PROVIDENCE FACEY MEDICAL FOUNDATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- PROVIDENCE FACEY MEDICAL FOUNDATION (EIN 95-4322584)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-11
- IRS object ID
- 201142249349300014
- Schema version
- 2009v1.7
- 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 B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-11T19:05:59-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | 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 | 2009-10-01 | 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 | JAMES CORWIN | Name |
| Title | CFO | Title |
| Phone | 8183659531 | Phone |
| Date Signed | 2011-08-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6192326500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | 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 | 189739319 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| 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 | 1152 | TotalNbrEmployees |
| Total Nbr Volunteers | 8 | TotalNbrVolunteers |
| Total Gross UBI | 13200 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -738 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 4197 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 13531 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 172778468 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 176205101 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 310245 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3040654 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 60702 | OtherRevenuePriorYear |
| Other Revenue Current Year | 18833 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 173153612 | TotalRevenuePriorYear |
| Total Revenue Current Year | 179278119 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 30765 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 45016 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 50989613 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 51899769 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 119186077 | OtherExpensePriorYear |
| Other Expenses Current Year | 123115221 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 170206455 | TotalExpensesPriorYear |
| Total Expenses Current Year | 175060006 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2947157 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4218113 | RevenuesLessExpensesCY |
| Total Assets BOY | 54091539 | TotalAssetsBOY |
| Total Assets EOY | 55984067 | TotalAssetsEOY |
| Total Liabilities BOY | 27183075 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 26882731 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26908464 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 29101336 | 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 | 158414776 | Expense |
| Grants | 45016 | Grants |
| Revenue | 175193116 | 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. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 873873 | Expense |
| Revenue | 1011985 | Revenue |
| Description | Clinical Research: Conducted 26 (14 are active) FDA-regulated studies (161 patients and 1,352 study visits) in various disciplines including Gastroenterology, Endocrinology, Internal Medicine, Oncology, Pediatrics, and Ophthamology. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1053071 | Expense |
| Description | Patient Education: 189 Health Education classes, serving 6,981 people, between October 2009 and September 2010. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 301195 | Expense |
| Description | Flu Clinics: 14,886 vaccinations given during Flu Clinics in the month of October 2009. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 301195 | TotalOfOtherProgramServiceExp |
| Total Program Service Expense | 160642915 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 134 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1152 | 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 |
| 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 200 | AddressLine1 |
| City | Mission Hills | City |
| State | CA | State |
| ZIP Code | 913451420 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 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 Chairman | 1.40 | X | 20400 | 0 | 0 | |||
| Ronald Kaufman MD | ||||||||
| Board Member | 1.00 | X | 11200 | 0 | 0 | |||
| Gary Leary | ||||||||
| Board Member/Legal consultant | 8.50 | X | 64200 | 0 | 0 | |||
| Michael Linn | ||||||||
| Board Member | 1.20 | X | 16852 | 0 | 0 | |||
| J Robert Liset | ||||||||
| Board Member | 0.70 | X | 9400 | 0 | 0 | |||
| Mary Odell | ||||||||
| Board Member | 1.00 | X | 10600 | 0 | 0 | |||
| Larry Scherzer | ||||||||
| Board Member | 1.20 | X | 11500 | 0 | 0 | |||
| Carl Cannata | ||||||||
| Board Member | 1.20 | X | 11500 | 0 | 0 | |||
| Michael Lynch MD | ||||||||
| Board Member | 0.90 | X | 10900 | 0 | 0 | |||
| Peter Richman MD | ||||||||
| Board Member | 0.90 | X | 8900 | 0 | 0 | |||
| Guillermo Gil | ||||||||
| CEO, President | 40.00 | 409694 | 0 | 37323 | X | |||
| James Corwin | ||||||||
| CFO | 40.00 | 298850 | 0 | 16615 | X | |||
| Teresa David | ||||||||
| COO | 40.00 | 262124 | 0 | 25904 | X | |||
| Jacki Delanders | ||||||||
| Admin Director | 40.00 | 154139 | 0 | 8039 | X | |||
| Margie Melby | ||||||||
| Admin Director | 40.00 | 130403 | 0 | 19515 | X | |||
| Stephanie Bamford | ||||||||
| Admin Director | 40.00 | 104699 | 0 | 22623 | X | |||
| Patricia Horanberg | ||||||||
| Admin Director | 40.00 | 122653 | 0 | 7914 | X | |||
| Prubjeet Khurana | ||||||||
| Admin Director | 40.00 | 121499 | 0 | 5061 | X | |||
| Susan Slack | ||||||||
| Admin Director | 40.00 | 97831 | 0 | 23541 | X | |||
| David Day | ||||||||
| Podiatrist | 40.00 | 149134 | 0 | 13997 | X | |||
| Joung Jeffrey Lee | ||||||||
| Podiatrist | 40.00 | 139529 | 0 | 4128 | X | |||
| Magaly Beilke | ||||||||
| Admin Director | 40.00 | 134854 | 0 | 23297 | X | |||
| Mari Zagrzejewski | ||||||||
| Admin Director | 40.00 | 133757 | 0 | 11591 | X | |||
| Sybil Tourville | ||||||||
| Admin Director | 40.00 | 144569 | 0 | 22569 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2002102 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 163463 | TotalOtherCompensation |
