MANIFEST MEDEX: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- MANIFEST MEDEX (EIN 27-2367522)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-07
- IRS object ID
- 202333119349303933
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-07T16:30:18-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 SECOND STREET SUITE 900 | AddressLine1Txt |
| City | SAN FRANCISCO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94105 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 272367522 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MANIFEST MEDEX | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MANI | BusinessNameControlTxt |
| Phone | 5106831333 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6001 SHELLMOUND STREET 500 | AddressLine1Txt |
| City | EMERYVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94608 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICIA GROBECK | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5106831309 | PhoneNum |
| Signature | 2023-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | PATRICIA | PersonFirstNm |
| Person Last | GROBECK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LESLIE VAN | PreparerPersonNm |
| PTIN | P01294411 | PTIN |
| Phone | 4159561500 | PhoneNum |
| Preparation | 2023-11-02 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ERICA GALVEZ | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6001 SHELLMOUND STREET 500 | AddressLine1Txt |
| City | EMERYVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94608 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $34,864,629 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.MANIFESTMEDEX.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | MANIFEST MEDEX FACILITATES THE COLLECTION OF ELECTRONIC CLINICAL RECORDS FROM HEALTHCARE PROVIDERS AND CLAIMS DATA FROM HEALTH INSURERS. THE CLINICAL AND CLAIMS DATA IS AGGREGATED TO PROVIDE COMPREHENSIVE LONGITUDINAL PATIENT RECORDS THAT EMPOWER MANIFEST MEDEX PARTICIPANTS WITH POWERFUL DATA TO EFFECTIVELY MANAGE THE CONTINUUM OF CARE AND DRIVE HIGHER QUALITY CARE AT A LOWER COST. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 84 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $27,316,877 | PYContributionsGrantsAmt |
| CY Contributions Grants | $23,346,838 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,797,745 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,517,791 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,521 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,627 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $40,119,770 | PYTotalRevenueAmt |
| CY Total Revenue | $34,864,629 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,588,036 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,573,110 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,292,211 | PYOtherExpensesAmt |
| CY Other Expenses | $24,556,729 | CYOtherExpensesAmt |
| PY Total Expenses | $31,880,247 | PYTotalExpensesAmt |
| CY Total Expenses | $38,129,839 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,239,523 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,265,210 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $35,771,057 | TotalAssetsBOYAmt |
| Total Assets EOY | $33,777,348 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,649,358 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,920,859 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,121,699 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $21,856,489 | NetAssetsOrFundBalancesEOYAmt |
| Mission | BE THE SMART GRID FOR HEALTH INFORMATION - DELIVER DATA-DRIVEN INSIGHT TO INDIVIDUALS AND HEALTH TEAMS WHEN AND WHERE THEY NEED IT SO THEY CAN IMPROVE CARE, LOWER COSTS AND ENHANCE HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $27,408,920 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $11,517,791 | RevenueAmt |
| Desc | AGGREGATING HEALTH CARE INFORMATION FROM DISPARATE PROVIDERS AND PAYERS TO ENABLE THEM TO PROVIDE MORE TIMELY, COMPLETE AND HIGHER QUALITY PATIENT-CENTERED CARE. | Desc |
| Total Program Service Expenses | $27,408,920 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 30 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 84 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TRISHA GROBECK | PersonNm |
| Phone | 5106831309 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6001 SHELLMOUND STREET NO 500 | AddressLine1Txt |
| City | EMERYVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94608 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Key EmployeeKeyEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| ERICA GALVEZ | ||||||||
| CEO (AS OF 6/30) | 40.00 | Yes (X) | $493,058 | $0 | $23,700 | |||
| CLAUDIA WILLIAMS | ||||||||
| CEO (THRU 6/30) | 40.00 | Yes (X) | $458,956 | $0 | $8,774 | |||
| ADAM HARRISON | ||||||||
| CHIEF GROWTH OFFICER | 40.00 | $365,237 | $0 | $36,387 | Yes (X) | |||
| ELIZABETH KILLINGSWORTH | ||||||||
| CPO | 40.00 | Yes (X) | $366,355 | $0 | $12,975 | |||
| JASON BUCKNER | ||||||||
| CHIEF INFORMATION OFFICER | 40.00 | $345,756 | $0 | $32,772 | Yes (X) | |||
| PATRICIA GROBECK | ||||||||
| CFO (AS OF 6/30) | 40.00 | Yes (X) | $312,200 | $0 | $27,400 | |||
| SARITA CHOY | ||||||||
| VP, MARKETING & COMMUNICATIONS | 40.00 | $311,953 | $0 | $17,477 | Yes (X) | |||
| NICHOLAS RICHARD YARKER | ||||||||
| MANAGING DIRECTOR | 40.00 | $255,721 | $0 | $23,205 | Yes (X) | |||
| DAVID KATES | ||||||||
| CTO (THRU 5/20) | 40.00 | $258,370 | $0 | $13,877 | Yes (X) | |||
| PAUL BIBERKRAUT | ||||||||
| CFO (THRU 6/30) | 40.00 | Yes (X) | $216,289 | $0 | $10,426 | |||
| BRITTANY HARNOIS | ||||||||
| CHIEF OF STAFF | 40.00 | $201,157 | $0 | $23,882 | Yes (X) | |||
| JARROD B MCNAUGHTON | ||||||||
| CHAIR | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| MARK SAVAGE | ||||||||
| VICE CHAIR | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| ABNER MASON | ||||||||
| MEMBER | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| DEVEN MCGRAW | ||||||||
| MEMBER | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| DOLORES GREEN | ||||||||
| MEMBER | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| KERRY HEINRICH | ||||||||
| MEMBER | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| LEIGH HUTCHINS | ||||||||
| MEMBER | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| MARK REYNOLDS | ||||||||
| MEMBER | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| PAUL MARKOVICH | ||||||||
| MEMBER (THRU 3/07) | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| PETER LONG | ||||||||
| MEMBER | 2.50 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,585,052 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $230,875 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 49 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DIAMETER HEALITH INC | |||||
| 10 EXECUTIVE DRIVE | FARMINGTON | CT | 06032 | SAAS LICENSE FEES | $5,900,000 |
| LOGICWORKS SYSTEM CORPORATION | |||||
| 155 AVENUE OF THE AMERICAS 8TH FL | NEW YORK | NY | 10013 | PLATFORM MAINTENANCE | $5,751,258 |
| J2 INTERACTIVE LLC | |||||
| 2 THIRTEENTH STREET | CHARLESTOWN | MA | 02129 | CONTRACTOR | $4,789,354 |
| INTERSYSTEMS CORPORATION | |||||
| PO BOX 84-5809 | BOSTON | MA | 022845809 | SAAS LICENSE FEES | $3,160,919 |
| AUDACIOUS INQUIRY | |||||
| 5523 RESEARCH PARK DRIVE SUITE 370 | CATONSVILLE | MD | 21228 | SAAS LICENSE FEES | $1,215,295 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 24 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $13,346,838 | GovernmentGrantsAmt |
| All Other Contributions | $10,000,000 | AllOtherContributionsAmt |
| Total Contributions | $23,346,838 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HEALTH INFORMATION EXC | Desc |
| Business | 541900 | BusinessCd |
| Total Revenue Column | $11,517,791 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,517,791 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,517,791 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,864,629 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,517,791 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,155,171 | TotalAmt |
| Program Services | $705,669 | ProgramServicesAmt |
| Management And General | $1,449,502 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,224,783 | TotalAmt |
| Program Services | $4,854,342 | ProgramServicesAmt |
| Management And General | $4,370,441 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,437 | TotalAmt |
| Program Services | $186,084 | ProgramServicesAmt |
| Management And General | $143,353 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,863,719 | TotalAmt |
| Program Services | $984,155 | ProgramServicesAmt |
| Management And General | $879,564 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,968 | TotalAmt |
| Management And General | $3,968 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,800 | TotalAmt |
| Management And General | $98,800 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,331,025 | TotalAmt |
| Program Services | $6,184,486 | ProgramServicesAmt |
| Management And General | $1,146,539 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,504 | TotalAmt |
| Management And General | $15,504 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,025 | TotalAmt |
| Program Services | $38,731 | ProgramServicesAmt |
| Management And General | $53,294 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $636,431 | TotalAmt |
| Program Services | $452,643 | ProgramServicesAmt |
| Management And General | $183,788 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $373,966 | TotalAmt |
| Management And General | $373,966 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $369,045 | TotalAmt |
| Program Services | $36,438 | ProgramServicesAmt |
| Management And General | $332,607 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,612 | TotalAmt |
| Program Services | $22,266 | ProgramServicesAmt |
| Management And General | $116,346 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,500 | TotalAmt |
| Management And General | $154,500 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $760,027 | TotalAmt |
| Management And General | $760,027 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $354,532 | TotalAmt |
| Management And General | $354,532 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SAAS FEES | $7,442,672 | $7,442,672 | |
| PLATFORM MAINTENANCE | $6,501,434 | $6,501,434 | |
| HIO CONTRIBUTION EXPENS | $189,750 | $189,750 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,438 | TotalAmt |
| Management And General | $94,438 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,129,839 | TotalAmt |
| Program Services | $27,408,920 | ProgramServicesAmt |
| Management And General | $10,720,919 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $10,000 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,816,675 | BOYAmt |
| EOY | $17,994,713 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $514,023 | BOYAmt |
| EOY | $7,312,709 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,263,596 | BOYAmt |
| EOY | $6,182,687 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,821,292 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,474,777 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,916,287 | BOYAmt |
| EOY | $1,346,515 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,250,476 | BOYAmt |
| EOY | $930,724 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,771,057 | BOYAmt |
| EOY | $33,777,348 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,252,106 | BOYAmt |
| EOY | $5,852,951 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,000 | BOYAmt |
| EOY | $35,000 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000,000 | BOYAmt |
| EOY | $5,000,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,367,252 | BOYAmt |
| EOY | $1,032,908 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,649,358 | BOYAmt |
| EOY | $11,920,859 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,121,699 | BOYAmt |
| EOY | $21,856,489 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,121,699 | BOYAmt |
| EOY | $21,856,489 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,771,057 | BOYAmt |
| EOY | $33,777,348 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,265,210 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,000,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,738,590 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $23,323,957 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,316,877 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $23,346,838 | CurrentTaxYearAmt |
| Total | $100,726,262 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,000,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $11,738,590 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $23,323,957 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,316,877 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $23,346,838 | CurrentTaxYearAmt |
| Total | $100,726,262 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $69,718,336 | SubstantialContributorsTotAmt |
| Public Support Total170 | $31,007,926 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,487 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $173,321 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $88,459 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,521 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $282,788 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $3,627 | CurrentTaxYearMinus1YearAmt |
| Total | $3,627 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $101,012,677 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $54,747,037 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.30700 | PublicSupportCY170Pct |
| Public Support PY170 | 0.19410 | PublicSupportPY170Pct |
| Ten Pct Facts Crcmstncs Test CY | Yes (X) | TenPctFactsCrcmstncsTestCYInd |
| Facts And Circumstances Test | PURSUANT TO REGULATION 1.170A-9(F)(3), THE ORGANIZATION NORMALLY RECEIVES A SUBSTANTIAL PART OF ITS SUPPORT DIRECTLY OR INDIRECTLY FROM THE GENERAL PUBLIC AND IS ACTIVELY ENGAGED IN THE ATTRACTION OF PUBLIC SUPPORT. THE ORGANIZATION IS PUBLICLY SUPPORTED UNDER THE FACTS AND CIRCUMSTANCES TEST AS FOLLOWS:(I) TEN PERCENT-OF-SUPPORT LIMITATION: THE PERCENTAGE OF SUPPORT NORMALLY RECEIVED BY THE ORGANIZATION FROM CONTRIBUTIONS MADE BY GOVERNMENT UNITS, FROM CONTRIBUTIONS MADE DIRECTLY OR INDIRECTLY BY THE GENERAL PUBLIC, OR FROM A COMBINATION OF THESE SOURCES EQUALS AT LEAST 10 PERCENT.(II) ATTRACTION OF PUBLIC SUPPORT: THE ORGANIZATION IS ORGANIZED AND OPERATED TO CONTINUOUSLY ATTRACT NEW AND ADDITIONAL SOURCES OF PUBLIC SUPPORT. THE ORGANIZATION CONTINUES TO SOLICIT ADDITIONAL HOSPITALS AND HOSPITAL SYSTEMS FOR INCREMENTAL REVENUE, ALTHOUGH HEALTH PLANS CONTRIBUTE SIGNIFICANTLY MORE REVENUE IN SUBSCRIPTION FEES. THE ORGANIZATION ALREADY HAS THE TWO LARGEST HEALTH PLANS IN THE STATE OF CALIFORNIA (OTHER THAN KAISER) WITH MEMBERSHIPS FROM ANTHEM BLUE CROSS AND BLUE SHIELD SO REVENUE IS MORE HIGHLY CONCENTRATED FROM THOSE TWO HEALTH PLANS. THE ORGANIZATION IS ACTIVELY PURSUING OTHER HEALTH PLANS. (III) SOURCES OF SUPPORT: THE ORGANIZATION HAS BEEN IN EXISTENCE SINCE 2010 (JUST OVER 10 YEARS). THREE YEARS AGO, THERE WAS A CHANGE IN STRATEGY OF THE ORGANIZATION THERE WAS A MERGER OF TWO ENTITIES THAT CHANGED THE SOURCE OF FUNDING THAT HAD HISTORICALLY BEEN DONE. AS THIS NEW STRATEGY WAS BEING IMPLEMENTED, THE ORGANIZATION WAS BEING LARGELY SUPPORTED BY A SINGLE SOURCE FOR THE FIRST COUPLE OF YEARS AFTER THE MERGER OCCURRED. THE ORGANIZATION HAS TAKEN OFF AFTER THE INITIAL START-UP PHASE AFTER THE MERGER AND IS CONTINUING TO EXPAND ITS BASE OF PUBLIC SUPPORT. THE ORGANIZATION ALSO RECEIVED APPROVAL FOR A $4.9 MILLION GRANT FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) FOR THE CALIFORNIA EMERGENCY MEDICAL SERVICES AUTHORITY PROGRAM, OF WHICH THE ORGANIZATION RECEIVED APPROXIMATELY $700K IN 2021. THE ORGANIZATION HAS ALSO APPLIED FOR FUNDING UNDER THE 2019 CALIFORNIA HEALTH INFORMATION EXCHANGE ONBOARDING PROGRAM (CAL-HOP) WHICH IS FUNDED BY A $50 MILLION CMS GRANT AND THE STATE OF CALIFORNIA. CAL-HOP WILL PROVIDE FUNDING TO ASSIST MEDI-CAL PROVIDERS ACCESS AND USE OF HEALTH INFORMATION EXCHANGE TO IMPROVE QUALITY OF CARE FOR MEDI-CAL BENEFICIARIES. FINALLY, THE ORGANIZATION ENDED THE FEE HOLIDAY GRANTED TO HOSPITAL PARTICIPANTS AT THE END OF 2018 AND DURING 2019 AND 2020 COMMENCED BILLING AND COLLECTION OF SUBSCRIPTION DUES FOR JUST UNDER 100 HOSPITAL PARTICIPANTS. (V) REPRESENTATIVE GOVERNING BODY: THE ORGANIZATION'S BOARD OF DIRECTORS IS COMPRISED OF INDIVIDUALS HAVING SPECIFIC KNOWLEDGE OR EXPERTISE IN THE INDUSTRY AS WELL AS INCLUDES DIRECTORS FROM THE GENERAL PUBLIC.(VI) AVAILABILITY OF PUBLIC SERVICES: THE ORGANIZATION SUPPORTS THE GREATER PUBLIC AT LARGE IN THAT IT ASSISTS WITH PROVIDING DATA DRIVEN HEALTH INFORMATION AND MAKING FOR READILY AVAILABLE TO INDIVIDUALS AND HEALTH TEAMS SO THE HEALTH TEAMS CAN IMPROVE CARE, LOWER COSTS, AND ENHANCE HEALTH. | FactsAndCircumstancesTestTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $150,000 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $150,000 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | LOBBYING FOR A STATEWIDE HEALTHCARE DATA EXCHANGE INFRASTRUCTURE FOR KEY MEDI-CAL PROGRAM AND STATE FUNCTIONS, INCLUDING THE RESPONSE TO COVID-19, FUNDED WITH FEDERAL MEDICAID MATCH, AND WITH A STATEWIDE MANDATE FOR PARTICIPATION. THERE ARE NO ACTIVE BILLS IN THE LEGISLATURE, BUT WE HAVE MET THE GOVERNOR'S OFFICE, SENATE, AND ASSEMBLY HEALTH COMMITTEES, AND MULTIPLE STATE AGENCIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $134,050 | OtherCostOrOtherBasisAmt |
| Depreciation | $119,219 | DepreciationAmt |
| Book Value | $14,831 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,662,380 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,331,850 | DepreciationAmt |
| Book Value | $1,330,530 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,862 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,708 | DepreciationAmt |
| Book Value | $1,154 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,346,515 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATING LEASE LIABILITY | Desc |
| Amt | $1,032,908 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,032,908 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $34,878,916 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $14,287 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $14,287 | RevenueNotReportedAmt |
| Revenue Subtotal | $34,864,629 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $34,864,629 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $38,144,126 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $14,287 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $14,287 | ExpensesNotReportedAmt |
| Expenses Subtotal | $38,129,839 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $38,129,839 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MANAGEMENT HAS DETERMINED THAT THE COMPANY HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. ANY FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES WOULD BE RECOGNIZED IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ERICA GALVEZ | ||||||||||||||
| CEO (AS OF 6/30) | $356,005 | $0 | $137,053 | $0 | $0 | $0 | $12,200 | $0 | $11,500 | $0 | $516,758 | $0 | $0 | $0 |
| CLAUDIA WILLIAMS | ||||||||||||||
| CEO (THRU 6/30) | $302,658 | $0 | $156,298 | $0 | $0 | $0 | $0 | $0 | $8,774 | $0 | $467,730 | $0 | $0 | $0 |
| ADAM HARRISON | ||||||||||||||
| CHIEF GROWTH OFFICER | $245,001 | $0 | $120,236 | $0 | $0 | $0 | $12,200 | $0 | $24,187 | $0 | $401,624 | $0 | $0 | $0 |
| ELIZABETH KILLINGSWORTH | ||||||||||||||
| CPO | $331,375 | $0 | $34,980 | $0 | $0 | $0 | $12,200 | $0 | $775 | $0 | $379,330 | $0 | $0 | $0 |
| JASON BUCKNER | ||||||||||||||
| CHIEF INFORMATION OFFICER | $275,994 | $0 | $69,762 | $0 | $0 | $0 | $12,200 | $0 | $20,572 | $0 | $378,528 | $0 | $0 | $0 |
| PATRICIA GROBECK | ||||||||||||||
| CFO (AS OF 6/30) | $223,473 | $0 | $88,727 | $0 | $0 | $0 | $6,828 | $0 | $20,572 | $0 | $339,600 | $0 | $0 | $0 |
| SARITA CHOY | ||||||||||||||
| VP, MARKETING & COMMUNICATIONS | $266,450 | $0 | $45,503 | $0 | $0 | $0 | $10,405 | $0 | $7,072 | $0 | $329,430 | $0 | $0 | $0 |
| NICHOLAS RICHARD YARKER | ||||||||||||||
| MANAGING DIRECTOR | $215,832 | $0 | $39,889 | $0 | $0 | $0 | $9,194 | $0 | $14,011 | $0 | $278,926 | $0 | $0 | $0 |
| DAVID KATES | ||||||||||||||
| CTO (THRU 5/20) | $141,175 | $0 | $58,240 | $0 | $58,955 | $0 | $6,269 | $0 | $7,608 | $0 | $272,247 | $0 | $0 | $0 |
| PAUL BIBERKRAUT | ||||||||||||||
| CFO (THRU 6/30) | $119,591 | $0 | $96,698 | $0 | $0 | $0 | $8,085 | $0 | $2,341 | $0 | $226,715 | $0 | $0 | $0 |
| BRITTANY HARNOIS | ||||||||||||||
| CHIEF OF STAFF | $165,274 | $0 | $35,883 | $0 | $0 | $0 | $8,170 | $0 | $15,712 | $0 | $225,039 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4A | FormAndLineReferenceDesc |
| Explanation | DAVID KATES RECEIVED SEVERANCE OF $58,955 IN 2022, WHICH HAS BEEN INCLUDED ON SCHEDULE J, COLUMN B(III). | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE SHIELD OF CALIFORNIA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship With Org | FOUNDER & SUBSTANTIAL CONTRIBUTOR | RelationshipWithOrgTxt |
| Loan Purpose | OPERATING CASH FLOW | LoanPurposeTxt |
| Loan To Organization | Yes (X) | LoanToOrganizationInd |
| Original Principal | $5,000,000 | OriginalPrincipalAmt |
| Balance Due | $5,000,000 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $5,000,000 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS SUMMARY 1-MANIFEST MEDEX'S AUDITORS COMPLETE AN AUDIT OF THE FINANCIAL STATEMENTS FOR THE APPLICABLE YEAR. 2-MANIFEST MEDEX'S TAX PREPARER USES INFORMATION FROM (I) THE AUDITED FINANCIAL STATEMENTS AND (II) MANIFEST MEDEX AND COMPLETES A DRAFT OF THE FORM 990. 3-INTERNAL STAFF, INCLUDING THE AVP OF FINANCE, CFO AND CEO REVIEW THE DRAFT FORM 990 AND MAKE ANY REQUIRED ADJUSTMENTS TO IT. 4-THE MANIFEST MEDEX BOARD IS PROVIDED A COPY OF THE FINAL DRAFT OF THE FORM 990 AND PROVIDED A REASONABLE PERIOD OF TIME TO REVIEW IT AND ASK ANY QUESTIONS OF MANAGEMENT BEFORE IT IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH "INSIDER" IS RESPONSIBLE FOR KNOWING AND FOLLOWING THE POLICY INCLUDING HAVING A DUTY TO DISCOVER AND DISCLOSE A CONFLICT. ALSO, EACH INSIDER, AND OTHER PERSONS THAT MX'S BOARD MAY IDENTIFY FROM TIME TO TIME, SHALL ANNUALLY SIGN A DISCLOSURE STATEMENT IN THE FORM ATTACHED HERETO, THAT: 1. AFFIRMS THAT THE PERSON HAS RECEIVED, READ AND UNDERSTANDS THIS POLICY, AND AGREES TO COMPLY WITH THE POLICY; AND 2. DISCLOSES THE PERSON'S INTERESTS AND FAMILY RELATIONSHIPS THAT COULD GIVE RISE TO A CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPANY'S BOARD ADOPTED AN EMPLOYEE COMPENSATION POLICY AND ESTABLISHED A COMPENSATION COMMITTEE. THIS COMMITTEE REVIEWS AND RECOMMENDS TO THE BOARD ALL COMPENSATION FOR OFFICERS AND OTHER KEY EMPLOYEES, EXCEPT FOR THE CEO WHICH THE BOARD AS A WHOLE ANALYZES AND APPROVES. THE REVIEW PROCESS INCLUDES A REVIEW OF BACKGROUND INFORMATION (E.G. EDUCATION, EXPERIENCE, ETC.) AND COMPARABILITY DATA (E.G. COMPENSATION SURVEYS). THE BOARD THEN DETERMINES WHETHER TO APPROVE THE COMPENSATION OF THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES BASED ON THE INFORMATION COMPILED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE ALL AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONSULTANTS & CONTRACTORS: PROGRAM SERVICE EXPENSES 6,184,486. MANAGEMENT AND GENERAL EXPENSES 1,146,539. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,331,025. |
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