PEACH TREE HEALTHCARE: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PEACH TREE HEALTHCARE (EIN 68-0371679)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202211369349310586
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T14:23:39-05:00 | 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 | 680371679 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACH TREE HEALTHCARE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PEAC | BusinessNameControlTxt |
| Phone | 5307493242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1114 YUBA STREET NO 220 | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES ELLSWORTH | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 5307493242 | PhoneNum |
| Signature | 2022-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JAMES | PersonFirstNm |
| Person Last | ELLSWORTH | 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 |
| Preparation | 2022-05-13 | PreparationDt |
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 | GREG STONE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1114 YUBA STREET NO 220 | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $32,671,880 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PICKPEACH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | PEACH TREE HEALTH IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 187 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,090,103 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,294,153 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,092,994 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $27,312,858 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | -$30,700 | CYInvestmentIncomeAmt |
| PY Other Revenue | $60,039 | PYOtherRevenueAmt |
| CY Other Revenue | $60,900 | CYOtherRevenueAmt |
| PY Total Revenue | $28,243,136 | PYTotalRevenueAmt |
| CY Total Revenue | $32,637,211 | 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 | $13,309,898 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,504,691 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,967,978 | PYOtherExpensesAmt |
| CY Other Expenses | $13,903,565 | CYOtherExpensesAmt |
| PY Total Expenses | $25,277,876 | PYTotalExpensesAmt |
| CY Total Expenses | $27,408,256 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,965,260 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,228,955 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,668,655 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,991,070 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,545,163 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,638,623 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,123,492 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,352,447 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PEACH TREE HEALTHCARE IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $19,481,152 | ExpenseAmt |
| Revenue | $27,312,858 | RevenueAmt |
| Desc | PEACH TREE HEALTHCARE IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) OPERATING AT THE FOLLOWING LOCATIONS: THARP ROAD DENTAL CLINIC, LIVE OAK MEDICAL CLINIC (INCLUDING PEACH TREE VISION LIVE OAK), PEACH TREE - YUBA CITY/COLUSA, PEACH TREE CLINIC (INCLUDING PEACH TREE VISION LINDA), PEACH TREE OROVILLE EYE CENTER, PEACH TREE NORTH SACRAMENTO (INCLUDING PEACH TREE VISION NORTH SACRAMENTO AND SACRAMENTO IMMEDIATE CARE), AND PEACH TREE CHICO EYE CENTER. PEACH TREE HEALTHCARE PROVIDES PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES INCLUDING DENTAL, VISION, BEHAVIORAL HEALTH, AND MEDICAL SPECIALTY SERVICES (FAMILY MEDICINE, PEDIATRICS, IMMEDIATE CARE, WOMEN'S HEALTH, ACUPUNCTURE, DIABETES, SPORTS PHYSICALS, NON-SURGERY ORTHOPEDICS, PHARMACY, AND PODIATRY). DURING THE JUNE 30, 2021 TAX YEAR 32,108 PATIENTS RECEIVED SERVICES AT OUR VARIOUS CLINICS. | Desc |
| Total Program Service Expenses | $19,481,152 | 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 | 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 | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 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 | 39 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 187 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | 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 | 0 | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES ELLSWORTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5307493242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1114 YUBA STREET SUITE 220 | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| TEJINDER GHUMAN MD | ||||||||
| PEDIATRICIAN | 40.00 | Yes (X) | $303,003 | $0 | $20,988 | |||
| SUMIT JOHL MD | ||||||||
| PEDIATRICIAN | 40.00 | Yes (X) | $268,995 | $0 | $20,205 | |||
| MARY PENA-PRIDEMORE MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $263,036 | $0 | $13,268 | |||
| RAMESH PUNDI MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $231,731 | $0 | $24,286 | |||
| AMANDA TAGLE MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $227,973 | $0 | $23,024 | |||
| GREG STONE | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $205,994 | $0 | $16,211 | Yes (X) | |||
| RUPAUL GHUMAN DDS | ||||||||
| DENTAL DIRECTOR | 40.00 | $194,856 | $0 | $25,379 | Yes (X) | |||
| RICHARD FURY MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $199,930 | $0 | $3,999 | Yes (X) | |||
| JAMES ELLSWORTH | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $0 | $0 | $0 | Yes (X) | |||
| ED SMITH | ||||||||
| CHAIR THROUGH 7/2020 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| ANDREW POTTER | ||||||||
| CHAIR START 7/2020 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| ROBERTA D'ARCY | ||||||||
| VICE CHAIR THROUGH 7/2020 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JANE DALTON | ||||||||
| VICE CHAIR 7/2020 - 8/2020 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| AWNI ALLABABIDI | ||||||||
| VICE CHAIR START 9/2020 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| KIRAN SIBIA | ||||||||
| SECRETARY/TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DON BLASER | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| DAWN ESPARZA | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| PHUONG LUU MD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| NAILAH KOKAYI | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| ERICKA SUMMERS | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| MATT WILLIAMS | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,895,518 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $147,360 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 29 | 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 |
|---|---|---|---|---|---|
| RIDGE EYE CARE | |||||
| 114 MISSION RANCH BLVD 50 | CHICO | CA | 95926 | CONTRACTED OPTOMETRY SERVICES | $2,272,480 |
| MACMAN MANAGEMENT HEALTHCARE SERVICES | |||||
| 1300 NATIONAL DR 175 | SACRAMENTO | CA | 95834 | CONTRACTED MEDICAL BILLING SERVICES | $1,127,090 |
| TBN LLC | |||||
| PO BOX 8104 | RENO | NV | 89507 | CONTRACTED CFO | $192,000 |
| WIPFLI LLP | |||||
| PO BOX 3160 | MILWAUKEE | WI | 53201 | ACCOUNTING/FINANCIAL CONSULTING | $113,456 |
| MOSS ADAMS LLP | |||||
| 999 THIRD AVE STE 2800 | SEATTLE | WA | 98104 | AUDIT & TAX SERVICES | $112,891 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,032,156 | GovernmentGrantsAmt |
| All Other Contributions | $261,997 | AllOtherContributionsAmt |
| Noncash Contributions | $559,193 | NoncashContributionsAmt |
| Total Contributions | $5,294,153 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $26,811,496 | $26,811,496 |
| OTHER OPERATING REVENUE | 621400 | $501,362 | $501,362 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $27,312,858 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,969 | TotalRevenueColumnAmt |
| Exclusion | $3,969 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $60,900 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $60,900 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,900 | TotalRevenueColumnAmt |
| Exclusion | $60,900 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $34,669 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$34,669 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$34,669 | TotalRevenueColumnAmt |
| Exclusion | -$34,669 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,637,211 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,312,858 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $30,200 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $651,999 | TotalAmt |
| Program Services | $426,960 | ProgramServicesAmt |
| Management And General | $225,039 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,940,911 | TotalAmt |
| Program Services | $7,279,829 | ProgramServicesAmt |
| Management And General | $2,661,082 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,650 | TotalAmt |
| Program Services | $127,178 | ProgramServicesAmt |
| Management And General | $50,472 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,064,026 | TotalAmt |
| Program Services | $1,508,734 | ProgramServicesAmt |
| Management And General | $555,292 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $670,105 | TotalAmt |
| Program Services | $487,791 | ProgramServicesAmt |
| Management And General | $182,314 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,000 | TotalAmt |
| Management And General | $192,000 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,154 | TotalAmt |
| Management And General | $68,154 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,484 | TotalAmt |
| Management And General | $85,484 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,003,777 | TotalAmt |
| Program Services | $2,841,325 | ProgramServicesAmt |
| Management And General | $2,162,452 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,945 | TotalAmt |
| Management And General | $61,945 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,677 | TotalAmt |
| Program Services | $76,356 | ProgramServicesAmt |
| Management And General | $29,321 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,285,496 | TotalAmt |
| Program Services | $249,534 | ProgramServicesAmt |
| Management And General | $1,035,962 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,127,123 | TotalAmt |
| Program Services | $1,846,802 | ProgramServicesAmt |
| Management And General | $280,321 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,008 | TotalAmt |
| Program Services | $32,684 | ProgramServicesAmt |
| Management And General | $19,324 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,537 | TotalAmt |
| Program Services | $30 | ProgramServicesAmt |
| Management And General | $18,507 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,415 | TotalAmt |
| Management And General | $9,415 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $803,143 | TotalAmt |
| Program Services | $659,084 | ProgramServicesAmt |
| Management And General | $144,059 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,501 | TotalAmt |
| Program Services | $63,483 | ProgramServicesAmt |
| Management And General | $113,018 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES/DRUGS | $3,749,295 | $3,746,038 | $3,257 |
| LICENSES AND TAXES | $58,462 | $49,967 | $8,495 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,548 | TotalAmt |
| Program Services | $85,357 | ProgramServicesAmt |
| Management And General | $21,191 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,408,256 | TotalAmt |
| Program Services | $19,481,152 | ProgramServicesAmt |
| Management And General | $7,927,104 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,049,742 | BOYAmt |
| EOY | $4,918,057 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,333 | BOYAmt |
| EOY | $17,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,605,498 | BOYAmt |
| EOY | $2,621,039 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,401 | BOYAmt |
| EOY | $187,895 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $236,590 | BOYAmt |
| EOY | $458,062 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,335,592 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,254,406 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,391,812 | BOYAmt |
| EOY | $3,081,186 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,279 | BOYAmt |
| EOY | $4,707,831 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,668,655 | BOYAmt |
| EOY | $15,991,070 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,796,573 | BOYAmt |
| EOY | $2,143,218 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $187,189 | BOYAmt |
| EOY | $118,118 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $256,960 | BOYAmt |
| EOY | $71,710 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,304,441 | BOYAmt |
| EOY | $305,577 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,545,163 | BOYAmt |
| EOY | $2,638,623 | 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 | $8,123,492 | BOYAmt |
| EOY | $13,352,447 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,123,492 | BOYAmt |
| EOY | $13,352,447 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,668,655 | BOYAmt |
| EOY | $15,991,070 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,228,955 | ReconcilationRevenueExpnssAmt |
| 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 | $2,494,135 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,192,986 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,271,944 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,090,103 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,294,153 | CurrentTaxYearAmt |
| Total | $17,343,321 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,494,135 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,192,986 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,271,944 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,090,103 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,294,153 | CurrentTaxYearAmt |
| Total | $17,343,321 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $17,343,321 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $55,873 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $60,122 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $60,039 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $64,869 | CurrentTaxYearAmt |
| Total | $240,903 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $983,997 | CurrentTaxYearMinus4YearsAmt |
| Total | $983,997 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $18,568,221 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $109,535,654 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.93400 | PublicSupportCY170Pct |
| Public Support PY170 | 0.92670 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS INCOME - 2016 AMOUNT: $ 983,997. | 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 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 | $7,125 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,125 | 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 DUES TO THE CALIFORNIA PRIMARY CARE ASSOCIATION; A PORTION OF THOSE DUES HAVE BEEN INDICATED AS USED FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,225,455 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,140,912 | DepreciationAmt |
| Book Value | $2,084,543 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,568,025 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,143,759 | DepreciationAmt |
| Book Value | $424,266 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,542,112 | OtherCostOrOtherBasisAmt |
| Depreciation | $969,735 | DepreciationAmt |
| Book Value | $572,377 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,081,186 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DEPOSITS | $102,279 |
| ESTIMATED THIRD-PARTY SETTLEMENT RECEIVABLE | $4,605,552 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,707,831 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED LEASE LIABILITY | Desc |
