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CHARLES B WANG COMMUNITY HEALTH CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CHARLES B WANG COMMUNITY HEALTH CENTER INC (EIN 13-2739694)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-07
IRS object ID
201223129349301112
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)
Timestamp2012-11-07T09:06:33-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN420714325EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MCGLADREY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11185 AVENUE OF THE AMERICASAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code100362602ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN132739694EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHARLES B WANG COMMUNITY HEALTH CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHARNameControl
Phone2123796988Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1268 CANAL STREETAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10013ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJANE T ENGName
TitleCHIEF EXECUTIVE OFFICERTitle
Phone2123796988Phone
Date Signed2012-11-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMARTIN GREIFName
PTINP00029738PTIN
Phone2123721000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJANE T ENGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1268 CANAL STREETAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10013ZIPCode
FieldValueIRS element (for citing)
Gross Receipts38451313GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CBWCHC.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTO BE A LEADER IN PROVIDING QUALITY, CULTURALLY RELEVANT, AND AFFORDABLE HEALTH CARE AND EDUCATION, AND TO ADVOCATE ON BEHALF OF THE HEALTH AND SOCIAL NEEDS OF UNDERSERVED ASIAN AMERICANSActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees585TotalNbrEmployees
Total Nbr Volunteers7TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year11319078ContributionsGrantsPriorYear
Contributions Grants Current Year8241051ContributionsGrantsCurrentYear
Program Service Revenue Prior Year27743629ProgramServiceRevenuePriorYear
Program Service Revenue CY29869824ProgramServiceRevenueCY
Investment Income Prior Year63685InvestmentIncomePriorYear
Investment Income Current Year33262InvestmentIncomeCurrentYear
Other Revenue Prior Year308837OtherRevenuePriorYear
Other Revenue Current Year305808OtherRevenueCurrentYear
Total Revenue Prior Year39435229TotalRevenuePriorYear
Total Revenue Current Year38449945TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year29384586SalariesEtcPriorYear
Salaries Etc Current Year29640433SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year11095TotalFundrsngExpCurrentYear
Other Expense Prior Year8970164OtherExpensePriorYear
Other Expenses Current Year9051937OtherExpensesCurrentYear
Total Expenses Prior Year38354750TotalExpensesPriorYear
Total Expenses Current Year38692370TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1080479RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-242425RevenuesLessExpensesCY
Total Assets BOY30657741TotalAssetsBOY
Total Assets EOY31194628TotalAssetsEOY
Total Liabilities BOY5866647TotalLiabilitiesBOY
Total Liabilities EOY6662429TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY24791094NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY24532199NetAssetsOrFundBalancesEOY
Mission DescriptionOUR MISSION IS TO BE A LEADER IN PROVIDING QUALITY, CULTURALLY RELEVANT, AND AFFORDABLE HEALTH CARE AND EDUCATION, AND TO ADVOCATE ON BEHALF OF THE HEALTH AND SOCIAL NEEDS OF UNDERSERVED ASIAN AMERICANS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense33259030Expense
Revenue29874839Revenue
DescriptionTHE ORGANIZATION OPERATED A FEDERALLY QUALIFIED HEALTH CENTER, WHICH HAD 206,002 VISITS IN 2011.Description
Total Program Service Expense33259030TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109630NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees585NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LYNN D SHERMANBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2123796988TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1268 CANAL STREETAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10013ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
PYSER EDELSACK
CHAIRPERSON4.00XX000
CHUN K YIP MD
VICE-CHAIRPERSON3.00XX000
EMILY WOO
SECRETARY3.00XX000
YVONNE GHAW
TREASURER3.00XX000
ROBERT BELL
BOARD MEMBER2.00X000
ROBERT CHANG
BOARD MEMBER2.00X000
HELEN CHONG
BOARD MEMBER2.00X000
IRENE CHU
BOARD MEMBER2.00X000
DOUGLAS JUNG
BOARD MEMBER2.00X000
JEANNE LEE JACKSON
BOARD MEMBER2.00X000
VICTOR LEE
BOARD MEMBER2.00X000
JOHN LI MD
BOARD MEMBER2.00X000
YVONNE LIU
BOARD MEMBER2.00X000
MARY PAN
BOARD MEMBER2.00X000
KENNETH SHIEH
BOARD MEMBER2.00X000
LILY TANG
BOARD MEMBER2.00X000
PAULINE TSE
BOARD MEMBER2.00X000
JAMES WONG
BOARD MEMBER2.00X000
JANE ENG ESQ
CHIEF EXECUTIVE OFFICER35.00X269809031537
LYNN SHERMAN
CHIEF FINANCIAL OFFICER35.00X193762029510
BETTY K CHENG
CHIEF OPERATING OFFICER35.00179107012369X
REGINA F LEE ESQ
CHIEF DEVELOPMENT OFFICER35.00176267018030X
PERRY PONG MD
CHIEF MEDICAL OFFICER35.00231609030332X
JIAN-PING CHEN MD
PSYCHIATRIST35.00303074026474X
KIN CHING KONG MD
OBSTETRICIAN/GYNECOLOGIST35.00451905025555X
CHRISTINE SHEN MD
SENIOR PEDIATRICIAN35.00227170022479X
JIEYING SHEN MD
SENIOR PEDIATRICIAN35.00341171024018X
LORETTA AU MD
SECTION CHIEF - PEDIATRICS35.00225103011000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2598977TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation231304TotalOtherCompensation
Number Individuals GT100 K52NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
GANNON CONTRACTING LLC
49 WEST 38TH STREETNEW YORKNY10018CONSTRUCTION343386
GE HEALTHCARE
PO BOX 640944PITTSBURGHPA15264ELECTRONIC MEDICAL RECORDS221180
THE CITY COLLEGE OF NEW YORK
160 CONVENT AVENUENEW YORKNY10031STAFF TRAINING112300
MCGLADREY LLP
1185 AVENUE OF THE AMERICASNEW YORKNY10036ACCOUNTING & TAX SERVICES109800
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Government Grants4991910GovernmentGrants
All Other Contributions3249141AllOtherContributions
Noncash Contributions63597NoncashContributions
Total Contributions8241051TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID9000992177319821773198
OTHER THIRD PARTY90009934818513481851
MEDICAL HOME90009911970401197040
