MONTAGE MEDICAL GROUP: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MONTAGE MEDICAL GROUP (EIN 26-4826604)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-15
- IRS object ID
- 201603209349317915
- Schema version
- 2015v2.1
- 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 | 2016-11-15T20:03:08-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Moss Adams LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 Second Street Suite 900 | AddressLine1Txt |
| City | San Francisco | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94105 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264826604 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Peninsula Primary Care | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PENI | BusinessNameControlTxt |
| Phone | 8317189720 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box HH | AddressLine1Txt |
| City | Monterey | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93942 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURA ZEHM | PersonNm |
| Person Title | VP/CFO | PersonTitleTxt |
| Phone | 8317189720 | PhoneNum |
| Signature | 2016-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Richard Croghan | PreparerPersonNm |
| PTIN | P00089862 | PTIN |
| Phone | 4159561500 | PhoneNum |
| Preparation | 2016-11-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVEN PACKER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box HH | AddressLine1Txt |
| City | Monterey | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93942 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,984,952 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.peninsulaprimarycare.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2009 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH CARE FOR THE GENERAL PUBLIC, CARRY ON ANY EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK OR INJURED, AND TO PARTICIPATE IN SCIENTIFIC HEALTHCARE-RELATED RESEARCH TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 142 | TotalEmployeeCnt |
| Total Volunteers | 4 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $665,996 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,500,000 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,905,555 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,054,815 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $695,174 | PYOtherRevenueAmt |
| CY Other Revenue | $1,430,137 | CYOtherRevenueAmt |
| PY Total Revenue | $8,266,725 | PYTotalRevenueAmt |
| CY Total Revenue | $12,984,952 | 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 | $8,641,453 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,259,659 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,882,033 | PYOtherExpensesAmt |
| CY Other Expenses | $4,659,130 | CYOtherExpensesAmt |
| PY Total Expenses | $11,523,486 | PYTotalExpensesAmt |
| CY Total Expenses | $15,918,789 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,256,761 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,933,837 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,154,968 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,985,603 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,093,034 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,857,506 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$3,938,066 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$6,871,903 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE HEALTH CARE FOR THE GENERAL PUBLIC, CARRY ON ANY EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK OR INJURED, AND TO PARTICIPATE IN SCIENTIFIC HEALTHCARE-RELATED RESEARCH TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,788,180 | ExpenseAmt |
| Revenue | $10,054,815 | RevenueAmt |
| Desc | DIRECT CLINICAL SERVICES. | Desc |
| Total Program Service Expenses | $14,788,180 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | Yes (1) | 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 | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 142 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHIRLEY NORMAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8312428605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box HH | AddressLine1Txt |
| City | Monterey | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93942 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MIKE LYON | ||||||||
| VICE CHAIR | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEVEN PACKER MD | ||||||||
| President | 1.00 | 54.00 | Yes (X) | Yes (X) | $0 | $929,346 | $309,395 | |
| Jill Sheffield | ||||||||
| CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Anthony Chavis | ||||||||
| SECRETARY | 0.00 | 55.00 | Yes (X) | Yes (X) | $0 | $582,678 | $88,713 | |
| DAVID STRAFACE MD | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $336,427 | $0 | $24,006 | ||
| Geraldin Taplin md | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $11,175 | $0 | $0 | ||
| John Mahoney | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Stan Mckee | ||||||||
| DIRECTOR | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| LAURA ZEHM | ||||||||
| CFO | 1.00 | 54.00 | Yes (X) | $0 | $606,752 | $102,146 | ||
| ALEXANDER IZMAILOV MD | ||||||||
| EMPLOYEE | 40.00 | 0.00 | $370,607 | $79,652 | $18,000 | Yes (X) | ||
| JIHAD JAFFER MD | ||||||||
| EMPLOYEE | 40.00 | 0.00 | $355,535 | $61,065 | $7,714 | Yes (X) | ||
| Nicholas Chee MD | ||||||||
