2022-05-11T10:03:03-05:00 2021-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2020-07-01 942308748 ALLIANCE MEDICAL CENTER INC ALLI 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 ALEX ARMSTRONG CHIEF EXECUTIVE OFFICER 7073852306 2022-05-10 1 ALEX ARMSTRONG 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2022-05-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ALEX ARMSTRONG 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 17838750 0 X WWW.ALLIANCEMED.ORG X 1971 CA OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 11 11 152 18 0 0 5769795 6426706 10612831 11216744 5856 2521 12647 192779 16401129 17838750 250 0 0 0 10742075 11995959 0 0 0 5519521 5520796 16261846 17516755 139283 321995 6778641 6722250 3175575 2799356 3603066 3922894 OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 0 0 9010372 0 7437380 MEDICAL PROGRAMS: COMPREHENSIVE PRIMARY MEDICAL SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS - SOME INSURED, SOME WITH MEDICARE, MEDI-CAL, AND OTHERS UNFUNDED. OUR BASIC SERVICES INCLUDE PRIMARY MEDICAL CARE WITH A 24/7 CALL SERVICE. 3043620 0 2568520 DENTAL PROGRAMS: COMPREHENSIVE DENTAL SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS - SOME INSURED, SOME WITH MEDI-CAL AND OTHERS UNFUNDED. OUR BASIC SERVICES INCLUDE ORAL HEALTH. 1889985 0 1403623 OTHER PROGRAMS: AMC OFFERS A HEALTH EDUCATION PROGRAM CALLED "MY BODY IS HEALTHY". THIS INCLUDES SENDING OUTREACH WORKERS INTO COMMUNITY ELEMENTARY SCHOOLS TO TEACH YOUNG CHILDREN NUTRITION, ORAL HEALTH, AND ANATOMY BASICS. AMC ALSO HAS WIC (WOMEN, INFANTS, AND CHILDREN) PROGRAM, WHICH IS A SUPPLEMENTAL NUTRITION PROGRAM FOR THOSE PREGNANT, BREASTFEEDING, AND POSTPARTUM WOMEN, INFANTS, AND CHILDREN UNDER AGE OF 5 WHO ARE LOW TO MODERATE INCOME AND AT NUTRITION RISK. ADDITIONALLY, AMC PROVIDES BEHAVIORAL HEALTH SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS. FURTHERMORE, AMC OPERATES SPECIALTY CLINICS WHERE PART-TIME SPECIALISTS PROVIDE OTHER SERVICES, INCLUDING PAIN MANAGEMENT, CHIROPRACTIC TREATMENT, AND OTHER ENABLING SERVICES. 13943977 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 21 0 152 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ANGELA ROBINSON 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 PHIL LUKS CHAIR 2.00 X X 0 0 0 ABRAHAM DANIELS PAST CHAIR 0.00 X X 0 0 0 TERRY LEACH VICE CHAIR 2.00 X X 0 0 0 NANCY NELLA SECRETARY 2.00 X X 0 0 0 LYN MURRAY TREASURER 2.00 X X 0 0 0 MARTIN CASTANEDA MEMBER (TERMED) 2.00 X 0 0 0 CHRISTINE ERICKSON MEMBER 2.00 X 0 0 0 MARCY FLORES-SUAZA MEMBER 2.00 X 0 0 0 MIMI GURBST MEMBER 2.00 X 0 0 0 JESUS GUZMAN MEMBER 2.00 X 0 0 0 SUSAN LENTZ MEMBER 2.00 X 0 0 0 MELITA LOVE MEMBER 2.00 X 0 0 0 JOAN CHURCHILL CHIEF EXECUTIVE OFFICER 40.00 X 174023 0 11373 ANGELA ROBINSON CONTRACTED CFO 15.00 X 0 0 0 SUSANNAH LABBE CHIEF MEDICAL DIRECTOR 40.00 X 205276 0 12275 CASSANDRA HELLER PHYSICIAN 40.00 X 272363 0 14587 ANNA EKSTROM PHYSICIAN 40.00 X 231989 0 16888 SETH AMMERMAN PHYSICIAN 40.00 X 198573 0 7892 CAREY ROBERT TERRY PHYSICIAN 40.00 X 189176 0 23363 ANDREW LANE SR DENTIST 40.00 X 165825 0 24747 1437225 0 111125 27 0 1 0 WIPFLI LLP PO BOX 3160 MILWAUKEE WI 53201 CFO & FINANCIAL CONSULTING 384780 HEALTH INFORMATION TECHNOLOGY 1310 REDWOOD WAY STE 125 PETALUMA CA 94954 IT CONSULTING 219948 THE WRITE CHOICE 2205 LUNDY LANE BETTENDORF IA 52722 GRANT WRITING & COMPLIANCE 115004 ELIANE SUNDBY PO BOX 318 GOLD RUN CA 95717 CONTRACTED IT 111956 4 4812111 1614595 6426706 NET PATIENT SERVICE REVENUE 621300 11216744 11216744 11216744 1440 1440 1081 0 1081 1081 1081 OTHER INCOME 621300 192779 192779 192779 17838750 11409523 0 2521 402947 402947 9576720 8913441 663279 260902 239290 21612 1167827 1058614 109213 587563 549143 38420 97975 97975 34566 34566 229088 229088 1496121 278705 1217416 7160 218 6942 351597 221199 130398 713912 617695 96217 721141 522899 198242 3556 2036 1520 89393 54519 34874 -466 -466 242045 223123 18922 72398 33654 38744 340B EXPENSES 485046 485046 SUPPLIES - CLINICAL 347801 347801 SUPPLIES - PHARMACEUTIC 156534 156534 472929 240060 232869 17516755 13943977 3572778 0 523431 469184 3103044 1982072 250567 1377440 1336615 1379541 238588 228484 3972999 2687470 1326396 1285529 6778641 6722250 1426902 2270399 5336 528957 1743337 0 3175575 2799356 X 3603066 3922894 3603066 3922894 6778641 6722250 321995 -2167 0 X 0 0 0 X PART I, LINE 3: ALLIANCE MEDICAL CENTER, INC. IS A NONPROFIT PROVIDING HEALTH CARE SERVICES TO SOCIALLAY AND ECONOMICALLY DEPRESEED SECTORS OF SONOMA COUNTY IN CALIFORNIA. ITS EXEMPT STATUS WAS APPROVED UNDER IRC 509(A)(1) AND 170(B) (1)(A)(III). IT IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL AND THEREFORE IS NOT REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2077755 996869 1080886 1891244 1690601 200643 4000 4000 1285529 X X 0 0 0 0 0 0 0 0 0 CASSANDRA HELLER PHYSICIAN 256723 0 10400 0 5240 0 9529 0 5058 0 286950 0 0 0 ANNA EKSTROM PHYSICIAN 230788 0 293 0 908 0 8955 0 7933 0 248877 0 0 0 SUSANNAH LABBE CHIEF MEDICAL DIRECTOR 202938 0 380 0 1958 0 7939 0 4336 0 217551 0 0 0 CAREY ROBERT TERRY PHYSICIAN 188289 0 300 0 587 0 6825 0 16538 0 212539 0 0 0 SETH AMMERMAN PHYSICIAN 197308 0 0 0 1265 0 7892 0 0 0 206465 0 0 0 ANDREW LANE SR DENTIST 162245 0 0 0 3580 0 6621 0 18126 0 190572 0 0 0 JOAN CHURCHILL CHIEF EXECUTIVE OFFICER 161600 0 10000 0 2423 0 6865 0 4508 0 185396 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 WIPFLI LLP CONTRACTED CFO ANGELA ROBINSON $97,975 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE ENTIRE BOARD OF DIRECTORS BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C AMC ETHICAL CONDUCT POLICY REQUIRES THAT EACH COVERED INDIVIDUAL REVIEW AND SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY AND, WHEN REQUIRED, A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE INFORMATION PROVIDED ON THE DISCLOSURE STATEMENT IS AVAILABLE FOR INSPECTION BY MEMBERS OF THE BOARD AND AMC'S LEGAL COUNSEL. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS OF ALLIANCE MEDICAL CENTER IS SOLELY RESPONSIBLE FOR THE SELECTION, COMPENSATION AND PERFORMANCE REVIEW OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. THE BOARD WILL PERFORM AN ANNUAL EVALUATION AND COMPENSATION REVIEW OF THE CEO, COMPARING THE INTERNAL SALARY SCALE WITH THAT OF THE CALIFORNIA PRIMARY CARE ASSOCIATION'S ANNUAL SALARY SURVEY. THE ALLIANCE MEDICAL CENTER'S CEO WILL DETERMINE THE COMPENSATION LEVEL FOR THE CFO, WHICH WILL THEN BE REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF DIRECTORS OR DESIGNATED BOARD COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 AMC'S GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.