2019-05-13T13:18:05-05:00 2018-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2017-07-01 942308748 ALLIANCE MEDICAL CENTER INC ALLI 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 ALEX ARMSTRONG CHIEF EXECUTIVE OFFICER 7073852306 2019-05-10 1 TERRI REXRODE CPA MST P00096513 9206620016 2019-05-10 74.87.127.216 2019-05-10 08:08:37 CD P A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 7D2FE2EA17AC540A2D29D4112E82844D375299C1 2017 2019-02-21 02:37:17Z ALEX ARMSTRONG 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 15827657 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. 10 10 152 25 0 0 4142480 4673558 11675711 11121654 135 2054 33103 30391 15851429 15827657 0 4700 0 0 8536078 8946273 0 0 0 6392589 6529944 14928667 15480917 922762 346740 6676529 7455520 1717985 2163002 4958544 5292518 OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 0 0 6622682 4700 6907050 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. 2996823 3331779 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. 1589428 913216 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. 11208933 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 4 0 152 1 0 0 0 0 0 0 0 0 0 0 X 10 10 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 DENNY MARTIN 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 TERESITA PONCE BOARD MEMBER 1.00 X 0 0 0 CARINA GONZALEZ CHIEF MEDICAL OFFICER 40.00 X 222720 0 12674 ALEX ARMSTRONG CHIEF EXECUTIVE OFFICER 40.00 X 187723 0 18423 JUDITH WATERMAN CONTRACTED CFO 5.00 X 0 0 0 DONALD DOBBS DENTAL DIRECTOR 40.00 X 162139 0 20061 MARIA ALVAREZ DIRECTOR OF BEHAVIORAL HEALTH 40.00 X 148408 0 22346 DANA YEE DENTIST 40.00 X 153706 0 12822 ANDREW LANE SR DENTIST 40.00 X 153971 0 20120 LAURA MARCUS NURSE PRACTITIONER 40.00 X 144202 0 8824 BRITTANY GONZALEZ DENTIST 40.00 X 145851 0 11149 1318720 0 126419 16 0 1 0 OCHIN INC 1881 SW NAITO PARKWAY PORTLAND OR 97201 HEALTH IT SUPPORT & SERVICES 1044148 COMPHEALTH PO BOX 972651 DALLAS TX 75397 HEALTHCARE STAFFING SERVICES 779387 PRICE WATERMAN ACCOUNTING 125 EAST MILL STREET UKIAH CA 95482 CONSULTING 368443 HEALTH INFORMATION TECHNOLOGY 1310 REDWOOD WAY STE 125 PETALUMA CA 94954 MEDICAL BILLING CONSULTANTS 183662 KOCH CONSTRUCTION COMPANY 1550 AIRPORT BLVD STE 104 SANTA ROSA CA 95403 CONSTRUCTION SERVICES 112648 7 2799293 1874265 4673558 NET PATIENT SERVICE REVENUE 621300 11121654 11121654 11121654 2054 2054 OTHER INCOME 621300 30391 30391 30391 15827657 11152045 0 2054 X 4700 4700 410443 222720 187723 7024295 6122330 901965 176604 134298 42306 801614 704808 96806 533317 469659 63658 106000 106000 79520 79520 321736 321736 2081518 928510 1153008 32545 500 32045 459571 246873 212698 531679 46602 485077 707191 562092 145099 64722 18276 46446 194109 100566 93543 4393 4393 231002 204967 26035 60891 18239 42652 340B EXPENSES 752304 752304 SUPPLIES - PHARMACEUTIC 283228 283228 SUPPLIES - CLINICAL 274265 274265 345270 113996 231274 15480917 11208933 4271984 0 2319330 1650605 2250853 359091 228686 1939042 1422667 174967 164437 3764490 2056029 1858037 1708461 26062 29811 6676529 7455520 1660662 2157128 57323 5874 1717985 2163002 X 4938907 5287268 19637 5250 4958544 5292518 6676529 7455520 X 346740 1621 -14387 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. 1863697 615910 1247787 1900793 1440119 460674 1708461 X 15829278 1621 1621 15827657 0 15827657 15480917 0 15480917 0 15480917 PART X, LINE 2: AS OF JUNE 30, 2018 AND 2017, 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 CARINA GONZALEZ CHIEF MEDICAL OFFICER 222720 0 0 0 0 0 0 0 12674 0 235394 0 0 0 ALEX ARMSTRONG CHIEF EXECUTIVE OFFICER 187723 0 0 0 0 0 5600 0 12823 0 206146 0 0 0 DONALD DOBBS DENTAL DIRECTOR 162139 0 0 0 0 0 0 0 20061 0 182200 0 0 0 MARIA ALVAREZ DIRECTOR OF BEHAVIORAL HEALTH 148408 0 0 0 0 0 5600 0 16746 0 170754 0 0 0 DANA YEE DENTIST 153706 0 0 0 0 0 5220 0 7602 0 166528 0 0 0 ANDREW LANE SR DENTIST 153971 0 0 0 0 0 5600 0 14520 0 174091 0 0 0 LAURA MARCUS NURSE PRACTITIONER 144202 0 0 0 0 0 0 0 8824 0 153026 0 0 0 BRITTANY GONZALEZ DENTIST 145851 0 0 0 0 0 5600 0 5549 0 157000 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 PRICE WATERMAN ACCOUNTING CONTRACTED CFO JUDITH WATERMAN $106,000 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 IX, LINE 11G CONTRACTED PROVIDER: PROGRAM SERVICE EXPENSES 806,179. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 806,179. CONSULTING FEES: PROGRAM SERVICE EXPENSES 7,279. MANAGEMENT AND GENERAL EXPENSES 495,063. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 502,342. LAB & XRAY SERVICES: PROGRAM SERVICE EXPENSES 91,381. MANAGEMENT AND GENERAL EXPENSES 42. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,423. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 23,671. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,671. BILLING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 613,991. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 613,991. PAYROLL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 18,340. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,340. RETIREMENT PLAN ADMINISTRATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 25,572. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,572. FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -14,387. PART XII, LINE 2C THERE HAS BEEN NO CHANGE TO THIS PROCESS FROM THE PRIOR YEAR. THE TAXPAYER RELIED ON THEIR ACCOUNTANT TO PREPARE AN EXTENSION FOR THIS RETURN. THE ACCOUNTANT'S FIRM WAS MERGED INTO ANOTHER FIRM DURING THE EXTENSION TIMEFRAME. UNFORTUNATELY, THE EXTENSION WAS INADVERTENTLY MISSED. THE TAXPAYER HAS ALWAYS BEEN TIMELY ON THEIR FILINGS AND REQUEST THAT THE PENALTIES BE ABATED. AS SOON AS THE TAXPAYER WAS MADE AWARE OF THIS OVERSITE, THEY REACTED AS QUICKLY AS POSSIBLE TO FILE A COMPLETE AND ACCURATE FORM 990. THE ACCOUNTANT HAS PUT ADDITIONAL PROCEDURES INTO PLACE TO MAKE SURE THAT TRANSITIONAL RETURNS ARE NOT OMITTED FROM THE EXTENSION LISTS AND SO THIS PROBLEM DOES NOT RE-OCCUR. WE ASK THAT THE PENALTY FOR LATE FILING BE ABATED.