE 900 | AddressLine1Txt |
| City | SAN FRANCISCO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94105 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680437840 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETALUMA HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PETA | BusinessNameControlTxt |
| Phone | 7075597500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1179 NORTH MCDOWELL BLVD | AddressLine1Txt |
| City | PETALUMA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94954 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MOLLY JOUANEH | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7075597500 | PhoneNum |
| Signature | 2022-04-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MOLLY | PersonFirstNm |
| Person Last | JOUANEH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL LUMSDEN | PreparerPersonNm |
| PTIN | P01262236 | PTIN |
| Phone | 4159561500 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KATHRYN POWELL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1455 N MCDOWELL BLVD | AddressLine1Txt |
| City | PETALUMA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94954 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $67,331,720 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PHEALTHCENTER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | TO ENSURE ACCESS & PROVIDE HIGH QUALITY PREVENTION-FOCUSED HEALTH CARE FOR THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 573 | TotalEmployeeCnt |
| Total Volunteers | 51 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,027,133 | PYContributionsGrantsAmt |
| CY Contributions Grants | $26,697,201 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,527,882 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $38,580,965 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,755 | PYInvestmentIncomeAmt |
| CY Investment Income | $150 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,288,063 | PYOtherRevenueAmt |
| CY Other Revenue | $2,008,112 | CYOtherRevenueAmt |
| PY Total Revenue | $43,849,833 | PYTotalRevenueAmt |
| CY Total Revenue | $67,286,428 | 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 | $34,916,968 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $39,139,803 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,228,251 | PYOtherExpensesAmt |
| CY Other Expenses | $14,688,823 | CYOtherExpensesAmt |
| PY Total Expenses | $48,145,219 | PYTotalExpensesAmt |
| CY Total Expenses | $53,828,626 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,295,386 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $13,457,802 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $37,659,318 | TotalAssetsBOYAmt |
| Total Assets EOY | $54,716,771 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,207,416 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,836,475 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,451,902 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,880,296 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE PETALUMA HEALTH CENTER'S MISSION IS TO ENSURE ACCESS, AND TO PROVIDE HIGH QUALITY PREVENTION-FOCUSED HEALTH CARE FOR THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $27,427,588 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $24,565,746 | RevenueAmt |
| Desc | FAMILY PRACTICE SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF FAMILY PRACTICE VISITS DURING FISCAL YEAR 2021 WERE 139,927. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,416,946 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,998,709 | RevenueAmt |
| Desc | GENERAL DENTISTRY AND FLUORIDE VARNISHING SERVICES PROVIDED TO PATIENTS. THE TOTAL NUMBER OF DENTAL VISITS DURING FISCAL YEAR 2021 WERE 22,004. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,859,155 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,299,078 | RevenueAmt |
| Desc | OBSTETRIC AND GYNECOLOGY SERVICES PROVIDED TO PATIENTS, INCLUDING BIRTHING AND PREGNANCY SERVICES. THE TOTAL NUMBER OF OB/GYN VISITS DURING FISCAL YEAR 2021 WERE 11,242. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,168,228 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $6,717,432 | RevenueAmt |