NYS UNCOMPENSATED CARE90009911548761154876
SELF-PAY900099894363894363

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column1368496TotalRevenueColumn
Related Or Exempt Function Income1368496RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue29869824TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column33246TotalRevenueColumn
Exclusion$33,246ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1384Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1368Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities16Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column16TotalRevenueColumn
Exclusion$16ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EXP REIMB-501(C)(3)ORG900099210769$210,769
MISCELLANEOUS INCOME90009990024$90,024
MEDICAL RECORDS90009950155015
FieldValueIRS element (for citing)
Total Other Revenue305808TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column38449945TotalRevenueColumn
Related Or Exempt Function Income29874839RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$334,055ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1163882Total
Program Services1005805ProgramServices
Management And General158077ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total22350468Total
Program Services19314850ProgramServices
Management And General3035618ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total874418Total
Program Services755656ProgramServices
Management And General118762ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3764212Total
Program Services3252961ProgramServices
Management And General511251ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1487453Total
Program Services1285429ProgramServices
Management And General202024ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total67556Total
Management And General67556ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total109800Total
Management And General109800ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total366573Total
Program Services225363ProgramServices
Management And General141210ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1261510Total
Program Services1053983ProgramServices
Management And General207527ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2795621Total
Program Services2362300ProgramServices
Management And General433321ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total104349Total
Program Services90176ProgramServices
Management And General14173ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total130853Total
Program Services113081ProgramServices
Management And General17772ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total4161Total
Program Services3516ProgramServices
Management And General645ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1028062Total
Program Services868712ProgramServices
Management And General159350ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total118716Total
Program Services78655ProgramServices
Management And General40061ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
LABORATORY & RADIOLOGY11783921178392
PHARMACEUTICALS760858760858
REPAIRS & MAINTENANCE36672129863568086
DUES AND SUBSCRIPTIONS31022221907691146

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total448543Total
Program Services391582ProgramServices
Management And General45866ManagementAndGeneral
Fundraising11095Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total38692370Total
Program Services33259030ProgramServices
Management And General5422245ManagementAndGeneral
Fundraising11095Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2000BOY
EOY2000EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY7254100BOY
EOY11123273EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY3790683BOY
EOY2183685EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3602886BOY
EOY2662046EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1236969BOY
EOY572529EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis21951743LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9595749LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY12665042BOY
EOY12355994EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY28939BOY
EOY11101EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2077122BOY
EOY2284000EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY30657741BOY
EOY31194628EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4105588BOY
EOY4766568EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY40333BOY
EOY19123EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY59436BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1661290BOY
EOY1876738EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5866647BOY
EOY6662429EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23576093BOY
EOY23703341EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1215001BOY
EOY828858EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY24791094BOY
EOY24532199EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY30657741BOY
EOY31194628EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-242425ReconcilationRevenueExpenses
Reconcilation Other Changes-16470ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6880855CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8795837CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9743897CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11319078CurrentTaxYearMinus1Year
Current Tax Year8241051CurrentTaxYear
Total44980718Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years25849362CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years26193965CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years27544356CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year27743629CurrentTaxYearMinus1Year
Current Tax Year29869824CurrentTaxYear
Total137201136Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years32730217CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years34989802CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years37288253CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39062707CurrentTaxYearMinus1Year
Current Tax Year38110875CurrentTaxYear
Total182181854Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509182181854PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years259344CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years326879CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years175287CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year63685CurrentTaxYearMinus1Year
Current Tax Year33246CurrentTaxYear
Total858441Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years259344CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years326879CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years175287CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year63685CurrentTaxYearMinus1Year
Current Tax Year33246CurrentTaxYear
Total858441Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years212741CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years234662CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years278060CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year308837CurrentTaxYearMinus1Year
Current Tax Year305808CurrentTaxYear
Total1340108Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years33202302CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years35551343CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years37741600CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39435229CurrentTaxYearMinus1Year
Current Tax Year38449929CurrentTaxYear
Total184380403Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98810PublicSupportPercentage509
Prior Year Support Percentage0.98680PriorYearSupportPercentage
Investment Income Percentage0.00470InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00600PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MEDICAL RECORDS MISCELLANEOUS CHC FDTN REVENUEGeneralExplanation

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

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis15316144OtherCostOrOtherBasis
Depreciation4349318Depreciation
Book Value10966826BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4182676OtherCostOrOtherBasis
Depreciation3280648Depreciation
Book Value902028BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2452923OtherCostOrOtherBasis
Depreciation1965783Depreciation
Book Value487140BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings12355994TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
SECURITY DEPOSITS407262
DEFERRED COMPENSATION ACCOUNT1876738
FieldValueIRS element (for citing)
Total Book Value Other Assets2284000TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDEFERRED COMPENSATION PAYABLEDescription
Amount$1,876,738Amount
FieldValueIRS element (for citing)
Total Of Amounts1876738TotalOfAmounts
Total Revenue38449945TotalRevenue
Total Expenses38692370TotalExpenses
Excess Or Deficit For Year-242425ExcessOrDeficitForYear
Net Unrealized GL On Investments-16470NetUnrealizedGLOnInvestments
Total Adjustments-16470TotalAdjustments
Excess Or Deficit Per FS-258895ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt38441275TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-16470NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities7800DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990-8670RevenueNotRptdF990
Revenue Subtotal38449945RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99038449945TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt38700170TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities7800DonatedServicesUseOfFacilities
Expenses Not Rptd F9907800ExpensesNotRptdF990
Expenses Subtotal38692370ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99038692370TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationAT DECEMBER 31, 2011, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES. THE HEALTH CENTER FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAXES). WHEN THE RETURN IS FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS COMMON TO HEALTH CENTERS INCLUDE SUCH MATTERS AS THE FOLLOWING: TAX-EXEMPT STATUS OF THE ENTITY, THE NATURE, CHARACTERIZATION AND TAXABILITY OF JOINT VENTURE INCOME AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME TAX ("UBIT"). UBIT IS REPORTED ON INTERNAL REVENUE SERVICE FORM 990-T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH THE TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS IN THE BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. FORM 990, FILED BY THE HEALTH CENTER, IS SUBJECT TO EXAMINATION UP TO THREE YEARS FROM THE EXTENDED DUE DATE OF EACH RETURN.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JANE ENG ESQ
26822500015840147000168370301346000
LYNN SHERMAN
1932100005520118790176310223272000
BETTY K CHENG
1775230001584010651017180191476000
REGINA F LEE ESQ
1746830001584010651073790194297000
PERRY PONG MD
2310570005520127010176310261941000
JIAN-PING CHEN MD
302714000360088430176310329548000
KIN CHING KONG MD
451665000240079240176310477460000
CHRISTINE SHEN MD
227015000155053550171240249649000
JIEYING SHEN MD
340879000292063870176310365189000
LORETTA AU MD
22474300036001047505250236103000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CENTRE COURT HOLDINGS LLCBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipIRENE CHU, BOARD MEMBER, HAS A FINANCIAL INTEREST IN THE INTERESTED PERSONRelationship
Amount Of Transaction333938AmountOfTransaction
Description Of TransactionRENT - IRENE CHU, BOARD MEMBER, HAS A FINANCIAL INTEREST IN CENTRE COURT HOLDINGS, LLC, WHICH RENTS SPACE TO THE HEALTH CENTER.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionFORGIVENESS OF DEBTDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99063597NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS REVIEWED BY SENIOR MANAGEMENT, INCLUDING THE CEO & CFO. COPIES ARE DISTRIBUTED TO THE BOARD OF DIRECTORS BEFORE IT IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION'S DIRECTORS, OFFICERS AND KEY EMPLOYEES SIGN DISCLOSURE STATEMENTS ANNUALLY, AND PERIODIC REVIEWS ARE CONDUCTED BY THE CEO.
FORM 990, PART VI, SECTION B, LINE 15ANNUALLY, THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS AND EVALUATES THE CEO AND DECIDES ON COMPENSATION. INFORMATION FROM OUTSIDE CONSULTANTS ON COMPARABLE SALARIES OF SIMILAR ORGANIZATIONS MAY BE USED IN THEIR DETERMINATION. SALARIES FOR OTHER OFFICERS & KEY EMPLOYEES ARE DETERMINED BY THE CEO, USING SALARY SURVEYS WITH INFORMATION FROM OTHER HEALTH CENTERS, AS WELL AS EMPLOYEE ANNUAL EVALUATIONS.
FORM 990, PART VI, SECTION C, LINE 19COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART VIITHE ORGANIZATION, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN PART VII, COLUMN F AND NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -16,470.CHANGES IN NET ASSETS OR FUND BALANCES: