OAK ORCHARD COMMUNITY INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- OAK ORCHARD COMMUNITY INC (EIN 16-1020913)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-06-25
- IRS object ID
- 202041779349301109
- Schema version
- 2019v5.1
- 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 | 2020-06-25T09:32:06-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161131146 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BONADIO & CO LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 171 SULLYS TRAIL | AddressLine1Txt |
| City | PITTSFORD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14534 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161020913 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OAK ORCHARD COMMUNITY HEALTH CENTERINC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OAKO | BusinessNameControlTxt |
| Phone | 5856375319 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 WEST AVENUE | AddressLine1Txt |
| City | BROCKPORT | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14420 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARY ANN PETTIBON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5856373905 | PhoneNum |
| Signature | 2020-06-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KAREN HIGNETT | PreparerPersonNm |
| PTIN | P01366951 | PTIN |
| Phone | 5853811000 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 72.225.42.203 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-06-18 | IPDt |
| IP Tm | 14:51:33 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 83480ED5CD84927E42A49AB9912AC6F37AE0F776 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2020-09-22 18:59:49Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARY ANN PETTIBON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 WEST AVENUE | AddressLine1Txt |
| City | BROCKPORT | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14420 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,577,535 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.OAKORCHARDHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | TO MEET THE HEALTH CARE AND WELLNESS NEEDS OF ALL CHILDREN AND ADULTS BY PROVIDING EXCELLENT MEDICAL, DENTAL, OPTOMETRY, BEHAVIORAL HEALTH, AND OUTREACH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 266 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $7,098,396 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,585,952 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,386,130 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,951,730 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,380 | PYInvestmentIncomeAmt |
| CY Investment Income | $39,853 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $18,486,906 | PYTotalRevenueAmt |
| CY Total Revenue | $19,577,535 | 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 | $11,944,850 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,322,153 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,276,514 | PYOtherExpensesAmt |
| CY Other Expenses | $5,816,177 | CYOtherExpensesAmt |
| PY Total Expenses | $17,221,364 | PYTotalExpensesAmt |
| CY Total Expenses | $18,138,330 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,265,542 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,439,205 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,307,549 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,758,879 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,848,039 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,860,164 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,459,510 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,898,715 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO MEET THE HEALTH CARE AND WELLNESS NEEDS OF ALL CHILDREN AND ADULTS BY PROVIDING EXCELLENT MEDICAL, DENTAL, OPTOMETRY, BEHAVIORAL HEALTH, AND OUTREACH SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,391,448 | ExpenseAmt |
| Revenue | $9,173,268 | RevenueAmt |
| Desc | REGIONAL MEDICAL SERVICES OFFERED TO MIGRANT FARM WORKERS AND THE GENERAL PUBLIC. APPROXIMATELY 17,400 INDIVIDUALS SERVED. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,516,104 | ExpenseAmt |
| Revenue | $1,939,405 | RevenueAmt |
| Desc | REGIONAL DENTAL SERVICES OFFERED TO MIGRANT FARM WORKERS AND THE GENERAL PUBLIC. APPROXIMATELY 7,400 INDIVIDUALS SERVED. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $573,445 | ExpenseAmt |
| Revenue | $469,706 | RevenueAmt |
| Desc | REGIONAL OPTOMETRY SERVICES OFFERED TO MIGRANT FARM WORKERS AND THE GENERAL PUBLIC. APPROXIMATELY 1,900 INDIVIDUALS SERVED. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,896,329 | ExpenseAmt |
| Revenue | $369,351 | RevenueAmt |
| Desc | OTHER SERVICES OFFERED TO MIGRANT FARM WORKERS AND THE GENERAL PUBLIC. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,896,329 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $369,351 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $14,377,326 | 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 | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 266 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAROL WHITE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5856373905 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 WEST AVENUE | AddressLine1Txt |
| City | BROCKPORT | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14420 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| BETTY GARCIA MATTHEWSON | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| NYLA GAYLORD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID JEWELL PHD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RENEE BIEDLINGMAIER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL SAYERS | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GARY SKOOG | ||||||||
| CHAIR | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LORIENDA SMITH | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GEORGE SOKOLSKY | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| EVELYN STELMACH | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RITA WAGNER | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KAREN WATT | ||||||||
| VICE CHAIR | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KATHY WILLIAMS | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SUSAN MEYER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY ANN PETTIBON | ||||||||
| PRESIDENT/CEO | 40.00 | Yes (X) | Yes (X) | $190,718 | $0 | $12,468 | ||
| CAROL A WHITE | ||||||||
| CFO | 40.00 | Yes (X) | $128,953 | $0 | $10,164 | |||
| NANCY CIAVARRI MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $190,230 | $0 | $8,500 | Yes (X) | |||
| TERESA CHANG | ||||||||
| PHYSICIAN | 40.00 | $173,802 | $0 | $7,039 | Yes (X) | |||
| ROBERT WHELPLEY | ||||||||
| PHYSICIAN | 40.00 | $187,330 | $0 | $8,586 | Yes (X) | |||
| KEITH FULEKI | ||||||||
| PHYSICIAN | 40.00 | $173,758 | $0 | $9,926 | Yes (X) | |||
| YUQI MAO | ||||||||
| PHYSICIAN | 40.00 | $173,993 | $0 | $12,392 | Yes (X) | |||
| RACHEL NOZZI | ||||||||
| DENTIST/CDO | 40.00 | $179,970 | $0 | $9,317 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,398,754 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $78,392 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LAKE CONSTRUCTION NY LLC | |||||
| PO BOX 596 | LAKEVILLE | NY | 14480 | CONSTRUCTION | $487,480 |
| FSI ACOUSTICAL SYSTEMS LLC | |||||
| 90 GOODWAY DRIVE | ROCHESTER | NY | 14623 | CONSTRUCTION | $310,335 |
| ECLINICAL WORKS LLC | |||||
| 2 TECHNOLOGY DRIVE | WESTBOROUGH | MA | 01581 | SOFTWARE | $219,980 |
| 7100 ROUTE 70A LLC | |||||
| 130 LINDEN OAKS DRIVE SUITE A | ROCHESTER | NY | 14625 | RENT | $187,472 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,506,162 | GovernmentGrantsAmt |
| All Other Contributions | $2,079,790 | AllOtherContributionsAmt |
| Total Contributions | $7,585,952 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PMTS | 621400 | $5,311,369 | $5,311,369 |
| OTHER THIRD PARTY PAYORS | 621400 | $3,343,702 | $3,343,702 |
| 340B PHARMACY INCOME | 900099 | $3,033,896 | $3,033,896 |
| SELF-PAY | 621400 | $262,763 | $262,763 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,951,730 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,853 | TotalRevenueColumnAmt |
| Exclusion | $39,853 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,577,535 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,951,730 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $39,853 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $541,034 | TotalAmt |
| Program Services | $99,365 | ProgramServicesAmt |
| Management And General | $441,669 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,089,067 | TotalAmt |
| Program Services | $8,500,745 | ProgramServicesAmt |
| Management And General | $1,588,322 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $942,076 | TotalAmt |
| Program Services | $707,846 | ProgramServicesAmt |
| Management And General | $234,230 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $749,976 | TotalAmt |
| Program Services | $548,758 | ProgramServicesAmt |
| Management And General | $201,218 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,159 | TotalAmt |
| Management And General | $30,159 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,680 | TotalAmt |
| Management And General | $42,680 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $720,199 | TotalAmt |
| Program Services | $324,764 | ProgramServicesAmt |
| Management And General | $395,435 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,659 | TotalAmt |
| Program Services | $108,028 | ProgramServicesAmt |
| Management And General | $46,631 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $420,806 | TotalAmt |
| Program Services | $338,147 | ProgramServicesAmt |
| Management And General | $82,659 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $654,232 | TotalAmt |
| Program Services | $526,636 | ProgramServicesAmt |
| Management And General | $127,596 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,635 | TotalAmt |
| Program Services | $59,460 | ProgramServicesAmt |
| Management And General | $164,175 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,457 | TotalAmt |
| Program Services | $80,060 | ProgramServicesAmt |
| Management And General | $19,397 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $678,146 | TotalAmt |
| Program Services | $557,015 | ProgramServicesAmt |
| Management And General | $121,131 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,790 | TotalAmt |
| Program Services | $51,807 | ProgramServicesAmt |
| Management And General | $33,983 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHARMACEUTICALS | $1,108,838 | $1,108,838 | |
| PATIENT CARE SUPPLIES | $1,094,175 | $1,069,368 | $24,807 |
| OTHER EXPENSES | $444,119 | $237,207 | $206,912 |
| BAD DEBT EXPENSE | $59,282 | $59,282 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,138,330 | TotalAmt |
| Program Services | $14,377,326 | ProgramServicesAmt |
| Management And General | $3,761,004 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,384,324 | BOYAmt |
| EOY | $6,908,693 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $789,727 | BOYAmt |
| EOY | $11,481 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $606,328 | BOYAmt |
| EOY | $168,162 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,356,073 | BOYAmt |
| EOY | $1,297,521 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,466,498 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,253,728 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,927,827 | BOYAmt |
| EOY | $8,212,770 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $243,270 | BOYAmt |
| EOY | $160,252 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,307,549 | BOYAmt |
| EOY | $16,758,879 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,500,729 | BOYAmt |
| EOY | $1,533,275 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,253 | BOYAmt |
| EOY | $274,166 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,204,479 | BOYAmt |
| EOY | $3,043,204 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,578 | BOYAmt |
| EOY | $9,519 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,848,039 | BOYAmt |
| EOY | $4,860,164 | 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 | $10,459,510 | BOYAmt |
| EOY | $11,898,715 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,459,510 | BOYAmt |
| EOY | $11,898,715 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,307,549 | BOYAmt |
| EOY | $16,758,879 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,439,205 | ReconcilationRevenueExpnssAmt |
| 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) |
|---|---|---|
| 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 | $658,213 | OtherCostOrOtherBasisAmt |
| Book Value | $658,213 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,255,950 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,727,363 | DepreciationAmt |
| Book Value | $6,528,587 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $261,506 | OtherCostOrOtherBasisAmt |
| Depreciation | $184,129 | DepreciationAmt |
| Book Value | $77,377 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,290,829 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,342,236 | DepreciationAmt |
| Book Value | $948,593 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,212,770 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $19,577,535 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $19,577,535 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $19,577,535 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,138,330 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $18,138,330 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,138,330 | TotalExpensesPerForm990Amt |
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARY ANN PETTIBON | ||||||||||||||
| PRESIDENT/CEO | $190,718 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,468 | $0 | $203,186 | $0 | $0 | $0 |
| NANCY CIAVARRI MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $190,230 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,500 | $0 | $198,730 | $0 | $0 | $0 |
| TERESA CHANG | ||||||||||||||
| PHYSICIAN | $173,802 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,039 | $0 | $180,841 | $0 | $0 | $0 |
| ROBERT WHELPLEY | ||||||||||||||
| PHYSICIAN | $187,330 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,586 | $0 | $195,916 | $0 | $0 | $0 |
| KEITH FULEKI | ||||||||||||||
| PHYSICIAN | $173,758 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,926 | $0 | $183,684 | $0 | $0 | $0 |
| YUQI MAO | ||||||||||||||
| PHYSICIAN | $173,993 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,392 | $0 | $186,385 | $0 | $0 | $0 |
| RACHEL NOZZI | ||||||||||||||
| DENTIST/CDO | $179,970 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,317 | $0 | $189,287 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS FOR THEIR REVIEW AT A BOARD MEETING, PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY THE ORGANIZATION REQUIRES OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO COMPLETE IN WRITING A CONFLICT OF INTEREST STATEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S SALARY IS REVIEWED BY BOARD MEMBERS BASED ON MARKET TRENDS AND COMPENSATION SURVEYS. ALL OTHER OFFICERS AND KEY EMPLOYEES ARE PROVIDED ANNUAL EVALUATIONS AND SALARIES ARE REVIEWED AND APPROVED BY THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION COMPLIES WITH ALL APPLICABLE FEDERAL AND STATE REGULATIONS. |
| PART XII, LINE 2C | THE ORGANIZATION HAS NOT CHANGED ITS PROCESS FROM THE PRIOR YEAR. |