2020-07-07T08:40:12-05:00 2019-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2018-07-01 942308748 ALLIANCE MEDICAL CENTER INC ALLI 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 JOAN CHURCHILL CHIEF EXECUTIVE OFFICER 7073852306 2020-06-18 1 TERRI REXRODE CPA MST P00096513 9206620016 2020-04-29 74.87.127.216 2020-06-18 10:58:19 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2018 2020-09-23 17:36:50Z JOAN CHURCHILL 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 15168445 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 11 183 15 0 0 4673558 4115792 11121654 10981872 2054 0 30391 70781 15827657 15168445 4700 900 0 0 8946273 10226352 0 0 0 6529944 6764678 15480917 16991930 346740 -1823485 7455520 5174565 2163002 1706593 5292518 3467972 X OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 1 0 7864725 900 6621502 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. 2953155 3535293 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. 1403676 895858 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) PRROGRAM, 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 SPECIALITY CLINICS WHERE PART-TIME SPECIALISTS PROVIDE OTHER SERVICES, INCLUDING PAIN MANAGEMENT, CHIROPRACTIC TREATMENT, AND OTHER ENABLING SERVICES. 12221556 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 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 41 0 183 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 JUDITH WATERMAN 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 ABRAHAM DANIELS CHAIRPERSON 1.00 X X 0 0 0 LYN MURRAY TREASURER 1.00 X X 0 0 0 MIMI GURBST BOARD MEMBER 1.00 X 0 0 0 NANCY NELLA BOARD MEMBER 1.00 X 0 0 0 TERRY LEACH SECRETARY 1.00 X X 0 0 0 SUSAN LENTZ VICE CHAIR 1.00 X X 0 0 0 ROSA GONZALEZ BOARD MEMBER 1.00 X 0 0 0 PHIL LUKS BOARD MEMBER 1.00 X 0 0 0 CHRISTINE ERICKSON BOARD MEMBER 1.00 X 0 0 0 ERIC ZIEDRICH BOARD MEMBER 1.00 X 0 0 0 MELITA LOVE BOARD MEMBER 1.00 X 0 0 0 ALEX ARMSTRONG CHIEF EXECUTIVE OFFICER 40.00 X 160051 0 18284 JUDITH WATERMAN CONTRACTED CFO 5.00 X 0 0 0 SUSANNAH LABBE MEDICAL DIRECTOR 40.00 X 176524 0 1119 DANA YEE DENTIST 40.00 X 157401 0 11811 ANDREW LANE SR DENTIST 40.00 X 158271 0 22622 LAURA MARCUS NURSE PRACTITIONER 40.00 X 163001 0 5515 BRITTANY GONZALEZ DENTIST 40.00 X 150528 0 11836 MARTHA SCHWARTZ DENTIST 40.00 X 147239 0 11405 1113015 0 82592 11 0 1 0 WIPFLI LLP PO BOX 3160 MILWAUKEE WI 53201 CFO & FINANCIAL CONSULTING 255815 HEALTH INFORMATION TECHNOLOGY 1310 REDWOOD WAY STE 125 PETALUMA CA 94954 MEDICAL BILLING CONSULTANTS 173562 THE WRITE CHOICE PO BOX 620215 MIDDLETON WI 53562 GRANT WRITING & COMPLIANCE 125268 MARY BRIDGET FITZGERALD 466 TEE CT HEALDSBURT CA 95448 CONSULTING 111221 4 2901625 1214167 4115792 NET PATIENT SERVICE REVENUE 621300 10981872 10981872 10981872 OTHER INCOME 621300 70781 70781 70781 15168445 11052653 0 0 900 900 178335 178335 8205107 7236919 968188 966764 841910 124854 876146 768258 107888 118725 118725 51162 51162 267816 267816 1501605 142799 1358806 35033 35033 301108 281214 19894 648610 110546 538064 750376 743448 6928 51330 51330 164870 134059 30811 140 140 359596 341154 18442 62211 18832 43379 340B EXPENSES 618303 433862 184441 SUPPLIES - PHARMACEUTIC 354213 354213 SUPPLIES - CLINICAL 313806 313806 1165774 448306 717468 16991930 12221556 4770374 0 1650605 1027210 2250853 511369 228686 249827 1422667 1638113 164437 217127 3824758 2293839 1708461 1530919 29811 7455520 5174565 2157128 1706593 5874 2163002 1706593 X 5287268 3463783 5250 4189 5292518 3467972 7455520 5174565 X -1823485 -1061 X X 0 1 X 1 1 1 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 1863697 744246 1119451 1911985 1549593 362392 49076 49076 1530919 X 15168445 0 15168445 0 15168445 16991930 0 16991930 0 16991930 PART X, LINE 2: AS OF JUNE 30, 2019 AND 2018, THE CENTER HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. X X 0 0 0 0 0 0 0 0 0 ALEX ARMSTRONG CHIEF EXECUTIVE OFFICER 160051 0 0 0 0 0 6400 0 11884 0 178335 0 0 0 SUSANNAH LABBE MEDICAL DIRECTOR 176524 0 0 0 0 0 0 0 1119 0 177643 0 0 0 DANA YEE DENTIST 157401 0 0 0 0 0 6296 0 5515 0 169212 0 0 0 ANDREW LANE SR DENTIST 158271 0 0 0 0 0 6330 0 16292 0 180893 0 0 0 LAURA MARCUS NURSE PRACTITIONER 163001 0 0 0 0 0 0 0 5515 0 168516 0 0 0 BRITTANY GONZALEZ DENTIST 150528 0 0 0 0 0 6021 0 5815 0 162364 0 0 0 MARTHA SCHWARTZ DENTIST 147239 0 0 0 0 0 5890 0 5515 0 158644 0 0 0 FORM 990, PART III, LINE 2 ADDED GASTROENTEROGLY. FORM 990, PART VI, SECTION A, LINE 3 WIPFLI LLP CONTRACTED CFO JUDITH P. WATERMAN $118,725 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. FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -1,061. PART XII, LINE 2C THERE HAS BEEN NO CHANGE TO THIS PROCESS FROM THE PRIOR YEAR.