2016-10-05T16:03:32-05:00 2015-12-31 330700332 VASQUEZ & CO LLP 801 S GRAND AVENUE SUITE 400 LOS ANGELES CA 90017 990 2015-01-01 954666712 UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC UNIV 3234065788 711 FLORENCE AVE LOS ANGELES CA 90044 YESSENIA HENRIQUEZ CHIEF FINANCE OFFICER 3234065788 2016-10-04 1 GILBERT R VASQUEZ P00743144 2138731700 2015 2017-02-10 21:41:12Z UMMA COMMUNITY CLINIC YESSENIA HENRIQUEZ CPA 711 FLORENCE AVENUE LOS ANGELES CA 90044 6262914 0 X WWW.UMMACLINIC.ORG X 1996 CA TO PROMOTE THE WELL BEING OF THE UNDESERVED BY PROVIDING ACCESS TO HIGH QUALITY HEALTHCARE FOR ALL, REGARDLESS OF THE ABILITY TO PAY. 12 12 69 0 0 0 2948363 3240334 2627313 2908186 193 168 105859 114226 5681728 6262914 0 0 0 0 3356278 2973392 0 0 316618 2522942 2812553 5879220 5785945 -197492 476969 3695301 4031235 868773 727738 2826528 3303497 TO PROMOTE THE WELL BEING OF THE UNDERSERVED BY PROVIDING ACCESS TO HIGH QUALITY HEALTHCARE FOR ALL, REGARDLESS OF THE ABILITY TO PAY. 0 0 4948892 3022412 THE UMMA COMMUNITY CLINIC PROVIDED COMPREHENSIVE ADULT AND PEDIATRIC HEALTHCARE SERVICE TO ADULTS AND CHILDREN WHO HAVE UTILIZED OVER 18,000 VISITS TO MAINTAIN THEIR WELL BEING. 4948892 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 25 0 1 69 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X X YESSENIA HENRIQUEZ 3239670375 711 FLORENCE AVE LOS ANGELES CA 90044 MURTAZA SANWARI MPH CHAIRMAN 2.00 X X 0 0 0 PAUL W WONG ESQ VICE-CHAIRMAN 2.00 X X 0 0 0 RAZIYA SHAIKH PHD TREASURER 2.00 X X 0 0 0 NORMA ARAMBULA SECRETARY 2.00 X X 0 0 0 MUNAF KADRI MD BOARD MEMBER 2.00 X 0 0 0 SAUL SARABIA BOARD MEMBER 2.00 X 0 0 0 RASHEEDA ROGERS BOARD MEMBER 2.00 X 0 0 0 NAIM SHAH SR BOARD MEMBER 2.00 X 0 0 0 KHALIQ SIDDIQ MD MPH BOARD MEMBER 2.00 X 0 0 0 ADRIAN CID URIBE ESQ BOARD MEMBER 2.00 X 0 0 0 VIVIANA TRUJILLO BOARD MEMBER 2.00 X 0 0 0 NADINA ALTAMIRANO BOARD MEMBER 2.00 X 0 0 0 YESSENIA HENRIQUEZ CHIEF FINANCE OFFICER 40.00 X 111439 0 0 JACKIE PROVOST CHIEF OPERATION DIRECTOR 40.00 X 111102 0 0 CESAR BARBA CHIEF MEDICAL INFORMATIC OFFICER 40.00 X 163126 0 0 SHOWKOT ARA RAHMAN INTERIM CHIEF MEDICAL OFFICER 40.00 X 175698 0 0 SARAH M ABDELRAHMAN PHYSICIAN 40.00 X 148140 0 0 709505 0 0 5 0 1 0 PROVIDERS HEALTH CARE LLC 4252 S HIGHLAND DR STE 104 SALT LAKE CITY UT 84124 PROVIDE LOCUM DOCTORS 210170 HEALTH MGMT ASSOCIATION INC 120 N WASHINGTON SQUARE STE 705 LANSING MI 48933 PROVIDE LOCUM DOCTORS 122687 COMPHEALTH PO BOX 972651 DALLAS TX 75395 PROVIDE LOCUM DOCTORS 102907 3 2214689 1025645 80903 3240334 NET PATIENT REVENUE 900099 2908186 2908186 2908186 168 168 OTHER INCOME 900099 114226 114226 114226 6262914 3022412 0 168 X 561365 561365 1967501 1684857 104797 177847 235312 191269 25645 18398 209214 170056 22801 16357 1529783 1379625 138779 11379 141346 99144 42202 30005 13512 9966 6527 86713 74937 11162 614 79430 70673 8757 MAINTENANCE & SERVICE A 238601 197346 39686 1569 CONSUMABLE SUPPLIES 206308 186099 19723 486 TELEPHONE 152337 94851 56984 502 ZAKAT DONATION 88807 88807 259223 136351 39933 82939 5785945 4948892 520435 316618 603369 1442256 475444 261153 349334 196103 87179 71303 2325709 704451 1707971 1621258 472004 439162 3695301 4031235 328690 292764 463098 275569 76985 159405 868773 727738 X 2347482 3080027 479046 223470 2826528 3303497 3695301 4031235 476969 0 X 0 1 X 1 1 1 X 2136335 2385526 3263485 2948363 3240334 13974043 1319645 2301284 2410197 2627313 2908186 11566625 3455980 4686810 5673682 5575676 6148520 25540668 0 0 0 25540668 2 205 193 168 568 2 205 193 168 568 18917 43483 54679 105859 114226 337164 3474897 4730295 5728566 5681728 6262914 25878400 0.98690 0.98960 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 656000 656000 971707 121763 849944 28078 17532 10546 669924 565156 104768 1621258 THIRD-PARTY SETTLEMENTS RECEIVABLE 419038 OTHER ASSETS 20124 439162 THIRD-PARTY SETTLEMENTS DEBT 159405 159405 X 6326877 63963 63963 6262914 0 6262914 5849908 63963 63963 5785945 0 5785945 PART X, LINE 2: THE CORPORATION QUALIFIES AS A TAX EXEMPT ORGANIZATION UNDER THE INTERNAL REVENUE CODE SECTION 501(C)(3) AND CALIFORNIA REVENUE AND TAXATION CODE 23701D. THE CORPORATION HAS EVALUATED ITS TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED RELATE TO THE CORPORATIONS CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE ARE UNRELATED BUSINESS INCOME ACTIVITIES THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS WILL MORE LIKELY THAN NOT (>50%) BE SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURE OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. THE CORPORATION FILES INFORMATION RETURNS IN THE US FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. WITH FEW EXCEPTIONS, THE CORPORATION IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. X X X X 0 0 0 0 0 0 0 0 0 CESAR BARBA CHIEF MEDICAL INFORMATIC OFFICER 163126 0 0 0 0 0 0 0 0 0 163126 0 0 0 SHOWKOT ARA RAHMAN INTERIM CHIEF MEDICAL OFFICER 175698 0 0 0 0 0 0 0 0 0 175698 0 0 0 X PHARMACEUTICALS 0 80903 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE EXTERNAL AUDITOR UPON COMPLETION OF THE INDEPENDENT AUDIT. IT IS REVIEWED BY THE FINANCE DIRECTOR, CEO AND FINANCE COMMITTEE BOARD MEMBERS. UPON REVIEW AND APPROVAL BY THE FINANCE COMMITTEE, IT IS PRESENTED TO THE FULL BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILLING WITH THE INTERNAL REVENUE SERVICES. THE FORM 990 IS POSTED ON UMMA WEBSITE AND IT IS ALSO UPLOADED INTO GUIDESTAR. FORM 990, PART VI, SECTION B, LINE 12C UMMA REQUIRES ITS DIRECTORS, OFFICERS, EMPLOYEES AND VOLUNTEERS TO OBSERVE HIGH STANDARDS OF BUSINESS AND PERSONAL ETHICS IN THE CONDUCT OF THEIR DUTIES AND RESPONSIBILITIES. THE PRIMARY OBLIGATION OF ANY PERSON SUBJECT TO THIS POLICY WHO MAY BE INVOLVED IN A CONFLICT OF INTEREST SITUATION IS TO BRING IT TO THE ATTENTION OF THOSE DESIGNATED UNDER THE DISCLOSURE PROCEDURE IN THIS POLICY AND CAN BE EVALUATED AND ADDRESSED. CONFLICT OF INTEREST DISCLOSURE FORMS WILL BE SUBMITTED TO THE CHAIRPERSON OF THE AUDIT, EXECUTIVE, AND GOVERNANCE COMMITTEE AND THE CHAIR OF THE BOARD ANNUALLY, AND WHEN APPROPRIATE, AT OR PRIOR TO ACTION ON RELEVANT BUSINESS TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 UMMA HR SPECIALISTS MEETS AND PROVIDES SALARY HISTORY TO OUTSIDE CONSULTANT, WHO IN TURN DETERMINES SALARY RANGES FOR ALL PERSONNEL (INCLUDING CFO/MANAGEMENT) BASED ON LIKE INDUSTRY AND ORGANIZATION SIZE. RESULTS OF FINDINGS ARE PRESENTED TO THE BOARD OF DIRECTORS, WHO UTILIZE THESE RESULTS ALONG WITH OTHER FACTORS TO DETERMINE, SET, AND APPROVE DESIRED SALARY FOR CEO / KEY EMPLOYEE/MANAGEMENT. DECEMBER 2012 IS WHEN THE PROCESS WAS LAST CONDUCTED FOR THE CEO AND OTHER OFFICERS. FORM 990, PART VI, SECTION C, LINE 19 SOME OR ALL OF THESE ITEMS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTANT & CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 1,379,625. MANAGEMENT AND GENERAL EXPENSES 105,028. FUNDRAISING EXPENSES 11,379. TOTAL EXPENSES 1,496,032. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 33,751. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,751.