| Desc | OTHER PROGRAM SERVICES INCLUDE INTEGRATED BEHAVIORAL HEALTH, VISION, WELLNESS, AND NUTRITION PROGRAMS FOR PATIENTS; ADDITIONALLY, THE ORGANIZATION OPERATES A NURSE PRACTITIONER AND PHYSICIAN'S ASSISTANT RESIDENCY PROGRAM TO TRAIN NEW NP/PA'S IN THE COMMUNITY MEDICINE MODEL OF CARE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $7,168,228 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $6,717,432 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $43,871,917 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | 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 | 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 | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | 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 | 87 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 573 | 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 |
| 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 | MOLLY JOUANEH | PersonNm |
| Phone | 7075597578 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1455 N MCDOWELL BLVD | AddressLine1Txt |
| City | PETALUMA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94954 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (34 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| KATHRYN POWELL MHA MA | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $318,608 | $0 | $47,344 | |||
| KEN WEINSTOCK MD | ||||||||
| DIR. OF BEHAVIORAL HEALTH SERVICES | 40.00 | $294,203 | $0 | $36,871 | Yes (X) | |||
| NURIT LICHT MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $264,220 | $0 | $30,314 | |||
| PHILIPPE EDOUARD MD FACP | ||||||||
| FAMILY PHYSICIAN | 40.00 | $248,539 | $0 | $26,509 | Yes (X) | |||
| DANIELLE ORYN DO MPH | ||||||||
| CHIEF MEDICAL INFORMATICS OFFICER | 40.00 | Yes (X) | $236,413 | $0 | $34,883 | |||
| RAMONA ENGLISH DMD | ||||||||
| CHIEF DENTAL OFFICER | 40.00 | Yes (X) | $235,280 | $0 | $27,111 | |||
| REBECCA KATZ MD | ||||||||
| PRIMARY CARE SITE DIRECTOR | 36.00 | $220,511 | $0 | $38,477 | Yes (X) | |||
| SAFI AHMED MD MPH | ||||||||
| FAMILY PHYSICIAN | 36.00 | $250,346 | $0 | $8,516 | Yes (X) | |||
| ANDREW ASHCROFT MD MPH | ||||||||
| FAMILY PHYSICIAN | 36.00 | $211,356 | $0 | $43,531 | Yes (X) | |||
| JONATHAN CHOE MD | ||||||||
| ASSOC. MEDICAL DIR, WOMEN'S HEALTH | 34.00 | $227,682 | $0 | $15,065 | Yes (X) | |||
| JANE READ MSA RN | ||||||||
| COO THROUGH 4/2021 | 40.00 | Yes (X) | $219,914 | $0 | $16,738 | |||
| CASSIE IUTZI MD MPH | ||||||||
| FAMILY PHYSICIAN | 40.00 | $207,239 | $0 | $27,188 | Yes (X) | |||
| PEDRO TOLEDO JD MA MHSA | ||||||||
| CHIEF ADMINISTRATIVE OFFICER | 40.00 | Yes (X) | $206,801 | $0 | $23,047 | |||
| JOHN PENDLETON MD | ||||||||
| ASSOC. MEDICAL DIRECTOR, OPERATIONS | 34.00 | $204,520 | $0 | $23,057 | Yes (X) | |||
| CARLIN CHI MD | ||||||||
| MEDICAL DIRECTOR, PRIMARY CARE | 40.00 | $188,145 | $0 | $31,982 | Yes (X) | |||
| MICHELLE GLANCY MBA | ||||||||
| CHIEF HUMAN RESOURCES OFFICER | 40.00 | Yes (X) | $202,120 | $0 | $15,782 | |||
| MOLLY JOUANEH CMA | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $187,941 | $0 | $726 | |||
| TIFFANY JIMENEZ RN | ||||||||
| COO START 5/2021 | 40.00 | Yes (X) | $0 | $0 | $0 | |||
| TONY SARNO | ||||||||
| PRES THROUGH 12/2020 / BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ROBERT RAMIREZ | ||||||||
| VP THROUGH 1/2021 / PRES START 1/2021 | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ELISA VELASQUEZ-ANDRADE PHD | ||||||||
| VICE PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MARC POUNDS CPA | ||||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| VANESSA LUNA SHANNON | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| WILLIAM BARRETT | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| CECILIA CASTANEDA | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| PHOEBE ELLIS | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| ELIZABETH GOLDBLATT PHD MPAHA | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| TOM ISAAK | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| ELAD LEVINSON LCSW | ||||||||
| BOARD MEMBER THROUGH 12/2020 | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| GLORIA ROBINSON | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| JOE TAMBE | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| TERESA TAYLOR-KING | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| GEORGINA WARMOTH | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| CATHERINE WEST MD DRPH | ||||||||
| BOARD MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,923,838 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $447,141 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 68 | 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 |
|---|---|---|---|---|---|
| THE MEDCOR GROUP INC | |||||
| 1801 W OLYMPIC BLVD | PASADENA | CA | 91199 | BILLING SERVICES | $920,556 |
| ECLINICALWORKS LLC | |||||
| TWO TECHNOLOGY DR | WESTBOROUGH | MA | 01581 | IT SUPPORT SERVICES | $480,972 |
