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SOUTHERN CALIFORNIA MEDICAL CENTER INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
SOUTHERN CALIFORNIA MEDICAL CENTER INC (EIN 26-2602821)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-04-16
IRS object ID
201831069349301088
Schema version
2016v3.0
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

FieldValueIRS element (for citing)
Return2018-04-16T17:31:26-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN330783700PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PDM LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line13460 TORRANCE BLVD STE 200AddressLine1Txt
CityTORRANCECityNm
State AbbreviationCAStateAbbreviationCd
ZIP90503ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN262602821EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SOUTHERN CALIFORNIA MEDICAL CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSOUTBusinessNameControlTxt
Phone8186506700PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line114550 HAYNES STAddressLine1Txt
CityVAN NUYSCityNm
State AbbreviationCAStateAbbreviationCd
ZIP91411ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSHEILA BUSHERIPersonNm
Person TitleCEOPersonTitleTxt
Phone8186506700PhoneNum
Signature2018-04-16SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonANTHONY P BOZANIC CPAPreparerPersonNm
PTINP01314417PTIN
Phone3105404118PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address64.183.112.46IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-04-16IPDt
IP Tm12:31:37IPTm
IP TimezonePDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdAB34D790D7F87B43C88F2E9C2CDFEA1D77BD3782AtSubmissionCreationDeviceId
At Submission Filing Device Id6085D6B26D852F4BA5261ABA5B78095287290D0CAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Principal OfficerSHEILA BUSHERIPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line114550 HAYNES STREETAddressLine1Txt
CityVAN NUYSCityNm
State AbbreviationCAStateAbbreviationCd
ZIP91411ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$6,066,511GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SCMEDCENTER.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2008FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionTO OPERATE A STATE-LICENSED COMMUNITY HEALTH CLINIC IN EL MONTE, PICO RIVERA, & VAN NUYS, CA.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee43TotalEmployeeCnt
Total Volunteers11TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,093,264PYContributionsGrantsAmt
CY Contributions Grants$1,240,532CYContributionsGrantsAmt
PY Program Service Revenue$3,446,110PYProgramServiceRevenueAmt
CY Program Service Revenue$4,744,862CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$48,875PYOtherRevenueAmt
CY Other Revenue$81,117CYOtherRevenueAmt
PY Total Revenue$4,588,249PYTotalRevenueAmt
CY Total Revenue$6,066,511CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,104,410PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$2,999,704CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,391,825PYOtherExpensesAmt
CY Other Expenses$2,684,297CYOtherExpensesAmt
PY Total Expenses$4,496,235PYTotalExpensesAmt
CY Total Expenses$5,684,001CYTotalExpensesAmt
PY Revenues Less Expenses$92,014PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$382,510CYRevenuesLessExpensesAmt
Total Assets BOY$1,350,285TotalAssetsBOYAmt
Total Assets EOY$1,677,170TotalAssetsEOYAmt
Total Liabilities BOY$1,019,655TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,472,570TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$330,630NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$204,600NetAssetsOrFundBalancesEOYAmt
MissionTO DELIVER THE HIGHEST QUALITY OF HEALTH CARE WITH THE FOCUS ON THE UNDERSERVED AND LOW INCOME POPULATION OF EL MONTE, PICO RIVERA AND VAN NUYS, CA. THE GOAL IS TO CREATE HEALTHY AND HAPPY FAMILIES BY FOCUSING ON EDUCATION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$4,953,692ExpenseAmt
Revenue$4,744,862RevenueAmt
DescTHE ORGANIZATION IS A FEDERALLY QUALIFIED HEALTH CLINIC THAT PROVIDES AND OPERATES QUALITY HEALTH CARE SERVICES FROM THREE CLINICS LOCATED IN EL MONTE, PICO RIVERA AND VAN NUYS. SERVICES INCLUDE GENERAL MEDICAL CARE, PHYSICALS, IMMUNIZATION, WELL CHILD CHECKUPS, BLOOD PRESSURE SCREENINGS, LABORATORY SERVICES, SPECIALIST REFERRALS, FAMILY CARE PRACTITIONERS, PRIMARY CARE, FAMILY/INTERNAL CARE MEDICINE, PEDIATRICS, PODIATRY, AND OBSTETRICS/GYNECOLOGY TO LOCAL COMMUNITIES WITH A FOCUS ON EDUCATION AND PREVENTION. THE ORGANIZATION CONTRACTS DIRECTLY OR INDIRECTLY WITH GOVERNMENTAL AGENCIES AND RECEIVES GRANTS TO SUPPORT SERVICE DELIVERY AND SPECIAL PROGRAMS. NO CLIENT IS TURNED AWAY DUE TO THE INABILITY TO PAY.Desc
