PROVIDENCE FACEY MEDICAL FOUNDATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: PROVIDENCE FACEY MEDICAL FOUNDATION (EIN 95-4322584)
Tax period: 2010-10-01 to 2011-09-30
Filed: 2012-06-22
IRS object ID: 201231749349300123
Schema version: 2010v3.4
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
Form 990
Schedule A
Schedule C
Schedule D
Schedule I
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-06-22T11:09:40-05:00	Timestamp
Tax Period End Date	2011-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DELOITTE TAX LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	655 WEST BROADWAY SUITE 700	AddressLine1
City	SAN DIEGO	City
State	CA	State
ZIP Code	921018590	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	954322584	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	FACEY MEDICAL FOUNDATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	FACE	NameControl
Phone	8183659531	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	15451 SAN FERNANDO MISSION BLVD No	AddressLine1
Address Line2	200	AddressLine2
City	MISSION HILLS	City
State	CA	State
ZIP Code	913451420	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	301510	Name
Title	CFO	Title
Phone	8183659531	Phone
Date Signed	2012-06-21	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Diana J McCutchen	Name
Phone	6192326500	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Bill Gil	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	15451 SAN FERNANDO MISSION BLVD No	AddressLine1
Address Line2	200	AddressLine2
City	MISSION HILLS	City
State	CA	State
ZIP Code	913451420	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	184529119	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.FACEY.COM	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1991	YearFormation
State Legal Domicile	CA	StateLegalDomicile
Activity Or Mission Description	Premier healthcare team providing quality medical service.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	8	NbrIndependentVotingMembers
Total Nbr Employees	1178	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	13200	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	13531	ContributionsGrantsPriorYear
Contributions Grants Current Year	510	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	176205101	ProgramServiceRevenuePriorYear
Program Service Revenue CY	181929634	ProgramServiceRevenueCY
Investment Income Prior Year	3040654	InvestmentIncomePriorYear
Investment Income Current Year	537347	InvestmentIncomeCurrentYear
Other Revenue Prior Year	18833	OtherRevenuePriorYear
Other Revenue Current Year	62490	OtherRevenueCurrentYear
Total Revenue Prior Year	179278119	TotalRevenuePriorYear
Total Revenue Current Year	182529981	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	45016	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	71565	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	51899769	SalariesEtcPriorYear
Salaries Etc Current Year	54734068	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	123115221	OtherExpensePriorYear
Other Expenses Current Year	124844908	OtherExpensesCurrentYear
Total Expenses Prior Year	175060006	TotalExpensesPriorYear
Total Expenses Current Year	179650541	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	4218113	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	2879440	RevenuesLessExpensesCY
Total Assets BOY	55984067	TotalAssetsBOY
Total Assets EOY	56660436	TotalAssetsEOY
Total Liabilities BOY	26882731	TotalLiabilitiesBOY
Total Liabilities EOY	25081528	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	29101336	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	31578908	NetAssetsOrFundBalancesEOY
Mission Description	We are a premier healthcare team dedicated to providing quality medical service in a caring and professional atmosphere. Each of us is committed to service, innovation, and quality care while serving the needs of the community.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	163774638	Expense
Grants	71565	Grants
Revenue	180848702	Revenue
Description	Direct patient medical care - this includes, but is not limited to, face to face provider appointments, laboratory and x-ray services, physical therapy services, immunizations, provided drugs and medications, procedures in Ophthalmology, OB/GYN, and Gastroenterology. Revenues also include income from Hospital & Health Plan Shared Risk, Health Plan Pay for Performance, Stop Loss Recoveries, and 3rd Party Liens.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	998983	Expense
Revenue	1080932	Revenue
Description	Clinical Research: Conducted 44 (9 are active) FDA-regulated studies (119 patients and 1,256 study visits) in various disciplines including Gastroenterology, Endocrinology, Internal Medicine, Oncology, Pediatrics, and Ophthalmology.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	996374	Expense
Description	Patient Education: 241 Health Education classes, serving 8,133 people, between October 2010 and September 2011.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	165769995	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	1	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transaction Related Entity	0	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	166	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	1178	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	10	NbrVotingGoverningBodyMembers
Number Independent Voting Members	8	NumberIndependentVotingMembers
Family Or Business Relationship	1	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	0	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	1	InvestmentInJointVenture
