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GRACELIGHT COMMUNITY HEALTH: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
GRACELIGHT COMMUNITY HEALTH (EIN 95-3702136)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201141339349304424
Schema version
2009v1.3
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)
Timestamp2011-05-13T12:48:56-07:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MYERS BRIER & KELLY 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 Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN953702136EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1QUEENSCARE FAMILY CLINICSBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlQUEENameControl
Phone3236694302Phone

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameLEE E HUEYName
TitleCFOTitle
Phone3236694302Phone
Date Signed2011-02-09DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameJOSEPH E LUNDYName
Phone6106607788Phone
Date Prepared2011-05-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts22272110GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
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 Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees235TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year5336249ContributionsGrantsPriorYear
Contributions Grants Current Year6146366ContributionsGrantsCurrentYear
Program Service Revenue Prior Year16376927ProgramServiceRevenuePriorYear
Program Service Revenue CY15951465ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year265956OtherRevenuePriorYear
Other Revenue Current Year174279OtherRevenueCurrentYear
Total Revenue Prior Year21979132TotalRevenuePriorYear
Total Revenue Current Year22272110TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12461839SalariesEtcPriorYear
Salaries Etc Current Year11372850SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year94232TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY101700TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year101700TotalFundrsngExpCurrentYear
Other Expense Prior Year8757747OtherExpensePriorYear
Other Expenses Current Year8040052OtherExpensesCurrentYear
Total Expenses Prior Year21313818TotalExpensesPriorYear
Total Expenses Current Year19514602TotalExpensesCurrentYear
Revenues Less Expenses Prior Year665314RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2757508RevenuesLessExpensesCY
Total Assets BOY5480127TotalAssetsBOY
Total Assets EOY8340715TotalAssetsEOY
Total Liabilities BOY1027317TotalLiabilitiesBOY
Total Liabilities EOY1130397TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4452810NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7210318NetAssetsOrFundBalancesEOY
Mission DescriptionQUEENSCARE FAMILY CLINICS,MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense17725176Expense
Revenue16125744Revenue
DescriptionQUEENSCARE FAMILY CLINICS PROVIDED 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 EXPERIENCED 127,415 PATIENT VISITS.Description
Total Program Service Expense17725176TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingtrueProfessionalFundraising
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
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109692NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees235NumberOfEmployees
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
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
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 BodytrueForm990ProvidedToGoverningBody
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 Line1LEE E HUEY CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3236694304TelephoneNumber

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 (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeFormerFormerHighest Compensated EmployeeHighestCompensatedEmployee
ALLAN MICHELENA
CHAIRMAN2.00XX40000
REV WAYNE R NEGRETE SJ
SECRETARY2.00XX40000
SR JUDY MURPHYCSJ
SECRETARY10.00XX14500680000
JAY GUERENA
TREASURER2.00XX40000
JORGE BLANCO
DIRECTOR2.00X50000
SHIRLEY DANIELS
DIRECTOR2.00X40000
ARCHBISHOP VATCHE HOVSEPIAN
DIRECTOR2.00X20000
FRANK REY DE PEREA
DIRECTOR2.00X50000
WILLY RUIZ
DIRECTOR2.00X30000
MARGARITA DUARTE TUCKER
DIRECTOR2.00X40000
NONGYAO VARANOND
DIRECTOR2.00X000
SR MARTHA VEGASSS
DIRECTOR2.00X30000
DAVID WALSH
DIRECTOR2.00X000
FR ANGELOS YOUSSEF
DIRECTOR2.00X40000
BARBARA B HINES
PRESIDENT & CEO20.00X313001357890
ALAN ROTHFELD MD
CHIEF MEDICAL OFFICER25.0017436100X
GUILLERMO DIAZ MD
ASST. CMO40.0015904400X
TERRY A BONECUTTER
CEO, EMERITUS20111623113073X
LEE E HUEY
CHIEF FINANCIAL OFFICER20X9110889498
FIKRY FANOUS MD
OB/GYN40201251X
KHANH NGUYEN MD
PHYSICIAN40179536X
ANGELITA ARAQUEL MD
PHYSICIAN40162360X
YUNG SOON AHN MD
PHYSICIAN40161587X
HYUN KIM MD
PHYSICIAN40160647X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1451517TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs406360TotalReportableCompFrmRltdOrgs
Number Individuals GT100 K21NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
QUEST DIAGNOSTICS
PO BOX 555LOS ANGELESCA90017LAB SERVICES458164
UNIVERSAL PROTECTION SERV
PO BOX 512719LOS ANGELESCA90051SECURITY190995
LADDARAN MEDICAL GRP
PO BOX 5555LOS ANGELESCA90000RADIOLOGY SERVICES101439
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants2606911GovernmentGrants
All Other Contributions3539455AllOtherContributions
Noncash Contributions2209762NoncashContributions
Total Contributions6146366TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE6214001143397911433979
REV FROM QFC/QCP PART62140045174864517486
FieldValueIRS element (for citing)
Total Program Service Revenue15951465TotalProgramServiceRevenue

