2020-06-11T17:46:56-05:00 2019-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2018-07-01 680371679 PEACH TREE HEALTHCARE PEAC 5307493242 1114 YUBA STREET NO 144 MARYSVILLE CA 95901 JAMES ELLSWORTH CHIEF FINANCIAL OFFICER 5307493242 2020-04-23 1 MICHAEL LUMSDEN P01262236 4159561500 2020-04-23 76.14.38.113 2020-04-23 14:35:01 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 00C4359F54289D19625D58AABAD73364CEA05A5F 2018 2020-09-23 17:36:50Z GREG STONE 1114 YUBA STREET NO 144 MARYSVILLE CA 95901 23455857 0 X WWW.PICKPEACH.ORG X 1995 CA PEACH TREE HEALTH IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. 11 11 216 13 0 0 2192986 2271944 20026912 21123791 0 0 55873 60122 22275771 23455857 0 0 0 0 12900438 12942956 0 0 0 9613962 10796355 22514400 23739311 -238629 -283454 8694162 8031688 3252476 2873456 5441686 5158232 X PEACH TREE HEALTHCARE IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. 0 0 16897263 0 21123791 PEACH TREE HEALTHCARE IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) OPERATING AT THE FOLLOWING LOCATIONS: THARP ROAD DENTAL CLINIC, LIVE OAK CLINIC (INCLUDING PEACH TREE VISION LIVE OAK), PEACH TREE - YUBA CITY/COLUSA, PEACH TREE CLINIC (INCLUDING PEACH TREE VISION LINDA), MARYSVILLE IMMEDIATE CARE CLINIC, 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, 2019 TAX YEAR 36,056 PATIENTS RECEIVED SERVICES AT OUR VARIOUS CLINICS. 16897263 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 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 47 0 1 216 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X JAMES ELLSWORTH 5307493242 1114 YUBA STREET SUITE 144 MARYSVILLE CA 95901 ED SMITH CHAIR 1.00 X X 0 0 0 ROBERTA D'ARCY VICE CHAIR 1.00 X X 0 0 0 LIN LARSON SECRETARY/TREASURER 1.00 X X 0 0 0 AWNI ALLABABIDI DIRECTOR 1.00 X 0 0 0 JANE DALTON DIRECTOR 1.00 X 0 0 0 MARY GOMEZ DIRECTOR 1.00 X 0 0 0 JOSEPH HERNANDEZ DIRECTOR 1.00 X 0 0 0 DOUG LOFTON DIRECTOR 1.00 X 0 0 0 BETH LOYD DIRECTOR 1.00 X 0 0 0 KARLA MASON-COHEN DIRECTOR 1.00 X 0 0 0 ANDY POTTER DIRECTOR 1.00 X 0 0 0 GREG STONE CHIEF EXECUTIVE OFFICER 40.00 X 185579 0 18335 KAY SIDHU CHIEF FINANCIAL OFFICER 40.00 X 144433 0 21981 HAKEEM O ADENIYI JR MD CHIEF MEDICAL OFFICER 40.00 X 251380 0 4658 RUPAUL GHUMAN DDS DENTAL DIRECTOR 40.00 X 185372 0 25799 SUMIT JOHL MD MEDICAL DOCTOR 40.00 X 338173 0 18673 TEJINDER GHUMAN MD MEDICAL DOCTOR 40.00 X 329999 0 18673 THIYAGU GANESAN MD MEDICAL DOCTOR 40.00 X 281078 0 11656 MARY R PENA-PRIDMORE MD MEDICAL DOCTOR 40.00 X 251187 0 5024 MARIA ABORDO MD MEDICAL DOCTOR 40.00 X 219187 0 10540 2186388 0 135339 30 0 1 0 RIDGE EYE CARE 7056 SKYWAY ROAD PARADISE CA 95969 CONTRACTED OPTOMETRY SERVICES 1370400 MACMAN MANAGEMENT HEALTHCARE SERVICES 1300 NATIONAL DR 175 SACRAMENTO CA 95834 CONTRACTED MEDICAL BILLING SERVICES 409420 DATATEL CONSULTING INC 7710 HAZARD CENTER DR SUITE E SAN DIEGO CA 92108 CONTRACTED IT SERVICES 312199 ULTIMATE BUILDING MAINTENANCE 598 GARDEN HWY STE 5 YUBA CITY CA 95991 CONTRACTED HOUSEKEEPING SERVICES 243701 ALLIED UNIVERSAL SECURITY SERVICES PO BOX 31001-2374 PASADENA CA 91110 CONTRACTED SECURITY SERVICES 134463 5 2158548 113396 2271944 NET PATIENT SERVICE REVENUE 621400 20796733 20796733 OTHER OPERATING REVENUE 621400 327058 327058 21123791 60122 0 60122 60122 60122 23455857 21123791 0 60122 X 879371 332102 547269 8494228 6317930 2176298 172336 130573 41763 2576057 1645153 930904 820964 575202 245762 5825 5825 916950 916950 7126 7126 2431391 2272346 159045 36265 36265 452619 351813 100806 978302 48287 930015 2215449 1935795 279654 71662 41540 30122 9440 1699 7741 70742 26894 43848 909385 742290 167095 166480 92926 73554 MEDICAL SUPPLIES/DRUGS 2189932 2189932 RECRUITING 156656 96656 60000 LEASE OPERATING EXPENSE 102679 69006 33673 LICENSES AND TAXES 60193 26265 33928 15259 854 14405 23739311 16897263 6842048 0 10000 88000 3285094 3453755 163314 175881 254016 169499 8735110 4738639 4808386 3996471 173352 148082 8694162 8031688 1518414 1781748 184800 54404 1311262 775877 238000 261427 3252476 2873456 X 5441686 5158232 5441686 5158232 8694162 8031688 -283454 0 X 0 1 X 1 1 1 X 1316934 5487191 2494135 2192986 2271944 13763190 1316934 5487191 2494135 2192986 2271944 13763190 13763190 0 0 0 55873 60122 115995 175375 226692 983997 1386064 15265249 88708230 0.90160 0.83090 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2014 AMOUNT: $ 175,375. 2015 AMOUNT: $ 226,692. 2016 AMOUNT: $ 983,997. 2017 AMOUNT: $ 0. 2018 AMOUNT: $ 0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7126 7126 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO THE CALIFORNIA PRIMARY CARE ASSOCIATION; A PORTION OF THOSE DUES HAVE BEEN INDICATED AS USED FOR LOBBYING PURPOSES. 3965379 1424081 2541298 3348201 2621837 726364 1421530 692721 728809 3996471 DEFERRED LEASE LIABILITY 261427 261427 X 23455857 0 23455857 0 23455857 23739311 0 23739311 0 23739311 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, 2019 AND 2018, 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. X X 0 0 0 0 0 0 0 0 0 GREG STONE CHIEF EXECUTIVE OFFICER 185579 0 0 0 0 0 3712 0 14623 0 203914 0 0 0 KAY SIDHU CHIEF FINANCIAL OFFICER 141474 0 2959 0 0 0 2889 0 19092 0 166414 0 0 0 HAKEEM O ADENIYI JR MD CHIEF MEDICAL OFFICER 232920 0 2171 0 16289 0 4658 0 0 0 256038 0 0 0 RUPAUL GHUMAN DDS DENTAL DIRECTOR 180414 0 4958 0 0 0 3707 0 22092 0 211171 0 0 0 SUMIT JOHL MD MEDICAL DOCTOR 256308 0 81865 0 0 0 5130 0 13543 0 356846 0 0 0 TEJINDER GHUMAN MD MEDICAL DOCTOR 247049 0 74815 0 8135 0 5130 0 13543 0 348672 0 0 0 THIYAGU GANESAN MD MEDICAL DOCTOR 264533 0 16545 0 0 0 5500 0 6156 0 292734 0 0 0 MARY R PENA-PRIDMORE MD MEDICAL DOCTOR 235981 0 15206 0 0 0 5024 0 0 0 256211 0 0 0 MARIA ABORDO MD MEDICAL DOCTOR 206977 0 12210 0 0 0 4384 0 6156 0 229727 0 0 0 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 REVIEWED WITH THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. 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 2,112,922. MANAGEMENT AND GENERAL EXPENSES 15,662. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,128,584. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 131,770. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,770. CONTRACTED ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 159,424. MANAGEMENT AND GENERAL EXPENSES 11,613. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 171,037.