PACKARD HEALTH INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- PACKARD HEALTH INC (EIN 38-2269817)
- Tax period
- 2019-09-01 to 2020-08-31
- Filed
- 2021-02-24
- IRS object ID
- 202100559349300705
- Schema version
- 2019v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-02-24T08:23:15-06:00 | ReturnTs |
| Tax Period End | 2020-08-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382706146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | YEO & YEO PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1450 EISENHOWER PLACE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 481083283 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-09-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 382269817 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKARD HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PACK | BusinessNameControlTxt |
| Phone | 7349711073 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5200 VENTURE PARK DRIVE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RAYMOND RION | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 7349711073 | PhoneNum |
| Signature | 2021-02-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRIAN R DIXON | PreparerPersonNm |
| PTIN | P01321580 | PTIN |
| Phone | 7347691331 | PhoneNum |
| Preparation | 2021-02-23 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RAYMOND RION | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5200 VENTURE PARK DRIVE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,892,311 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PACKARDHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 114 | TotalEmployeeCnt |
| Total Volunteers | 19 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,576,124 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,818,174 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,423,188 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,066,404 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,983 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,461 | CYInvestmentIncomeAmt |
| PY Other Revenue | $40,622 | PYOtherRevenueAmt |
| CY Other Revenue | $272 | CYOtherRevenueAmt |
| PY Total Revenue | $9,043,917 | PYTotalRevenueAmt |
| CY Total Revenue | $14,892,311 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,248,190 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,952,132 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $45,550 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $14,500 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $302,453 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,520,912 | PYOtherExpensesAmt |
| CY Other Expenses | $2,937,229 | CYOtherExpensesAmt |
| PY Total Expenses | $7,814,652 | PYTotalExpensesAmt |
| CY Total Expenses | $8,903,861 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,229,265 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,988,450 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,564,541 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,624,380 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $697,418 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,759,576 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,867,123 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,864,804 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE BEST POSSIBLE CARE TO OUR PATIENTS AND COMMUNITY, INCLUDING PEOPLE WHOSE ECONOMIC, SOCIAL OR CULTURAL CONDITIONS MIGHT OTHERWISE PREVENT THEM FROM ACCESSING HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $7,049,068 | ExpenseAmt |
| Revenue | $7,066,404 | RevenueAmt |
| Desc | PRIMARY HEALTH SERVICES, INCLUDING MENTAL HEALTH CARE AND HEALTH PROMOTION TO PATIENTS IN THE WASHTENAW COUNTY AREA. | Desc |
| Total Program Service Expenses | $7,049,068 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 114 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD MONTRIEF | PersonNm |
| Phone | 7349711073 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5200 VENTURE PARK DRIVE | AddressLine1Txt |
| City | ANN ARBOR | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 48108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| RAYMOND RION | |||||||
| EXECUTIVE DI | 40.00 | Yes (X) | Yes (X) | $235,654 | $0 | $16,911 | |
| DR ANKOOR SONI | |||||||
| MEDICAL DIRE | 40.00 | Yes (X) | $174,246 | $0 | $12,885 | ||
| DR HOLLY ROSS | |||||||
| COMPLIANCE O | 40.00 | Yes (X) | $113,991 | $0 | $7,167 | ||
| MARK JACOBY | |||||||
| CFO | 40.00 | Yes (X) | $92,955 | $0 | $15,979 | ||
| SHANNON CAMPBELL | |||||||
| OPERATIONS D | 40.00 | Yes (X) | $112,538 | $0 | $8,194 | ||
| TODD MONTRIEF | |||||||
| CFO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| GARY BOREN | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHARON MOORE | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THOMAS BIGGS | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NORA MALOY | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARGARET CALARCO | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHUCK HOFFMAN | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAULA LANTZ | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DUANE NEWLAND | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RANA SMITH | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| EDD SNYDER | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG STRONG | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEBORAH VANDENBROEK | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRYAN WAGONER | |||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LINDSEY KOTAGAL | |||||||
| PHYSICIAN | 40.00 | $181,577 | $0 | $10,014 | Yes (X) | ||
| RONALD ROMERO | |||||||
| PHYSICIAN | 40.00 | $135,527 | $0 | $21,077 | Yes (X) | ||
| RAVI VADLAMUDI | |||||||
| PHYSICIAN | 40.00 | $183,091 | $0 | $23,893 | Yes (X) | ||
| NIYATI SHAH | |||||||
| PHYSICIAN | 40.00 | $119,265 | $0 | $8,191 | Yes (X) | ||
| KAILA A QUEEN | |||||||
| PHYSICIAN | 40.00 | $163,077 | $0 | $7,870 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,511,921 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $132,181 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HENRY SCHEIN | |||||
| DEPT CH 10241 | PALATINE | IL | 60055 | CLINIC SUPPLIES | $367,445 |
| 340BASICS | |||||
| 311 ARSENAL STREET | WATERTOWN | MA | 02472 | 340B SERVICES | $303,637 |
| ATHENAHEALTH INC | |||||
| 315 MADISON AVE STE 1804 | NEW YORK | NY | 10017 | BILLING AND AR | $298,865 |
| WASHTENAW COCOMMUNITY MENTAL HEALTH | |||||
| 555 TOWNER STREET | YPSLIANTI | MI | 48198 | STAFF | $130,450 |
| CARDINAL HEALTH | |||||
| 7000 CARDINAL PLACE | DUBLIN | OH | 43017 | 340B PHARMACEUT | $116,214 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,496,499 | GovernmentGrantsAmt |
| All Other Contributions | $5,321,675 | AllOtherContributionsAmt |
| Noncash Contributions | $3,108,620 | NoncashContributionsAmt |
| Total Contributions | $7,818,174 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT FEES | 624100 | $5,530,539 | $5,530,539 |
| CONTRACT SERVICE FEES | 624100 | $1,129,355 | $1,129,355 |
| CAPITATION FEES | 624100 | $406,510 | $406,510 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,066,404 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,461 | TotalRevenueColumnAmt |
| Exclusion | $7,461 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $272 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $272 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $272 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,892,311 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,066,676 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $7,461 | 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 | $910,387 | TotalAmt |
| Program Services | $632,341 | ProgramServicesAmt |
| Management And General | $252,719 | ManagementAndGeneralAmt |
| Fundraising | $25,327 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,161,113 | TotalAmt |
| Program Services | $3,149,552 | ProgramServicesAmt |
| Management And General | $879,682 | ManagementAndGeneralAmt |
| Fundraising | $131,879 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,268 | TotalAmt |
| Program Services | $55,922 | ProgramServicesAmt |
| Management And General | $7,126 | ManagementAndGeneralAmt |
| Fundraising | $220 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $454,928 | TotalAmt |
| Program Services | $380,991 | ProgramServicesAmt |
| Management And General | $69,195 | ManagementAndGeneralAmt |
| Fundraising | $4,742 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $362,436 | TotalAmt |
| Program Services | $291,219 | ProgramServicesAmt |
| Management And General | $66,450 | ManagementAndGeneralAmt |
| Fundraising | $4,767 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,790 | TotalAmt |
| Program Services | $72,754 | ProgramServicesAmt |
| Management And General | $53,036 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,500 | TotalAmt |
| Fundraising | $14,500 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,232,594 | TotalAmt |
| Program Services | $1,205,205 | ProgramServicesAmt |
| Management And General | $27,389 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,422 | TotalAmt |
| Fundraising | $114,422 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,874 | TotalAmt |
| Program Services | $52,127 | ProgramServicesAmt |
| Management And General | $35,950 | ManagementAndGeneralAmt |
| Fundraising | $1,797 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $336,416 | TotalAmt |
| Program Services | $289,649 | ProgramServicesAmt |
| Management And General | $44,540 | ManagementAndGeneralAmt |
| Fundraising | $2,227 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,931 | TotalAmt |
| Program Services | $44,832 | ProgramServicesAmt |
| Management And General | $1,047 | ManagementAndGeneralAmt |
| Fundraising | $52 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,016 | TotalAmt |
| Program Services | $48,394 | ProgramServicesAmt |
| Management And General | $8,852 | ManagementAndGeneralAmt |
| Fundraising | $1,770 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,700 | TotalAmt |
| Program Services | $8,641 | ProgramServicesAmt |
| Management And General | $7,059 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $665,038 | $665,038 | |
| DUES, LICENSES & SUBSCRIP | $78,465 | $59,211 | $19,254 |
| INTEREST | $68,298 | $68,298 | |
| OTHER | $68,167 | $3,133 | $65,034 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,518 | TotalAmt |
| Program Services | $21,761 | ProgramServicesAmt |
| Management And General | $15,007 | ManagementAndGeneralAmt |
| Fundraising | $750 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,903,861 | TotalAmt |
| Program Services | $7,049,068 | ProgramServicesAmt |
| Management And General | $1,552,340 | ManagementAndGeneralAmt |
| Fundraising | $302,453 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,742 | BOYAmt |
| EOY | $66,457 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,004,596 | BOYAmt |
| EOY | $3,781,276 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,213,588 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,011,992 | BOYAmt |
| EOY | $850,548 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,989 | BOYAmt |
| EOY | $157,035 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,796,347 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $464,297 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $346,140 | BOYAmt |
| EOY | $6,332,050 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,082 | BOYAmt |
| EOY | $223,426 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,564,541 | BOYAmt |
| EOY | $12,624,380 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $384,607 | BOYAmt |
| EOY | $615,576 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,887 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,144,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $297,924 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $697,418 | BOYAmt |
| EOY | $2,759,576 | 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 | $3,867,123 | BOYAmt |
| EOY | $8,436,508 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,428,296 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,867,123 | BOYAmt |
| EOY | $9,864,804 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,564,541 | BOYAmt |
| EOY | $12,624,380 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,988,450 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $9,231 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,310,809 | OtherCostOrOtherBasisAmt |
| Book Value | $1,310,809 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,135,629 | OtherCostOrOtherBasisAmt |
| Depreciation | $317,362 | DepreciationAmt |
| Book Value | $4,818,267 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $223,675 | OtherCostOrOtherBasisAmt |
| Depreciation | $94,747 | DepreciationAmt |
| Book Value | $128,928 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $63,543 | OtherCostOrOtherBasisAmt |
| Depreciation | $52,188 | DepreciationAmt |
| Book Value | $11,355 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $62,691 | OtherCostOrOtherBasisAmt |
| Book Value | $62,691 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,332,050 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $14,901,542 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $9,231 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $9,231 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,892,311 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $14,892,311 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,903,861 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $8,903,861 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $8,903,861 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| RAYMOND RION | |||||
| EXECUTIVE DIRECTOR | $227,154 | $8,500 | $9,426 | $7,485 | $252,565 |
| DR ANKOOR SONI | |||||
| MEDICAL DIRECTOR | $174,246 | $5,861 | $7,024 | $187,131 | |
| LINDSEY KOTAGAL | |||||
| PHYSICIAN | $181,577 | $7,263 | $2,751 | $191,591 | |
| RONALD ROMERO | |||||
| PHYSICIAN | $135,527 | $4,066 | $17,011 | $156,604 | |
| RAVI VADLAMUDI | |||||
| PHYSICIAN | $183,091 | $7,324 | $16,569 | $206,984 | |
| KAILA A QUEEN | |||||
| PHYSICIAN | $163,077 | $7,870 | $170,947 | ||
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 500 | ContributionCnt |
| Noncash Contributions Rpt F990 | $3,108,620 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | PRICES VERIFIED ONLINE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE CFO AND TREASURER IN DETAIL, THE 990 IS ALSO PROVIDED TO THE EXECUTIVE DIRECTOR AND BOARD PRIOR TO FILING FOR REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD REVISITS THE CONFLICTS OF INTEREST POLICY ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD DETERMINES THE COMPENSATION OF THE EXECUTIVE DIRECTOR BASED ON PERFORMANCE AND OTHER FACTORS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE DIRECTOR DETERMINES THE COMPENSATION FOR OFFICERS & KEY EMPLOYEES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES 1,205,205 27,389 0 |