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code621400BusinessCode
Total Revenue Column174279TotalRevenueColumn
Related Or Exempt Function Income174279RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue174279TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column22272110TotalRevenueColumn
Related Or Exempt Function Income16125744RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total641976Total
Program Services343754ProgramServices
Management And General298222ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8212361Total
Program Services7718570ProgramServices
Management And General493791ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total-15850Total
Program Services-15850ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1830440Total
Program Services1689710ProgramServices
Management And General140730ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total703923Total
Program Services637779ProgramServices
Management And General66144ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total53299Total
Program Services27490ProgramServices
Management And General25809ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total67266Total
Program Services0ProgramServices
Management And General67266ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total101700Total
Fundraising101700Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total13489Total
Program Services13489ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total87533Total
Program Services83459ProgramServices
Management And General4074ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total262606Total
Program Services219910ProgramServices
Management And General42696ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total76442Total
Program Services38953ProgramServices
Management And General37489ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total452817Total
Program Services430688ProgramServices
Management And General22129ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total286354Total
Program Services268174ProgramServices
Management And General18180ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
RENT9411017360522050490
PHYSICIAN FEES62245162245100
LAB FEES64766964766900
MEDICAL & OTHER SUPPLIES54633754225740800
PHARMACEUTICALS2357313235731300

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1625375Total
Program Services1363308ProgramServices
Management And General262067ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19514602Total
Program Services17725176ProgramServices
Management And General1687726ManagementAndGeneral
Fundraising101700Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2450BOY
EOY2450EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1042025BOY
EOY3396358EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY603394BOY
EOY791498EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1400881BOY
EOY1214085EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY660138BOY
EOY901584EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY115477BOY
EOY144184EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis5912128LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4462673LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1172642BOY
EOY1449455EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY75000BOY
EOY75000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY408120BOY
EOY366101EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5480127BOY
EOY8340715EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1027317BOY
EOY1130397EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1027317BOY
EOY1130397EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3773104BOY
EOY6325312EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY679706BOY
EOY885006EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4452810BOY
EOY7210318EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5480127BOY
EOY8340715EOY
FieldValueIRS element (for citing)
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 Balance679706BeginningOfYearBalance
Contributions2209762Contributions
Other Expenditures2004462OtherExpenditures
End Of Year Balance885006EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1396683InvestmentCostOrOtherBasis
Depreciation683538Depreciation
Book Value713145BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis4515445InvestmentCostOrOtherBasis
Depreciation3779135Depreciation
Book Value736310BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1449455TotalOfBookValueLandBuildings

