2023-05-13T20:39:51-05:00 2022-06-30 680037990 GILBERT CPAS 2880 GATEWAY OAKS DR STE 100 SACRAMENTO CA 95833 990 2021-07-01 942583156 CHAPA-DE INDIAN HEALTH PROGRAM INC CHAP 5308872800 11670 ATWOOD ROAD AUBURN CA 95603 SIERK HAITSMA CFO 5308872800 2023-05-12 1 SIERK HAITSMA 999009999 KEITH R GLEN P01317613 9166466464 2023-05-12 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z LISA DAVIES 11670 ATWOOD ROAD AUBURN CA 95603 65032823 0 X WWW.CHAPA-DE.ORG X 1979 CA PROVIDES COMPREHENSIVE HEALTH CARE AND ANCILLARY SERVICES TO THE NATIVE-AMERICAN POPULATION OF SIERRA, PLACER AND NEVADA COUNTIES OF CALIFORNIA. 5 5 309 0 0 0 17847918 17794216 38852079 44382616 1962180 2763810 0 81774 58662177 65022416 0 0 0 0 23705459 25723337 0 0 0 11825705 13749047 35531164 39472384 23131013 25550032 171407470 178697226 19381307 13939657 152026163 164757569 PROVIDES COMPREHENSIVE HEALTH CARE AND ANCILLARY SERVICES TO THE NATIVE-AMERICAN POPULATION OF SIERRA, PLACER AND NEVADA COUNTIES OF CALIFORNIA. 0 0 26777137 44382616 PRIMARY HEALTH CARE PROGRAM- CHAPA-DE INDIAN PROGRAM, INC PROVIDED COMPREHENSIVE HEALTH SERVICES TO THE NATIVE-AMERICAN POPULATION AND OTHER RESIDENTS OF SIERRA, PLACER, AND NEVADA COUNTIES OF CALIFORNIA. COMPREHENSIVE HEALTH SERVICES INCLUDE DIRECT PATIENT CARE, IMMUNIZATIONS, HEALTH PROMOTION AND DISEASE PREVENTION, DRUG ABUSE AND EDUCATION/PREVENTION PROGRAMS, AND DENTAL CARE. DIABETES PREVENTION PROGRAM-THIS PROGRAM PROVIDES DIABETES PREVENTION, MANAGEMENT AND LIFESTYLE EDUCATION, AND TESTING SERVICES TO NATIVE- AMERICAN PATIENTS DURING THE FISCAL YEAR. THESE PATIENTS LIVE PRIMARILY IN SIERRA, PLACER, AND NEVADA COUNTIES OF CALIFORNIA. 26777137 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 104 0 1 309 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X SIERK HAITSMA 5308872800 11670 ATWOOD ROAD AUBURN CA 95603 JASON CAMP BOARD MEMBER 2.00 X 0 0 0 GENE WHITEHOUSE SECRETARY 2.00 X X 0 0 0 BRENDA ADAMS CHAIR 2.00 X X 0 0 0 DAVID KEYSER VICE-CHAIR 2.00 X X 0 0 0 JOHN L WILLIAMS BOARD MEMBER 2.00 X 0 0 0 LISA DAVIES CHIEF EXECUTIVE OFFICER 40.00 X 409814 0 40102 SIERK HAITSMA CHIEF FINANCIAL OFFICER 40.00 X 277181 0 24133 DARLA CLARK CHIEF OPERATIONS OFFICER 40.00 X 261513 0 33709 ALINEA STEVENS MEDICAL DIRECTOR 32.00 X 282270 0 50234 PAULINE KARUNAKARAN DENTAL DIRECTOR 40.00 X 250316 0 25874 ANTHONY REYES CHIEF ADMINISTRATIVE OFFICER 40.00 X 205772 0 33335 ERIC OSBORN CHIEF INFORMATION OFFICER 40.00 X 214189 0 14304 NICOLE CONZONER DIRECTOR OF NURSING 40.00 X 163734 0 43726 AMY EARGLE BEHAVIORAL HEALTH DIRECTOR 36.00 X 161028 0 9289 WILLIAM JORNLIN PHYSICIAN 40.00 X 253367 0 46749 RICHARD MALEK PSYCHIATRIST 40.00 X 264601 0 630 MARLOWE DIECKMANN PHYSICIAN 40.00 X 223828 0 38851 SHARI FOX PSYCHIATRIST 32.00 X 249082 0 12380 BENJAMIN OLDACH PHYSICIAN 40.00 X 225890 0 26761 3442585 0 400077 14 0 1 0 RCP CONSTRUCTION INC 5180 GOLDEN FOOTHILLS PKWY 110 EL DORADO HILLS CA 95762 BUILDING CONTRACTOR 2614537 EFFORT PHARMACY SERVICES INC 3215 PENNINGTON ROAD3215 PENNINGT LIVE OAK CA 95953 PHARMACY SERVICES 1849842 DEACON CONSTRUCTION LLC 7745 GREENBACK LANE 250 CITRUS HEIGHTS CA 95610 BUILDING CONTRACTOR 1287231 UNITED BUILDING MAINTENANCE INC 8211 SIERRA COLLEGE BVLD STE 420 ROSEVILLE CA 95661 JANITORIAL SERVICES 331798 ECLINICALWORKS PO BOX 847950 BOSTON MA 022847950 SOFTWARE LICENSE & SUPPORT 309008 5 17794216 17794216 HEALTH SERVICES 621400 44382616 44382616 44382616 2774217 2774217 10407 -10407 -10407 -10407 OTHER 81774 81774 81774 65022416 44453983 0 2774217 2515237 1829857 685380 17476475 12785099 4691376 4297379 2991175 1306204 1434246 998302 435944 414307 326534 87773 66266 52227 14039 193039 193039 3689185 2907615 781570 161883 3315 158568 592519 80068 512451 1204090 55899 1148191 108424 84667 23757 1819573 269491 1550082 158089 158089 MEDICAL SUPPLIES 3402044 3376812 25232 PATIENT RELATED COSTS 642616 609985 32631 BUILDING AND EQUIPMENT 631436 203508 427928 OTHER PERSONNEL RELATED 224646 68675 155971 440930 133908 307022 39472384 26777137 12695247 0 6400 5800 35279557 31857443 2160222 304399 3312912 5755059 175432 184221 60710134 20732000 29620139 39978134 100592350 100300972 260458 311198 171407470 178697226 4175320 3329103 15205987 10610554 19381307 13939657 X 152026163 164757569 152026163 164757569 171407470 178697226 25550032 -12818626 0 X 0 1 X 1 1 1 X 11043154 11517833 25916727 17847918 17794216 84119848 11043154 11517833 25916727 17847918 17794216 84119848 84119848 245453 876819 1693657 1962180 2689607 7467716 91587564 0.91850 0.94170 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11825678 11825678 44011645 16898225 27113420 4872811 3833775 1039036 39978134 INVESTMENTS 100300972 F 100300972 52010751 -12818626 -12818626 64829377 193039 193039 65022416 39279345 0 39279345 193039 193039 39472384 X X 0 0 0 0 0 0 0 0 0 LISA DAVIES CHIEF EXECUTIVE OFFICER 360814 0 49000 0 0 0 17400 0 22702 0 449916 0 0 0 ALINEA STEVENS MEDICAL DIRECTOR 252438 0 29832 0 0 0 15486 0 34748 0 332504 0 0 0 SIERK HAITSMA CHIEF FINANCIAL OFFICER 246005 0 31176 0 0 0 14760 0 9373 0 301314 0 0 0 WILLIAM JORNLIN PHYSICIAN 239330 0 14037 0 0 0 12000 0 34749 0 300116 0 0 0 DARLA CLARK CHIEF OPERATIONS OFFICER 231688 0 29825 0 0 0 14050 0 19659 0 295222 0 0 0 PAULINE KARUNAKARAN DENTAL DIRECTOR 231857 0 18459 0 0 0 13911 0 11963 0 276190 0 0 0 RICHARD MALEK PSYCHIATRIST 258101 0 6500 0 0 0 0 0 630 0 265231 0 0 0 MARLOWE DIECKMANN PHYSICIAN 219778 0 4050 0 0 0 4102 0 34749 0 262679 0 0 0 SHARI FOX PSYCHIATRIST 238745 0 10337 0 0 0 0 0 12380 0 261462 0 0 0 BENJAMIN OLDACH PHYSICIAN 221840 0 4050 0 0 0 3996 0 22765 0 252651 0 0 0 ANTHONY REYES CHIEF ADMINISTRATIVE OFFICER 189637 0 16135 0 0 0 11527 0 21808 0 239107 0 0 0 ERIC OSBORN CHIEF INFORMATION OFFICER 197949 0 16240 0 0 0 2400 0 11904 0 228493 0 0 0 NICOLE CONZONER DIRECTOR OF NURSING 150254 0 13480 0 0 0 9316 0 34410 0 207460 0 0 0 AMY EARGLE BEHAVIORAL HEALTH DIRECTOR 147972 0 13056 0 0 0 8779 0 510 0 170317 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PRESENTED BY THE CFO TO THE FULL BOARD OF DIRECTORS AND IS APPROVED FOR FILING. THE CHAIRPERSON IS AUTHORIZED TO SIGN THE FORM 990 AFTER THE APPROVAL BY THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION PERFORMS AN ANNUAL EVALUATION OF ALL POTENTIAL CONFLICT OF INTEREST SITUATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HIRES CEO AND TOP MANAGEMENT OF THE ORGANIZATION. THE COMPENSATION AMOUNT IS BASED ON PREVAILING SALARIES IN THE AREA AND THE EXPERIENCE AND QUALIFICATIONS OF THE EMPLOYEE. THIS PROCESS WAS LAST UNDERTAKEN IN 2020. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE GENERAL PUBLIC.