Written Policy Or Procedure	1	WrittenPolicyOrProcedure
States Where Copy Of Return Is Filed	CA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Margie J Melby	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	8188375610	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	15451 San Fernando Mission Blvd 300	AddressLine1
City	Mission Hills	City
State	CA	State
ZIP Code	913451420	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Randall Ewig
Board Chair	1.60	X	24939	0	0
Ronald Kaufman MD
Board Member	1.10	X	12900	0	0
Gary Leary
Board Member	1.70	X	68160	0	0
Michael Linn
Board Member	1.20	X	13200	0	0
J Robert Liset
Board Member	0.80	X	10300	0	0
Mary Odell
Board Member	1.20	X	13200	0	0
Larry Scherzer
Board Member	1.40	X	14700	0	0
Michael Lynch MD
Board Member	0.90	X	11200	0	0
Peter Richman MD
Board Member	1.00	X	11700	0	0
Jennifer Wortham
Board Member	0.10	X	800	0	0
James Corwin
CFO	40.00		305647	0	33927	X
Teresa David
COO	40.00		293514	0	19927	X
Guillermo Gil
CEO, President	40.00		431595	0	20601	X
Victoria Bayona
Director, IT Apps	40.00		122040	0	6454		X
Magaly Beilke
Admin Director, HR	40.00		180807	0	7326		X
Jacki Delanders
Admin Director, Contracting	40.00		160883	0	24097		X
Prubjeet Khurana
Admin Director, Strategy/Planning	40.00		184058	0	6022		X
Mari Zagrzejewski
Admin Director, UM	40.00		161443	0	10430		X
David B Day
podiatrist	40.00		165217	0	13066			X
Joung Jeffrey Lee
Podiatrist	40.00		149138	0	5156			X
Cathy Hawes
Admin Director, Patient Care Delivery	40.00		144977	0	599			X
Margie Melby
Admin Director, Controller	40.00		147846	0	13352			X
Susan Slack
Admin Director, Revenue Cycle	40.00		147850	0	8812			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2654074	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	163315	TotalOtherCompensation
Number Individuals GT100 K	47	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Facey Medical Group
15451 San Fernando Mission Blvd Su	Mission Hills	CA	91345	Professional Medical Services	77328625
Quest Diagnostics
8401 Fallbrook	West Hills	CA	91304	Laboratory Services	1784530
Erdman & Associates
350 Interlocken Blvd	Bloomfield	CO	80021	Constuction & Consulting Services	1594344
Las Casa Maintenance Inc
9018 Balboa Blvd Suite 281	Northridge	CA	91325	Janitorial Services	776871
Medical Present Value
5000 Plaza on the Lake Suite 265	Austin	TX	78746	Billing Processing Services	250603

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	13	NumberOfContractorsGT100K
All Other Contributions	510	AllOtherContributions
Total Contributions	510	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Services	900099	180848702	180848702
Clinical Research	900099	1080932	1080932

Field	Value	IRS element (for citing)
Total Program Service Revenue	181929634	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	424863	TotalRevenueColumn
Exclusion	$424,863	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	2100697	Securities
Other	10925	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	1999138	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	101559	Securities
Other	10925	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	112484	TotalRevenueColumn
Exclusion	$112,484	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount	Unrelated Business RevenueUnrelatedBusinessRevenue
Miscellaneous	900099	49290	$49,290
Management Fees	812900	13200		13200

Field	Value	IRS element (for citing)
Total Other Revenue	62490	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	182529981	TotalRevenueColumn
Related Or Exempt Function Income	181929634	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	13200	UnrelatedBusinessRevenue
Exclusion	$586,637	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	71565	Total
Program Services	71565	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	1997334	Total
Program Services	496225	ProgramServices
Management And General	1501109	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	43574371	Total
Program Services	38558350	ProgramServices
Management And General	5016021	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	620412	Total
Program Services	527350	ProgramServices
Management And General	93062	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	5147131	Total
Program Services	4346815	ProgramServices
Management And General	800316	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	3394820	Total
Program Services	2965063	ProgramServices
Management And General	429757	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	390782	Total
Management And General	390782	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	192346	Total
Management And General	192346	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	15147	Total
Management And General	15147	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	79549	Total
Management And General	79549	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	6080492	Total
Program Services	6080492	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	211724	Total
Program Services	162418	ProgramServices
Management And General	49306	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	4458549	Total
Program Services	2065548	ProgramServices
Management And General	2393001	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	2353525	Total
Program Services	1764586	ProgramServices
Management And General	588939	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	14587610	Total
Program Services	13180503	ProgramServices
Management And General	1407107	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	226282	Total
Program Services	179774	ProgramServices
Management And General	46508	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	53514	Total
Program Services	19514	ProgramServices
Management And General	34000	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	19456	Total
Management And General	19456	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	4731044	Total
Program Services	4331994	ProgramServices
Management And General	399050	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	835744	Total
Program Services	749641	ProgramServices
Management And General	86103	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Medical Fees to FMG	77328614	77328614	0
Supplies	10909188	10572870	336318
Bad Debt	2368673	2368673	0
Misc UBI Expense	2669		2669

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	179650541	Total
Program Services	165769995	ProgramServices
Management And General	13880546	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	13600	BOY
EOY	13450	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	10859926	BOY
EOY	12619762	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	8531799	BOY
EOY	7006182	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1722768	BOY
EOY	1619353	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	2498773	BOY
EOY	2971753	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	53234472	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	34624193	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	18631370	BOY
EOY	18610279	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	13584331	BOY
EOY	13678157	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	141500	BOY
EOY	141500	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	55984067	BOY
EOY	56660436	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	17381943	BOY
EOY	16881044	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	2688884	BOY
EOY	2289574	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	486356	BOY
EOY	538559	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	6325548	BOY
EOY	5372351	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	26882731	BOY
EOY	25081528	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	29101336	BOY
EOY	31578908	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	29101336	BOY
EOY	31578908	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	55984067	BOY
EOY	56660436	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	2879440	ReconcilationRevenueExpenses
Reconcilation Other Changes	-401868	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	Volunteers
Paid Staff Or Management	0	PaidStaffOrManagement
Media Advertisements	0	MediaAdvertisements
Mailings Members	0	MailingsMembers
Publications Or Broadcast	0	PublicationsOrBroadcast
Grants Other Organizations	0	GrantsOtherOrganizations
Direct Contact Legislators	0	DirectContactLegislators
Rallies Demonstrations	0	RalliesDemonstrations
Other Activities	1	OtherActivities
Other Activities	$15,147	OtherActivitiesAmount
Total Lobbying Expenditures IIB	15147	TotalLobbyingExpendituresIIB
Not Described In501c3	0	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Explanation of Other Lobbying Activities:	Identifier
Return Reference	Part II-B, Line 1i:	ReturnReference
Explanation	Facey Medical Foundation paid membership dues to California Association of Physician Groups ("CAPG"). A portion of the dues paid are utilized by this organization for lobbying activities.	Explanation

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	21372858	OtherCostOrOtherBasis
Depreciation	13504318	Depreciation
Book Value	7868540	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	21717352	OtherCostOrOtherBasis
Depreciation	14803384	Depreciation
Book Value	6913968	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	10144262	OtherCostOrOtherBasis
Depreciation	6316491	Depreciation
Book Value	3827771	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	18610279	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	Medical MalPractice Self-Insured Retention	Description
Amount	$5,372,351	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	5372351	TotalOfAmounts
Total Revenue	182529981	TotalRevenue
Total Expenses	179650541	TotalExpenses
Excess Or Deficit For Year	2879440	ExcessOrDeficitForYear
Net Unrealized GL On Investments	-267012	NetUnrealizedGLOnInvestments
Other	-$134,856	OtherAmount
Total Adjustments	-401868	TotalAdjustments
Excess Or Deficit Per FS	2477572	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	182136054	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	-267012	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	-267012	RevenueNotRptdF990
Revenue Subtotal	182403066	RevenueSubtotal
Other Revenues Not Included	126915	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	126915	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	182529981	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	179557793	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	179557793	ExpensesSubtotal
Other Expenses Not Included	92748	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	92748	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	179650541	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:	Part X:	FMF accounts for income taxes in accordance with Financial Accounting Standards Board (FASB) Accounts Standards Codification (ASC) 740, Income Taxes. FASB ASC 740 prescribes a comprehensive model for how a company should recognize, measure, present, and disclose in its financial statements uncertain tax positions that the company has taken, or expects to take, on a tax return. During the years ended September 30, 2011 and 2010, FMF did not record any liability for unrecognized tax benefits.
Part XI, Line 8 - Other Adjustments:		Imputed interest on unihealth grant obligation -100,689. Book/Tax Difference on K-1 -34,167.
		PART XII, LINE 4B: Other revenue & expense reclass 92,748 Book/Tax Difference on K-1 34,167 PART XIII, LINE 4B: Other revenue & expense reclass 92,748

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Method Of ValuationMethodOfValuation	Purpose Of GrantPurposeOfGrant
Providence Holy Cross Foundation
15031 Rinaldi St	Mission Hills	CA	91345	953544877	501(c)(3)	15856	FMV	Building expansion fund
Northeast Valley Health Corp
1172 N Maclay Ave	San Fernando	CA	913401300	277120632	501(c)(3)	26000	FMV	To purchase flu vaccines for underserved population
Henry Mayo Newhall Memorial Hospital
23845 McBean Parkway	Valencia	CA	913552083	953849903	501(c)(3)	12500	FMV	NICU nurses station
California Association of Physician Groups Foundation
915 Wilshire Blvd Suite 1620	Los Angeles	CA	90017	470878940	501(c)(3)	6500	FMV	Donation to CAPG Foundation in support of health care awareness

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	4	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Procedure for Monitoring Grants in the U.S.:	Identifier
Return Reference	Part I, Line 2:	ReturnReference
Explanation	Schedule I, Part I, Line 2: Facey Medical Foundation only makes grants to 501(c)(3) organizations to ensure the funds will be used properly.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	1	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
James Corwin
229239	0	71244	0	5164	0	3600	0	30327	0	339574	0	0	0
Teresa David
223299	0	64916	0	5299	0	12881	0	7046	0	313441	0	0	0
Guillermo Gil
315668	0	106589	0	9338	0	19600	0	1001	0	452196	0	0	0
Magaly Beilke
153544	0	26998	0	265	0	5444	0	1882	0	188133	0	0	0
Jacki Delanders
134926	0	25766	0	191	0	5081	0	19016	0	184980	0	0	0
Prubjeet Khurana
158086	0	25920	0	52	0	5520	0	502	0	190080	0	0	0
Mari Zagrzejewski
135084	0	25920	0	439	0	4973	0	5457	0	171873	0	0	0
David B Day
164582	0	0	0	635	0	5174	0	7892	0	178283	0	0	0
Joung Jeffrey Lee
149014	0	0	0	124	0	0	0	5156	0	154294	0	0	0
Margie Melby
124213	0	22928	0	705	0	4535	0	8817	0	161198	0	0	0
Susan Slack
127072	0	20412	0	366	0	2950	0	5862	0	156662	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Return Reference	Part I, Line 7	ReturnReference
Explanation	Facey has an administrative incentive plan ("AIP") for executive bonuses, which are determined based on financial performance, clinical performance, patient satisfaction, employee turnover, collection percentage and Facey Medical Group assessment. Financial performance is based on designated net operating income levels. The bonus incentives are based on a fixed formula, however, Facey Medical Group's board of directors assess management performance and as such has the discretion to determine a portion of the bonus.	Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Michael Lynch	BusinessNameLine1

Field	Value	IRS element (for citing)
Relationship	Board Member	Relationship
Amount Of Transaction	421222	AmountOfTransaction
Description Of Transaction	Facey Eye Institute, Inc. provides billing and collection services to Facey Medical Foundation. The $421,222 consists of the gross fees received by Facey Eye Institute, Inc. from Vision Service Plan and is reimbursed to Facey Medical Foundation. The amount also includes reimbursement of overhead expenses from Facey Medical Foundation to Facey Eye Institute, Inc. in an amount that is approximately 5% of the total collections. Michael Lynch is the sole shareholder of Facey Eye Institute. All services are negotiated at market rates and are considered to be at arm's length.	DescriptionOfTransaction
Sharing Of Revenues	0	SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
Form 990, Part VI, Section A, line 2	Michael Lynch and Peter Richman have a business relationship.
Form 990, Part VI, Section B, line 11	The 2010 Form 990 will be reviewed by the Audit Committee prior to filing. Committee Minutes will reflect the review of the tax return for the 2010 tax year. A copy of the return will be distributed to each board member and reviewed at a board meeting. The Board minutes will reflect the review of the Form 990.
	Officer and Board conduct is reviewed annually, questionnaires are filled out and sworn statements are signed stating whether or not such conflicts exist. The CEO and Board Chairperson are responsible for monitoring and enforcing compliance with the conflict of interest policies.	Form 990, Part VI, Section B, line 12c
	All members of the FMF Administrative Team (FAM) are reviewed by the Compensation Committee which is chaired by Board Members not affiliated with Management. All salaries are compared with multiple external salary surveys and ensure no person is paid in excess of 90% of any credible survey.	Form 990, Part VI, Section B, line 15
	The organization makes its financial statements and tax returns available upon request. The organization does not make its governing documents or conflict of interest policy available to the public.	Form 990, Part VI, Section C, line 19
	Total compensation reported for Gary Leary on Part VII is $68,160. The $68,160 is composed of $54,360 in legal services fees and the other $13,800 is for board service compensation.	FORM 990, PART VII:
Changes in Net Assets or Fund Balances:	Net unrealized losses on investments: -267,012. Imputed interest on unihealth grant obligation -100,689. Book/Tax Difference on K-1 -34,167. Total to Form 990, Part XI, Line 5: -401,868.	Form 990, Part XI, line 5:
	Although Facey Medical Foundation qualifies for public charity status for Schedule A purposes as an organization providing medical care pursuant to Internal Revenue Code section 170(b)(1)(A)(iii) and Treasury Regulations section 1.170A-9(d)(1)(ii), it is not required to file Schedule H with its Form 990 as it is not an organization that is required to be licensed, registered or similarly recognized by a state as a hospital.	Form 990, Schedule A, Part I, Line 3 and Schedule H:
	While certain departments within the organization have document retention and destruction guidelines that are followed, the organization does not have a comprehensive policy for all departments that has been approved by its governing Board. Such a policy has been drafted and is awaiting final review and approval by the Board.	Form 990, Part VI, Section B, Line 14:
	The following programs and amounts represent the community benefit provided by Facey Medical Foundation and the costs associated with them for the fiscal year reported on this Form 990: Direct Charitable Write-Offs Charity (Indigent Care) $ 327,403 Medi-Medi/Medi-Cal $1,296,454 Flu Clinics $ 26,000 Community Outreach/Education Programs $ 996,374 Total Community Benefit Costs thru 9/30/11 $2,646,231 In September 2006, FMF entered into a binding grant agreement with UniHealth, whereby FMF is required to pay annual grants to UniHealth of $500,000 for a total aggregate of $5,000,000 over 10 years. In addition to the annual grant obligations, FMF may be required to make additional grant payments equal to 50% of the amount by which FMF's annual net operating income, exceeds 1.5% of FMF's annual net revenue, as defined in the grant agreement. The additional grant payments shall not exceed $5,000,000 in the aggregate for fiscal years 2006 through 2015. For the years ended September 30, 2011 and 2010, respectively, no amounts have been accrued for the additional grant payments, as FMF's operating results have not met the requirements as defined in the grant agreement. The annual grant and additional grant payments, if any, are due 45 days after receipt of FMF's annual audited financial statements. As of September 30, 2011 and 2010, the $5,000,000 grant-net of payments and a $211,000 and $311,000 discount, respectively, is reflected in net assets in the accompanying statements of financial position. The discount rate used, 4.6%, represents the 10-year treasury rate in existence at the date the grant agreement was executed. FMF may prepay the discounted amounts of any remaining grant obligation or additional grant payment at any time during the 10-year period. The grant payable as of September 30, 2011 and 2010, is $2,289,000 and $2,689,000, respectively, and is included in the accompanying statements of financial position. Because the grant was consummated with UniHealth, FMF's then sole corporate member, the transaction was considered a net asset transfer for accounting purposes.	FORM 990, PART III:
	Facey Medical Foundation has investments in limited partnerships that operate surgical centers. These limited partnerships are controlled by another tax exempt 501(c)(3) organization.	FORM 990, PART VI, LINE 16: