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GRACELIGHT COMMUNITY HEALTH: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
GRACELIGHT COMMUNITY HEALTH (EIN 95-3702136)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-06
IRS object ID
201421269349301397
Schema version
2012v2.0
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)
Timestamp2014-05-06T15:29:56-07:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LUNDY FLEMING LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12 BALA PLZ STE 300AddressLine1
CityBALA CYNWYDCity
StatePAState
ZIP Code190041512ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN953702136EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1QUEENSCARE HEALTH CENTERSBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlQUEENameControl
Phone3236694304Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11300 N VERMONT AVENUEAddressLine1
CityLOS ANGELESCity
StateCAState
ZIP Code90027ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGARY C GRUBBSName
TitleCFOTitle
Phone3236694304Phone
Date Signed2014-05-06DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameNOEL A FLEMINGName
Phone6106607788Phone
Date Prepared2014-05-06DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1BARBARA B HINESBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11300 N VERMONT AVENUE STE 1002AddressLine1
CityLOS ANGELESCity
StateCAState
ZIP Code90027ZIPCode
FieldValueIRS element (for citing)
Gross Receipts22631269GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.queenscarehealthcenters.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1925YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionQUEENSCARE HEALTH CENTERS, DIRECTLY AND INDIRECTLY,PROVIDES MEDICAL, DENTAL,AND VISION CARE SERVICES TO UNDERSERVED AND NEGLECTED POPULATIONS IN LOS ANGELES COUNTY, INCLUDING THE UNINSURED, INDIGENT, ELDERLY, AND CHILDREN.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees267TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year5770652ContributionsGrantsPriorYear
Contributions Grants Current Year5006429ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15966456ProgramServiceRevenuePriorYear
Program Service Revenue CY16333352ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year949482OtherRevenuePriorYear
Other Revenue Current Year1291488OtherRevenueCurrentYear
Total Revenue Prior Year22686590TotalRevenuePriorYear
Total Revenue Current Year22631269TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12957666SalariesEtcPriorYear
Salaries Etc Current Year13123627SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year5700TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY3250TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year3250TotalFundrsngExpCurrentYear
Other Expense Prior Year8730056OtherExpensePriorYear
Other Expenses Current Year8386976OtherExpensesCurrentYear
Total Expenses Prior Year21693422TotalExpensesPriorYear
Total Expenses Current Year21513853TotalExpensesCurrentYear
Revenues Less Expenses Prior Year993168RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1117416RevenuesLessExpensesCY
Total Assets BOY11833920TotalAssetsBOY
Total Assets EOY13533101TotalAssetsEOY
Total Liabilities BOY1591959TotalLiabilitiesBOY
Total Liabilities EOY2173724TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10241961NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY11359377NetAssetsOrFundBalancesEOY
Mission DescriptionQUEENSCARE HEALTH CENTERS,MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense19331671Expense
Revenue17624840Revenue
DescriptionQUEENSCARE HEALTH CENTERS PROVIDES DIRECTLY AND THROUGH THE QFC/QCP PARTNERSHIP MEDICAL, DENTAL, AND VISION SERVICES TO UNDERSERVED POPULATIONS, IN- CLUDING THE UNINSURED, INDIGENT, ELDERLY, AND CHILDREN. DURING THIS FISCAL YEAR, QUEENSCARE HEALTH CENTERS PROVIDED SERVICES TO MORE THAN 28,000 PATIENTS WHICH ACCOUNTED FOR MORE THAN 118,000 VISITS.Description
Total Program Service Expense19331671TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096119NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees267NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1GARY C GRUBBS CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3236694305TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11300 N VERMONT AVE STE 1002AddressLine1
CityLOS ANGELESCity
StateCAState
ZIP Code90027ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
ALLAN MICHELENA
CHAIRMAN2.00XX215022500
SR JUDY MURPHYCSJ
SECRETARY2.00XX152001131500
JAY GUERENA
Vice Chair2.00XX200043750
JORGE BLANCO
DIRECTOR2.00X90000
SHIRLEY DANIELS
DIRECTOR2.00X155000
ARCHBISHOP VATCHE HOVSEPIAN
DIRECTOR2.00X100000
FRANK REY DE PEREA
DIRECTOR2.00X220000
MARY EVELYN RAMOS
DIRECTOR2.00X90000
MANUEL ROMERO
DIRECTOR2.00X110000
WILLY RUIZ
DIRECTOR2.00X80000
MARGARITA DUARTE TUCKER
DIRECTOR2.00X100000
SR MARTHA VEGASSS
DIRECTOR2.00X70000
RAY VERNOY
DIRECTOR2.00X40000
DAVID WALSH
DIRECTOR2.00X157515000
EDWARD J AVILA
DIRECTOR2X750
BARBARA B HINES
PRESIDENT & CEO20X12161911406836203
ALEJANDRO A ARMSTRONG
COO4015800734152X
GARY C GRUBBS
CHIEF FINANCIAL OFFICER20X569215718013332
FIKRY FANOUS MD
OB/GYN40216212X
EMELOU C SAGARALMD
PHYSICIAN4018293613874X
KHANH NGUYEN MD
PHYSICIAN40187730X
ANGELITA G ARAQUEL MD
PHYSICIAN401775198021X
HYUN H KIM MD
PHYSICIAN401816601018X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1314829TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs292523TotalReportableCompFrmRltdOrgs
Total Other Compensation106600TotalOtherCompensation
Number Individuals GT100 K31NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
QUEST DIAGNOSTICS
PO BOX 555LOS ANGELESCA90017LAB SERVICES494615
MEDICAL PROFESSIONAL INC
PO BOX 910569SAN DIEGOCA92191Contract Workers374028
RBB ARCHITECTSINC
10980 WILSHIRE BLVDLOS ANGELESCA90024Architects & Planning286008
FACILITY MASTERS
2903 SATURN ST STE EBREACA92821Cleaning Services213146
UNIV OF SO CAL SCHOOL OF PHARMACY
1985 ZONAL AVENUELOS ANGELESCA90089DENTAL SERVICES440383
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants2943460GovernmentGrants
All Other Contributions2062969AllOtherContributions
Noncash Contributions1052603NoncashContributions
Total Contributions5006429TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumn
NET PATIENT REVENUE62140011989802
REV FROM QFC/QCP PART6214004343550
FieldValueIRS element (for citing)
Total Program Service Revenue16333352TotalProgramServiceRevenue

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code621400BusinessCode
Total Revenue Column1291488TotalRevenueColumn
Related Or Exempt Function Income1291488RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1291488TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column22631269TotalRevenueColumn
Related Or Exempt Function Income17624840RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total665685Total
Program Services184385ProgramServices
Management And General481300ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9269660Total
Program Services8677729ProgramServices
Management And General591931ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total217481Total
Program Services185720ProgramServices
Management And General31761ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2233544Total
Program Services2095137ProgramServices
Management And General138407ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total737257Total
Program Services661175ProgramServices
Management And General76082ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total56284Total
Program Services4872ProgramServices
Management And General51412ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total45000Total
Program Services0ProgramServices
Management And General45000ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total3250Total
Fundraising3250Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total87416Total
Program Services79075ProgramServices
Management And General8341ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total270607Total
Program Services239316ProgramServices
Management And General31291ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total88759Total
Program Services27866ProgramServices
Management And General60893ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total398352Total
Program Services360413ProgramServices
Management And General37939ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total376948Total
Program Services350766ProgramServices
Management And General26182ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
RENT10280568150672129890
PHYSICIAN FEES64464564464500
LAB FEES & RADIOLOGY79894579894500
PHARMACEUTICALS1474013147401300

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3117951Total
Program Services2732547ProgramServices
Management And General385404ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total21513853Total
Program Services19331671ProgramServices
Management And General2178932ManagementAndGeneral
Fundraising3250Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3550BOY
EOY4470EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6134640BOY
EOY4802141EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1014337BOY
EOY202031EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1348963BOY
EOY1608605EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY940895BOY
EOY840229EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY186285BOY
EOY182223EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10756998LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5675119LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1792295BOY
EOY5081879EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY412955BOY
EOY811523EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11833920BOY
EOY13533101EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1591959BOY
EOY2173724EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1591959BOY
EOY2173724EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY9212767BOY
EOY10512067EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1029194BOY
EOY847310EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10241961BOY
EOY11359377EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11833920BOY
EOY13533101EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses1117416ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170
Public Support Total5090PublicSupportTotal509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1029194BeginningOfYearBalance
Contributions896008Contributions
Other Expenditures1077892OtherExpenditures
End Of Year Balance847310EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1094486BeginningOfYearBalance
Contributions1672440Contributions
Other Expenditures1737732OtherExpenditures
End Of Year Balance1029194EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance885006BeginningOfYearBalance
Contributions1081782Contributions
Other Expenditures872302OtherExpenditures
End Of Year Balance1094486EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance679706BeginningOfYearBalance
Contributions2209762Contributions
Other Expenditures2004462OtherExpenditures
End Of Year Balance885006EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance723476BeginningOfYearBalance
Other Expenditures43770OtherExpenditures
End Of Year Balance679706EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis3051121InvestmentCostOrOtherBasis
Book Value3051121BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1475388InvestmentCostOrOtherBasis
Depreciation964398Depreciation
Book Value510990BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis5281474InvestmentCostOrOtherBasis
Depreciation4710721Depreciation
Book Value570753BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis949015InvestmentCostOrOtherBasis
Book Value949015BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5081879TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Other receivables389369
Receivable from affiliates274009
Security deposits6309
Other141836
FieldValueIRS element (for citing)
Total Book Value Other Assets811523TotalBookValueOtherAssets
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt22631269TotRevenueEtcAuditedFinclStmt
Revenue Subtotal22631269RevenueSubtotal
Total Revenue Per Form99022631269TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt21513853TotExpensesEtcAuditedFinclStmt
Expenses Subtotal21513853ExpensesSubtotal
Total Expenses Per Form99021513853TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierExplanationExplanation
Pt V Line 4QueensCare Health Centers ("QHC") intends to use its endowment funds to support healthcare related activities.
Pt X Line 2As required by U.S. GAAP, QHC has identified and evaluated its significant tax positions for which the statute of limitations remain open and has determined that there is no material unrecognized benefit or liability to be recorded. The open tax years are the years ended June 30, 2010 through June 30, 2013 for federal tax purposes
Pt X Line 2and the years ended June 30, 2009 through June 30, 2013 for California tax purposes. There have been no material changes in unrecognized benefits as of June 30, 2013, nor are any material changes anticipated in the twelve months following June 30, 2013. There have been no related tax penalties or interest, which would be classified as a tax expense in the statement of activities.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgBonus Filing OrgBonusFilingOrg
BARBARA B HINES
1216191122621806725672561084510846139720132170
ALEJANDRO A ARMSTRONG
1565319800243521921591476
FIKRY FANOUS MD
197976216212348614750
EMELOU C SAGARALMD
18235613874196810580
KHANH NGUYEN MD
1845411877303189
ANGELITA G ARAQUEL MD
17464580211855402874
HYUN H KIM MD
17892510181826782735

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions0NumberOfContributions
Noncash Contribs Rptd F9901052603NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Pt I Line 20Form 990During its fiscal year 7/1/2012 - 6/30/13, QueensCare
Form 990Health Centers received donations of numerous
Form 990pharmaceutical and medical products with an aggregate estimated
Form 990value of $1,052,603 from various pharmaceutical
: MANUFACTURERS AND OTHER ORGANIZATIONS.;

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (81 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 11bFollowing preparation of a final draft of the Form 990,
the organization's CEO and CFO review, analyze and discuss the
final draft to better ensure its accuracy and completeness.
After the return is filed, the CEO and CFO review
and discuss material aspects and details of the return
at the next regularly scheduled meeting of the Board
of Directors.
Pt VI, Line 12cThe organization's Board members, corporate officers,
and staff are subject to a conflict of interest policy.
Pursuant to that policy, each such person is required
to identify any transaction with the organization in
which the person has (or may have) a financial interest.
If a conflict (or potential conflict)is identified, the
Board, excluding any involved Board members, carefully
reviews the terms of the transaction and makes a
determination as to whether the transaction is fair and
reasonable to the organization under all the facts and
circumstances. The organization monitors and enforces
compliance with this policy by: (i) discussing such
issues at its annual meeting; (ii) requiring all
covered persons to annually provide written certifica-
tion of their compliance with the policy; and
(iii) carefully reviewing all material transactions to
identify potential or real conflicts.
Pt VI, Line 15aA Compensation Committee comprised of independent Board
members formulates a proposed compensation level for the
Form 990, Part IX, Line 24fMESSENGER, POSTAGE 68382. 62469. 5913. 0. OTHER PROFESSIONAL FEES 847140. 584074. 263066. 0. EQUIP. REPAIR & MAINTENANCE 205447. 205447. 0. 0. PRINTING & PUBLICATIONS 28670. 24473. 4197. 0. PURCHASED SERV-CONTR WORKERS 521487. 521070. 417. 0. PURCHASED SERV-ADVERTISING 69966. 69966. 0. 0. PURCHASED SERV-SECURITY 213474. 213474. 0. 0. PAYROLL SERVICE 110028. 93586. 16442. 0. PURCHASED SERV-DATA SERVICE 39568. 38174. 1394. 0. MEDICAL WASTE & UNIFORM CLEANING 43296. 43274. 22. 0. UTILITIES 18176. 1
CEO by reviewing general compensation data for
similarly situated organizations. Following such a
review, the Compensation Committee presents its findings
and recommendations to the Board for approval at a duly
organized meeting of the Board at which Board members
are provided with the opportunity to ask questions.
Based on the findings and recommendations of the
Compensation Committee, a Board vote is taken to
establish the new compensation level for the CEO.
Deliberations of the Compensation Committee and the
Board are recorded in the organization's minute book.
The evaluation, review, and recommedation process was
last undertaken by the organization's Compensation
Committee in June 2013 and its findings and
recommendations with regard to the CEO's compensation level
were approved by the Board in June 2013.
Pt VI, Line 19The organization's annual financial report is available
on a third-party website (Guidestar). The organization
provides copies of its governing documents, its conflict
of interest policy, as well as its three most recent
Forms 990 to any interested person that makes a request
for such documents.
Pt VI, Line 3Pursuant to that certain Amended and Restated Clinic
Affiliation Agreement, QueensCare Health Centers and
QueensCare formed the QFC/QCP partnership to jointly
operate six community family clinics located in the
greater Los Angeles area. QueensCare's responsibilities
under the terms of that Agreement include supervision of medical treatments,
measuring outcomes, providing day-to-day management for the operation of
the QFC/QCP partnership and on-site management of QHC's
personnel to include hiring, training, and discharging
QHC personnel.
Pt VI, Line 4On May 20, 2013 a Certificate of Restated Articles of Incorporation
was filed with the California Secretary of State's office
to change the corporation's name to QueensCare Health Centers.
Pt VII, Line 1aBoard Chairman Allan Michelena devoted approximately two
hours of his time per week to a related organization,
QueensCare, serving as a director of QueensCare.
Board Secretary Sr. Judy Murphy devoted approximately ten
hours of her time per week to QueensCare serving as QueensCare's
Secretary, and provided other important services as an independent contractor.
Vice Chair Jay Guerena devoted approximately two
hours of his time per week to QueensCare serving as
a director of QueensCare.
CEO Barbara B. Hines devoted approximately 20 hours of
her time per week serving as QueensCare's CEO.
CFO Gary C. Grubbs also devoted approximately
20 hours of his time per week serving as QueensCare's
Chief Financial Officer.
Sch A, Pt IQueensCare Health Centers is a hospital
described in section 170(b)(1)(a)(iii) of the Internal
Revenue Code because its principal purpose is to provide
medical care through neighborhood medical clinics.
QueensCare Health Centers is not licensed to operate a hospital.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1QUEENSCAREBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11300 N VERMONT AVENUE STE 1002AddressLine1
CityLOS ANGELESCity
StateCAState
ZIP Code90027ZIPCode
FieldValueIRS element (for citing)
EIN951644040EIN
Primary ActivitiesHEALTHCARE FOR THE POORPrimaryActivities
Legal Domicile StateCALegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1ST JOSEPH'S HEALTH SUPPORT ALLIANCEBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1QFCQCPBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1130 N VERMONT AVEAddressLine1
CityLOS ANGELESCity
StateCAState
ZIP Code90027ZIPCode
FieldValueIRS element (for citing)
EIN260502255EIN
Primary ActivityTO OPERATE & MANAGE HEALTHCARE CLINICSPrimaryActivity
Legal Domicile StateCALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income-7651940ShareOfTotalIncome
Share Of EOY Assets1019ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnertrueGeneralOrManagingPartner
Percentage Ownership0.60000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
QFCQCP
b7652959accrual
QUEENSCARE
c102273accrual
QFCQCP
j4343720accrual
QFCQCP
l11995249accrual
QUEENSCARE
o199844accrual
QUEENSCARE
p881778
QUEENSCARE
q508975