LAGUNA BEACH COMMUNITY CLINIC INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- LAGUNA BEACH COMMUNITY CLINIC INC (EIN 95-2637633)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-04-20
- IRS object ID
- 202121109349301427
- Schema version
- 2019v5.2
- 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 | 2021-04-20T13:22:01-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 953001179 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINDES INC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 87 | AddressLine1Txt |
| City | LONG BEACH | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 908010087 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 952637633 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAGUNA BEACH COMMUNITY CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAGU | BusinessNameControlTxt |
| Phone | 9494972975 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 362 THIRD STREET | AddressLine1Txt |
| City | LAGUNA BEACH | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92651 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JORGE RUBAL MD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9494972975 | PhoneNum |
| Signature | 2021-04-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DONITA M JOSEPH | PreparerPersonNm |
| PTIN | P00286656 | PTIN |
| Phone | 5624351191 | PhoneNum |
| Preparation | 2021-04-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JORGE RUBAL MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 362 THIRD STREET | AddressLine1Txt |
| City | LAGUNA BEACH | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92651 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,768,445 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LBCLINIC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE PRIMARY MEDICAL AND OTHER SERVICE PROGRAMS TO INDIVIDUALS AND FAMILIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 25 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,583,384 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,032,311 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,122,682 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,316,169 | CYProgramServiceRevenueAmt |
| PY Investment Income | $37,541 | PYInvestmentIncomeAmt |
| CY Investment Income | $29,727 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,882 | PYOtherRevenueAmt |
| CY Other Revenue | $47,098 | CYOtherRevenueAmt |
| PY Total Revenue | $2,752,489 | PYTotalRevenueAmt |
| CY Total Revenue | $4,425,305 | 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 | $1,500,897 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,850,907 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $57,211 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,069,543 | PYOtherExpensesAmt |
| CY Other Expenses | $2,261,237 | CYOtherExpensesAmt |
| PY Total Expenses | $2,570,440 | PYTotalExpensesAmt |
| CY Total Expenses | $4,112,144 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $182,049 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $313,161 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,624,425 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,278,954 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $693,620 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,039,016 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,930,805 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,239,938 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF LAGUNA BEACH COMMUNITY CLINIC (LBCC) IS TO PROVIDE EXCELLENT MEDICAL CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,973,690 | ExpenseAmt |
| Revenue | $2,316,169 | RevenueAmt |
| Desc | AS A HEALTH SERVICES ORGANIZATION WITH A TARGET POPULATION OF ECONOMICALLY DISADVANTAGED, LOW-INCOME, AND UNDERSERVED INDIVIDUALS AND FAMILIES, LBCC IS A SAFETY NET ORGANIZATION. 88% OF LBCC PATIENTS ARE LIVING BELOW 200% FEDERAL POVERTY LEVEL; APPROXIMATELY 61% LIVE IN SEVERE POVERTY (2020 OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT UTILIZATION REPORT). 33% OF PATIENTS ARE HISPANIC, MANY OF WHOM SPEAK ONLY SPANISH. PATIENTS ARE LOCAL SHOP STAFF, HOTEL AND RESTAURANT EMPLOYEES, ARTISTS, HOUSEHOLD WORKERS, GARDENERS, DAY LABORERS, AND NANNIES. THE PATIENTS WE SERVE ARE AT RISK OF FOREGOING EARLY MEDICAL CARE OF CONDITIONS, WHICH WOULD NEGATIVELY AFFECT THEIR MORBIDITY RATES, AND ALSO BURDEN THE HEALTHCARE SYSTEM IN THE LONG RUN. THEIR NEEDS TO ACCESS HEALTHCARE INCLUDE FINDING: - A REGISTERED MEDI-CAL PROVIDER. - A PROVIDER WHICH ACCEPTS UNINSURED PATIENTS AND OFFERS LOW-COST SERVICE: MANY WILL NEVER QUALIFY FOR GOVERNMENT SUBSIDIZED INSURANCE THROUGH MEDI-CAL OR WILL OPT-OUT, AND WILL REMAIN UNINSURED. THESE PATIENTS RISK FALLING THROUGH THE GAPS IN THE SAFETY-NET. - CARE THAT IS ACCESSIBLE BOTH LINGUISTICALLY AND GEOGRAPHICALLY. - HIGH QUALITY CARE.A SAFETY-NET PROVIDER, LAGUNA BEACH COMMUNITY CLINIC (LBCC) SERVES DISADVANTAGED, LOW-INCOME, AND UNDERSERVED PATIENTS. LBCC IS AN INDEPENDENT, NON-PROFIT, PRIMARY CARE HEALTH FACILITY THAT PROVIDES FAMILY-CENTERED MEDICAL AND DENTAL CARE. THE CLINIC OFFERS NON-EMERGENCY CURATIVE AND PREVENTIVE CARE, AS WELL AS EDUCATIONAL SERVICES FOR INDIVIDUALS AND FAMILIES IN ORANGE COUNTY AND SERVES AS A TRAINING SITE FOR HEALTH CARE PROFESSIONALS. THE AGENCY'S MISSION IS TO PROVIDE EXCELLENT MEDICAL CARE TO INDIVIDUALS IN ORANGE COUNTY, REGARDLESS OF THEIR ABILITY TO PAY.THE CLINIC WAS FOUNDED IN 1970 WHEN A GROUP OF CONCERNED PHYSICIANS AND COMMUNITY LEADERS ESTABLISHED A FREE CLINIC TO MEET THE NEEDS OF LOW-INCOME AND MEDICALLY UNINSURED PEOPLE OF SOUTH ORANGE COUNTY. IN 1985, LBCC BECAME A LICENSED COMMUNITY CLINIC DEDICATED TO MEETING THE COMPREHENSIVE MEDICAL NEEDS OF THE DISADVANTAGED. THE CLINIC BECAME A PATIENT CENTERED MEDICAL HOME (PCMH) IN 2015 AND RECEIVED DESIGNATION AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) LOOK-ALIKE IN LATE 2018. THE DESIGNATION AIDS IN FUTURE FINANCIAL SUSTAINABILITY AND IS INDICATIVE OF HIGHER PATIENT CARE STANDARDS, LOWER PATIENT COSTS,EXPANDED SERVICES TO INCLUDE MEDICAL AND DENTAL, HIGHER GOVERNANCE STANDARDS, AND COMMITMENT TO PROVIDING ACCESS FOR UNDERSERVED PATIENTS. NO LONGER A FREE CLINIC, TODAY SERVICES ARE DELIVERED WITH RESPECT FOR CLIENT DIGNITY, AND PATIENT PAYMENTS ARE BASED ON A SLIDING FEE SCALE. THE CLINIC IS A REGISTERED MEDI-CAL PROVIDER WITH COVERED CALIFORNIA CERTIFIED ENROLLMENT COUNSELORS ON-SITE, AND ADDITIONALLY WELCOMES PATIENTS WITHOUT HEALTH INSURANCE. THE CLINIC OFFERS CARE IN THE AREAS OF: PRIMARY CARE; DIAGNOSTIC AND RADIOLOGY SCREENINGS; FAMILY PLANNING, OBSTETRICAL AND GYNECOLOGICAL CARE; SPECIALTY SERVICES OF ENDOCRINOLOGY, UROLOGY, NEPHROLOGY, AND NEUROLOGY; PREVENTIVE DENTAL; SUBSTANCE ABUSE SERVICES; IMMUNIZATIONS; WELL-CHILD SERVICES; HEALTH EDUCATION; MENTAL HEALTH; PHARMACEUTICAL; NUTRITION; REFERRAL TO OPTOMETRY AND ADDITIONAL DENTAL; AND INSURANCE ELIGIBILITY ASSISTANCE. LBCC DELIVERS THE FULL SCOPE OF PRIMARY CARE SERVICES, INCLUDING OFFERING WALK-IN URGENT CARE HOURS SIX DAYS PER WEEK. | Desc |
| Total Program Service Expenses | $3,973,690 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | Yes (1) | 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 | 0 | 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 | Yes (1) | 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 | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 25 | 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 | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | 0 | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | 0 | 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 | JORGE RUBAL MD | PersonNm |
| Phone | 9494940761 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 362 THIRD STREET | AddressLine1Txt |
| City | LAGUNA BEACH | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92651 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| JORGE RUBAL MD | |||||||
| CEO/CMO | 50.00 | Yes (X) | $391,995 | $0 | $27,802 | ||
| CHAU NGO MD | |||||||
| INTERNIST | 30.00 | $132,900 | $0 | $25,774 | Yes (X) | ||
| ADRIANNA NIETO-SAYEGH RN | |||||||
| COO | 50.00 | Yes (X) | $131,165 | $0 | $24,442 | ||
| CHERI WITCHER | |||||||
| REVENUE CYCLE DIRECTOR | 40.00 | $115,092 | $0 | $17,805 | Yes (X) | ||
| HUNG TRAN | |||||||
| CIO | 10.00 | Yes (X) | $31,161 | $0 | $2,384 | ||
| MONICA SILVA | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARK ORGILL | |||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ROYA COLE | |||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SUSAN NEELY | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| JANET CHANCE | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| PAMELA LAWRENCE | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ANNE E JOHNSON | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| MARION JACOBS | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ARMANDO CHAPARRO | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| EDWARD LUCERO | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| LIDIA MANDALA | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ANITA JACKSON | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| GARY BEVERAGE | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DANIEL HASPERT | |||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| MARILYN WILSON | |||||||
| CFO | 16.00 | Yes (X) | $70,050 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $872,363 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $98,207 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $358,432 | GovernmentGrantsAmt |
| All Other Contributions | $1,673,879 | AllOtherContributionsAmt |
| Noncash Contributions | $622,786 | NoncashContributionsAmt |
| Total Contributions | $2,032,311 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT FEES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $2,316,169 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,316,169 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,316,169 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,191 | TotalRevenueColumnAmt |
| Exclusion | $34,191 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,203 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,203 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,203 | TotalRevenueColumnAmt |
| Exclusion | $36,203 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $338,676 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $343,140 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$4,464 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,464 | TotalRevenueColumnAmt |
| Exclusion | -$4,464 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $10,895 | TotalRevenueColumnAmt |
| Exclusion | $10,895 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $10,895 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,425,305 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,316,169 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $76,825 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $796,994 | TotalAmt |
| Program Services | $770,349 | ProgramServicesAmt |
| Management And General | $26,645 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $871,622 | TotalAmt |
| Program Services | $844,292 | ProgramServicesAmt |
| Management And General | $27,330 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,955 | TotalAmt |
| Program Services | $32,922 | ProgramServicesAmt |
| Management And General | $2,033 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,503 | TotalAmt |
| Program Services | $43,799 | ProgramServicesAmt |
| Management And General | $2,704 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,833 | TotalAmt |
| Program Services | $94,970 | ProgramServicesAmt |
| Management And General | $5,863 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,349 | TotalAmt |
| Program Services | $91,349 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,455 | TotalAmt |
| Management And General | $8,455 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,072 | TotalAmt |
| Program Services | $105,861 | ProgramServicesAmt |
| Fundraising | $57,211 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,856 | TotalAmt |
| Program Services | $73,542 | ProgramServicesAmt |
| Management And General | $1,314 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,074 | TotalAmt |
| Program Services | $85,903 | ProgramServicesAmt |
| Management And General | $3,171 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,179 | TotalAmt |
| Program Services | $24,179 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,991 | TotalAmt |
| Program Services | $45,613 | ProgramServicesAmt |
| Management And General | $1,378 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,782 | TotalAmt |
| Program Services | $39,388 | ProgramServicesAmt |
| Management And General | $1,394 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PHARMACEUTICALS | $888,708 | $888,708 | |
| DONATED MATERIALS | $622,786 | $622,786 | |
| OPERATION SUPPLIES | $74,501 | $73,545 | $956 |
| COMPUTER | $69,586 | $69,586 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,898 | TotalAmt |
| Program Services | $66,898 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,112,144 | TotalAmt |
| Program Services | $3,973,690 | ProgramServicesAmt |
| Management And General | $81,243 | ManagementAndGeneralAmt |
| Fundraising | $57,211 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $282,080 | BOYAmt |
| EOY | $944,521 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $159,337 | BOYAmt |
| EOY | $136,645 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,508 | BOYAmt |
| EOY | $231,280 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $372,180 | BOYAmt |
| EOY | $282,661 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,304 | BOYAmt |
| EOY | $30,249 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,374,954 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $728,533 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $687,517 | BOYAmt |
| EOY | $646,421 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,022,499 | BOYAmt |
| EOY | $1,000,092 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $7,085 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,624,425 | BOYAmt |
| EOY | $3,278,954 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,173 | BOYAmt |
| EOY | $345,697 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $426,447 | BOYAmt |
| EOY | $434,019 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $259,300 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,620 | BOYAmt |
| EOY | $1,039,016 | 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 | $435,101 | BOYAmt |
| EOY | $1,174,370 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,495,704 | BOYAmt |
| EOY | $1,065,568 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,930,805 | BOYAmt |
| EOY | $2,239,938 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,624,425 | BOYAmt |
| EOY | $3,278,954 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $313,161 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$4,028 | NetUnrlzdGainsLossesInvstAmt |
| 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 | $1,867,675 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,062,820 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,212,518 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,583,384 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,032,311 | CurrentTaxYearAmt |
| Total | $7,758,708 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,867,675 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,062,820 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,212,518 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,583,384 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,032,311 | CurrentTaxYearAmt |
| Total | $7,758,708 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $539,960 | SubstantialContributorsTotAmt |
| Public Support Total170 | $7,218,748 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,916 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $45,660 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $57,537 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $66,020 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $70,394 | CurrentTaxYearAmt |
| Total | $270,527 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,090 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $810 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,295 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $50 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,895 | CurrentTaxYearAmt |
| Total | $21,140 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $8,050,375 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $5,733,977 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.89670 | PublicSupportCY170Pct |
| Public Support PY170 | 0.78210 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,077,802 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $16,609 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $53,843 | OtherExpendituresAmt |
| End Year Balance | $1,040,568 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,046,621 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $83,390 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $52,209 | OtherExpendituresAmt |
| End Year Balance | $1,077,802 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,067,887 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $32,082 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $53,348 | OtherExpendituresAmt |
| End Year Balance | $1,046,621 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $992,498 | BeginningYearBalanceAmt |
| Contributions | $50,000 | ContributionsAmt |
| Investment Earnings Or Losses | $75,015 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $49,626 | OtherExpendituresAmt |
| End Year Balance | $1,067,887 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $250,646 | BeginningYearBalanceAmt |
| Contributions | $750,000 | ContributionsAmt |
| Investment Earnings Or Losses | $4,695 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $12,843 | OtherExpendituresAmt |
| End Year Balance | $992,498 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $345,000 | OtherCostOrOtherBasisAmt |
| Book Value | $345,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $569,546 | OtherCostOrOtherBasisAmt |
| Depreciation | $333,748 | DepreciationAmt |
| Book Value | $235,798 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $327,408 | OtherCostOrOtherBasisAmt |
| Depreciation | $261,785 | DepreciationAmt |
| Book Value | $65,623 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $133,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $133,000 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $646,421 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PPP LOAN ADVANCE | Desc |
| Amt | $259,300 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $259,300 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,473,212 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$4,028 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $60,390 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $56,362 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,416,850 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $8,455 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $8,455 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,425,305 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,164,079 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $60,390 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $60,390 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,103,689 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $8,455 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $8,455 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,112,144 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ENDOWMENT FUNDS ARE TO BE APPLIED TOWARD THE GREATEST COMMUNITY HEALTH NEEDS AS DETERMINED BY THE CLINIC. |
| PART X, LINE 2: | THE CLINIC HAS BEEN DESIGNATED AS TAX-EXEMPT UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), IS ALSO EXEMPT FROM STATE FRANCHISE TAXES UNDER SECTION 23701(D) OF THE CALIFORNIA REVENUE AND TAXATION CODE, AND IS NOT GENERALLY SUBJECT TO FEDERAL OR STATE INCOME TAXES. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES PRESCRIBE A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. IT REQUIRES THAT AN ORGANIZATION RECOGNIZE IN THE FINANCIAL STATEMENTS THE IMPACT OF THE TAX POSITION IF THAT POSITION WILL MORE LIKELY THAN NOT BE SUSTAINED ON AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. AS OF AND FOR THE YEAR ENDED JUNE 30, 2020, THE CLINIC HAD NO UNRECOGNIZED TAX BENEFITS, TAX PENALTIES, OR INTEREST. THE CLINIC IS SUBJECT TO POTENTIAL INCOME TAX AUDITS ON OPEN TAX YEARS BY ANY TAXING JURISDICTION IN WHICH IT OPERATES. THE STATUTE OF LIMITATIONS FOR FEDERAL PURPOSES IS THREE YEARS AND FOR CALIFORNIA IS FOUR YEARS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JORGE RUBAL MD | ||||||||||||||
| CEO/CMO | $391,995 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $27,802 | $0 | $419,797 | $0 | $0 | $0 |
| CHAU NGO MD | ||||||||||||||
| INTERNIST | $132,900 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $25,774 | $0 | $158,674 | $0 | $0 | $0 |
| ADRIANNA NIETO-SAYEGH RN | ||||||||||||||
| COO | $131,165 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $24,442 | $0 | $155,607 | $0 | $0 | $0 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Noncash Contributions Rpt F990 | $622,786 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE DRAFT 990 IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12 | STAFF WHO ATTEND BOARD MEETINGS MONITOR BOARD BEHAVIOR THAT MAY FALL WITHIN UNACCEPTABLE PARAMETERS OF THE POLICY. ANNUAL AUDIT REVIEW OF BOARD MEETING MINUTES MAY ALSO REVEAL POTENTIAL CONFLICT. OFFSITE BOOKKEEPING MONITORS STAFF ADHERENCE DURING VENDOR REVIEW. ADHERENCE TO CONFLICT OF INTEREST POLICY IS NOT MONITORED ANNUALLY, BUT PER TERM OF OFFICE FOR THE BOARD AND HIRE DATE OF THE EMPLOYEE. |
| FORM 990, PART VI, SECTION B, LINE 15 | A BOARD MEMBER PERFORMED A COMPENSATION ANALYSIS FOR DR. RUBAL'S INCREASE IN COMPENSATION. THE BOARD MEMBER REVIEWED IT WITH THE BOARD OF DIRECTORS AND THE BOARD PRESIDENT CONFIRMED THE INCREASE IN COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC BY REQUEST. |
| FORM 990, PART X, LINE 25: OTHER LIABILITIES | IN MARCH 2020, CONGRESS PASSED THE PAYCHECK PROTECTION PROGRAM (PPP), AUTHORIZING LOANS TO SMALL BUSINESSES FOR USE IN PAYING EMPLOYEES THAT THEY CONTINUE TO EMPLOY THROUGHOUT THE COVID-19 PANDEMIC AND FOR RENT, UTILITIES AND INTEREST ON MORTGAGES. LOANS OBTAINED THROUGH THE PPP ARE ELIGIBLE TO BE FORGIVEN AS LONG AS THE PROCEEDS ARE USED FOR QUALIFYING PURPOSES AND CERTAIN OTHER CONDITIONS ARE MET. IN MAY 2020, THE CLINIC RECEIVED PPP LOAN PROCEEDS OF $259,300. THE LOAN, WHICH WAS IN THE FORM OF A NOTE DATED MAY 5, 2020 ISSUED BY THE BORROWER, MATURES ON MAY 5, 2022 AND BEARS INTEREST AT A RATE OF 1.0% PER ANNUM, PAYABLE MONTHLY COMMENCING ON NOVEMBER 5, 2020. THE NOTE MAY BE PREPAID BY THE BORROWER AT ANY TIME PRIOR TO MATURITY WITH NO PREPAYMENT PENALTIES. FUNDS FROM THE LOAN MAY ONLY BE USED FOR PAYROLL COSTS, COSTS USED TO CONTINUE GROUP HEALTH CARE BENEFITS, MORTGAGE PAYMENTS, RENT, UTILITIES, AND INTEREST ON OTHER DEBT OBLIGATIONS INCURRED. THE CLINIC INTENDS TO USE THE ENTIRE LOAN AMOUNT FOR QUALIFYING EXPENSES. UNDER THE TERMS OF THE PPP, CERTAIN AMOUNTS OF THE LOAN MAY BE FORGIVEN IF THEY ARE USED FOR QUALIFYING EXPENSES AS DESCRIBED IN THE CARES ACT. FINAL APPROVAL OF ANY LOAN FORGIVENESS AMOUNT IS SUBJECTED TO THE SMALL BUSINESS ADMINISTRATION. |
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