| Number Individuals GT100 K | 25 | 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 | 74370175 |
| Marshall Erdman & Associates | |||||
| 350 Interlocken Blvd | Bloomfield | CO | 80021 | Construction & Consulting services | 4487952 |
| Quest Diagnostics | |||||
| 8401 Fallbrook Ave | West Hills | CA | 91304 | Laboratory services | 1833378 |
| La Casa Maintenance Inc | |||||
| 9018 Balboa Blvd Suite 281 | Northridge | CA | 91325 | Janitorial services | 647830 |
| Safety Protective Services | |||||
| 2621 W Olympic Blvd | Los Angeles | CA | 90006 | Security services | 269713 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 22 | NumberOfContractorsGT100K |
| All Other Contributions | 13531 | AllOtherContributions |
| Total Contributions | 13531 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Net Patient services | 900099 | 175193116 | 175193116 |
| Clinical Research | 900099 | 1011985 | 1011985 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 176205101 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 280854 | TotalRevenueColumn |
| Exclusion | $280,854 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 13217000 | Securities |
| Other | 4000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 10459288 | Securities |
| Other | 1912 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2757712 | Securities |
| Other | 2088 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2759800 | TotalRevenueColumn |
| Exclusion | $2,759,800 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| Management Fees | 812900 | 13200 | 13200 | |
| Miscellaneous | 900099 | 5633 | $5,633 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 18833 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 179278119 | TotalRevenueColumn |
| Related Or Exempt Function Income | 176205101 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 13200 | UnrelatedBusinessRevenue |
| Exclusion | $3,046,287 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45016 | Total |
| Program Services | 45016 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1608604 | Total |
| Program Services | 328261 | ProgramServices |
| Management And General | 1280343 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41882148 | Total |
| Program Services | 37455677 | ProgramServices |
| Management And General | 4426471 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 424105 | Total |
| Program Services | 360489 | ProgramServices |
| Management And General | 63616 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4641426 | Total |
| Program Services | 3725143 | ProgramServices |
| Management And General | 916283 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3343486 | Total |
| Program Services | 2831371 | ProgramServices |
| Management And General | 512115 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 657100 | Total |
| Management And General | 657100 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199676 | Total |
| Management And General | 199676 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10808 | Total |
| Management And General | 10808 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6403811 | Total |
| Program Services | 6403811 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112587 | Total |
| Program Services | 89721 | ProgramServices |
| Management And General | 22866 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4095009 | Total |
| Program Services | 1217516 | ProgramServices |
| Management And General | 2877493 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1972307 | Total |
| Program Services | 1440121 | ProgramServices |
| Management And General | 532186 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14336718 | Total |
| Program Services | 12879495 | ProgramServices |
| Management And General | 1457223 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 203313 | Total |
| Program Services | 163532 | ProgramServices |
| Management And General | 39781 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47680 | Total |
| Program Services | 25615 | ProgramServices |
| Management And General | 22065 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41378 | Total |
| Management And General | 41378 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4356706 | Total |
| Program Services | 3470955 | ProgramServices |
| Management And General | 885751 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2137449 | Total |
| Program Services | 2060707 | ProgramServices |
| Management And General | 76742 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Medical Fees to FMG | 74370175 | 74370175 | 0 | 0 |
| Supplies | 12241234 | 11847990 | 393244 | 0 |
| Bad Debt | 1927320 | 1927320 | 0 | 0 |
| Misc UBI Expense | 1950 | 0 | 1950 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175060006 | Total |
| Program Services | 160642915 | ProgramServices |
| Management And General | 14417091 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12898 | BOY |
| EOY | 13600 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12101474 | BOY |
| EOY | 10859926 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9345569 | BOY |
| EOY | 8531799 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1582805 | BOY |
| EOY | 1722768 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2257408 | BOY |
| EOY | 2498773 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 48787061 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 30155691 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16145406 | BOY |
| EOY | 18631370 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12504479 | BOY |
| EOY | 13584331 | 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 | 54091539 | BOY |
| EOY | 55984067 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17000269 | BOY |
| EOY | 17381943 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3070635 | BOY |
| EOY | 2688884 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45728 | BOY |
| EOY | 486356 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 705177 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6361266 | BOY |
| EOY | 6325548 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27183075 | BOY |
| EOY | 26882731 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26908464 | BOY |
| EOY | 29101336 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26908464 | BOY |
| EOY | 29101336 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54091539 | BOY |
| EOY | 55984067 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
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 | $10,808 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 10808 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | 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 | 20360479 | OtherCostOrOtherBasis |
| Depreciation | 11390987 | Depreciation |
| Book Value | 8969492 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20110370 | OtherCostOrOtherBasis |
| Depreciation | 13085618 | Depreciation |
| Book Value | 7024752 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8316212 | OtherCostOrOtherBasis |
| Depreciation | 5679086 | Depreciation |
| Book Value | 2637126 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 18631370 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Medical Mal Practice Self-Insured Retention | Description |
| Amount | $6,325,548 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6325548 | TotalOfAmounts |
| Total Revenue | 179278119 | TotalRevenue |
| Total Expenses | 175060006 | TotalExpenses |
| Excess Or Deficit For Year | 4218113 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -1916656 | NetUnrealizedGLOnInvestments |
| Other | -$108,585 | OtherAmount |
| Total Adjustments | -2025241 | TotalAdjustments |
| Excess Or Deficit Per FS | 2192872 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 177339344 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -1916656 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -1916656 | RevenueNotRptdF990 |
| Revenue Subtotal | 179256000 | RevenueSubtotal |
| Other Revenues Not Included | 22119 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 22119 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 179278119 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 175037887 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 175037887 | ExpensesSubtotal |
| Other Expenses Not Included | 22119 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 22119 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 175060006 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | FMF adopted the provisions of Financial Accounting Standards Board (FASB) Interpretation (FIN) No. 48, Accounting for Uncertainty in Income Taxes --an interpretation of FASB Statement No. 109, on October 1, 2009. As a result of the adoption, FMF did not recognize a liability for unrecognized tax contingencies. |
| Part XI, Line 8 - Other Adjustments: | Imputed interest on unihealth grant obligation : -118249. Income from K-1 adjustment: 9664. | |
| PART XII, LINE 4B: OTHER REVENUE & EXPENSE RECLASS PART XIII, LINE 4B: OTHER REVENUE & EXPENSE RECLASS |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| North East Valley Health Corp | |||||||
| 1172 N Maclay Ave | San Fernando | CA | 91340 | 237120632 | 501(c)(3) | 26046 | HEALTH CARE |
| Providence Holy Cross Foundation | |||||||
| 15031 Rinaldi Street | Mission Hills | CA | 91345 | 954838458 | 501(c)(3) | 10800 | HEALTH CARE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Other Information: | Identifier |
| Return Reference | Part IV: | ReturnReference |
| Explanation | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Guillermo Gil | |||||||||||||
| 285435 | 0 | 115743 | 0 | 8516 | 0 | 37323 | 0 | 0 | 0 | 447017 | 0 | 0 | 0 |
| James Corwin | |||||||||||||
| 230860 | 0 | 62836 | 0 | 5154 | 0 | 0 | 0 | 16615 | 0 | 315465 | 0 | 0 | 0 |
| Teresa David | |||||||||||||
| 199584 | 0 | 57253 | 0 | 5287 | 0 | 22957 | 0 | 2947 | 0 | 288028 | 0 | 0 | 0 |
| Jacki Delanders | |||||||||||||
| 137302 | 0 | 16653 | 0 | 184 | 0 | 3353 | 0 | 4686 | 0 | 162178 | 0 | 0 | 0 |
| David Day | |||||||||||||
| 148515 | 0 | 0 | 0 | 619 | 0 | 6500 | 0 | 7497 | 0 | 163131 | 0 | 0 | 0 |
| Magaly Beilke | |||||||||||||
| 113436 | 0 | 21161 | 0 | 257 | 0 | 21999 | 0 | 1298 | 0 | 158151 | 0 | 0 | 0 |
| Sybil Tourville | |||||||||||||
| 120423 | 0 | 23311 | 0 | 835 | 0 | 20500 | 0 | 2069 | 0 | 167138 | 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 | 431812 | AmountOfTransaction |
| Description Of Transaction | Facey Eye Institute, Inc. provides billing and collection services to Facey Medical Foundation. The $431,812 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 (10 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| 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 2009 Form 990 will be reviewed by the Audit Committee prior to filing. Committee Minutes will reflect the review of the tax return for the 2009 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. |
| Form 990, Part VI, Section B, line 12c | 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 15 | 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 C, line 19 | 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, Schedule A, Part I, Line 3 and Schedule H: 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, Part VI, Section B, Line 14: 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 is currently being drafted for review and approval by the Board. | |
| FORM 990, PART III: | 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) $ 257,781 Medi-Medi/Medi-Cal $3,725,500 Flu Clinics $ 301,195 Community Outreach/Education Programs $1,053,071 Total Community Benefit Costs thru 9/30/10 $5,337,547 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 30,2010 and 2009, 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, 2010 and 2009, the $5,000,000 grant -- net of payments and a $311,000 and $429,000 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, 2010 and 2009, is $2,689,000 and $3,017,000, 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 VI, LINE 16: | 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 VII: | Total compensation reported for Gary Leary on Part VII is $64,200. The $64,200 is composed of $50,400 in legal services fees and the other $13,800 is for board service compensation. |