ALIVIO MEDICAL CENTER INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ALIVIO MEDICAL CENTER INC (EIN 36-3661051)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-09-07
- IRS object ID
- 202122509349301402
- Schema version
- 2019v5.1
- Note
- A later return for the same period supersedes this one.
- 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 | 2021-09-07T11:55:57-07:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prado & Renteria CPAs Prof Corp | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1837 S Michigan Ave 2nd Fl | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60616 | 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 | 363661051 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALIVIO MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ALIV | BusinessNameControlTxt |
| Phone | 3128296304 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 966 W 21ST ST | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60608 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ESTHER CORPUZ | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 3128296304 | PhoneNum |
| Signature | 2021-08-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENQIN ZHANG | PreparerPersonNm |
| PTIN | P02152541 | PTIN |
| Phone | 3125671330 | PhoneNum |
| Preparation | 2021-08-20 | 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) |
|---|---|---|
| Amended Return | Yes (X) | AmendedReturnInd |
| Principal Officer | ESTHER CORPUZ | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 966 West 21st Street | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60608 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,801,318 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1988 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | ALIVIO MEDICAL CENTER IS COMMITTED TO PROVIDING ACCESS TO QUALITY, COST EFFECTIVE HEALTH CARE TO THE HISPANIC COMMUNITY,THE UNINSURED, AND THE UNDERINSURED, NOT TO THE EXCLUSION | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 258 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,910,809 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,516,542 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,867,291 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,885,440 | CYProgramServiceRevenueAmt |
| PY Investment Income | $33,058 | PYInvestmentIncomeAmt |
| CY Investment Income | $81,664 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,652,975 | PYOtherRevenueAmt |
| CY Other Revenue | $2,965,644 | CYOtherRevenueAmt |
| PY Total Revenue | $18,464,133 | PYTotalRevenueAmt |
| CY Total Revenue | $19,449,290 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,654,331 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,805,092 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $212,991 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,013,693 | PYOtherExpensesAmt |
| CY Other Expenses | $7,555,883 | CYOtherExpensesAmt |
| PY Total Expenses | $17,668,024 | PYTotalExpensesAmt |
| CY Total Expenses | $19,360,975 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $796,109 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $88,315 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,555,755 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,950,479 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,268,178 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,698,216 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,287,577 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,252,263 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE COMMUNITY HEALTH CENTER IS COMMITTED TO PROVIDING ACCESS TO QUALITY COST EFFECTIVE HEALTH CARE TO THE HISPANIC COMMUNITY, THE UNISURED, AND UNDERINSURED, NOT TO THE EXCLUSION OF OTHER CULTURES AND RACES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $12,383,164 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $6,609,929 | RevenueAmt |
| Desc | THE COMMUNITY HEALTH CENTER WAS ESTABLISHED TO PROVIDE QUALITY, AFFORDABLE HEALTH CARE TO THE LOCAL COMMUNITY. THE COMPREHENSIVE SERVICES INCLUDE PRIMARY OUTPATIENT MEDICAL CARE, OBSTETRICS, GYNECOLOGY, DIAGNOSTIC SERVICES, NUTRITION SERVICES, BEHAVIOR HEALTH SERVICES, EDUCATION AND PREVENTION PROGRAMS AS WELL AS OTHER SUPPORTING SERVICES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,302,610 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE VENTANILLA PROGRAM IS TO COLLABORATE TO IMPLEMENT AND DEVELOP THE VENTANILLA DE SALUD IN ORDER TO IMPROVE PHYSICAL AND MENTAL WELL-BEING OF MEXICANS LIVING IN THE UNITED STATES OF AMERICA, THROUGH INCREASING ACCESS TO PRIMARY AND PREVENTIVE SERVICES, COVERAGE OF PUBLIC SERVICES, PROVIDING QUALITY AND CULTURALLY SENSITIVE SERVICES; REDUCING THE USE OF EMERGENCY SERVICES AND ESTABLISHING THE VENTANILLAS DE SALUD NETWORK AS A RELIABLE AND SUSTAINABLE STRATEGY FOR INFORMATION, EDUCATION AND HEALTH REFERRALS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $186,760 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE CHICAGO FAMILY CASE MANAGEMENT (CFCM) PROVIDES A COMPREHENSIVE ARRAY OF MATERNAL AND CHILD HEALTH SERVICES TO PREGNANT WOMEN AND INFANTS UP TO TWELVE MONTHS OF AGE, INCLUDING CASE MANAGEMENT, OUTREACH AND TRANSPORTATION. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,392,791 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | Other programs | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,392,791 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $16,265,325 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (true) | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | Yes (true) | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 258 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Esther Corpuz CEO | PersonNm |
| Phone | 3128296304 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 966 WEST 21ST STREET | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60608 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TERESA FRAGA | ||||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PETER MARTINEZ | ||||||||
| 1ST VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH AQUINO RN PHD | ||||||||
| 2ND VICE PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOSE M AYBAR PHD | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ROBERTO CORNELIO | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SCOTT CRUZ ESQ | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LOURDES DIAZ | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARGARITA LOPEZ | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ALEJANDRA PEREZ TAMAYO MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TOMY SANCHEZ | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JILL SEIDMAN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| FRANCISCA TAMAYO | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSEPH VALLEZ | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ESTHER CORPUZ | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $200,519 | $0 | $2,546 | Yes (X) | |||
| ABDUL BHURGRI | ||||||||
| MEDICAL DIRECTOR | 40.00 | $188,364 | $0 | $19,624 | Yes (X) | |||
| RUSSEL EFFRIG | ||||||||
| CFO | 40.00 | $143,674 | $0 | $11,033 | Yes (X) | |||
| JOANNE ZIMMERLY | ||||||||
| FAMILY NURSE PRACTITIONER | 40.00 | $104,738 | $0 | $13,176 | Yes (X) | |||
| MARK KOSANOVICH | ||||||||
| PHYSICIAN | 40.00 | $237,231 | $0 | $1,111 | Yes (X) | |||
| JENNIFER VARGAS | ||||||||
| PHYSICIAN | 40.00 | $200,497 | $0 | $3,036 | Yes (X) | |||
| NORMA B WESTERVELT | ||||||||
| PHYSICIAN | 40.00 | $151,866 | $0 | $19,102 | Yes (X) | |||
| QIAN WANG | ||||||||
| PHYSICIAN | 40.00 | $151,600 | $0 | $17,895 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,378,489 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $87,523 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,633,740 | GovernmentGrantsAmt |
| All Other Contributions | $882,802 | AllOtherContributionsAmt |
| Noncash Contributions | $746,541 | NoncashContributionsAmt |
| Total Contributions | $8,516,542 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| MEDICAID | 624100 | $4,003,839 | $0 | $0 |
| SELF-PAY | 624100 | $753,337 | $0 | $0 |
| MEDICARE | 624100 | $257,881 | $0 | $0 |
| OTHER MANAGED CARE | 624100 | $1,275,511 | $0 | $0 |
| OTHER THIRD PARTY | 624100 | $1,594,872 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,885,440 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,956 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,590 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,590 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,590 | TotalRevenueColumnAmt |
| Exclusion | $19,590 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $386,736 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $352,028 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $34,708 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,708 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,708 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| 340 B PHARMACY | 624100 | $2,914,674 | $2,914,674 | $0 | $0 |
| OTHER | 900099 | $31,380 | $31,380 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,946,054 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,449,290 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,913,158 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $19,590 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,466,012 | TotalAmt |
| Program Services | $1,315,562 | ProgramServicesAmt |
| Management And General | $126,250 | ManagementAndGeneralAmt |
| Fundraising | $24,200 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,719,386 | TotalAmt |
| Program Services | $7,859,575 | ProgramServicesAmt |
| Management And General | $715,399 | ManagementAndGeneralAmt |
| Fundraising | $144,412 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,112 | TotalAmt |
| Program Services | $46,764 | ProgramServicesAmt |
| Management And General | $4,483 | ManagementAndGeneralAmt |
| Fundraising | $865 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $816,620 | TotalAmt |
| Program Services | $739,468 | ProgramServicesAmt |
| Management And General | $63,059 | ManagementAndGeneralAmt |
| Fundraising | $14,093 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $750,962 | TotalAmt |
| Program Services | $632,221 | ProgramServicesAmt |
| Management And General | $106,264 | ManagementAndGeneralAmt |
| Fundraising | $12,477 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,028 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $78,028 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,928 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $42,928 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,807 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $4,282 | ManagementAndGeneralAmt |
| Fundraising | $4,525 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,205 | TotalAmt |
| Program Services | $485,307 | ProgramServicesAmt |
| Management And General | $98,869 | ManagementAndGeneralAmt |
| Fundraising | $3,029 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,778 | TotalAmt |
| Program Services | $112,907 | ProgramServicesAmt |
| Management And General | $16,871 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,631 | TotalAmt |
| Program Services | $61,188 | ProgramServicesAmt |
| Management And General | $115,414 | ManagementAndGeneralAmt |
| Fundraising | $1,029 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $254,575 | TotalAmt |
| Program Services | $20,736 | ProgramServicesAmt |
| Management And General | $233,839 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $553,209 | TotalAmt |
| Program Services | $481,292 | ProgramServicesAmt |
| Management And General | $71,917 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,929 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $81,929 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| BAD DEBT | $890,019 | $890,019 | $0 | $0 |
| DONATED VACCINES | $746,541 | $746,541 | $0 | $0 |
| CONSUMABLE SUPPLIES | $1,533,019 | $1,489,936 | $43,083 | $0 |
| CONSULTANT FEE | $667,731 | $0 | $660,037 | $7,694 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,804,483 | TotalAmt |
| Program Services | $1,383,809 | ProgramServicesAmt |
| Management And General | $420,007 | ManagementAndGeneralAmt |
| Fundraising | $667 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,360,975 | TotalAmt |
| Program Services | $16,265,325 | ProgramServicesAmt |
| Management And General | $2,882,659 | ManagementAndGeneralAmt |
| Fundraising | $212,991 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $778,166 | BOYAmt |
| EOY | $1,753,637 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,510 | BOYAmt |
| EOY | $3,510 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $402,059 | BOYAmt |
| EOY | $2,639,581 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,308,326 | BOYAmt |
| EOY | $3,138,438 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,048 | BOYAmt |
| EOY | $35,657 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,903 | BOYAmt |
| EOY | $104,756 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,120,983 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,114,841 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,362,594 | BOYAmt |
| EOY | $6,006,142 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,117,192 | BOYAmt |
| EOY | $1,136,114 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,396,957 | BOYAmt |
| EOY | $2,132,644 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,555,755 | BOYAmt |
| EOY | $16,950,479 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,579,473 | BOYAmt |
| EOY | $1,708,517 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $495,976 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,115,260 | BOYAmt |
| EOY | $5,909,454 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,469 | BOYAmt |
| EOY | $80,245 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,268,178 | BOYAmt |
| EOY | $7,698,216 | 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 | $8,026,089 | BOYAmt |
| EOY | $7,915,289 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,261,488 | BOYAmt |
| EOY | $1,336,974 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,287,577 | BOYAmt |
| EOY | $9,252,263 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,555,755 | BOYAmt |
| EOY | $16,950,479 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $88,315 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$123,629 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support CY170 | 0 | PublicSupportCY170Pct |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
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 | $1,000,000 | BeginningYearBalanceAmt |
| End Year Balance | $1,000,000 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,000,000 | BeginningYearBalanceAmt |
| End Year Balance | $1,000,000 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,000,000 | BeginningYearBalanceAmt |
| End Year Balance | $1,000,000 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,000,000 | BeginningYearBalanceAmt |
| End Year Balance | $1,000,000 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,000,000 | BeginningYearBalanceAmt |
| End Year Balance | $1,000,000 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $471,567 | InvestmentCostOrOtherBasisAmt |
| Book Value | $471,567 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $10,839,533 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $6,466,130 | DepreciationAmt |
| Book Value | $4,373,403 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,280,196 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $532,572 | DepreciationAmt |
| Book Value | $747,624 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $5,295,067 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $4,925,176 | DepreciationAmt |
| Book Value | $369,891 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $234,620 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $190,963 | DepreciationAmt |
| Book Value | $43,657 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,006,142 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN LIMITED LIABILITY COM | Desc |
| Book Value | $2,132,644 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $2,132,644 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFFERED COMPENSATION | Desc |
| Amt | $80,245 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $80,245 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $18,435,642 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$123,629 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$123,629 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,559,271 | RevenueSubtotalAmt |
| Other Revenues Not Included | $890,019 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $890,019 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $19,449,290 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,470,956 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $18,470,956 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $890,019 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $890,019 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $19,360,975 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt V, Line 4 | Fund of perpetual duration. |
| Pt XII, Line 4b | Provision of bad debt is offset against patient service revenue per audited financial statements. For Form 990 purposes it is presented as an expense on Part IX, line 24a. |
| Pt XI, Line 4b | Provision of bad debt is offset against patient service revenue per audited financial statements. For Form 990 purposes it is presented as an expense on Part IX, line 24a. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ESTHER CORPUZ | |||||||||||||
| $200,519 | $0 | $0 | $0 | $0 | $0 | $1,434 | $0 | $2,137 | $0 | $204,090 | $0 | $0 | $0 |
| ABDUL BHURGRI | |||||||||||||
| $188,364 | $0 | $0 | $0 | $0 | $0 | $2,850 | $0 | $1,143 | $16,610 | $192,357 | $16,610 | $0 | $0 |
| RUSSEL EFFRIG | |||||||||||||
| $143,674 | $0 | $0 | $0 | $0 | $0 | $181 | $0 | $11,665 | $0 | $155,520 | $0 | $0 | $0 |
| MARK KOSANOVICH | |||||||||||||
| $237,231 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $3,281 | $0 | $240,512 | $0 | $0 | $0 |
| JENNIFER VARGAS | |||||||||||||
| $200,497 | $0 | $0 | $0 | $0 | $0 | $1,925 | $0 | $497 | $0 | $202,919 | $0 | $0 | $0 |
| NORMA B WESTERVELT | |||||||||||||
| $151,866 | $0 | $0 | $0 | $0 | $0 | $2,411 | $0 | $1,143 | $16,610 | $155,420 | $16,610 | $0 | $0 |
| QIAN WANG | |||||||||||||
| $151,600 | $0 | $0 | $0 | $0 | $0 | $1,204 | $0 | $398 | $16,610 | $153,202 | $16,610 | $0 | $0 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $746,541 | NoncashContributionsRptF990Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 19 | The Organization makes all governing documents,conflict of interest policies and financial statements available upon request. |
| Pt VI, Line 12c | The members must disclose if there is a conflict of interest at the annual Board Meeting. The Board Members complete and sign a form documenting that at the time there are no conflicts of interest. Each year the board members sign a new form and if there is a conflict the member abstains from voting. If a board member is found to have not disclosed a conflict, the member will be brought before the executive committee. |
| Pt VI, Line 15a | The Board of Directors Reviews Annually, the compensation of the CEO. |
| Pt VI, Line 15b | The CEO Evaluates compensation of employees every two years. |
| Pt VI, Line 11b | Due to time constrains, a copy of Form 990 will be provided to the board at the next board meeting. |
| Form 990, Part III, Line 4d | Other programs 1392791. 0. 0. |
Schedule R IRS990ScheduleR
Unrelated Org Txbl Partnership UnrelatedOrgTxblPartnershipGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MHN ACO LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 939 W North Avenue Suite 875 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60642 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300833127 | EIN |
| Primary Activities | Health Care Services | PrimaryActivitiesTxt |
| Legal Domicile State | IL | LegalDomicileStateCd |
| All Partners C3 S | Yes (true) | AllPartnersC3SInd |
| Share Of Total Income | -$60,888 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $2,181,454 | ShareOfEOYAssetsAmt |
| General Or Managing Partner | false | GeneralOrManagingPartnerInd |
| Ownership | 0.11111 | OwnershipPct |
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