2021-05-13T17:39:56-05:00 2020-06-30 680037990 GILBERT CPAS 2880 GATEWAY OAKS DR STE 100 SACRAMENTO CA 95833 990 2019-07-01 942583156 CHAPA-DE INDIAN HEALTH PROGRAM INC CHAP 5308872800 11670 ATWOOD ROAD AUBURN CA 95603 SIERK HAITSMA CFO 5308872800 2021-05-12 1 KEITH R GLEN P01317613 9166466464 2021-05-12 2019 2022-09-23 18:48:47Z LISA DAVIES 11670 ATWOOD ROAD AUBURN CA 95603 118531728 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 5 311 0 0 0 11517833 25916727 35315005 33291642 874162 1693657 0 0 47707000 60902026 0 0 0 0 19590097 20496253 0 0 0 11339250 12005073 30929347 32501326 16777653 28400700 101620330 132597049 12265407 14369851 89354923 118227198 PROVIDES COMPREHENSIVE HEALTH CARE AND ANCILLARY SERVICES TO THE NATIVE-AMERICAN POPULATION OF SIERRA, PLACER AND NEVADA COUNTIES OF CALIFORNIA. 0 0 20006533 33291642 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. 304511 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. 1088373 1088373 21399417 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 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 80 0 1 311 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 DARLA CLARK COO 40.00 X 186848 0 26037 LISA DAVIES CEO 40.00 X 300326 0 35103 SIERK HAITSMA CFO 40.00 X 214000 0 20519 MICHAEL R QUION LEAD PHYSICIAN 40.00 X 222217 0 33571 WILLIAM JORNLIN PHYSICIAN 40.00 X 231641 0 37990 PAULINE KARUNAKARAN DENTAL DIRECTOR 40.00 X 206453 0 23104 RICHARD A MALEK PSYCHIATRIST 40.00 X 261628 0 697 1623113 0 177021 7 0 1 0 KEKER VAN NEST & PETERS LLP 633 BATTERY ST SAN FRANCISCO CA 94111 PROFESSIONAL SERVICES 719314 ECLINICALWORKS PO BOX 847950 BOSTON MA 022847950 SOFTWARE LICENSE & SUPPORT 277992 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 LOCUM TENENS AGENCY 198584 DICKSTEIN LAW OFFICE 2443 FAIR OAKS BLVD 250 SACRAMENTO CA 95825 PROFESSIONAL SERVICES 160502 HEALTH INFORMATION TECHNOLOGY CARE LLC 1310 REDWOOD WAY STE 125 PETALUMA CA 94954 COMPUTER SERVICES 142909 5 25907304 9423 25916727 HEALTH SERVICES 621400 33291642 33291642 33291642 1503861 1503861 57687402 132096 57502279 127423 185123 4673 189796 189796 60902026 33291642 0 1693657 988990 729962 259028 15012400 11127760 3884640 3285184 2348046 937138 1209679 864604 345075 1693336 955380 737956 44413 25058 19355 28384 28384 2947116 1662566 1284550 143448 1606 141842 572248 128935 443313 792258 7758 784500 159544 119191 40353 1518880 122401 1396479 118376 814 117562 MEDICAL SUPPLIES 2310197 2302535 7662 BUILDING AND EQUIPMENT 589760 193041 396719 PATIENT RELATED COSTS 553846 544106 9740 OTHER PERSONNEL RELATED 151304 65609 85695 381963 200045 181918 32501326 21399417 11101909 0 6299 6800 76004226 34761691 115453 287067 3011987 2007769 183784 214395 41650818 17566734 22105553 24084084 71011835 193028 223408 101620330 132597049 2274302 3180254 9991105 6893197 0 4296400 12265407 14369851 X 89225332 118227198 129591 0 89354923 118227198 101620330 132597049 28400700 471575 0 X X 0 1 X 1 1 1 X 11423346 10973174 11043154 11517833 25916727 70874234 11423346 10973174 11043154 11517833 25916727 70874234 70874234 2192 3428 245453 876819 1693657 2821549 73695783 134655157 0.96170 0.98040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4961827 4961827 30942450 13994173 16948277 3892903 3572561 320342 1853638 1853638 24084084 INVESTMENTS 71011835 F 71011835 PPP LOAN 4296400 4296400 61345217 471575 471575 60873642 28384 28384 60902026 32472942 0 32472942 28384 28384 32501326 PART X, LINE 1: THE ORGANIZATION DID NOT APPLY FOR PPP FORGIVENESS AND REPAID THE LOAN IN FULL ON NOVEMBER 18, 2020, SUBSEQUENT TO FISCAL YEAR END. X X 0 0 0 0 0 0 0 0 0 DARLA CLARK COO 170848 0 16000 0 0 0 10410 0 15627 0 212885 0 0 0 LISA DAVIES CEO 275326 0 25000 0 0 0 16688 0 18415 0 335429 0 0 0 SIERK HAITSMA CFO 196000 0 18000 0 0 0 11760 0 8759 0 234519 0 0 0 MICHAEL R QUION LEAD PHYSICIAN 217460 0 4757 0 0 0 13317 0 20254 0 255788 0 0 0 WILLIAM JORNLIN PHYSICIAN 225927 0 5714 0 0 0 12000 0 25990 0 269631 0 0 0 PAULINE KARUNAKARAN DENTAL DIRECTOR 202453 0 4000 0 0 0 12147 0 10957 0 229557 0 0 0 RICHARD A MALEK PSYCHIATRIST 256614 0 5014 0 0 0 0 0 697 0 262325 0 0 0 FORM 990, PART VI THE BOARD OF DIRECTORS HIRES ALL OFFICERS OF THE ORGANIZATION. THE COMPENSATION AMOUNT IS BASED ON PREVAILING SALARIES IN THE AREA AND THE EXPERIENCE AND QUALIFICATIONS OF THE OFFICER. 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. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR PERIOD.