| Amt | $305,577 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $305,577 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $32,671,880 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $32,671,880 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$34,669 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$34,669 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $32,637,211 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $27,442,925 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $34,669 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $34,669 | ExpensesNotReportedAmt |
| Expenses Subtotal | $27,408,256 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,408,256 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUSES BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2021 AND 2020, 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. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF FIXED ASSETS RECLASSED TO FORM 990, PART VIII -34,669. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF FIXED ASSETS RECLASSED TO FORM 990, PART VIII 34,669. |
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 (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TEJINDER GHUMAN MD | ||||||||||||||
| PEDIATRICIAN | $261,603 | $0 | $28,920 | $0 | $12,480 | $0 | $5,700 | $0 | $15,288 | $0 | $323,991 | $0 | $0 | $0 |
| SUMIT JOHL MD | ||||||||||||||
| PEDIATRICIAN | $243,280 | $0 | $19,435 | $0 | $6,280 | $0 | $4,917 | $0 | $15,288 | $0 | $289,200 | $0 | $0 | $0 |
| MARY PENA-PRIDEMORE MD | ||||||||||||||
| PHYSICIAN | $240,685 | $0 | $12,551 | $0 | $9,800 | $0 | $5,226 | $0 | $8,042 | $0 | $276,304 | $0 | $0 | $0 |
| RAMESH PUNDI MD | ||||||||||||||
| PHYSICIAN | $231,731 | $0 | $0 | $0 | $0 | $0 | $4,558 | $0 | $19,728 | $0 | $256,017 | $0 | $0 | $0 |
| AMANDA TAGLE MD | ||||||||||||||
| PHYSICIAN | $222,943 | $0 | $5,030 | $0 | $0 | $0 | $4,460 | $0 | $18,564 | $0 | $250,997 | $0 | $0 | $0 |
| GREG STONE | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $205,994 | $0 | $0 | $0 | $0 | $0 | $923 | $0 | $15,288 | $0 | $222,205 | $0 | $0 | $0 |
| RUPAUL GHUMAN DDS | ||||||||||||||
| DENTAL DIRECTOR | $192,801 | $0 | $2,055 | $0 | $0 | $0 | $3,825 | $0 | $21,554 | $0 | $220,235 | $0 | $0 | $0 |
| RICHARD FURY MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $197,427 | $0 | $1,650 | $0 | $853 | $0 | $3,999 | $0 | $0 | $0 | $203,929 | $0 | $0 | $0 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 11848 | ContributionCnt |
| Noncash Contributions Rpt F990 | $555,936 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST OF DONATED PROPERTY | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | PPE | Desc |
| Contribution | 11500 | ContributionCnt |
| Noncash Contributions Rpt F990 | $3,257 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST OF DONATED PROP | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS CONTRIBUTED IN SCHEDULE M, PART I, COLUMN (B). | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION CONTRACTED WITH TBN LLC FOR CFO DUTIES WHICH WERE FULFILLED BY JAMES ELLSWORTH. TOTAL COMPENSATION PAID TO TBN LLC IN EXCHANGE FOR THESE SERVICES TOTALED $192,000 DURING THE 2020 CALENDAR YEAR AND $192,000 FOR THE 6/30/2021 FISCAL YEAR (7/1/2020 - 6/30/2021). |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM, WHO WORKS IN CONJUNCTION WITH THE PEACH TREE HEALTHCARE ACCOUNTING AND FINANCE DEPARTMENT TO COMPLETE THE FORM 990. UPON REVIEW AND APPROVAL BY THE ORGANIZATION'S CFO, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND ALSO REVIEWED WITH THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY, AND ARE REQUIRED TO ANNUALLY RETURN A CONFLICT OF INTEREST DISCLOSURE STATEMENT TO THE CHIEF EXECUTIVE OFFICER. THE BOARD OF DIRECTORS HAS DELEGATED AUTHORITY TO DETERMINE IF A CONFLICT OF INTEREST EXISTS FOR DIRECTORS, CORPORATE OFFICERS, AND THE CEO, WHO MUST LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. IN THE CASE OF A CONFLICT OF INTEREST DISCLOSURE MADE BY A MEDICAL STAFF MEMBER, PHYSICIAN, EXECUTIVE STAFF MEMBER, DEPARTMENT DIRECTOR, SUPERVISOR, OR OTHER INDIVIDUAL, THE CHIEF EXECUTIVE OFFICER DETERMINES, BASED ON THE FACTS AND CIRCUMSTANCES DISCLOSED, IF A CONFLICT OF INTEREST EXISTS AND SHALL ALSO REPORT THE RESULTS OF ALL DETERMINATIONS TO THE CHAIRMAN OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | ALL COMPENSATION FOR SENIOR MANAGEMENT AND KEY EMPLOYEES IS APPROVED BY THE BOARD OF DIRECTORS. SENIOR MANAGEMENT COMPENSATION IS ESTABLISHED USING HISTORICAL BENCHMARKS FROM PREVIOUS EMPLOYEES, AS WELL AS THE SALARY GUIDE FROM THE CALIFORNIA PRIMARY CARE ASSOCIATION, WHICH IS EXAMINED ANNUALLY TO ENSURE SALARIES AND BENEFITS ARE ON PAR WITH COMPARABLE ORGANIZATIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,744,890. MANAGEMENT AND GENERAL EXPENSES 406,344. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,151,234. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 63,468. MANAGEMENT AND GENERAL EXPENSES 1,585,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,649,087. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 32,967. MANAGEMENT AND GENERAL EXPENSES 170,489. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 203,456. |