CENTERPLACE HEALTH INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
CENTERPLACE HEALTH INC (EIN 20-2779327)
Tax period
2022-05-01 to 2023-04-30
Filed
2024-03-15
IRS object ID
202420759349300627
Schema version
2022v5.0
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)
Return2024-03-15T09:30:32-05:00ReturnTs
Tax Period End2023-04-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN593204548PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1JAMES MOORE & CO PLBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line15931 NW 1ST PLAddressLine1Txt
CityGAINESVILLECityNm
State AbbreviationFLStateAbbreviationCd
ZIP326072063ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-05-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN202779327EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CENTERPLACE HEALTH INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCENTBusinessNameControlTxt
Phone9415290249PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11750 17TH STREET BLDG NAddressLine1Txt
CitySARASOTACityNm
State AbbreviationFLStateAbbreviationCd
ZIP34234ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKARI ELLINGSTADPersonNm
Person TitleCHIEF EXECUTIVE OFFICERPersonTitleTxt
Phone9415290249PhoneNum
Signature2024-03-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstKARIPersonFirstNm
Person LastELLINGSTADPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCORINNE LAROCHEPreparerPersonNm
PTINP01500189PTIN
Phone3523781331PhoneNum
Preparation2024-03-13PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerKARI ELLINGSTADPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11750 17TH STREET BLDG NAddressLine1Txt
CitySARASOTACityNm
State AbbreviationFLStateAbbreviationCd
ZIP34234ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$19,386,691GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTPS://CENTERPLACEHEALTH.ORG/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2014FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionA FQHC (FEDERALLY QUALIFIED HEALTHCARE CENTER) EMPLOYING MEDICAL & DENTAL PROVIDERS SPECIALIZING IN QUALITY PRIMARY CARE SERVICES TO PATIENTS THAT ARE UNDERSERVED, UNDERINSURED AND/OR UNINSURED.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee236TotalEmployeeCnt
Total Volunteers12TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$5,650,811PYContributionsGrantsAmt
CY Contributions Grants$7,807,736CYContributionsGrantsAmt
PY Program Service Revenue$11,581,893PYProgramServiceRevenueAmt
CY Program Service Revenue$11,571,760CYProgramServiceRevenueAmt
PY Investment Income$1,807PYInvestmentIncomeAmt
CY Investment Income$7,195CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$17,234,511PYTotalRevenueAmt
CY Total Revenue$19,386,691CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$11,205,225PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,593,528CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$5,375,438PYOtherExpensesAmt
CY Other Expenses$4,698,416CYOtherExpensesAmt
PY Total Expenses$16,580,663PYTotalExpensesAmt
CY Total Expenses$17,291,944CYTotalExpensesAmt
PY Revenues Less Expenses$653,848PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,094,747CYRevenuesLessExpensesAmt
Total Assets BOY$4,724,060TotalAssetsBOYAmt
Total Assets EOY$5,660,266TotalAssetsEOYAmt
Total Liabilities BOY$2,173,345TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,014,804TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,550,715NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,645,462NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionCENTERPLACE HEALTH, AS A FQHC (FEDERALLY QUALIFIED HEALTHCARE CENTER), EMPLOYS MEDICAL AND DENTAL PROVIDERS SPECIALIZING IN QUALITY, EFFICIENT AND EFFECTIVE PRIMARY CARE SERVICES AND PREVENTABLE HEALTH EDUCATION TO PATIENTS THAT ARE AT RISK, VULNERABLE, UNDERSERVED, UNDERINSURED AND/OR UNINSURED.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$11,697,965ExpenseAmt
Revenue$11,571,760RevenueAmt
DescCENTERPLACE HEALTH, AS A FQHC (FEDERALLY QUALIFIED HEALTHCARE CENTER), EMPLOYS MEDICAL AND DENTAL PROVIDERS SPECIALIZING IN QUALITY, EFFICIENT AND EFFECTIVE PRIMARY CARE SERVICES AND PREVENTABLE HEALTH EDUCATION TO PATIENTS THAT ARE AT RISK, VULNERABLE, UNDERSERVED, UNDERINSURED AND/OR UNINSURED.Desc
Total Program Service Expenses$11,697,965TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document22IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee236EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org DocumentsYes (1)ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy0ConflictOfInterestPolicyInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHRISTINA GARAWAYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9415290249PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11750 17TH STREET BLDG NAddressLine1Txt
CitySARASOTACityNm
State AbbreviationFLStateAbbreviationCd
ZIP34234ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
WILLIAM LITTLE
CHAIR5.00Yes (X)Yes (X)$0$0$0
MARIA SOMERA RAMIREZ
VICE CHAIR5.00Yes (X)Yes (X)$0$0$0
HOWARD BERMAN
TREASURER5.00Yes (X)Yes (X)$0$0$0
ARNOLD DENNARD
SECRETARY5.00Yes (X)Yes (X)$0$0$0
IRENE FLESHNER
IMMEDIATE PAST CHAIR5.00Yes (X)Yes (X)$0$0$0
SCOTT BUSHWAY
DIRECTOR, AS OF 10/20225.00Yes (X)$0$0$0
MARYLEE GROSSO
DIRECTOR, AS OF 1/20235.00Yes (X)$0$0$0
MIKHAIL SCOTT
DIRECTOR, AS OF 10/20225.00Yes (X)$0$0$0
CRYSTAL BROOKS
DIRECTOR, AS OF 1/20235.00Yes (X)$0$0$0
MAUREEN O'BRIEN
DIRECTOR, AS OF 1/20235.00Yes (X)$0$0$0
MARIA DECARLO
DIRECTOR5.00Yes (X)$0$0$0
GLORIA DEHAVEN
DIRECTOR5.00Yes (X)$0$0$0
JAMES REID
CFO, UNTIL 12/202240.00Yes (X)$171,186$0$21,867
MELISSA PARKER
CEO, UNTIL 6/202240.00Yes (X)$70,062$0$8,442
KARI ELLINGSTAD
CEO, AS OF 9/202240.00Yes (X)$59,086$0$6,409
LISA GONZALEZ-ABELLO
CMO40.00$189,613$0$27,963Yes (X)
CHRISTINE TRUPIANO MD
PROVIDER40.00$310,780$0$23,983Yes (X)
JOSEPH SINGER MD
PROVIDER40.00$284,279$0$23,054Yes (X)
ANTHONY DORBU MD
PROVIDER40.00$252,615$0$21,443Yes (X)
MARCUS FOOS MD
PROVIDER40.00$174,835$0$21,830Yes (X)
SAHAR DOWIDAR MD
PROVIDER40.00$146,620$0$21,343Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,659,076TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$176,334TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K16IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ARCH HEALTHCARE INC
3231 GULF GATE DR STE 202SARASOTAFL34231HEALTHCARE SERVICES$174,376
NURSECORE
DEPT 41753 PO BOX 650823DALLASTX75265STAFFING SERVICES$161,846
CENTERSTONE OF FLORIDA INC
PO BOX 9478BRANDENTONFL34206HEALTHCARE SERVICES$147,478
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$6,448,665GovernmentGrantsAmt
All Other Contributions$1,359,071AllOtherContributionsAmt
Noncash Contributions$5,000NoncashContributionsAmt
Total Contributions$7,807,736TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICAID FEES624100$7,048,080$7,048,080
PHARMACY FEES624100$2,135,498$2,135,498
PATIENT FEES624100$2,011,691$2,011,691
MEDICARE FEES624100$376,491$376,491
FieldValueIRS element (for citing)
Total Program Service Revenue$11,571,760TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,195TotalRevenueColumnAmt
Exclusion$7,195ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,386,691TotalRevenueColumnAmt
Related Or Exempt Func Income$11,571,760RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$7,195ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$557,480TotalAmt
Program Services$390,066ProgramServicesAmt
Management And General$167,414ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,070,215TotalAmt
Program Services$7,046,085ProgramServicesAmt
Management And General$3,024,130ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$140,247TotalAmt
Program Services$98,130ProgramServicesAmt
Management And General$42,117ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,075,875TotalAmt
Program Services$752,785ProgramServicesAmt
Management And General$323,090ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$749,711TotalAmt
Program Services$524,570ProgramServicesAmt
Management And General$225,141ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$73,120TotalAmt
Management And General$73,120ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$76,842TotalAmt
Management And General$76,842ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,083,640TotalAmt
Program Services$642,815ProgramServicesAmt
Management And General$440,825ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$33,225TotalAmt
Program Services$945ProgramServicesAmt
Management And General$32,280ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$187,002TotalAmt
Program Services$109,320ProgramServicesAmt
Management And General$77,682ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$195,061TotalAmt
Program Services$48,736ProgramServicesAmt
Management And General$146,325ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$580,935TotalAmt
Program Services$374,450ProgramServicesAmt
Management And General$206,485ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$33,626TotalAmt
Management And General$33,626ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$17,829TotalAmt
Program Services$15,132ProgramServicesAmt
Management And General$2,697ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$16TotalAmt
Management And General$16ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$150,426TotalAmt
Program Services$106,563ProgramServicesAmt
Management And General$43,863ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$108,503TotalAmt
Program Services$26,457ProgramServicesAmt
Management And General$82,046ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PHARMACEUTICALS/SUPPLIE$983,839$913,031$70,808
BAD DEBT EXPENSE$323,121$323,121
DISPENSING FEE$265,662$265,662
DUES & SUBSCRIPTIONS$243,534$158,792$84,742

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$342,035TotalAmt
Program Services$224,426ProgramServicesAmt
Management And General$117,609ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$17,291,944TotalAmt
Program Services$11,697,965ProgramServicesAmt
Management And General$5,593,979ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$213,705BOYAmt
EOY-$20,564EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,037,595BOYAmt
EOY$869,791EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
EOY$6,000EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,755,443BOYAmt
EOY$4,047,179EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$198,238BOYAmt
EOY$264,616EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$902,783LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$409,539LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$519,079BOYAmt
EOY$493,244EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,724,060BOYAmt
EOY$5,660,266EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,183,796BOYAmt
EOY$866,827EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$30,000BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$149,900BOYAmt
EOY$147,977EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$809,649BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,173,345BOYAmt
EOY$1,014,804EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,550,715BOYAmt
EOY$4,645,462EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,550,715BOYAmt
EOY$4,645,462EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,724,060BOYAmt
EOY$5,660,266EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$2,094,747ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,278,200CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,876,798CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,985,261CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,850,810CurrentTaxYearMinus1YearAmt
Current Tax Year$7,807,735CurrentTaxYearAmt
Total$27,798,804TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,278,200CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,876,798CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,985,261CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,850,810CurrentTaxYearMinus1YearAmt
Current Tax Year$7,807,735CurrentTaxYearAmt
Total$27,798,804TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$1,267,024SubstantialContributorsTotAmt
Public Support Total170$26,531,780PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$918CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$10,522CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,540CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,807CurrentTaxYearMinus1YearAmt
Current Tax Year$7,195CurrentTaxYearAmt
Total$22,982TotalAmt
FieldValueIRS element (for citing)
Total Support$27,821,786TotalSupportAmt
Gross Receipts Rltd Activities$41,587,144GrossReceiptsRltdActivitiesAmt
Public Support CY1700.95360PublicSupportCY170Pct
Public Support PY1700.93780PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,552OtherCostOrOtherBasisAmt
Depreciation$5,190DepreciationAmt
Book Value$16,362BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$823,606OtherCostOrOtherBasisAmt
Depreciation$390,070DepreciationAmt
Book Value$433,536BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$57,625OtherCostOrOtherBasisAmt
Depreciation$14,279DepreciationAmt
Book Value$43,346BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$493,244TotalBookValueLandBuildingsAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CHRISTINE TRUPIANO MD
PROVIDER$310,780$0$0$0$0$0$9,323$0$14,660$0$334,763$0$0$0
JOSEPH SINGER MD
PROVIDER$284,279$0$0$0$0$0$8,528$0$14,526$0$307,333$0$0$0
ANTHONY DORBU MD
PROVIDER$252,615$0$0$0$0$0$7,578$0$13,865$0$274,058$0$0$0
LISA GONZALEZ-ABELLO
CMO$189,613$0$0$0$0$0$6,378$0$21,585$0$217,576$0$0$0
MARCUS FOOS MD
PROVIDER$174,835$0$0$0$0$0$5,245$0$16,585$0$196,665$0$0$0
JAMES REID
CFO, UNTIL 12/2022$171,186$0$0$0$0$0$0$0$21,867$0$193,053$0$0$0
SAHAR DOWIDAR MD
PROVIDER$146,620$0$0$0$0$0$4,399$0$16,944$0$167,963$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationCOMPENSATION FOR THE CHIEF EXECUTIVE OFFICER IS APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION AMOUNTS ARE DETERMINED BY AVAILABLE SALARY SURVEY DATA AND COMPENSATION PAID BY SIMILAR ORGANIZATIONS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1ATHE EXECUTIVE COMMITTEE SHALL CONSIST ONLY OF THE OFFICERS OF THE CORPORATION AND WILL MEET AS NEEDED TO CONDUCT BUSINESS OF THE CORPORATION AS DEFINED IN THE BYLAWS TO: (A) TAKE ACTIONS ON BEHALF OF THE BOARD BETWEEN MEETINGS, AS NECESSARY; (B) CONDUCT THE BUSINESS OF THE BOARD; (C) OVERSEE THE EVALUATION OF THE CEO, INCLUDING ALL PROCESSES RELATED TO THIS FUNCTION INCLUDING ESTABLISHING CRITERIA, INTERVIEWING, AND PREPARING SUMMARY INFORMATION TO THE BOARD; AND (D) RECOMMEND SUCCESSION PLANNING FOR KEY FQHC LEADERSHIP.