Other Assets OtherAssets (8 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM QUEENSCARE156257
UST-UNEMPLOYMENT INSURANCE TRUST105174
HOLLYWOOD PRESBYTERIAN MEDICAL BUILDING5015
ALLIANT INSURANCE-WILSHIRE CLINIC FIRE40950
FIREMAN'S FUND -WORKERS' COMPENSATION29904
TDA FORFEITURE ACCOUNT27819
COBRA463
MESSAGE EXCHANGE CENTER519
FieldValueIRS element (for citing)
Total Book Value Other Assets366101TotalBookValueOtherAssets
Total Revenue22272110TotalRevenue
Total Expenses19514602TotalExpenses
Excess Or Deficit For Year2757508ExcessOrDeficitForYear
Excess Or Deficit Per FS2757508ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt22272110TotRevenueEtcAuditedFinclStmt
Revenue Subtotal22272110RevenueSubtotal
Total Revenue Per Form99022272110TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19514602TotExpensesEtcAuditedFinclStmt
Expenses Subtotal19514602ExpensesSubtotal
Total Expenses Per Form99019514602TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierExplanationExplanation
Pt V Line 4QueensCare Family Clinics intends to use its endowment funds to support healthcare related activities.
Pt XTHE CLINICS HAVE APPLIED ASC 740 TO ALL TAX POSITIONS FOR WHICH THE STATUTE OF LIMITATIONS REMAINED OPEN AND DETERMINED THERE WERE NO MATERIAL UNRECOGNIZED TAX BENEFITS. IN ADDITION, THERE HAVE BEEN NO MATERIAL CHANGES IN UNRECOGNIZED BENEFITS SINCE JULY 1, 2009, NOR ARE ANY ANTICIPATED IN THE NEXT
Pt X12 MONTHS. THERE HAVE BEEN NO RELATED TAX PENALTIES OR INTEREST, WHICH WOULD BE CLASSIFIED AS TAX EXPENSE IN THE STATEMENT OF ACTIVITIES. AS A RESULT, THE ADOPTION OF ASC 740 DID NOT HAVE A MATERIAL EFFECT ON THE CLINICS' FINANCIAL STATEMENTS.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Solicitation Of Govt GrantsXSolicitationOfGovtGrants
Agreement Ref FundraisingtrueAgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation (3 entries)

ActivityActivityFundraiser Control Of FundsFundraiserControlOfFundsGross ReceiptsGrossReceiptsAmount Retained By ContractorAmountRetainedByContractorNet To OrganizationNetToOrganization
KELLEHER & ASSOCIATES
GRANT WRITERfalse21370022000191700
GARY BESS & ASSOCIATES
GRANT WRITERfalse556700069505560050
MEDICAL STAFF MGMT
ENROLLERSfalse45410072750381350
FieldValueIRS element (for citing)
Total Gross Receipts6234800TotalGrossReceipts
Total Retained By Contractors101700TotalRetainedByContractors
Total Net To Organization6133100TotalNetToOrganization

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgs
BARBARA B HINES
3130013578931300135789
ALAN ROTHFELD MD
174361174361
GUILLERMO DIAZ MD
159044159044
TERRY A BONECUTTER
111623113073111623113073
LEE E HUEY
91108894989110889498
FIKRY FANOUS MD
201251201251
KHANH NGUYEN MD
179536179536
ANGELITA ARAQUEL MD
162360162360
YUNG SOON AHN MD
161587161587
HYUN KIM MD
160647160647

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions0NumberOfContributions
Noncash Contribs Rptd F9902209762NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues
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 7/1/2009 - 6/30/10, QueensCare
Form 990Family Clinics received donations of numerous
Form 990pharmaceutical products with an aggregate estimated
Form 990value of $2,209,762 from various pharmaceutical
: MANUFACTURERS..;

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (79 entries)

IdentifierIdentifierExplanationExplanation
Pt VI-B, Line 11AFollowing preparation of a final draft of the Form 990,
and review by the organization's CEO, the final draft
is presented to the Finance Committee for approval.
Prior to filing the return, it is distributed to all
Board members prior to the meeting of the Board at which details
of the return are discussed and each Board member is
provided with the opportunity to ask questions.
Pt VI-B, 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-B, Line 15A Compensation Committee comprised of independent Board
members formulates a proposed compensation level for the
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 2010 and its findings and
recommendations with regard to the CEO's compensation level
were approved by the Board in June 2010.
Pt VI-C, 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-A, 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 providing
day-to-day mangement for the operation of the QFC/QCP
and on-site management of QFC's personnel to include
hiring, training, and discharging QFC personnel.
QueensCare also has responsibility for the management
and coordination of all administrative services that
are provided in the Clinics.
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.
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.
Chief Financial Officer Lee E. Huey 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 Line1NABusinessNameLine1

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-7728038ShareOfTotalIncome
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnertrueGeneralOrManagingPartner
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 OrgfalseGiftGrantOrCapContrFrOtherOrg
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 (9 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
QFCQCP
b7728038
QFCQCP
j435195
QFCQCP
k12364860
QFCQCP
m725325
QFCQCP
n12364862
QFCQCP
p4636824
QUEENSCARE
n397415
QUEENSCARE
o
QUEENSCARE
p