2019-05-14T12:47:25-05:00 2018-06-30 954557617 Harrington Group CPAs LLP 234 East Colorado Blvd Suite M150 Pasadena CA 91101 990 2017-07-01 953702136 QueensCare Health Centers QUEE 3236694305 950 South Grand Avenue 2nd Flr S Los Angeles CA 90015 Barbara B Hines President & CEO 3236694305 2019-05-14 1 Sean E Cain CPA P01612986 6264036801 209.133.35.227 2019-05-14 10:47:12 PD P C2C22B4F1B9AA0772E09E87A4EA864779F63AD2A 0B4F3B71C2EC911E577D967EDC65E3E555B204AC 2017 2019-02-21 02:37:17Z Barbara B Hines 950 South Grand Avenue 2nd Flr S Los Angeles CA 90015 32777747 0 X www.queenscarehealthcenters.org X 1925 CA QueensCare Health Centers ("the Centers") directly and indirectly provides medical, dental and vision care services to underserved and neglected populations in Los Angeles County, including the uninsured, indigent, elderly and children. 15 15 286 15 0 23737 4560320 4035160 24171043 26169357 0 172215 3476363 2401015 32207726 32777747 0 0 0 0 16327264 18916584 0 0 0 9189064 9688357 25516328 28604941 6691398 4172806 29588347 33605939 1359974 1205515 28228373 32400424 QueensCare Health Centers ("the Centers") directly and indirectly provides medical, dental and vision care services to underserved and neglected populations in Los Angeles County. 0 0 21836853 28570372 QueensCare Health Centers provides directly and through Q/QHC Healthcare Partners, medical, dental and vision services to underserved populations, including the uninsured, indigent, elderly and children. During this fiscal year, QueensCare Health Centers provided services to Approximately 25,000 patients which accounted for more than 112,000 visits. 21836853 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 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 1 1 1 0 0 1 53 0 1 286 1 1 1 0 0 0 0 0 0 0 0 0 X 15 15 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 CA X Arthur Doi 3236694317 950 South Grand Avenue 2nd Flr S Los Angeles CA 90015 Jay Guerena Chair 2.00 2.00 X X 0 1500 0 Marina Aronoff Vice Chair 2.00 X X 0 0 0 Yasmin Garcia Secretary 2.00 X X 0 0 0 Jorge Blanco Director 2.00 X 0 0 0 Jacquelyn P Pantoja Director 2.00 X 0 0 0 Mary Ramos Director 2.00 X 0 0 0 Manuel Romero Director 2.00 X 0 0 0 Martha Arias Director 2.00 X 0 0 0 Serina Demirians Director 2.00 X 0 0 0 Harry Kram MD Director 2.00 X 0 0 0 Shirley Daniels Director 2.00 X 0 0 0 William Chim Director 2.00 X 0 0 0 Jeffrey Hermann Director 2.00 2.00 X 0 0 0 Allan Michelena Director 2.00 2.00 X 0 2150 0 Matthew Wells Director 2.00 X 0 0 0 Barbara B Hines President & CEO 20.00 20.00 X 294094 62283 42882 Gary C Grubbs CFO(term end 7/17) 8.00 32.00 X 0 273004 17623 Anitha Lakshmi Mullangi Chief Medical Officer(term end 10/17) 40.00 X 163766 0 11848 John Nguyen MD Chief Medical Officer(term start 12/17) 40.00 X 3288 0 0 Eloisa Perard CAO 40.00 X 0 94038 3933 Chad Vargas COO 40.00 X 120156 0 13155 Arthur Doi VP Accounting & Finance 40.00 X 0 139571 23125 Jennifer Polzin COO (Term end 10/17 40.00 X 0 146796 11660 Maria T Lim Heya Physician 40.00 X 229206 0 29831 Yung Soon Ahn Physician 40.00 X 217151 0 19997 Moe Aung MD Physician 40.00 X 203251 0 19646 Moe Kyi MD Physician 40.00 X 197903 0 27719 Eric Celo Physician 40.00 X 193040 0 11023 1621855 719342 232442 32 0 1 0 University of So Cal School of Pharmacy 1985 Zonal Ave PSC 700A Los Angeles CA 90089 Pharmacist Services 471895 Quest Diagnostics Inc PO Box 5068 Los Angeles CA 90074 Medical Laboratories Services 256597 Ryan K Lee MD 222 West Eulalia Street Suite 211 Glendale CA 91204 Independent Contractor 194228 Justinder S Malhotra MD PO Box 811424 Los Angeles CA 90081 Independent Contractor 110935 Progressive Dental Studio 1110 North Orchard Drive Burbank CA 91506 Dental Lab Services 109547 5 3980782 54378 4035160 Net Patient Revenue 621400 21625586 21625586 