FORM 990, PART VI, SECTION A, LINE 4THE ORGANIZATION APPROVED CHANGES TO ITS BYLAWS ON 11/15/2022. SIGNIFICANT CHANGES INCLUDE THE FOLLOWING: - SPECIFYING WHICH GRANT APPLICATIONS AND AMENDMENTS REQUIRE BOARD APPROVAL. - ADDING LANGUAGE FOR LEAVE OF ABSENCE REQUESTS BY BOARD MEMBERS. - REMOVAL OF THE 'RESPONSIBILITIES AND DUTIES OF A BOARD DIRECTOR' SECTION. - UPDATING THE 'GOVERNANCE COMMITTEE' LANGUAGE TO BE MORE SUCCINCT AND ACCURATE. - RENAMING THE 'CLINICAL COMMITEE' TO THE 'QUALITY COMMITTE AND COMBINING WITH THE 'COMPLIANCE COMMITTEE' TO CREATE THE 'QUALITY AND COMPLIANCE COMMITTEE', AS WELL AS SIMPLIFYING THE LANGUAGE. - DISBANDING THE 'MARKETING AND COMMUNICATIONS COMMITTEE AND REMOVING THE RELATED SECTION. - ADDING THE SECTION FOR THE 'AUDIT COMMITTEE', WHICH IS COMPRISED OF BOARD MEMBERS AND WILL MEET AS NECESSARY TO REVIEW AND APPROVE THE ANNUAL INDEPENDENT FINANCIAL AUDIT AS WELL AS OTHER AUDITS AS OCCURRING. - UPDATING THE FISCAL YEAR LANGUAGE FOR ACCURACY. - ADDING LANGUAGE STATING THAT AN ADDITIONAL TERM OF OFFICE MAY BE EXTENDED TO A BOARD MEMBER IN EXCEPTIONAL CIRCUMSTANCES OR TO MEET THE NEEDS OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE FORM 990 DRAFT IS MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO ISSUANCE.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER IS APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION AMOUNTS ARE DETERMINED BY AVAILABLE SALARY SURVEY DATA AND COMPENSATION PAID BY SIMILAR ORGANIZATIONS. COMPENSATION FOR THE CHIEF FINANCIAL OFFICER IS APPROVED BY THE CEO. COMPENSATION OF KEY EMPLOYEES IS APPROVED BY THE CHIEF FINANCIAL OFFICER. COMPENSATION AMOUNTS ARE DETERMINED BY AVAILABLE SALARY SURVEY DATA AND COMPENSATION PAID BY SIMILAR ORGANIZATIONS.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC BY REQUEST BY VISITING THE HEADQUARTERS OF THE ORGANIZATION WITH SUFFICIENT NOTICE GIVEN.
FORM 990, PART IX, LINE 24ERECRUITING: PROGRAM SERVICE EXPENSES 95,831. MANAGEMENT AND GENERAL EXPENSES 37,563. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,394. LABORATORY FEES: PROGRAM SERVICE EXPENSES 82,597. MANAGEMENT AND GENERAL EXPENSES 34,206. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116,803. LICENSING/CRENDENTIALING: PROGRAM SERVICE EXPENSES 35,304. MANAGEMENT AND GENERAL EXPENSES 18,841. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,145. OTHER: PROGRAM SERVICE EXPENSES 10,694. MANAGEMENT AND GENERAL EXPENSES 17,517. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,211. BANK/FINANCE EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,482. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,482.

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