CHAPA-DE INDIAN HEALTH PROGRAM INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- CHAPA-DE INDIAN HEALTH PROGRAM INC (EIN 94-2583156)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-13
- IRS object ID
- 202101339349305195
- Schema version
- 2019v5.2
- 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 | 2021-05-13T17:39:56-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 680037990 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GILBERT CPAS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2880 GATEWAY OAKS DR STE 100 | AddressLine1Txt |
| City | SACRAMENTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95833 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 942583156 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAPA-DE INDIAN HEALTH PROGRAM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHAP | BusinessNameControlTxt |
| Phone | 5308872800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11670 ATWOOD ROAD | AddressLine1Txt |
| City | AUBURN | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95603 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SIERK HAITSMA | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5308872800 | PhoneNum |
| Signature | 2021-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KEITH R GLEN | PreparerPersonNm |
| PTIN | P01317613 | PTIN |
| Phone | 9166466464 | PhoneNum |
| Preparation | 2021-05-12 | 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 | LISA DAVIES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11670 ATWOOD ROAD | AddressLine1Txt |
| City | AUBURN | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95603 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $118,531,728 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHAPA-DE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDES COMPREHENSIVE HEALTH CARE AND ANCILLARY SERVICES TO THE NATIVE-AMERICAN POPULATION OF SIERRA, PLACER AND NEVADA COUNTIES OF CALIFORNIA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 311 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $11,517,833 | PYContributionsGrantsAmt |
| CY Contributions Grants | $25,916,727 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $35,315,005 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $33,291,642 | CYProgramServiceRevenueAmt |
| PY Investment Income | $874,162 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,693,657 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $47,707,000 | PYTotalRevenueAmt |
| CY Total Revenue | $60,902,026 | 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 | $19,590,097 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,496,253 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,339,250 | PYOtherExpensesAmt |
| CY Other Expenses | $12,005,073 | CYOtherExpensesAmt |
| PY Total Expenses | $30,929,347 | PYTotalExpensesAmt |
| CY Total Expenses | $32,501,326 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $16,777,653 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $28,400,700 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $101,620,330 | TotalAssetsBOYAmt |
| Total Assets EOY | $132,597,049 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,265,407 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,369,851 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $89,354,923 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $118,227,198 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDES COMPREHENSIVE HEALTH CARE AND ANCILLARY SERVICES TO THE NATIVE-AMERICAN POPULATION OF SIERRA, PLACER AND NEVADA COUNTIES OF CALIFORNIA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $20,006,533 | ExpenseAmt |
| Revenue | $33,291,642 | RevenueAmt |
| Desc | PRIMARY HEALTH CARE PROGRAM- CHAPA-DE INDIAN PROGRAM, INC PROVIDED COMPREHENSIVE HEALTH SERVICES TO THE NATIVE-AMERICAN POPULATION AND OTHER RESIDENTS OF SIERRA, PLACER, AND NEVADA COUNTIES OF CALIFORNIA. COMPREHENSIVE HEALTH SERVICES INCLUDE DIRECT PATIENT CARE, IMMUNIZATIONS, HEALTH PROMOTION AND DISEASE PREVENTION, DRUG ABUSE AND EDUCATION/PREVENTION PROGRAMS, AND DENTAL CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $304,511 | ExpenseAmt |
| Desc | DIABETES PREVENTION PROGRAM-THIS PROGRAM PROVIDES DIABETES PREVENTION, MANAGEMENT AND LIFESTYLE EDUCATION, AND TESTING SERVICES TO NATIVE- AMERICAN PATIENTS DURING THE FISCAL YEAR. THESE PATIENTS LIVE PRIMARILY IN SIERRA, PLACER, AND NEVADA COUNTIES OF CALIFORNIA. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,088,373 | ExpenseAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,088,373 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $21,399,417 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | 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 | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 80 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 311 | 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 | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIERK HAITSMA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5308872800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11670 ATWOOD ROAD | AddressLine1Txt |
| City | AUBURN | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95603 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JASON CAMP | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| GENE WHITEHOUSE | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| BRENDA ADAMS | ||||||||
| CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DAVID KEYSER | ||||||||
| VICE - CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JOHN L WILLIAMS | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| DARLA CLARK | ||||||||
| COO | 40.00 | $186,848 | $0 | $26,037 | Yes (X) | |||
| LISA DAVIES | ||||||||
| CEO | 40.00 | $300,326 | $0 | $35,103 | Yes (X) | |||
| SIERK HAITSMA | ||||||||
| CFO | 40.00 | $214,000 | $0 | $20,519 | Yes (X) | |||
| MICHAEL R QUION | ||||||||
| LEAD PHYSICIAN | 40.00 | $222,217 | $0 | $33,571 | Yes (X) | |||
| WILLIAM JORNLIN | ||||||||
| PHYSICIAN | 40.00 | $231,641 | $0 | $37,990 | Yes (X) | |||
| PAULINE KARUNAKARAN | ||||||||
| DENTAL DIRECTOR | 40.00 | $206,453 | $0 | $23,104 | Yes (X) | |||
| RICHARD A MALEK | ||||||||
| PSYCHIATRIST | 40.00 | $261,628 | $0 | $697 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,623,113 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $177,021 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | 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 |
|---|---|---|---|---|---|
| KEKER VAN NEST & PETERS LLP | |||||
| 633 BATTERY ST | SAN FRANCISCO | CA | 94111 | PROFESSIONAL SERVICES | $719,314 |
| ECLINICALWORKS | |||||
| PO BOX 847950 | BOSTON | MA | 022847950 | SOFTWARE LICENSE & SUPPORT | $277,992 |
| COMPHEALTH | |||||
| PO BOX 972651 | DALLAS | TX | 753972651 | LOCUM TENENS AGENCY | $198,584 |
| DICKSTEIN LAW OFFICE | |||||
| 2443 FAIR OAKS BLVD 250 | SACRAMENTO | CA | 95825 | PROFESSIONAL SERVICES | $160,502 |
| HEALTH INFORMATION TECHNOLOGY CARE LLC | |||||
| 1310 REDWOOD WAY STE 125 | PETALUMA | CA | 94954 | COMPUTER SERVICES | $142,909 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $25,907,304 | GovernmentGrantsAmt |
| All Other Contributions | $9,423 | AllOtherContributionsAmt |
| Total Contributions | $25,916,727 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HEALTH SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $33,291,642 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,291,642 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $33,291,642 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,503,861 | TotalRevenueColumnAmt |
| Exclusion | $1,503,861 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $57,687,402 | SecuritiesAmt |
| Other | $132,096 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $57,502,279 | SecuritiesAmt |
| Other | $127,423 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $185,123 | SecuritiesAmt |
| Other | $4,673 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $189,796 | TotalRevenueColumnAmt |
| Exclusion | $189,796 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,902,026 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,291,642 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,693,657 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $988,990 | TotalAmt |
| Program Services | $729,962 | ProgramServicesAmt |
| Management And General | $259,028 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,012,400 | TotalAmt |
| Program Services | $11,127,760 | ProgramServicesAmt |
| Management And General | $3,884,640 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,285,184 | TotalAmt |
| Program Services | $2,348,046 | ProgramServicesAmt |
| Management And General | $937,138 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,209,679 | TotalAmt |
| Program Services | $864,604 | ProgramServicesAmt |
| Management And General | $345,075 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,693,336 | TotalAmt |
| Program Services | $955,380 | ProgramServicesAmt |
| Management And General | $737,956 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,413 | TotalAmt |
| Program Services | $25,058 | ProgramServicesAmt |
| Management And General | $19,355 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,384 | TotalAmt |
| Management And General | $28,384 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,947,116 | TotalAmt |
| Program Services | $1,662,566 | ProgramServicesAmt |
| Management And General | $1,284,550 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,448 | TotalAmt |
| Program Services | $1,606 | ProgramServicesAmt |
| Management And General | $141,842 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $572,248 | TotalAmt |
| Program Services | $128,935 | ProgramServicesAmt |
| Management And General | $443,313 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $792,258 | TotalAmt |
| Program Services | $7,758 | ProgramServicesAmt |
| Management And General | $784,500 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,544 | TotalAmt |
| Program Services | $119,191 | ProgramServicesAmt |
| Management And General | $40,353 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,518,880 | TotalAmt |
| Program Services | $122,401 | ProgramServicesAmt |
| Management And General | $1,396,479 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,376 | TotalAmt |
| Program Services | $814 | ProgramServicesAmt |
| Management And General | $117,562 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,310,197 | $2,302,535 | $7,662 |
| BUILDING AND EQUIPMENT | $589,760 | $193,041 | $396,719 |
| PATIENT RELATED COSTS | $553,846 | $544,106 | $9,740 |
| OTHER PERSONNEL RELATED | $151,304 | $65,609 | $85,695 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $381,963 | TotalAmt |
| Program Services | $200,045 | ProgramServicesAmt |
| Management And General | $181,918 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,501,326 | TotalAmt |
| Program Services | $21,399,417 | ProgramServicesAmt |
| Management And General | $11,101,909 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,299 | BOYAmt |
| EOY | $6,800 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,004,226 | BOYAmt |
| EOY | $34,761,691 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,453 | BOYAmt |
| EOY | $287,067 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,011,987 | BOYAmt |
| EOY | $2,007,769 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $183,784 | BOYAmt |
| EOY | $214,395 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,650,818 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,566,734 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,105,553 | BOYAmt |
| EOY | $24,084,084 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $71,011,835 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,028 | BOYAmt |
| EOY | $223,408 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,620,330 | BOYAmt |
| EOY | $132,597,049 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,274,302 | BOYAmt |
| EOY | $3,180,254 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,991,105 | BOYAmt |
| EOY | $6,893,197 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $4,296,400 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,265,407 | BOYAmt |
| EOY | $14,369,851 | 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 | $89,225,332 | BOYAmt |
| EOY | $118,227,198 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,591 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,354,923 | BOYAmt |
| EOY | $118,227,198 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,620,330 | BOYAmt |
| EOY | $132,597,049 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $28,400,700 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $471,575 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,423,346 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,973,174 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,043,154 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,517,833 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $25,916,727 | CurrentTaxYearAmt |
| Total | $70,874,234 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,423,346 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,973,174 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $11,043,154 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,517,833 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $25,916,727 | CurrentTaxYearAmt |
| Total | $70,874,234 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $70,874,234 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,192 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,428 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $245,453 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $876,819 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,693,657 | CurrentTaxYearAmt |
| Total | $2,821,549 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $73,695,783 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $134,655,157 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.96170 | PublicSupportCY170Pct |
| Public Support PY170 | 0.98040 | 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,961,827 | OtherCostOrOtherBasisAmt |
| Book Value | $4,961,827 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,942,450 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,994,173 | DepreciationAmt |
| Book Value | $16,948,277 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,892,903 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,572,561 | DepreciationAmt |
| Book Value | $320,342 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,853,638 | OtherCostOrOtherBasisAmt |
| Book Value | $1,853,638 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,084,084 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENTS | Desc |
| Book Value | $71,011,835 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $71,011,835 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PPP LOAN | Desc |
| Amt | $4,296,400 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,296,400 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $61,345,217 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $471,575 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $471,575 | RevenueNotReportedAmt |
| Revenue Subtotal | $60,873,642 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $28,384 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $28,384 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $60,902,026 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $32,472,942 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $32,472,942 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $28,384 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $28,384 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $32,501,326 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION DID NOT APPLY FOR PPP FORGIVENESS AND REPAID THE LOAN IN FULL ON NOVEMBER 18, 2020, SUBSEQUENT TO FISCAL YEAR END. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DARLA CLARK | ||||||||||||||
| COO | $170,848 | $0 | $16,000 | $0 | $0 | $0 | $10,410 | $0 | $15,627 | $0 | $212,885 | $0 | $0 | $0 |
| LISA DAVIES | ||||||||||||||
| CEO | $275,326 | $0 | $25,000 | $0 | $0 | $0 | $16,688 | $0 | $18,415 | $0 | $335,429 | $0 | $0 | $0 |
| SIERK HAITSMA | ||||||||||||||
| CFO | $196,000 | $0 | $18,000 | $0 | $0 | $0 | $11,760 | $0 | $8,759 | $0 | $234,519 | $0 | $0 | $0 |
| MICHAEL R QUION | ||||||||||||||
| LEAD PHYSICIAN | $217,460 | $0 | $4,757 | $0 | $0 | $0 | $13,317 | $0 | $20,254 | $0 | $255,788 | $0 | $0 | $0 |
| WILLIAM JORNLIN | ||||||||||||||
| PHYSICIAN | $225,927 | $0 | $5,714 | $0 | $0 | $0 | $12,000 | $0 | $25,990 | $0 | $269,631 | $0 | $0 | $0 |
| PAULINE KARUNAKARAN | ||||||||||||||
| DENTAL DIRECTOR | $202,453 | $0 | $4,000 | $0 | $0 | $0 | $12,147 | $0 | $10,957 | $0 | $229,557 | $0 | $0 | $0 |
| RICHARD A MALEK | ||||||||||||||
| PSYCHIATRIST | $256,614 | $0 | $5,014 | $0 | $0 | $0 | $0 | $0 | $697 | $0 | $262,325 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI | THE BOARD OF DIRECTORS HIRES ALL OFFICERS OF THE ORGANIZATION. THE COMPENSATION AMOUNT IS BASED ON PREVAILING SALARIES IN THE AREA AND THE EXPERIENCE AND QUALIFICATIONS OF THE OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PRESENTED BY THE CFO TO THE FULL BOARD OF DIRECTORS AND IS APPROVED FOR FILING. THE CHAIRPERSON IS AUTHORIZED TO SIGN THE FORM 990 AFTER THE APPROVAL BY THE FULL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION PERFORMS AN ANNUAL EVALUATION OF ALL POTENTIAL CONFLICT OF INTEREST SITUATIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS HIRES CEO AND TOP MANAGEMENT OF THE ORGANIZATION. THE COMPENSATION AMOUNT IS BASED ON PREVAILING SALARIES IN THE AREA AND THE EXPERIENCE AND QUALIFICATIONS OF THE EMPLOYEE. THIS PROCESS WAS LAST UNDERTAKEN IN 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE GENERAL PUBLIC. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR PERIOD. |