2024-05-13T17:16:51-05:00 2023-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2022-07-01 680371679 PEACH TREE HEALTHCARE PEAC 5307493242 1114 YUBA STREET 220 MARYSVILLE CA 95901 JAMES ELLSWORTH CHIEF FINANCIAL OFFICER 5307493242 2024-05-13 1 JAMES ELLSWORTH 999009999 0 MICHAEL LUMSDEN P01262236 4159561500 2024-05-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GREG STONE 1114 YUBA STREET 220 MARYSVILLE CA 95901 34737120 0 X WWW.PICKPEACH.ORG X 1995 CA PEACH TREE HEALTH IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. 9 9 347 13 0 0 8349342 6600957 24672280 27991870 5048 144293 25375 0 33052045 34737120 0 0 0 0 15110495 21051914 0 0 0 13632765 14753243 28743260 35805157 4308785 -1068037 20403638 24220451 2742406 7627256 17661232 16593195 X PEACH TREE HEALTHCARE IS COMMITTED TO PROVIDING PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES. 0 0 23976264 0 27991870 PEACH TREE HEALTHCARE IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) OPERATING AT THE FOLLOWING LOCATIONS: THARP ROAD DENTAL CLINIC, LIVE OAK MEDICAL CLINIC (INCLUDING PEACH TREE VISION LIVE OAK AND PEACH TREE CHIROPRACTIC), PEACH TREE YUBA CITY/COLUSA, PEACH TREE CLINIC (INCLUDING PEACH TREE VISION LINDA), PEACH TREE OROVILLE EYE CENTER, PEACH TREE NORTH SACRAMENTO (INCLUDING PEACH TREE VISION NORTH SACRAMENTO AND SACRAMENTO IMMEDIATE CARE), AND PEACH TREE CHICO EYE CENTER. PEACH TREE HEALTHCARE PROVIDES PERSONALIZED, AFFORDABLE, HIGH-QUALITY HEALTH SERVICES INCLUDING DENTAL, VISION, BEHAVIORAL HEALTH, AND MEDICAL SPECIALTY SERVICES (FAMILY MEDICINE, PEDIATRICS, IMMEDIATE CARE, WOMEN'S HEALTH, ACUPUNCTURE, DIABETES, SPORTS PHYSICALS, NON-SURGERY ORTHOPEDICS, PHARMACY, AND PODIATRY). DURING THE JUNE 30, 2023 TAX YEAR, 121,036 PATIENTS RECEIVED SERVICES AT OUR VARIOUS CLINICS. 23976264 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 21 0 1 347 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X JAMES ELLSWORTH 5307493242 1114 YUBA STREET SUITE 220 MARYSVILLE CA 95901 DAWN TREHARNE-ESPARZA CHAIR THROUGH 8/2022 1.00 X X 0 0 0 MATT WILLIAMS CHAIR START 8/2022 1.00 X X 0 0 0 ANDREW POTTER VICE CHAIR THROUGH 3/2023 1.00 X X 0 0 0 ERICKA SUMMERS VICE CHAIR START 3/2023 1.00 X X 0 0 0 KIRAN SIBIA SECRETARY/TREASURER 1.00 X X 0 0 0 AWNI ALLABABIDI DIRECTOR 1.00 X 0 0 0 DON BLASER DIRECTOR 1.00 X 0 0 0 CAMILLA CASTALDO DIRECTOR 1.00 X 0 0 0 NAILAH KOKAYI DIRECTOR THROUGH 2/2023 1.00 X 0 0 0 ATIEN KOUASSI DIRECTOR THROUGH 5/2023 1.00 X 0 0 0 PHUONG LUU MD DIRECTOR 1.00 X 0 0 0 JASON ROBERTS DIRECTOR 1.00 X 0 0 0 PAMELA TUMBER DIRECTOR 1.00 X 0 0 0 GREG STONE CHIEF EXECUTIVE OFFICER 40.00 X 281167 0 26035 JAMES ELLSWORTH CHIEF FINANCIAL OFFICER 40.00 X 216478 0 15588 KEITH HOPKINS MD CHIEF MEDICAL OFFICER THROUGH 9/2022 40.00 X 121576 0 3531 KAUMAKAOKALANI SHIMATSU MD CHIEF MEDICAL OFFICER START 1/2023 40.00 X 0 0 0 RUPAUL GHUMAN DDS DENTAL DIRECTOR 40.00 X 225340 0 30466 ERIC HERNANDEZ CHIEF OPERATIONS OFFICER 40.00 X 191573 0 12213 GINA ROSSETTI MD CHIEF HEALTH OFFICER 40.00 X 173249 0 6265 MICHELLE WOODARD CHIEF ADMINISTRATIVE OFFICER 40.00 X 153190 0 4234 SUMIT JOHL MD PEDIATRICIAN 40.00 X 371103 0 24569 TEJINDER GHUMAN MD PEDIATRICIAN 40.00 X 360315 0 24569 RASHMI TUNUGUNTLA DO PHYSICIAN 40.00 X 305509 0 6100 AMANDA TAGLE MD PHYSICIAN 40.00 X 269017 0 23767 RAMESH PUNDI MD PHYSICIAN 40.00 X 247487 0 31961 RICHARD FURY MD FORMER CHIEF MEDICAL OFFICER 40.00 X 112738 0 23788 3028742 0 233086 38 1 1 0 RIDGE EYE CARE 1700 BRUCE RD CHICO CA 95928 CONTRACTED OPTOMETRY SERVICES 2741190 MACMAN MANAGEMENT HEALTHCARE SERVICES 1930 DEL PASO RD 120 SACRAMENTO CA 95834 CONTRACTED BILLING SERVICES 1158356 GROUP ONE CONSULTING INC 13405 FOLSOM BLVD SUITE 511 FOLSOM CA 95630 CONTRACTED IT SERVICES 553995 OSIS PO BOX 772852 CHICAGO IL 606772852 CONTRACTED IT SERVICES 496311 IMAGINE MEDICAL GROUP 3939 WEST RIDGE ROAD SUITE A 100 ERIE PA 16506 CONTRACTED BEHAVIOR HEALTH SERVICES 248745 10 5848737 752220 974997 6600957 NET PATIENT SERVICE REVENUE 621400 26597038 26597038 OTHER OPERATING REVENUE 621400 1394832 1394832 27991870 144293 144293 34737120 27991870 0 144293 X 1550662 650184 900478 15505912 10535006 4970906 271584 181765 89819 2545052 1692427 852625 1178704 774568 404136 124916 124916 89513 89513 6630533 4274921 2355612 85146 32334 52812 145173 99878 45295 824108 109928 714180 2283440 1824396 459044 102460 38908 63552 23799 9038 14761 23878 21085 2793 835304 648855 186449 284269 68652 215617 MEDICAL SUPPLIES & DRUG 2797797 2797797 RECRUITMENT 165816 66000 99816 LICENSES & FEES 64756 47105 17651 272335 103417 168918 35805157 23976264 11828893 0 408521 875583 8251994 8165928 27000 200171 2601752 3445165 285594 681016 480084 530357 11905463 7834820 3061527 4070643 5287166 6251588 20403638 24220451 2309314 3113884 140260 355331 292832 4158041 2742406 7627256 X 17661232 16593195 17661232 16593195 20403638 24220451 -1068037 0 X 0 1 X 1 1 1 X 2271944 5090103 5294153 8349342 6600957 27606499 2271944 5090103 5294153 8349342 6600957 27606499 27606499 60122 60039 64869 30423 144293 359746 27966245 124193793 0.98710 0.98840 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: DURING THE JUNE 30, 2023 TAX YEAR, THE ORGANIZATION INCURRED INDIRECT LOBBYING EXPENDITURES THROUGH DUES PAID TO OUTSIDE ORGANIZATIONS, INCLUDING THE CALIFORNIA PRIMARY CARE ASSOCIATION. THE PORTION OF THESE DUES WHICH WAS UTILIZED FOR LOBBYING ACTIVITIES COULD NOT BE ASCERTAINED, BUT ARE DE MINIMIS IN RELATION TO THE OVERALL ACTIVITIES OF THE ORGANIZATION. 4915524 3041107 1874417 4185394 3518352 667042 2804545 1275361 1529184 4070643 DEPOSITS 116097 ESTIMATED THIRD-PARTY SETTLEMENT RECEIVABLE 2170732 OPERATING LEASE, RIGHT OF USE ASSETS 3964759 6251588 OPERATING LEASE LIABILITY 4158041 4158041 X 34737120 0 34737120 0 34737120 35805157 0 35805157 0 35805157 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUSES BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2023 AND 2022, THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. X X 1 0 0 0 0 0 0 0 0 SUMIT JOHL MD PEDIATRICIAN 336174 0 24505 0 10424 0 6100 0 18469 0 395672 0 0 0 TEJINDER GHUMAN MD PEDIATRICIAN 328213 0 22100 0 10002 0 6100 0 18469 0 384884 0 0 0 RASHMI TUNUGUNTLA DO PHYSICIAN 303319 0 2040 0 150 0 6100 0 0 0 311609 0 0 0 GREG STONE CHIEF EXECUTIVE OFFICER 259220 0 20947 0 1000 0 0 0 26035 0 307202 0 0 0 AMANDA TAGLE MD PHYSICIAN 259717 0 9000 0 300 0 5298 0 18469 0 292784 0 0 0 RAMESH PUNDI MD PHYSICIAN 217111 0 9060 0 21316 0 3309 0 28652 0 279448 0 0 0 RUPAUL GHUMAN DDS DENTAL DIRECTOR 222215 0 2625 0 500 0 4431 0 26035 0 255806 0 0 0 JAMES ELLSWORTH CHIEF FINANCIAL OFFICER 216328 0 0 0 150 0 3881 0 11707 0 232066 0 0 0 ERIC HERNANDEZ CHIEF OPERATIONS OFFICER 191423 0 0 0 150 0 3818 0 8395 0 203786 0 0 0 GINA ROSSETTI MD CHIEF HEALTH OFFICER 144231 0 20000 0 9018 0 3459 0 2806 0 179514 0 0 0 MICHELLE WOODARD CHIEF ADMINISTRATIVE OFFICER 148907 0 2783 0 1500 0 3064 0 1170 0 157424 0 0 0 RICHARD FURY MD FORMER CHIEF MEDICAL OFFICER 112528 0 210 0 0 0 2255 0 21533 0 136526 0 0 0 PART I, LINE 4A DURING THE 2022 CALENDAR YEAR, KEITH HOPKINS, MD RECEIVED A SEVERANCE PAYMENT OF $24,471 WHICH WAS REPORTED AS TAXABLE COMPENSATION ON HIS 2022 FORM W-2. X 15644 974997 COST OF DONATED PROPERTY 0 0 0 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS CONTRIBUTED IN SCHEDULE M, PART I, COLUMN (B). FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM, WHO WORKS IN CONJUNCTION WITH THE PEACH TREE HEALTHCARE ACCOUNTING AND FINANCE DEPARTMENT TO COMPLETE THE FORM 990. UPON REVIEW AND APPROVAL BY THE ORGANIZATION'S CFO, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND ALSO REVIEWED WITH THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY, AND ARE REQUIRED TO ANNUALLY RETURN A CONFLICT OF INTEREST DISCLOSURE STATEMENT TO THE CHIEF EXECUTIVE OFFICER. THE BOARD OF DIRECTORS HAS DELEGATED AUTHORITY TO DETERMINE IF A CONFLICT OF INTEREST EXISTS FOR DIRECTORS, CORPORATE OFFICERS, AND THE CEO, WHO MUST LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. IN THE CASE OF A CONFLICT OF INTEREST DISCLOSURE MADE BY A MEDICAL STAFF MEMBER, PHYSICIAN, EXECUTIVE STAFF MEMBER, DEPARTMENT DIRECTOR, SUPERVISOR, OR OTHER INDIVIDUAL, THE CHIEF EXECUTIVE OFFICER DETERMINES, BASED ON THE FACTS AND CIRCUMSTANCES DISCLOSED, IF A CONFLICT OF INTEREST EXISTS AND SHALL ALSO REPORT THE RESULTS OF ALL DETERMINATIONS TO THE CHAIRMAN OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ALL COMPENSATION FOR SENIOR MANAGEMENT AND KEY EMPLOYEES IS APPROVED BY THE BOARD OF DIRECTORS. SENIOR MANAGEMENT COMPENSATION IS ESTABLISHED USING HISTORICAL BENCHMARKS FROM PREVIOUS EMPLOYEES, AS WELL AS THE SALARY GUIDE FROM THE CALIFORNIA PRIMARY CARE ASSOCIATION, WHICH IS EXAMINED ANNUALLY TO ENSURE SALARIES AND BENEFITS ARE ON PAR WITH COMPARABLE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,850,991. MANAGEMENT AND GENERAL EXPENSES 427,857. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,278,848. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 416,874. MANAGEMENT AND GENERAL EXPENSES 17,858. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 434,732. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 7,056. MANAGEMENT AND GENERAL EXPENSES 1,909,897. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,916,953.