Q/QHC Healthcare Partners 621400 4543771 4543771 26169357 172215 172215 Other income 621400 2401015 2401015 2401015 32777747 28570372 0 172215 928699 928699 13213196 11023350 2189846 668317 556350 111967 3092812 2597215 495597 1013560 843507 170053 27085 4828 22257 80037 80037 607010 519425 87585 219811 219811 82147 70121 12026 1197530 1669 1195861 1317203 888576 428627 63743 14435 49308 539714 448988 90726 117385 59902 57483 Pharmaceuticals 1210351 1210351 Purchased services 1117138 934246 182892 Physician Fees 967071 967071 Medical & Other supplie 562007 545254 16753 1580125 1151565 428560 28604941 21836853 6768088 0 4170 4170 5753464 9088021 1815790 354999 7615214 6744804 10974470 10974470 100023 145077 339802 385613 7930505 7072892 1222166 857613 1987162 5758164 -223914 -706992 29588347 33605939 1359974 1205515 1359974 1205515 X 28218650 32390701 9723 9723 28228373 32400424 29588347 33605939 4172806 -755 0 X 0 1 X 1 1 1 X 9722 9722 9722 9722 69382 59660 9722 219953 150571 69382 847310 333763 961120 219953 1.00000 0 0 1372562 1141117 231445 6557943 5931775 626168 857613 Treasury securities 5758164 C 5758164 X Part V, Line 4: QueensCare Health Centers ("the Centers") intends to use its endowment funds to support healthcare related activities. Part X, Line 2: The Centers is exempt from taxation under Internal Revenue Code Section 501(c)(3) and California Revenue and Taxation Code Section 23701d. Generally accepted accounting principles provide accounting and disclosure guidance about positions taken by an organization in its tax returns that might be uncertain. Management has considered its tax positions and believes that all of the positions taken by the Centers in its federal and state exempt organization tax returns are more likely than not to be sustained upon examination. The Centers' returns are subject to examination by federal and state taxing authorities, generally for three and four years, respectively, after they are filed. X X X X 0 0 0 0 0 0 0 0 0 Barbara B Hines President & CEO 294094 56739 0 0 0 5544 17267 3884 15182 6549 326543 72716 0 0 Gary C Grubbs CFO(term end 7/17) 0 270126 0 0 0 2878 0 13076 0 4547 0 290627 0 0 Anitha Lakshmi Mullangi Chief Medical Officer(term end 10/17 163363 0 0 0 403 0 9489 0 2359 0 175614 0 0 0 Arthur Doi VP Accounting & Finance 0 138178 0 0 0 1393 0 8555 0 14570 0 162696 0 0 Jennifer Polzin COO (Term end 10/17 0 146271 0 0 0 525 0 8946 0 2714 0 158456 0 0 Maria T Lim Heya Physician 228240 0 0 0 966 0 13851 0 15980 0 259037 0 0 0 Yung Soon Ahn Physician 214379 0 0 0 2772 0 12835 0 7162 0 237148 0 0 0 Moe Aung MD Physician 202831 0 0 0 420 0 12280 0 7366 0 222897 0 0 0 Moe Kyi MD Physician 197483 0 0 0 420 0 12152 0 15567 0 225622 0 0 0 Eric Celo Physician 191270 0 0 0 1770 0 11023 0 0 0 204063 0 0 0 Form 990, Part VI, Section A, line 3 Pursuant to that certain Amended and Restated Partnership Agreement, QueensCare Health Centers and QueensCare formed Q/QHC Healthcare Partners to jointly operate five community health centers located in the greater Los Angeles area. QueensCare's responsibilities under the terms of that Agreement include supervision of medical treatments, measuring outcomes, providing day-to-day management for the operation of Q/QHC Healthcare Partners and on-site management of the Centers' personnel to include hiring, training, and discharging the Centers' personnel. Form 990, Part VII, Section A, Hours of Officers: Director Allan Michelena devoted approximately two hours of his time per week to a related organization, QueensCare, serving as a director of QueensCare. Board Chairman Jay Guerena devoted approximately two hours of his time per week to QueensCare serving as a director of QueensCare. CEO Barbara B. Hines devoted approximately 8 hours of her time per week serving as QueensCare's CEO. CFO Gary C. Grubbs also devoted approximately 32 hours of his time per week serving as QueensCare's Chief Financial Officer. Director Jeffrey Hermann devoted approximately two hours of his time per week to QueensCare, serving as a director of QueensCare. Form 990, Part VI, Section B, line 11b Following preparation of a final draft of the Form 990 by the organization's tax preparers, the organization's CEO and VP Accounting & Finance review, analyze and discuss the final draft to better ensure its accuracy and completeness. After the return is filed, the CEO and VP Accounting & Finance review and discuss material aspects and details of the return at the next regularly scheduled meeting of the Board of Directors. Form 990, Part VI, Section B, line 12c The organization's Board members, corporate officers, and staff are subject to a written conflicts of interest policy. Pursuant to that policy, each such person is required to identify any transaction with the organization in which the person has (or may have) a financial interest. If a conflict (or potential conflict) is identified, the Board, excluding any involved Board members, carefully reviews the terms of the transaction and makes a determination as to whether the transaction is fair and reasonable to the organization under all the facts and circumstances. The organization monitors and enforces compliance with this policy by: (i) discussing such issues at its annual meeting; (ii) requiring all covered persons to annually provide written certification of their compliance with the policy; and (iii) carefully reviewing all material transactions to identify potential or real conflicts. Form 990, Part VI, Section B, line 15a A Compensation Committee comprised of independent Board members formulates a proposed compensation level for the CEO by reviewing general compensation data for similarly situated organizations. Following such a review, the Compensation Committee presents its findings and recommendations to the Board at which Board members are provided with the opportunity to ask questions. Based on the findings and recommendations of the Compensation Committee, a Board vote is taken to establish the new compensation level for the CEO. Deliberations of the Compensation Committee and the Board are recorded in the organization's minute book. The evaluation, review, and recommendation process was last undertaken by the Compensation Committee in April 2017 and its findings and recommendations with regard to the CEO's compensation level were approved by the Board in September 2017. Form 990, Part VI, Section C, line 19 The organization's annual information return (Form 990) is available on a third-party website (GuideStar). The organization provides copies of its governing documents, its conflict of interest policy, as well as its three most recent Forms 990 to any interested person that makes a request for such documents. QueensCare 950 S Grand Ave 2nd Fl South Los Angeles CA 90015 951644040 Healthcare for the poor CA 501(c)(3) Line 7 St Joseph's Health Support Alliance 0 QueensCare Health Centers Foundation 950 S Grand Ave 2nd Fl South Los Angeles CA 90015 463366321 Support QHC mission CA 501(c)(3) Line 7 QueensCare Health Centers 0 QQHC Healthcare Partners 950 S Grand Ave 2nd Fl South Los Angeles CA 90015 260502255 To operate & Manage Healthcare Clinincs CA N/A Related 0 1 0.60000 0 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 QueensCare C 8889 Accrual QueensCare O 197011 Accrual QueensCare P 508761 Accrual QueensCare Q 215251 Accrual QueensCare Health Centers Foundation K 215000 Accrual QQHC Healthcare Partners B 6797378 Accrual QQHC Healthcare Partners J 4531786 Accrual QQHC Healthcare Partners L 11359429 Accrual QueensCare Health Centers Foundation S 78962 Accrual