2023-05-15T15:59:14-05:00 2022-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2021-07-01 941496052 MOMENTUM FOR HEALTH MOME 4086426056 1922 THE ALAMEDA 300 SAN JOSE CA 95126 DAVID MINETA CEO 4086426056 2023-05-15 1 DAVID MINETA 999009999 LESLIE VAN P01294411 4159561500 2023-05-12 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z DAVID MINETA 1922 THE ALAMEDA 300 SAN JOSE CA 95126 75019037 0 X WWW.MOMENTUMFORHEALTH.ORG X 1997 CA HELPING PEOPLE ACHIEVE MENTAL AND EMOTIONAL HEALTH, DISCOVER THEIR POTENTIAL, AND FULLY PARTICIPATE IN LIFE. 15 14 611 24 132024 119441 44249851 46280279 8594499 8653236 17611 11017692 8081103 372887 60943064 66324094 0 1409956 0 0 44901264 46933465 0 0 465417 13202125 9054878 58103389 57398299 2839675 8925795 53278490 55751355 33128985 26695780 20149505 29055575 X HELPING PEOPLE ACHIEVE MENTAL AND EMOTIONAL HEALTH, DISCOVER THEIR POTENTIAL, AND FULLY PARTICIPATE IN LIFE. 0 0 21011556 102226 PROVIDE OUTPATIENT BEHAVIORAL, MENTAL, AND SUBSTANCE ADDICTION SERVICES. 11552397 1154228 PROVIDE CRISIS RESIDENTIAL SERVICES. 8530097 523121 MEDICAL SERVICE, RESIDENTIAL, SUPPORT HOUSING, EMPLOYMENT SERVICES, AND ADMINSTRATIVE SUPPORT. 5185695 6873661 PROVIDE OUTPATIENT AND RESIDENTIAL SERVICES FUNDED BY BILLING TO THE COMMERCIAL PAYORS. 5185695 6873661 46279745 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 182 0 1 611 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 CA X FINANCE DEPARTMENT 4086426056 1922 THE ALAMEDA STE 300 SAN JOSE CA 95126 DAVID MINETA PRESIDENT/CEO 40.00 0.00 X X 287596 0 14991 MARY L ROTUNNO CHAIR 5.00 0.00 X X 0 0 0 DELPHIA EDWARDS VICE CHAIR 5.00 0.00 X X 0 0 0 JAMES BERTRONIS TREASURER 5.00 0.00 X X 0 0 0 FERNANDO V HERNANDEZ SECRETARY 5.00 0.00 X X 0 0 0 JOYCE PUOPOLO ASSISTANT SECRETARY 5.00 0.00 X X 0 0 0 GEORGINA BACA DIRECTOR 2.00 0.00 X 0 0 0 E MARIE BRIERLEY DIRECTOR (THRU 2/22) 2.00 0.00 X 0 0 0 RICHARD FOLEY DIRECTOR 2.00 0.00 X 0 0 0 RICHARD LOFTUS DIRECTOR (START 2/22) 2.00 0.00 X 0 0 0 HAL MAHON DIRECTOR 2.00 0.00 X 0 0 0 JASON NOREIGA DIRECTOR 2.00 0.00 X 0 0 0 STEPHANIE PEIL DIRECTOR (THRU 2/22) 2.00 0.00 X 0 0 0 JASON REYNOLDS DIRECTOR (START 2/22) 2.00 0.00 X 0 0 0 WILLIAM RIPPE DIRECTOR 2.00 0.00 X 0 0 0 LEE THROPE DIRECTOR 2.00 0.00 X 0 0 0 JAHMAL C WILLIAMS DIRECTOR (START 2/22) 2.00 0.00 X 0 0 0 SHEFALI MILLER CHIEF MEDICAL OFFICER 40.00 0.00 X 495066 0 23938 KEVIN DEWITT COO/CFO 40.00 0.00 X 249265 0 18124 JOHN JENNINGS CHIEF HR OFFICER (THRU 01/22) 40.00 0.00 X 207847 0 26430 JERRY MCCANN CHIEF PERFORMANCE OFFICER 40.00 0.00 X 186903 0 20477 JAMES MILLSAP EXECUTIVE DIRECTOR 40.00 0.00 X 182983 0 28410 PETER TRAN DIR. OF INFORMATION TECHNOLOGY 40.00 0.00 X 168596 0 18765 ELEONORE SOSA PACE CHIEF OFFICER OF RES & CRML JUSTICE 40.00 0.00 X 163236 0 11792 GAIL CAMPANALE CHIEF OFFICER OF OUTPATIENT PROGRAMS 40.00 0.00 X 151953 0 19361 RACHEL LAPIDUS PSYCHIATRIST 40.00 0.00 X 432594 0 24064 TYSON TORRES PSYCHIATRIST 40.00 0.00 X 431182 0 24058 MAKSIM MARCHENKO PSYCHIATRIST 40.00 0.00 X 406063 0 13102 MICHAEL HUYNH PSYCHIATRIST 40.00 0.00 X 393619 0 19148 TOMASZ A ROSSE PSYCHIATRIST 40.00 0.00 X 380610 0 24101 4137513 0 286761 96 0 1 0 TRAN JR CONTRUCTION CORP 728 DAKOTA DR SAN JOSE CA 95111 HVAC, CONSTRUCTION 682900 JAIME MATURINO GARDENING 1585 N 4TH ST SUITE X SAN JOSE CA 95112 MAINTENANCE, GARDENING, ETC 372019 2 298767 45767006 214506 4100 46280279 PATIENT SERVICES REVENUE 621400 8653236 8653236 8653236 22810 22810 921221 1010302 -89081 -89081 132024 -221105 3748000 14862500 3755011 3860607 -7011 11001893 10994882 10994882 0 298767 69023 -69023 -69023 MISCELLANEOUS REVENUE 900099 530991 530991 530991 66324094 8653236 132024 11258555 1409956 1409956 2214916 910144 1304772 36611420 30751406 5510622 349392 1202727 1062357 130170 10200 4193397 3505663 653297 34437 2711005 2277963 396120 36922 220725 220725 48083 48083 1399261 503106 882937 13218 69111 24163 44332 616 1022859 932135 87099 3625 937483 675694 254612 7177 2790966 2175001 615965 329809 289396 40089 324 127171 30491 94063 2617 508398 335796 172602 933820 774230 153317 6273 667192 622244 44332 616 57398299 46279745 10653137 465417 4331201 2272230 3983587 7008660 1057405 4423239 763484 3187418 462715 473852 45276185 9330338 36483140 35945847 5463624 1689958 733334 750151 53278490 55751355 10180188 9051406 32874 79486 22843214 14146849 72709 3418039 33128985 26695780 X 20135895 29041965 13610 13610 20149505 29055575 53278490 55751355 8925795 -19725 0 X 0 1 X 1 0 X 32651012 37131259 43740642 52101856 46280279 211905048 32651012 37131259 43740642 52101856 46280279 211905048 211905048 25078 52549 74058 17611 616066 785362 130650 165010 104664 142876 132024 675224 234575 193788 173389 86222 530991 1218965 214584599 42178609 0.98750 0.99910 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 234,575. 2018 AMOUNT: $ 193,788. 2019 AMOUNT: $ 173,389. 2020 AMOUNT: $ 86,222. 2021 AMOUNT: $ 530,991. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13939896 13939896 29241939 8559065 20682874 91082 78070 13012 1470877 508964 961913 532391 184239 348152 35945847 DEPOSITS HELD 50843 FACILITY LEASES 3367196 3418039 X 67383694 -19725 1079325 1059600 66324094 0 66324094 58477624 1079325 1079325 57398299 0 57398299 PART X, LINE 2: THE AGENCY 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, 2022, THE AGENCY HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 69,023. RENTAL EXPENSES 1,010,302. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 69,023. RENTAL EXPENSES 1,010,302. SHINING STAR 168271 168271 411 400 36067 GOLF TOURNAMENT 130496 130496 22394 1109 8642 298767 298767 411 22794 1109 44709 69023 -69023 0 FINANCIAL ASSISTANCE 668 1409956 X X X 0 0 0 0 0 0 0 1 0 SHEFALI MILLER CHIEF MEDICAL OFFICER 492942 0 2124 0 0 0 11437 0 12501 0 519004 0 0 0 RACHEL LAPIDUS PSYCHIATRIST 430708 0 1886 0 0 0 11563 0 12501 0 456658 0 0 0 TYSON TORRES PSYCHIATRIST 428201 0 2981 0 0 0 11557 0 12501 0 455240 0 0 0 MAKSIM MARCHENKO PSYCHIATRIST 403097 0 2966 0 0 0 11557 0 1545 0 419165 0 0 0 MICHAEL HUYNH PSYCHIATRIST 387686 0 5933 0 0 0 8096 0 11052 0 412767 0 0 0 TOMASZ A ROSSE PSYCHIATRIST 380610 0 0 0 0 0 11600 0 12501 0 404711 0 0 0 DAVID MINETA PRESIDENT/CEO 287596 0 0 0 0 0 11407 0 3584 0 302587 0 0 0 KEVIN DEWITT COO/CFO 249265 0 0 0 0 0 7270 0 10854 0 267389 0 0 0 JOHN JENNINGS CHIEF HR OFFICER (THRU 01/22) 206968 0 879 0 0 0 16896 0 9534 0 234277 0 0 0 JAMES MILLSAP EXECUTIVE DIRECTOR 181434 0 1549 0 0 0 16126 0 12284 0 211393 0 0 0 JERRY MCCANN CHIEF PERFORMANCE OFFICER 186114 0 789 0 0 0 16629 0 3848 0 207380 0 0 0 PETER TRAN DIR. OF INFORMATION TECHNOLOGY 165703 0 2893 0 0 0 6264 0 12501 0 187361 0 0 0 ELEONORE SOSA PACE CHIEF OFFICER OF RES & CRML JUSTICE 162565 0 671 0 0 0 11276 0 516 0 175028 0 0 0 GAIL CAMPANALE CHIEF OFFICER OF OUTPATIENT PROGRAMS 151393 0 560 0 0 0 11400 0 7961 0 171314 0 0 0 PART I, LINE 7 BONUS PAYMENTS ARE CONSIDERED NON-FIXED PAYMENTS. FOR THOSE THAT ARE ELIGIBLE FOR BONUS PAYMENTS, THEY ARE BASED ON QUARTERLY PERFORMANCE AND CAN RANGE FROM 1%-3% OF THEIR SALARY. FORM 990, PART VI, SECTION B, LINE 11B MOSS ADAMS PREPARES THE TAX RETURNS BASED ON THE AUDITED FINANCIAL STATEMENTS. APPLICABLE INFORMATION IS ALSO PROVIDED BY MOMENTUM FINANCE CONTROLLER, REVIEWED BY (INTERIM) CFO, WHO ALSO REVIEWED THE DRAFT TAX RETURNS, DISCUSSED WITH THE TAX TEAM AND APPROVED THE TAX RETURNS. THE (INTERIM) CFO PROVIDED THE TAX RETURNS TO THE EXECUTIVE COMMITTEE, THE AUDIT COMMITTEE, AND THE BOARD FOR THEIR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL REVIEWS ARE CONDUCTED TO MONITOR AND ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS REVIEWED BY THE FINANCE COMMITTEE USING SURVEYS AND COMPARABLE DATA. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. HOMEBASE HOMES INC 104 WHISPERING PINES SUITE 200 SCOTTS VALLEY CA 95066 770155566 LOW INCOME HOUSING CA 501(C)(3) LINE 10 MOMENTUM FOR HEALTH 1 THE FOUNDATION FOR MENTAL HEALTH 438 NORTH WHITE ROAD SAN JOSE CA 95127 770224382 DORMANT CA 501(C)(3) LINE 12A, I MOMENTUM FOR HEALTH 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0