| EMPLOYEE | 40.00 | 0.00 | $403,623 | $2,912 | $35,177 | Yes (X) | ||
| Pir Shah MD | ||||||||
| employee | 40.00 | 0.00 | $397,772 | $63,400 | $41,601 | Yes (X) | ||
| Michael Galloway MD | ||||||||
| employee | 40.00 | 0.00 | $356,582 | $0 | $9,594 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,231,721 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,325,805 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $636,346 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | 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 | Address Line1ContractorAddress/ForeignAddress/AddressLine1Txt | CityContractorAddress/ForeignAddress/CityNm | Province Or StateContractorAddress/ForeignAddress/ProvinceOrStateNm | CountryContractorAddress/ForeignAddress/CountryCd |
|---|---|---|---|---|---|---|---|---|---|
| Cypress Healthcare Partners | |||||||||
| PO Box HH | Monterey | CA | 93942 | Medical Services | $1,041,876 | ||||
| Quality Systems Inc | |||||||||
| PO Box 511449 | Los Angeles | CA | 90051 | AR Billing Maintenance | $360,065 | ||||
| MCKESSON MEDICAL SURGICAL | |||||||||
| MEDICAL | $212,965 | 130-10711 Cambie Road | Richmond | British Columbia | CA | ||||
| Computer Technical Specialties | |||||||||
| 7441 Matterhorn Pl | Salinas | CA | 93907 | Computer Support | $155,354 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,500,000 | RelatedOrganizationsAmt |
| Total Contributions | $1,500,000 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | patient fees | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $10,054,815 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,054,815 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,054,815 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Incentive payments | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,430,137 | TotalRevenueColumnAmt |
| Exclusion | $1,430,137 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,430,137 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,984,952 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,054,815 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,430,137 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $371,608 | TotalAmt |
| Program Services | $371,608 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,111,128 | TotalAmt |
| Program Services | $10,111,128 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,790 | TotalAmt |
| Program Services | $21,790 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $507,698 | TotalAmt |
| Program Services | $507,698 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,435 | TotalAmt |
| Program Services | $247,435 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,115,926 | TotalAmt |
| Program Services | $10,317 | ProgramServicesAmt |
| Management And General | $1,105,609 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,498,864 | TotalAmt |
| Program Services | $1,498,864 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,191 | TotalAmt |
| Program Services | $108,191 | ProgramServicesAmt |
| Management And General | $25,000 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,220 | TotalAmt |
| Program Services | $203,220 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,044,671 | TotalAmt |
| Program Services | $1,044,671 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,434 | TotalAmt |
| Program Services | $143,434 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Vaccines and Medicine | $274,526 | $274,526 |
| Medical Supplies | $235,060 | $235,060 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,238 | TotalAmt |
| Program Services | $10,238 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,918,789 | TotalAmt |
| Program Services | $14,788,180 | ProgramServicesAmt |
| Management And General | $1,130,609 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,131 | BOYAmt |
| EOY | $295,732 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $754,077 | BOYAmt |
| EOY | $1,322,602 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,360 | BOYAmt |
| EOY | $81,581 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,654,645 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $389,973 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,256,384 | BOYAmt |
| EOY | $1,264,672 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,016 | BOYAmt |
| EOY | $21,016 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,154,968 | BOYAmt |
| EOY | $2,985,603 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,115,984 | BOYAmt |
| EOY | $1,193,579 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,977,050 | BOYAmt |
| EOY | $8,663,927 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,093,034 | BOYAmt |
| EOY | $9,857,506 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,938,066 | BOYAmt |
| EOY | -$6,871,903 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,938,066 | BOYAmt |
| EOY | -$6,871,903 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,154,968 | BOYAmt |
| EOY | $2,985,603 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,933,837 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $66,554 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,609 | DepreciationAmt |
| Book Value | $60,945 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,588,091 | OtherCostOrOtherBasisAmt |
| Depreciation | $384,364 | DepreciationAmt |
| Book Value | $1,203,727 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,264,672 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| LOAN FROM CHOMP | $8,663,712 |
| PENSION LOAN EE | $57 |
| Suspense | $158 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,663,927 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | CHF, CHOMP, CHE, CHP, and PPC have been determined to be exempt organizations by the Internal Revenue Service and the California Franchise Tax Board and generally are not subject to taxes on income pursuant to Section 501(c)(3) and Section 23701(d) of the Internal Revenue Code and California Revenue and Taxation Code, respectively. Aspire, CCCMIC, CMN, and Coastal are taxable entities and income taxes are accounted for using an asset and liability approach that requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined based on the differences between the consolidated financial statement and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Aspire, CCCMIC, CMN, and Coastal have net cumulative losses and the deferred tax assets associated with these losses have been fully reserved. There were no tax provisions recorded for the years ended December 31, 2015 and 2014. The Organization assesses uncertain tax positions in accordance with the provisions of the Financial Accounting Standards Board ("FASB") Accounting Standards Codification ("ASC") Topic 740-10, Income Taxes. The Organization recognizes the tax benefit from uncertain tax positions only if it is more likely than not that the tax positions will be sustained on examination by the tax authorities, based on the technical merits of the position. The tax benefit is measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. The Organization recognizes interest and penalties related to income tax matters in operating expenses. There were no uncertain tax positions as of December 31, 2015 and 2014. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN PACKER MD | ||||||||||||||
| President | $0 | $660,471 | $0 | $231,250 | $0 | $37,625 | $0 | $279,163 | $0 | $30,232 | $0 | $1,238,741 | $0 | $0 |
| Anthony Chavis | ||||||||||||||
| SECRETARY | $0 | $440,375 | $0 | $117,404 | $0 | $24,899 | $0 | $65,442 | $0 | $23,271 | $0 | $671,391 | $0 | $0 |
| DAVID STRAFACE MD | ||||||||||||||
| DIRECTOR | $216,249 | $0 | $56,930 | $0 | $63,248 | $0 | $23,000 | $0 | $1,006 | $0 | $360,433 | $0 | $0 | $0 |
| LAURA ZEHM | ||||||||||||||
| CFO | $0 | $460,836 | $0 | $125,043 | $0 | $20,873 | $0 | $78,875 | $0 | $23,271 | $0 | $708,898 | $0 | $0 |
| ALEXANDER IZMAILOV MD | ||||||||||||||
| EMPLOYEE | $247,521 | $79,652 | $89,857 | $0 | $33,229 | $0 | $18,000 | $0 | $0 | $0 | $388,607 | $79,652 | $0 | $0 |
| JIHAD JAFFER MD | ||||||||||||||
| EMPLOYEE | $275,669 | $61,065 | $64,534 | $0 | $15,332 | $0 | $0 | $0 | $7,714 | $0 | $363,249 | $61,065 | $0 | $0 |
| Nicholas Chee MD | ||||||||||||||
| EMPLOYEE | $349,924 | $2,912 | $53,699 | $0 | $0 | $0 | $24,000 | $0 | $11,177 | $0 | $438,800 | $2,912 | $0 | $0 |
| Pir Shah MD | ||||||||||||||
| employee | $397,772 | $63,400 | $0 | $0 | $0 | $0 | $24,000 | $0 | $17,601 | $0 | $439,373 | $63,400 | $0 | $0 |
| Michael Galloway MD | ||||||||||||||
| employee | $333,793 | $0 | $22,789 | $0 | $0 | $0 | $0 | $0 | $9,594 | $0 | $366,176 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 3 | FormAndLineReferenceDesc |
| Explanation | PPC RELIES ON A RELATED ORGANIZATION, COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA, TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS USING ALL OF THE METHODS DESCRIBED ON LINE 3 EXCEPT "FORM 990 OF OTHER ORGANIZATIONS." | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | Cypress Healthcare is a professional physician management company. When the former Executive director left in March, 2012, Cypress Healthcare assumed some of the responsibilities of the ED. |
| Form 990, Part VI, Section B, line 11 | the cfo is responsible for reviewing the form 990 before filing. Electronic copies are sent to all board members for review prior to filing. |
| Form 990, Part VI, Section B, line 12c | THE ORGANIZATION USES SELF DISCLOSURE BY INTERESTED PERSONS AND MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. |
| Form 990, Part VI, Section C, line 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC BY REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HOSPITAL FOUNDATION | |||||||||||
| po box hh | MONTEREY | CA | 93942 | 942789696 | SUPPORT SERVICES | CA | 501(C)(3) | Line 9 | N/A | 0 | |
| COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA | |||||||||||
| Po box hh | MONTEREY | CA | 93942 | 940760193 | HEALTHCARE SERVICES | CA | 501(C)(3) | Line 3 | 0 | COMMUNITY HOSPITAL FOUNDATION | |
| COMMUNITY HOSPITAL PROPERTIES | |||||||||||
| PO box hh | MONTEREY | CA | 93942 | 942795922 | suppORT SERVICES | CA | 501(C)(3) | Line 11a, I | 0 | COMMUNITY HOSPITAL FOUNDATION | |
| COMMUNITY HOSPITAL ENDOWMENTS | |||||||||||
| po box hh | mONTEREY | CA | 93942 | 942795423 | support SERVICES | CA | 501(C)(3) | Line 11a, I | 0 | COMMUNITY HOSPITAL FOUNDATION | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Aspire Health Plan | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 23625 Holman Highway | AddressLine1Txt |
| City | Monterey | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93940 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461567681 | EIN |
| Primary Activities | Insurance Company | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |