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GRACELIGHT COMMUNITY HEALTH: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
GRACELIGHT COMMUNITY HEALTH (EIN 95-3702136)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-15
IRS object ID
201341359349308474
Schema version
2011v1.2
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)
Timestamp2013-05-15T15:03:14-07:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

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 Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN953702136EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1QUEENSCARE FAMILY CLINICSBusinessNameLine1
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 Signed2013-05-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOSEPH E LUNDYName
Phone6106607788Phone
Date Prepared2013-05-15DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts22686590GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.queenscarefamilyclinics.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1925YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionQUEENSCARE FAMILY CLINICS, 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 Employees246TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year5921304ContributionsGrantsPriorYear
Contributions Grants Current Year5770652ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17002670ProgramServiceRevenuePriorYear
Program Service Revenue CY15966456ProgramServiceRevenueCY
Investment Income Prior Year2963InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year227933OtherRevenuePriorYear
Other Revenue Current Year949482OtherRevenueCurrentYear
Total Revenue Prior Year23154870TotalRevenuePriorYear
Total Revenue Current Year22686590TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12100953SalariesEtcPriorYear
Salaries Etc Current Year12957666SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year12000TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY5700TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year5700TotalFundrsngExpCurrentYear
Other Expense Prior Year9003442OtherExpensePriorYear
Other Expenses Current Year8730056OtherExpensesCurrentYear
Total Expenses Prior Year21116395TotalExpensesPriorYear
Total Expenses Current Year21693422TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2038475RevenuesLessExpensesPriorYear
Revenues Less Expenses CY993168RevenuesLessExpensesCY
Total Assets BOY10475922TotalAssetsBOY
Total Assets EOY11833920TotalAssetsEOY
Total Liabilities BOY1227129TotalLiabilitiesBOY
Total Liabilities EOY1591959TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY9248793NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10241961NetAssetsOrFundBalancesEOY
Mission DescriptionQUEENSCARE FAMILY CLINICS,MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense19772385Expense
Revenue16915938Revenue
DescriptionQUEENSCARE FAMILY CLINICS 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 FAMILY CLINICS PROVIDED SERVICES TO MORE THAN 32,000 PATIENTS WHICH ACCOUNTED FOR MORE THAN 122,000 VISITS.Description
Total Program Service Expense19772385TotalProgramServiceExpense
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 AssetsfalseReportOtherAssets
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 With1096138NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees246NumberOfEmployees
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 DocsfalseChangesToOrganizingDocs
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

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeFormerFormerHighest Compensated EmployeeHighestCompensatedEmployee
ALLAN MICHELENA
CHAIRMAN2.00XX170000
SR JUDY MURPHYCSJ
SECRETARY10.00XX141001131500
JAY GUERENA
TREASURER2.00XX205000
JORGE BLANCO
DIRECTOR2.00XX110000
SHIRLEY DANIELS
DIRECTOR2.00X140000
ARCHBISHOP VATCHE HOVSEPIAN
DIRECTOR2.00X80000
FRANK REY DE PEREA
DIRECTOR2.00X220000
MARY EVELYN RAMOS
DIRECTOR2.00X80000
MANUEL ROMERO
DIRECTOR2.00X60000
WILLY RUIZ
DIRECTOR2.00X70000
MARGARITA DUARTE TUCKER
DIRECTOR2.00X110000
SR MARTHA VEGASSS
DIRECTOR2.00X70000
RAY VERNOY
DIRECTOR2.00X90000
DAVID WALSH
DIRECTOR2.00X127500
FR ANGELOS YOUSSEF
DIRECTOR2X850
BARBARA B HINES
PRESIDENT & CEO20X118669118643
GUILLERMO DIAZ MD
CMO40201099X
ALEJANDRO A ARMSTRONG
COO40165980X
LEE E HUEY
CHIEF FINANCIAL OFFICER20X7336798042X
FIKRY FANOUS MD
OB/GYN40204875X
EMELOU C SAGARALMD
PHYSICIAN40184815X
KHANH NGUYEN MD
PHYSICIAN40184786X
MARIA T LIM HEYA MD
PHYSICIAN40179495X
ILUMINADA O BETITA MD
PHYSICIAN40178740X
GARY C GRUBBS
CHIEF FINANCIAL OFFICER20X1692216922
FieldValueIRS element (for citing)
Total Reportable Comp From Org1539023TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs346757TotalReportableCompFrmRltdOrgs
Number Individuals GT100 K8NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
QUEST DIAGNOSTICS
PO BOX 555LOS ANGELESCA90017LAB SERVICES503332
UNIVERSAL PROTECTION SERV
PO BOX 512719LOS ANGELESCA90051SECURITY228834
MEDICAL PROFESSIONAL INC
PO BOX 910569SAN DIEGOCA92191Contract Workers210916
ADP INC
PO BOX 31001-1874PASADENACA91110PAYROLL & HR SERVICES198537
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Government Grants2744868GovernmentGrants
All Other Contributions3025784AllOtherContributions
Noncash Contributions1702525NoncashContributions
Total Contributions5770652TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumn
NET PATIENT REVENUE62140011933138
REV FROM QFC/QCP PART6214004033318
FieldValueIRS element (for citing)
Total Program Service Revenue15966456TotalProgramServiceRevenue

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code621400BusinessCode
Total Revenue Column949482TotalRevenueColumn
Related Or Exempt Function Income949482RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue949482TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column22686590TotalRevenueColumn
Related Or Exempt Function Income16915938RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total575791Total
Program Services196930ProgramServices
Management And General378861ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9155946Total
Program Services8704249ProgramServices
Management And General451697ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total20198Total
Program Services20198ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2396071Total
Program Services2126597ProgramServices
Management And General269474ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total809660Total
Program Services735861ProgramServices
Management And General73799ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total64544Total
Program Services4405ProgramServices
Management And General60139ManagementAndGeneral
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)
Total5700Total
Fundraising5700Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total122406Total
Program Services117451ProgramServices
Management And General4955ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total273040Total
Program Services239921ProgramServices
Management And General33119ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total88597Total
Program Services40729ProgramServices
Management And General47868ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total420425Total
Program Services384142ProgramServices
Management And General36283ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total327318Total
Program Services298384ProgramServices
Management And General28934ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
RENT9607097867651739440
PHYSICIAN FEES68829368829300
LAB FEES66958966958900
PHARMACEUTICALS2134908213490800

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2935227Total
Program Services2623963ProgramServices
Management And General311264ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total21693422Total
Program Services19772385ProgramServices
Management And General1915337ManagementAndGeneral
Fundraising5700Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2750BOY
EOY3550EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6077674BOY
EOY6134640EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY925967BOY
EOY1014337EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY392649BOY
EOY1348963EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1022557BOY
EOY940895EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY115458BOY
EOY186285EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7069063LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5276768LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1568990BOY
EOY1792295EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY75000BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY294877BOY
EOY412955EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10475922BOY
EOY11833920EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1227129BOY
EOY1591959EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1227129BOY
EOY1591959EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8154307BOY
EOY9212767EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1094486BOY
EOY1029194EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9248793BOY
EOY10241961EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10475922BOY
EOY11833920EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses993168ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 Balance1094486BeginningOfYearBalance
Contributions1672440Contributions
Other Expenditures1737732OtherExpenditures
End Of Year Balance1029194EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1471833InvestmentCostOrOtherBasis
Depreciation887125Depreciation
Book Value584708BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis5126045InvestmentCostOrOtherBasis
Depreciation4389643Depreciation
Book Value736402BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis471185InvestmentCostOrOtherBasis
Book Value471185BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1792295TotalOfBookValueLandBuildings
Total Revenue22686590TotalRevenue
Total Expenses21693422TotalExpenses
Excess Or Deficit For Year993168ExcessOrDeficitForYear
Excess Or Deficit Per FS993168ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt22686590TotRevenueEtcAuditedFinclStmt
Revenue Subtotal22686590RevenueSubtotal
Total Revenue Per Form99022686590TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt21693422TotExpensesEtcAuditedFinclStmt
Expenses Subtotal21693422ExpensesSubtotal
Total Expenses Per Form99021693422TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
Pt V Line 4QueensCare Family Clinics ("QFC") intends to use its endowment funds to support healthcare related activities.
Pt XAs required by U.S. GAAP, QFC 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, 2009 through June 30, 2012 for federal tax purposes
Pt Xand the years ended June 30, 2008 through June 30, 2012 for California tax purposes. There have been no material changes in unrecognized benefits as of June 30, 2012, nor are any material changes anticipated in the twelve months following June 30, 2012. 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 PaymenttrueSeverancePayment
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 (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgBonus Filing OrgBonusFilingOrg
BARBARA B HINES
118669118643118669118643
GUILLERMO DIAZ MD
1951242010995975
ALEJANDRO A ARMSTRONG
165980165980
LEE E HUEY
73367980427336798042
FIKRY FANOUS MD
18751420487575016611
EMELOU C SAGARALMD
184155184815660
KHANH NGUYEN MD
1821151847862671
MARIA T LIM HEYA MD
1775151794951400580
ILUMINADA O BETITA MD
1767331787401065942

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPt I Line 4aIdentifier
ExplanationFormer CFO, Lee E. Huey, received a severance payment of $42,770Explanation

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions0NumberOfContributions
Noncash Contribs Rptd F9901702525NoncashContribsRptdF990
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 7/1/2011 - 6/30/12, QueensCare
Form 990Family Clinics received donations of numerous
Form 990pharmaceutical and medical products with an aggregate estimated
Form 990value of $1,702,524 from various pharmaceutical
: MANUFACTURERS AND OTHER ORGANIZATIONS.;

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (78 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 11aFollowing 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 15A Compensation Committee comprised of independent Board
members formulates a proposed compensation level for the
Form 990, Part IX, Line 24fMESSENGER, POSTAGE 76061. 69060. 7001. 0. OTHER PROFESSIONAL FEES 623697. 466587. 157110. 0. EQUIP. REPAIR & MAINTENANCE 257747. 257685. 62. 0. PRINTING & PUBLICATIONS 39255. 35349. 3906. 0. PURCHASED SERV-CONTR WORKERS 354799. 354799. 0. 0. PURCHASED SERV-ADVERTISING 64009. 63388. 621. 0. PURCHASED SERV-SECURITY 243181. 243181. 0. 0. PAYROLL SERVICE 107533. 91106. 16427. 0. PURCHASED SERV-DATA SERVICE 35013. 33742. 1271. 0. MEDICAL WASTE & UNIFORM CLEANING 49263. 49229. 34. 0. UTILITIES 16106.
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 2012 and its findings and
recommendations with regard to the CEO's compensation level
were approved by the Board in June 2012.
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 Family Clinics 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 QFC's
personnel to include hiring, training, and discharging
QFc personnel.
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.
Board Treasurer Jay Guerena devoted approximately two
hours of his time per week to QueensCare serving as
Chairman of the Board of Directors.
CEO Barbara B. Hines devoted approximately 20 hours of
her time per week serving as QueensCare's CEO.
Former CFO Lee E. Huey and current CFO Gary C. Grubbs each devoted approximately
20 hours of his time per week serving as QueensCare's
Chief Financial Officer.
Sch A, Pt IQueensCare Family Clinics 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 Family Clinics 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-7171158ShareOfTotalIncome
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
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
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 (10 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
QFCQCP
b7171158accrual
QUEENSCARE
c93599accrual
QFCQCP
j416771accrual
QFCQCP
k11951880accrual
QFCQCP
m747454accrual
QFCQCP
n11951880
QFCQCP
p4780772
QUEENSCARE
n447373
QUEENSCARE
o36378
QUEENSCARE
p625652