Total Program Service Expenses$4,953,692TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document89IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee43EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1OMAR KADERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8186506700PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line114550 HAYNES STAddressLine1Txt
CityVAN NUYSCityNm
State AbbreviationCAStateAbbreviationCd
ZIP91411ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
NAVEED TORIAN
TREASURER/ SECRETARY1.50Yes (X)Yes (X)$0$0$0
FRED TAHMASBI
CHAIRMAN2.00Yes (X)Yes (X)$0$0$0
ROSA ESTORGA
BOARD MEMBER1.00Yes (X)$0$0$0
LOURDES MARTINEZ
BOARD MEMBER1.00Yes (X)$0$0$0
MARIA AHUMADA
BOARD MEMBER1.00Yes (X)$0$0$0
HAMID HAMIDI
VICE CHAIR1.50Yes (X)Yes (X)$0$0$0
WENDY CAMACHO
BOARD MEMBER1.00Yes (X)$0$0$0
ARMANDO RAYGOZA
BOARD MEMBER1.00Yes (X)$0$0$0
JAHANGIR RASHIDI
BOARD MEMBER1.00Yes (X)$0$0$0
ANGELA ANDERSON BAUTISTA
BOARD MEMBER1.00Yes (X)$0$0$0
SHAHINARAM RAHMANIAN
BOARD MEMBER1.00Yes (X)$0$0$0
SHEILA BUSHERI
CEO40.00Yes (X)$155,770$0$144
MOHAMMED RASEKHI MD
CMO40.00Yes (X)$310,255$0$7,980
TROY VAUGHN
COO (LEFT NOV 2016)40.00Yes (X)$138,462$0$0
OMAR KADER
CFO, NEW COO (STARTED JUL 2016)40.00Yes (X)$51,672$0$714
FieldValueIRS element (for citing)
Total Reportable Comp From Org$656,159TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$8,838TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
NAZANIN PARSAEI
2700 NEILSON WAY APT 163SANTA MONICACA90405MEDICAL CONSULTANT$165,840
MCLAREN LLP
6700 VALJEAN AVEVAN NUYSCA91409RENT$151,900
ERNESTO E MAGDALENO PAC
10720 LAKEWOOD BLDOWNEYCA90241MEDICAL CONSULTANT$140,617
ADVANTAGE LOCUMS
9021 MERIDIAN WAY OHIOWEST CHESTEROH45069BOOKING FEES FOR MEDICAL STAFF$128,375
MCKESSON MEDICAL-SURGICAL
PO BOX 51020LOS ANGELESCA900515320MEDICAL SUPPLIES$121,306
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Government Grants$1,219,032GovernmentGrantsAmt
All Other Contributions$21,500AllOtherContributionsAmt
Total Contributions$1,240,532TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SVC REVENUE621110$2,744,418$2,744,418
PHARMACY SALES621110$852,451$852,451
CAPITATION621110$752,437$752,437
PRIVATE INSURANCE AND621110$295,729$295,729
OTHER PROGRAM SERVICES621110$99,827$99,827
FieldValueIRS element (for citing)
Total Program Service Revenue$4,744,862TotalProgramServiceRevenueAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$81,117RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$81,117RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$81,117TotalRevenueColumnAmt
Exclusion$81,117ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,066,511TotalRevenueColumnAmt
Related Or Exempt Func Income$4,744,862RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$81,117ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$609,010TotalAmt
Program Services$517,658ProgramServicesAmt
Management And General$91,352ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$2,020,802TotalAmt
Program Services$1,717,682ProgramServicesAmt
Management And General$303,120ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$123,107TotalAmt
Program Services$104,641ProgramServicesAmt
Management And General$18,466ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$246,785TotalAmt
Program Services$209,767ProgramServicesAmt
Management And General$37,018ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$558,251TotalAmt
Program Services$506,878ProgramServicesAmt
Management And General$51,373ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$136,955TotalAmt
Program Services$136,955ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$211,576TotalAmt
Program Services$169,261ProgramServicesAmt
Management And General$42,315ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$669,490TotalAmt
Program Services$535,592ProgramServicesAmt
Management And General$133,898ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$55,058TotalAmt
Program Services$44,046ProgramServicesAmt
Management And General$11,012ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$194TotalAmt
Program Services$194ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$126,064TotalAmt
Program Services$100,852ProgramServicesAmt
Management And General$25,212ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$63,856TotalAmt
Program Services$51,084ProgramServicesAmt
Management And General$12,772ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$597,987$597,987
LABORATORY FEES$171,074$171,074
BILLING EXPENSES$74,938$74,938
TAXES AND LICENSES$18,854$15,083$3,771

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$5,684,001TotalAmt
Program Services$4,953,692ProgramServicesAmt
Management And General$730,309ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$66,236BOYAmt
EOY$159,291EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$599,791BOYAmt
EOY$863,393EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$955,135LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$311,875LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$673,353BOYAmt
EOY$643,260EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$10,905BOYAmt
EOY$11,226EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,350,285BOYAmt
EOY$1,677,170EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$531,074BOYAmt
EOY$532,107EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$30,000BOYAmt
EOY$30,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$7,570BOYAmt
EOY$1,932EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$451,011BOYAmt
EOY$908,531EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,019,655BOYAmt
EOY$1,472,570EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$330,630BOYAmt
EOY$204,600EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$330,630BOYAmt
EOY$204,600EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,350,285BOYAmt
EOY$1,677,170EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$382,510ReconcilationRevenueExpnssAmt
Prior Period Adjustments-$508,540PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$381,919OtherCostOrOtherBasisAmt
Depreciation$118,512DepreciationAmt
Book Value$263,407BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$415,899OtherCostOrOtherBasisAmt
Depreciation$174,650DepreciationAmt
Book Value$241,249BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$157,317OtherCostOrOtherBasisAmt
Depreciation$18,713DepreciationAmt
Book Value$138,604BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$643,260TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO AFFILIATES$383,531
ACCRUED THIRD PARTY LIABILITY$525,000
FieldValueIRS element (for citing)
Total Liability$908,531TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$6,066,511TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$6,066,511RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$6,066,511TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$5,684,001TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$5,684,001ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$5,684,001TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION RECOGNIZES THE IMPACT OF TAX POSITIONS IN THE FINANCIAL STATEMENTS IF THAT POSITION IS MORE LIKELY THAN NOT OF BEING SUSTAINED ON AUDIT, BASED ON TECHNICAL MERITS OF THE POSITION. THE ORGANIZATION HAS NOT RECORDED ANY UNCERTAIN TAX POSITIONS. THE ORGANIZATION RECOGNIZES POTENTIAL ACCRUED INTEREST AND PENALTIES FOR UNCERTAIN TAX POSITIONS IN INCOME TAX EXPENSE. DURING THE YEAR ENDED JUNE 30, 2017, THE ORGANIZATION DID NOT RECOGNIZE ANY AMOUNT IN POTENTIAL INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
SHEILA BUSHERI
CEO$155,770$0$0$0$0$0$0$0$144$0$155,914$0$0$0
MOHAMMED RASEKHI MD
CMO$310,255$0$0$0$0$0$0$0$7,980$0$318,235$0$0$0

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonSHEILA BUSHERIPersonNm
Relationship With OrgCEORelationshipWithOrgTxt
Loan PurposeCASH FLOWLoanPurposeTxt
Loan To OrganizationYes (X)LoanToOrganizationInd
Original Principal$30,000OriginalPrincipalAmt
Balance Due$30,000BalanceDueAmt
Default0DefaultInd
Board Or Committee ApprovalYes (1)BoardOrCommitteeApprovalInd
Written AgreementYes (1)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$30,000TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
SHEILA BUSHERI AND MOHAMMED RASEKHI
CEO AND CMO$86,400PICO RIVERA, LLC, OWNED BY THE CEO AND CMO, LEASES A BUILDING TO THE ORGANIZATION0
SHEILA BUSHERI AND MOHAMMED RASEKHI
CEO AND CMO$373,905MCLAREN, LLC, OWNED BY THE CEO AND CMO, LEASES A BUILDING TO THE ORGANIZATION0
SHEILA BUSHERI AND MOHAMMED RASEKHI
CEO AND CMO$57,118UNIVERSAL DIAGNOSTIC LABORATORY, OWNED BY THE CEO AND CMO, LEASES SPACE FROM THE ORGANIZATION0
SHEILA BUSHERI AND MOHAMMED RASEKHI
CEO AND CMO$163,964UNIVERSAL DIAGNOSTIC LABORATORY, OWNED BY THE CEO AND CMO, PROVIDES LABORATORY SERVICES TO THE ORGANIZATION0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2THE CEO AND CMO ARE MARRIED.
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE TAX RETURN IS PRESENTED TO THE FINANCE COMMITTEE FOR REVIEW AND APPROVAL BEFORE IT IS FILED. THE ORGANIZATION ALSO DISTRIBUTES A COPY OF THE TAX RETURN TO THE BOARD OF DIRECTORS FOR INFORMATION ONLY.
FORM 990, PART VI, SECTION B, LINE 12CALL BOARD OF DIRECTORS MEMBERS SIGN THE CONFLICT OF INTEREST STATEMENTS CONFIRMING THAT THEY UNDERSTAND THE CONFLICT OF INTEREST POLICY. THE SECRETARY OF THE BOARD MONITORS THIS PROCEDURE TO ASSURE THAT THERE ARE NO CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD OF DIRECTORS APPROVES THE SALARIES, WAGES, AND OTHER COMPENSATION PAID TO TOP MANAGEMENT EMPLOYEES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION PROVIDES ANY GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS UPON REQUEST.
FORM 990, PART XII, LINE 2C:THERE HAVE BEEN NO CHANGES IN OVERSIGHT OR THE SELECTION PROCESS DURING THE YEAR.
FORM 990, PART XI, LINE 8DURING FISCAL 2017, THE ORGANIZATION DISCOVERED THAT THEY OWED AN ESTIMATED AMOUNT OF $357,561 TO THE STATE OF CALIFORNIA FOR THE PERIOD FROM FISCAL 2014 THROUGH 2017. THE AMOUNT RELATED TO FISCAL PERIOD 2014 THROUGH 2016 TOTALED $417,310. AS A RESULT, AN ESTIMATED LIABILITY FOR THE FISCAL YEAR OF JUNE 30, 2016 HAS BEEN REPORTED AS AN ADJUSTMENT TO UNRESTRICTED NET ASSETS. NET ASSETS AS OF JUNE 30, 2016 WAS REDUCED BY $417,310 AND PATIENT REVENUE FOR FISCAL 2016 WAS REDUCED BY $100,643. DURING 2017, MANAGEMENT OF THE ORGANIZATION DISCOVERED AN ERROR IN ACCOUNTING FOR PATIENT SERVICE RECEIVABLES AS OF JUNE 30, 2015. THUS, THE BEGINNING NET ASSETS AS OF JUNE 30, 2015, WAS REDUCED BY $91,230.

Schedule R IRS990ScheduleR

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdPredominant Income TypePredominantIncomeTypeTxtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerInd
PICO RIVERA LLC
7300 STEALTHPICO RIVERACA90660PROPERTY RENTALCAN/A000
MCLAREN LLC
14550 HAYNES STREETVAN NUYSCA91410PROPERTY RENTALCAN/A000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1UNIVERSAL DIAGNOSTIC LABORATORIESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line16700 VALJEAN AVENUEAddressLine1Txt
CityVAN NUYSCityNm
State AbbreviationCAStateAbbreviationCd
ZIP91406ZIPCd
FieldValueIRS element (for citing)
Primary ActivitiesLAB SERVICES AND PROPERTY RENTALPrimaryActivitiesTxt
Legal Domicile StateCALegalDomicileStateCd
Entity TypeSEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
PICO RIVERA LLC
K$86,400FAIR MARKET VALUE
MCLAREN LLC
K$373,905FAIR MARKET VALUE
UNIVERSAL DIAGNOSTIC LABORATORY
J$57,118FAIR MARKET VALUE
UNIVERSAL DIAGNOSTIC LABORATORY
M$163,964FAIR MARKET VALUE