| SERVICO BUILDING MAINTENANCE | |||||
| PO BOX 25 | GLEN ELLEN | CA | 95442 | JANITORIAL SERVICES | $408,494 |
| BARBIER SECURITY GROUP | |||||
| 369-B THIRD STREET 440 | SAN RAFAEL | CA | 94901 | SECURITY SERVICES | $222,928 |
| MOSS ADAMS LLP | |||||
| PO BOX 101822 | PASADENA | CA | 911891822 | AUDITING & TAX SERVICES | $145,350 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $18,030,679 | GovernmentGrantsAmt |
| All Other Contributions | $8,666,522 | AllOtherContributionsAmt |
| Noncash Contributions | $2,970,356 | NoncashContributionsAmt |
| Total Contributions | $26,697,201 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $32,066,034 | $32,066,034 |
| PERFORMANCE PAYMENTS-HEALTH PLANS | 621400 | $4,329,924 | $4,329,924 |
| PHARMACY REVENUE | 621400 | $2,185,007 | $2,185,007 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $38,580,965 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $44,745 | TotalRevenueColumnAmt |
| Exclusion | $44,745 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $697 | TotalRevenueColumnAmt |
| Exclusion | $697 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $45,292 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$45,292 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$45,292 | TotalRevenueColumnAmt |
| Exclusion | -$45,292 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $2,008,112 | TotalRevenueColumnAmt |
| Exclusion | $2,008,112 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,008,112 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $67,286,428 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,580,965 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,008,262 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,393,714 | TotalAmt |
| Program Services | $2,118,932 | ProgramServicesAmt |
| Management And General | $1,274,782 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,377,187 | TotalAmt |
| Program Services | $23,031,098 | ProgramServicesAmt |
| Management And General | $3,346,089 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,055,725 | TotalAmt |
| Program Services | $928,870 | ProgramServicesAmt |
| Management And General | $126,855 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,314,452 | TotalAmt |
| Program Services | $5,330,854 | ProgramServicesAmt |
| Management And General | $983,598 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,998,725 | TotalAmt |
| Program Services | $1,678,225 | ProgramServicesAmt |
| Management And General | $320,500 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,152 | TotalAmt |
| Management And General | $148,152 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,956 | TotalAmt |
| Management And General | $156,956 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,639,567 | TotalAmt |
| Program Services | $3,006,894 | ProgramServicesAmt |
| Management And General | $1,632,673 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,950 | TotalAmt |
| Program Services | $28,293 | ProgramServicesAmt |
| Management And General | $31,657 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $893,850 | TotalAmt |
| Program Services | $609,205 | ProgramServicesAmt |
| Management And General | $284,645 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $780,257 | TotalAmt |
| Program Services | $625,755 | ProgramServicesAmt |
| Management And General | $154,502 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,433,274 | TotalAmt |
| Program Services | $1,910,217 | ProgramServicesAmt |
| Management And General | $523,057 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,015 | TotalAmt |
| Program Services | $53,647 | ProgramServicesAmt |
| Management And General | $25,368 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,104 | TotalAmt |
| Program Services | $69,218 | ProgramServicesAmt |
| Management And General | $44,886 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,706 | TotalAmt |
| Management And General | $279,706 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,757,885 | TotalAmt |
| Program Services | $1,466,836 | ProgramServicesAmt |
| Management And General | $291,049 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,582 | TotalAmt |
| Program Services | $74,923 | ProgramServicesAmt |
| Management And General | $72,659 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES/DRUGS | $1,947,485 | $1,947,485 | |
| MINOR EQUIPMENT | $476,065 | $382,683 | $93,382 |
| DUES AND SUBSCRIPTIONS | $308,550 | $189,759 | $118,791 |
| IN-KIND EXPENSE | $124,349 | $124,349 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,076 | TotalAmt |
| Program Services | $294,674 | ProgramServicesAmt |
| Management And General | $47,402 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,828,626 | TotalAmt |
| Program Services | $43,871,917 | ProgramServicesAmt |
| Management And General | $9,956,709 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,723,681 | BOYAmt |
| EOY | $8,789,999 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $263,398 | BOYAmt |
| EOY | $5,194,654 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $403,854 | BOYAmt |
| EOY | $798,592 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,801,615 | BOYAmt |
| EOY | $4,957,638 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,089 | BOYAmt |
| EOY | $71,920 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,933 | BOYAmt |
| EOY | $89,135 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $833,124 | BOYAmt |
| EOY | $565,978 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $32,200,214 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,990,332 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,937,712 | BOYAmt |
| EOY | $20,209,882 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,612,912 | BOYAmt |
| EOY | $14,038,973 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,659,318 | BOYAmt |
| EOY | $54,716,771 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,812,070 | BOYAmt |
| EOY | $6,560,933 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,051,981 | BOYAmt |
| EOY | $777,217 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,103,793 | BOYAmt |
| EOY | $4,920,353 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,130,189 | BOYAmt |
| EOY | $1,307,236 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,939,899 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,169,484 | BOYAmt |
| EOY | $15,270,736 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,207,416 | BOYAmt |
| EOY | $28,836,475 | 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 | $12,423,256 | BOYAmt |
| EOY | $25,820,596 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,646 | BOYAmt |
| EOY | $59,700 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,451,902 | BOYAmt |
| EOY | $25,880,296 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,659,318 | BOYAmt |
| EOY | $54,716,771 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $13,457,802 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$29,408 | NetUnrlzdGainsLossesInvstAmt |
| 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) |
|---|---|---|
| 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) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,762,595 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,451,384 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,608,360 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,027,133 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $26,697,201 | CurrentTaxYearAmt |
| Total | $44,546,673 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,762,595 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,451,384 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,608,360 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,027,133 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $26,697,201 | CurrentTaxYearAmt |
| Total | $44,546,673 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $44,546,673 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,060 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,011 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,966 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,755 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $45,442 | CurrentTaxYearAmt |
| Total | $67,234 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $210,464 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $432,814 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $785,952 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,288,063 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,008,112 | CurrentTaxYearAmt |
| Total | $4,725,405 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $49,339,312 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $187,973,214 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.90290 | PublicSupportCY170Pct |
| Public Support PY170 | 0.87250 | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,745 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,745 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS MEMBERSHIP DUES TO THE CALIFORNIA PRIMARY CARE ASSOCIATION; A PORTION OF THOSE MEMBERSHIP DUES WERE DESIGNATED AS UTILIZED FOR LOBBYING ACTIVITIES FOR LEGISLATION PERTINENT TO THE HEALTH CARE FIELD. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,835,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,835,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,900,672 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,429,550 | DepreciationAmt |
| Book Value | $12,471,122 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,235,691 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,003,604 | DepreciationAmt |
| Book Value | $3,232,087 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,665,168 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,313,107 | DepreciationAmt |
| Book Value | $1,352,061 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,563,683 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,244,071 | DepreciationAmt |
| Book Value | $1,319,612 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,209,882 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BOND RESERVE FUNDS | $174,711 |
| OTHER RECEIVABLES | $1,864,021 |
| DEPOSITS | $55,658 |
| BOND PRINCIPAL/INTEREST FUNDS | $55,889 |
| ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS | $2,965,151 |
| OPERATING LEASE RIGHT-OF-USE ASSETS | $8,923,543 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $14,038,973 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED AMOUNTS DUE TO THIRD-PARTY PAYORS | $6,558,517 |
| OPERATING LEASE LIABILITIES | $8,712,219 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $15,270,736 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $67,257,020 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$29,408 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$29,408 | RevenueNotReportedAmt |
| Revenue Subtotal | $67,286,428 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $67,286,428 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $53,828,626 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $53,828,626 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $53,828,626 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2021, THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| 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 (17 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KATHRYN POWELL MHA MA | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $283,961 | $0 | $31,622 | $0 | $3,025 | $0 | $33,644 | $0 | $13,700 | $0 | $365,952 | $0 | $0 | $0 |
| KEN WEINSTOCK MD | ||||||||||||||
| DIR. OF BEHAVIORAL HEALTH SERVICES | $283,393 | $0 | $8,813 | $0 | $1,997 | $0 | $14,018 | $0 | $22,853 | $0 | $331,074 | $0 | $0 | $0 |
| NURIT LICHT MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $253,621 | $0 | $10,000 | $0 | $599 | $0 | $14,590 | $0 | $15,724 | $0 | $294,534 | $0 | $0 | $0 |
| PHILIPPE EDOUARD MD FACP | ||||||||||||||
| FAMILY PHYSICIAN | $244,010 | $0 | $3,058 | $0 | $1,471 | $0 | $13,589 | $0 | $12,920 | $0 | $275,048 | $0 | $0 | $0 |
| DANIELLE ORYN DO MPH | ||||||||||||||
| CHIEF MEDICAL INFORMATICS OFFICER | $234,802 | $0 | $1,055 | $0 | $556 | $0 | $11,683 | $0 | $23,200 | $0 | $271,296 | $0 | $0 | $0 |
| RAMONA ENGLISH DMD | ||||||||||||||
| CHIEF DENTAL OFFICER | $204,803 | $0 | $30,000 | $0 | $477 | $0 | $12,554 | $0 | $14,557 | $0 | $262,391 | $0 | $0 | $0 |
| REBECCA KATZ MD | ||||||||||||||
| PRIMARY CARE SITE DIRECTOR | $208,505 | $0 | $11,739 | $0 | $267 | $0 | $12,160 | $0 | $26,317 | $0 | $258,988 | $0 | $0 | $0 |
| SAFI AHMED MD MPH | ||||||||||||||
| FAMILY PHYSICIAN | $248,580 | $0 | $1,423 | $0 | $343 | $0 | $209 | $0 | $8,307 | $0 | $258,862 | $0 | $0 | $0 |
| ANDREW ASHCROFT MD MPH | ||||||||||||||
| FAMILY PHYSICIAN | $203,910 | $0 | $6,814 | $0 | $632 | $0 | $12,822 | $0 | $30,709 | $0 | $254,887 | $0 | $0 | $0 |
| JONATHAN CHOE MD | ||||||||||||||
| ASSOC. MEDICAL DIR, WOMEN'S HEALTH | $222,258 | $0 | $5,039 | $0 | $385 | $0 | $12,143 | $0 | $2,922 | $0 | $242,747 | $0 | $0 | $0 |
| JANE READ MSA RN | ||||||||||||||
| COO THROUGH 4/2021 | $197,926 | $0 | $20,000 | $0 | $1,988 | $0 | $6,335 | $0 | $10,403 | $0 | $236,652 | $0 | $0 | $0 |
| CASSIE IUTZI MD MPH | ||||||||||||||
| FAMILY PHYSICIAN | $201,007 | $0 | $5,995 | $0 | $237 | $0 | $9,198 | $0 | $17,990 | $0 | $234,427 | $0 | $0 | $0 |
| PEDRO TOLEDO JD MA MHSA | ||||||||||||||
| CHIEF ADMINISTRATIVE OFFICER | $206,483 | $0 | $0 | $0 | $318 | $0 | $11,753 | $0 | $11,294 | $0 | $229,848 | $0 | $0 | $0 |
| JOHN PENDLETON MD | ||||||||||||||
| ASSOC. MEDICAL DIRECTOR, OPERATIONS | $198,109 | $0 | $6,026 | $0 | $385 | $0 | $11,524 | $0 | $11,533 | $0 | $227,577 | $0 | $0 | $0 |
| CARLIN CHI MD | ||||||||||||||
| MEDICAL DIRECTOR, PRIMARY CARE | $182,796 | $0 | $4,736 | $0 | $613 | $0 | $10,603 | $0 | $21,379 | $0 | $220,127 | $0 | $0 | $0 |
| MICHELLE GLANCY MBA | ||||||||||||||
| CHIEF HUMAN RESOURCES OFFICER | $181,474 | $0 | $20,000 | $0 | $646 | $0 | $2,590 | $0 | $13,192 | $0 | $217,902 | $0 | $0 | $0 |
| MOLLY JOUANEH CMA | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $187,692 | $0 | $0 | $0 | $249 | $0 | $0 | $0 | $726 | $0 | $188,667 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 521643828 | BondIssuerEIN |
| CUSIP | 13032UET1 | CUSIPNum |
| Bond Issued | 2016-09-13 | BondIssuedDt |
| Issue Price | $5,955,305 | IssuePriceAmt |
| Purpose | REFUND OF BONDS ORIGINALLY ISSUED 6/2/2010 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $730,000 | RetiredAmt |
| Total Proceeds | $5,955,305 | TotalProceedsAmt |
| In Reserve Fund | $174,711 | InReserveFundAmt |
| Issuance Costs From Proceeds | $115,500 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $153,716 | CreditEnhancementAmt |
| Other Spent Proceeds | $5,511,378 | OtherSpentProceedsAmt |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | Yes (1) | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NORTH BAY OFFICE FURNITURE | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | ENTITY IS SOLELY OWNED BY BOARD MEMBER ROBERT RAMIREZ | RelationshipDescriptionTxt |
| Transaction | $6,281 | TransactionAmt |
| Transaction | THE ORGANIZATION PURCHASED OFFICE FURNITURE AT FAIR MARKET VALUE FROM NORTH BAY OFFICE FURNITURE, WHICH IS SOLELY OWNED BY BOARD MEMBER ROBERT RAMIREZ. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $2,881,123 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 7 | ContributionCnt |
| Noncash Contributions Rpt F990 | $89,233 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, COLUMN (B): | THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN SCHEDULE M, PART I, COLUMN (B). |
| SCHEDULE M, PART I, LINE 16: | ON JULY 1, 2020, THE ORGANIZATION OFFICIALLY MERGED-IN COASTAL HEALTH ALLIANCE, ANOTHER FQHC, WITH THE ORGANIZATION REMAINING AS THE SURVIVING CORPORATION. THE AMOUNT REPORTED ON SCHEDULE M, PART I, LINE 16 REPRESENTS THE FAIR MARKET VALUE OF PROPERTY, PLANT, AND EQUIPMENT TRANSFERRED OVER FROM COASTAL HEALTH ALLIANCE AND RECOGNIZED AS AN INHERENT CONTRIBUTION ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE JUNE 30, 2021 TAX YEAR. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN OUTSIDE TAX PREPARER IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING TEAM. THE CEO AND MEMBERS OF THE FINANCE AND ACCOUNTING STAFF OF THE ORGANIZATION THEN REVIEW THE FORM 990 AND, UPON APPROVAL, SUBMITS THE FORM 990 TO THE BOARD FINANCE COMMITTEE FOR REVIEW BEFORE FILING WITH THE IRS; THE FORM 990 IS ALSO MADE AVAILABLE TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | IT IS THE POLICY OF PETALUMA HEALTH CENTER THAT ALL FULL-TIME AND PART-TIME EMPLOYEES, CONTRACTORS, AND MEMBERS OF THE BOARD OF DIRECTORS AVOID CONFLICTS OF INTEREST, OR APPEARANCE OF CONFLICT, BETWEEN THEIR PERSONAL INTERESTS AND THE INTERESTS OF THE ORGANIZATION WHEN DEALING WITH ANY INDIVIDUAL OR OUTSIDE ORGANIZATION HAVING, OR SEEKING TO HAVE, A BUSINESS RELATIONSHIP WITH PETALUMA HEALTH CENTER. ALL MEMBERS OF THE PETALUMA HEALTH CENTER BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE THE CONFLICT OF INTEREST DISCLOSURE STATEMENT; ALL STAFF MEMBERS, VOLUNTEERS, AND CONTRACTORS ARE REQUIRED TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT OF INTEREST THAT ARISES TO THE HUMAN RESOURCES DEPARTMENT WITHIN 10 BUSINESS DAYS OF LEARNING OF IT. AFTER DISCLOSURE OF A POSSIBLE CONFLICT OF INTEREST, THE CEO AFFORDS THE INTERESTED PERSON WHO MAKES THE DISCLOSURE AN OPPORTUNITY TO EXPLAIN TO THE SENIOR MANAGEMENT TEAM (FOR EMPLOYEES), OR THE EXECUTIVE COMMITTEE OF THE BOARD (FOR BOARD MEMBERS) THE FACTS AND CIRCUMSTANCES OF THE TRANSACTION OR ARRANGEMENT THAT LED TO SUCH DISCLOSURE. THE INTERESTED PERSON LEAVES THE SENIOR MANAGEMENT TEAM OR BOARD EXECUTIVE COMMITTEE MEETING WHILE THE INTEREST IS DISCUSSED AND VOTED UPON. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING THE CHIEF EXECUTIVE OFFICER'S SALARY INCREASE INVOLVES A DISCUSSION AMONGST THE EXECUTIVE COMMITTEE OF THE BOARD, SALARY RESEARCH BY THE CHIEF HR OFFICER, AND RECOMMENDATION OF A NEW SALARY FROM THE EXECUTIVE COMMITTEE TO THE BOARD OF DIRECTORS FOR APPROVAL. THE CEO REVIEWS AND APPROVES THE COMPENSATION OF OTHER OFFICERS AND MANAGERS UTILIZING COMPARABILITY DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |