PEACH TREE HEALTHCARE: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- PEACH TREE HEALTHCARE (EIN 68-0371679)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-16
- IRS object ID
- 201601379349303130
- Schema version
- 2014v6.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-16T10:47:14-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 462978632 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAVEZ SILVA & COMPANY | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 UNIVERSITY AVENUE SUITE 288 | AddressLine1Txt |
| City | SACRAMENTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95825 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680371679 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEACH TREE HEALTHCARE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PEAC | BusinessNameControlTxt |
| Phone | 5307493242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1114 YUBA STREET NO 144 | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KAY SIDHU | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5307493242 | PhoneNum |
| Signature | 2016-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID R CHAVEZ | PreparerPersonNm |
| PTIN | P01059448 | PTIN |
| Phone | 9162734808 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KAY SIDHU | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1114 YUBA STREET NO 144 | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,405,924 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PICKPEACH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1995 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | PEACH TREE HEALTH IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 120 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,011,302 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,316,934 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,848,275 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,215,437 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,019 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,963,398 | PYOtherRevenueAmt |
| CY Other Revenue | $1,292,293 | CYOtherRevenueAmt |
| PY Total Revenue | $11,824,994 | PYTotalRevenueAmt |
| CY Total Revenue | $13,824,664 | 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 | $7,439,319 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,372,666 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,084,811 | PYOtherExpensesAmt |
| CY Other Expenses | $5,124,853 | CYOtherExpensesAmt |
| PY Total Expenses | $12,524,130 | PYTotalExpensesAmt |
| CY Total Expenses | $12,497,519 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$699,136 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,327,145 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,200,466 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,035,994 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,104,387 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,612,772 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,096,079 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,423,222 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PEACH TREE HEALTH IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,737,466 | ExpenseAmt |
| Revenue | $12,507,730 | RevenueAmt |
| Desc | PROVIDED HEALTHCARE AND PHARMACEUTICAL SERVICES TO THE MEDICALLY UNDERSERVED POPULATION OF YUBA AND SUTTER COUNTY, CALIFORNIA, AND SURROUNDING COMMUNITIES. | Desc |
| Total Program Service Expenses | $8,737,466 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | 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 | 37 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | 0 | BackupWthldComplianceInd |
| Employee | 120 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 | KAY SIDHU | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5307493242 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1114 YUBA ST ROOM 144 | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95901 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ANA ANDRADE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BECKY DITTEMORE-ESCALANTE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CYNTHIA PENA | ||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| EDMUND SMITH | ||||||||
| PAST CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN NICOLETTI | ||||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| LIN LARSON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARCIA MYERS | ||||||||
| VICE-CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| NARINDER DHALIWAL | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBERTA D'ARCY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RUTH MIKKELSEN | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GREGORY STONE | ||||||||
| CEO | 40.00 | $165,254 | $0 | $2,951 | Yes (X) | |||
| KAY SIDHU | ||||||||
| CFO | 40.00 | $120,168 | $0 | $12,256 | Yes (X) | |||
| THEODORE FONG | ||||||||
| CHIEF DEVELOPMENT OFFICER | 40.00 | $140,000 | $0 | $20,857 | Yes (X) | |||
| ROSALIE PENA-PRIDMORE | ||||||||
| MEDICAL DOCTOR | 40.00 | $211,435 | $0 | $28,489 | Yes (X) | |||
| AZAD GAGANDEEP | ||||||||
| MEDICAL DOCTOR | 40.00 | $186,473 | $0 | $25,279 | Yes (X) | |||
| MARIA ABORDO | ||||||||
| MEDICAL DOCTOR | 40.00 | $200,433 | $0 | $47,179 | Yes (X) | |||
| PENNY LARSON | ||||||||
| MEDICAL DOCTOR | 40.00 | $170,257 | $0 | $3,226 | Yes (X) | |||
| CHERRY ANN WY | ||||||||
| MEDICAL DOCTOR | 40.00 | $223,751 | $0 | $44,750 | Yes (X) | |||
| TOMAS WY | ||||||||
| MEDICAL DOCTOR | 40.00 | $176,823 | $0 | $11,017 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,594,594 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $196,004 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RIDGE EYE CARE | |||||
| 7056 SKYWAY | PARADISE | CA | 95969 | OPHTHALMOLOGISTS | $403,440 |
| HEALTH INFORMATION TECHNOLOGY | |||||
| 775 BAYWOOD DRIVE SUITE 314 | PETALUMA | CA | 94954 | CONTRACTED IT SERVICES | $308,673 |
| TITAN NURSE STAFFING | |||||
| 2110 S 169TH PLAZA 100 | OMAHA | NE | 68130 | STAFFING AGENCY | $185,027 |
| YUBA SUTTER HOSPITALIST GROUP | |||||
| 726 4TH STREET | MARYSVILLE | CA | 95901 | HOSPITALIST SERVICES | $162,500 |
| AMERICAN HEALTHCARE ENTERPRISES | |||||
| 701 SOUTH HAM LANE SUITE E | LODI | CA | 95242 | CONTRACTED PHYSICIAN | $125,170 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,316,934 | GovernmentGrantsAmt |
| Total Contributions | $1,316,934 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $11,215,437 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,215,437 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,215,437 | TotalProgramServiceRevenueAmt |
| Gross Sales Of Inventory | $2,698,178 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,581,260 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,116,918 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,116,918 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $175,375 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $175,375 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $175,375 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,824,664 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,507,730 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $512,590 | TotalAmt |
| Program Services | $350,413 | ProgramServicesAmt |
| Management And General | $162,177 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,166,849 | TotalAmt |
| Program Services | $3,615,761 | ProgramServicesAmt |
| Management And General | $1,551,088 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,764 | TotalAmt |
| Program Services | $111,103 | ProgramServicesAmt |
| Management And General | $47,661 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,082,316 | TotalAmt |
| Program Services | $757,405 | ProgramServicesAmt |
| Management And General | $324,911 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $452,147 | TotalAmt |
| Program Services | $316,412 | ProgramServicesAmt |
| Management And General | $135,735 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,052 | TotalAmt |
| Program Services | $10,533 | ProgramServicesAmt |
| Management And General | $4,519 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,308 | TotalAmt |
| Program Services | $63,198 | ProgramServicesAmt |
| Management And General | $27,110 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,480,047 | TotalAmt |
| Program Services | $1,735,537 | ProgramServicesAmt |
| Management And General | $744,510 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $349,259 | TotalAmt |
| Program Services | $244,411 | ProgramServicesAmt |
| Management And General | $104,848 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $335,756 | TotalAmt |
| Program Services | $234,962 | ProgramServicesAmt |
| Management And General | $100,794 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,062 | TotalAmt |
| Program Services | $26,636 | ProgramServicesAmt |
| Management And General | $11,426 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $349,484 | TotalAmt |
| Program Services | $244,569 | ProgramServicesAmt |
| Management And General | $104,915 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,706 | TotalAmt |
| Program Services | $45,981 | ProgramServicesAmt |
| Management And General | $19,725 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVISION FOR BAD DEBT | $301,234 | $210,804 | $90,430 |
| PURCHASED SERVICES | $273,023 | $191,061 | $81,962 |
| LICENSES, TAXES, AND OT | $272,349 | $190,590 | $81,759 |
| REPAIRS & MAINTENANCE | $252,627 | $176,788 | $75,839 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $301,946 | TotalAmt |
| Program Services | $211,302 | ProgramServicesAmt |
| Management And General | $90,644 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,497,519 | TotalAmt |
| Program Services | $8,737,466 | ProgramServicesAmt |
| Management And General | $3,760,053 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $298,500 | BOYAmt |
| EOY | $836,382 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $583,448 | BOYAmt |
| EOY | $878,709 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,356,210 | BOYAmt |
| EOY | $2,664,758 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240,258 | BOYAmt |
| EOY | $229,818 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,783 | BOYAmt |
| EOY | $118,217 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,218,092 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,032,514 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,359,998 | BOYAmt |
| EOY | $1,185,578 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,269 | BOYAmt |
| EOY | $122,532 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,200,466 | BOYAmt |
| EOY | $6,035,994 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,205,170 | BOYAmt |
| EOY | $1,339,182 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $602,985 | BOYAmt |
| EOY | $1,261,233 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $594,022 | BOYAmt |
| EOY | $718,680 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $702,210 | BOYAmt |
| EOY | $293,677 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,104,387 | BOYAmt |
| EOY | $3,612,772 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,096,079 | BOYAmt |
| EOY | $2,423,222 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,096,079 | BOYAmt |
| EOY | $2,423,222 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,200,466 | BOYAmt |
| EOY | $6,035,994 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,327,145 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $716,178 | OtherCostOrOtherBasisAmt |
| Depreciation | $326,982 | DepreciationAmt |
| Book Value | $389,196 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,945,408 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,440,817 | DepreciationAmt |
| Book Value | $504,591 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $556,506 | OtherCostOrOtherBasisAmt |
| Depreciation | $264,715 | DepreciationAmt |
| Book Value | $291,791 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,185,578 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED LEASE LIABILITY | $121,963 |
| THIRD-PARTY SETTLEMENTS | $171,714 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $293,677 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $13,824,665 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,824,665 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,824,665 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,497,519 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,497,519 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,497,519 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GREGORY STONE | ||||||||||||||
| CEO | $165,254 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,951 | $0 | $168,205 | $0 | $0 | $0 |
| THEODORE FONG | ||||||||||||||
| CHIEF DEVELOPMENT OFFICER | $140,000 | $0 | $0 | $0 | $0 | $0 | $16,827 | $0 | $4,030 | $0 | $160,857 | $0 | $0 | $0 |
| ROSALIE PENA-PRIDMORE | ||||||||||||||
| MEDICAL DOCTOR | $192,145 | $0 | $4,980 | $0 | $14,310 | $0 | $24,459 | $0 | $4,030 | $0 | $239,924 | $0 | $0 | $0 |
| AZAD GAGANDEEP | ||||||||||||||
| MEDICAL DOCTOR | $176,538 | $0 | $1,845 | $0 | $8,090 | $0 | $21,229 | $0 | $4,050 | $0 | $211,752 | $0 | $0 | $0 |
| MARIA ABORDO | ||||||||||||||
| MEDICAL DOCTOR | $188,515 | $0 | $11,918 | $0 | $0 | $0 | $44,097 | $0 | $3,082 | $0 | $247,612 | $0 | $0 | $0 |
| PENNY LARSON | ||||||||||||||
| MEDICAL DOCTOR | $169,477 | $0 | $780 | $0 | $0 | $0 | $0 | $0 | $3,226 | $0 | $173,483 | $0 | $0 | $0 |
| CHERRY ANN WY | ||||||||||||||
| MEDICAL DOCTOR | $186,910 | $0 | $12,047 | $0 | $24,794 | $0 | $38,867 | $0 | $5,883 | $0 | $268,501 | $0 | $0 | $0 |
| TOMAS WY | ||||||||||||||
| MEDICAL DOCTOR | $176,538 | $0 | $285 | $0 | $0 | $0 | $6,987 | $0 | $4,030 | $0 | $187,840 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | CEO COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS ANNUALLY AND UPON HIRE. CEO COMPENSATION IS ESTABLISHED BY USING HISTORICAL BENCHMARKS FROM CEO'S, AS WELL AS THE SALARY GUIDE FROM THE CALIFORNIA PRIMARY CARE ASSOCIATION. WRITTEN EMPLOYEMENT CONTRACTS ARE OBTAINED FOR ALL CEO'S. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | LINE 11A EXPLANATION - THE CLINIC ENGAGES A CPA FIRM TO PREPARE THE INFORMATION RETURN. A DRAFT OF THE RETURN IS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE AND MANAGEMENT PRIOR TO SUBMISSION TO THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICTS OF INTEREST FOR INDIVIDUALS SERVING AS PART OF ANY GOVERNING BODY ARE REVIEWED AT A MINIMUM ANNUALLY. FULL DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST FOR ALL INDIVIDUALS SERVING AS PART OF ANY GOVERNING BODY IS REQUIRED. |
| FORM 990, PART VI, SECTION B, LINE 15 | ALL COMPENSATION TO SENIOR MANAGEMENT AND KEY EMPLOYEES IS APPROVED BY THE BOARD OF DIRECTORS. SENIOR MANAGEMENT COMPENSATION IS ESTABLISHED BY USING HISTORICAL BENCHMARKS FROM PREVIOUS EMPLOYEES, AS WELL AS THE SALARY GUIDE FROM THE CALIFORNIA PRIMARY CARE ASSOCIATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST, THE CLINIC WILL MAKE AVAILABLE ALL PUBLIC RECORDS. |
| FORM 990, PART IX, LINE 11G | CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,241,392. MANAGEMENT AND GENERAL EXPENSES 532,532. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,773,924. CONSULTING: PROGRAM SERVICE EXPENSES 360,495. MANAGEMENT AND GENERAL EXPENSES 154,645. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 515,140. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 110,726. MANAGEMENT AND GENERAL EXPENSES 47,499. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 158,225. IT SERVICES: PROGRAM SERVICE EXPENSES 22,924. MANAGEMENT AND GENERAL EXPENSES 9,834. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,758. |