2018-05-14T17:07:44-05:00 2017-06-30 464016990 THE PUN GROUP LLP 200 E SANDPOINTE AVENUE SUITE 600 SANTA ANA CA 92707 990 2016-07-01 942308748 ALLIANCE MEDICAL CENTER INC ALLI 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 ALEX ARMSTRONG CEO 7074318234 2018-05-14 KENNETH H PUN P01443751 9497778800 2016 2022-09-23 18:48:47Z ALEX ARMSTRONG 1381 UNIVERSITY AVE HEALDSBURG CA 95448 15851429 0 X WWW.ALLIANCEMED.ORG X 1971 CA OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 12 12 161 25 0 0 3922898 4142480 9321360 11675711 1455 135 89654 33103 13335367 15851429 0 0 0 0 7847275 8536078 0 0 0 4815600 6392589 12662875 14928667 672492 922762 5337632 6676529 1301850 1717985 4035782 4958544 OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 0 0 6964217 7512421 MEDICAL PROGRAMS: COMPREHENSIVE PRIMARY MEDICAL SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS - SOME INSURED, SOME WITH MEDICARE, MEDICAID AND OTHERS UNFUNDED. OUR BASIC SERVICES INCLUDE PRIMARY MEDICAL CARE WITH A 24/7 CALL SERVICE. 2706602 3187149 DENTAL PROGRAMS: COMPREHENSIVE DENTAL SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS - SOME INSURED, SOME WITH MEDICAID AND OTHERS UNFUNDED. OUR BASIC SERVICES INCLUDE ORAL HEALTH. 1154282 1009379 OTHER PROGRAMS: AMC OFFERS A HEALTH EDUCATION PROGRAM CALLED "MY BODY IS HEALTHY". THIS INCLUDES SENDING OUTREACH WORKERS INTO COMMUNITY ELEMENTARY SCHOOLS TO TEACH YOUNG CHILDREN NUTRITION, ORAL HEALTH AND ANATOMY BASICS. AMC ALSO HAS WIC (WOMEN, INFANTS AND CHILDREN) PROGRAM, WHICH IS A SUPPLEMENTAL NUTRITION PROGRAM FOR THOSE PREGNANT,BREASTFEEDING, AND POSTPARTUM WOMEN, INFANTS AND CHILDREN UNDER AGE OF 5 WHO ARE LOW TO MODERATE INCOME AND AT NUTRITION RISK. ADDITIONALLY, AMC PROVIDES BEHAVIORAL HEALTH SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS. FURTHERMORE, AMC OPERATES SPECIALITY CLINICS WHERE PART-TIME SPECIALISTS PROVIDE OTHER SERVICES, INCLUDING PAIN MANAGEMENT, CHIROPRACTIC TREATMENT, AND OTHER ENABLING SERVICES. 10825101 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 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 40 0 1 161 1 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 CA X JUDITH WATERMAN CFO 7074318234 1381 UNIVERSITY AVE HEALDSBURG CA 95448 ABRAHAM DANIELS CHAIRPERSON 1.00 X X 0 0 0 LYN MURRAY TREASURER 1.00 X X 0 0 0 TERRY LEACH VICE CHAIR 1.00 X X 0 0 0 SUSAN LENTZ VICE CHAIR 1.00 X X 0 0 0 DENNY MARTIN BOARD MEMBER 1.00 X 0 0 0 MIMI GURBST BOARD MEMBER 1.00 X 0 0 0 ERICK LONGORIA BOARD MEMBER 1.00 X 0 0 0 ROSA GONZALEZ BOARD MEMBER 1.00 X 0 0 0 KATHRYN LOMBERA BOARD MEMBER 1.00 X 0 0 0 PHIL LUKS BOARD MEMBER 1.00 X 0 0 0 JOHN FRITSCHEN BOARD MEMBER 1.00 X 0 0 0 TERESITA PONCE BOARD MEMBER 1.00 X 0 0 0 CARINA GONZALEZ CMO 40.00 X 3956 0 0 ALEX ARMSTRONG CEO 40.00 X 136859 0 0 JOSE CHIBRAS PHYSICIAN 40.00 X 179629 0 0 DONALD DOBBS DENTAL DIRECTOR 40.00 X 143589 0 0 DANA YEE DENTIST 40.00 X 139168 0 0 ANDREW LANE SR DENTIST 32.00 X 148727 0 0 BRITTANY GONZALES DENTIST 40.00 X 135620 0 0 MARIA ALVAREZ DIRECTOR OF BEHAVIORAL HEALTH 40.00 X 131646 0 0 1019194 0 0 7 0 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 75397 HEALTHCARE STAFFING SERVICES 779387 1 2703357 1439123 4142480 NET PATIENT REVENUE 621300 11675711 11675711 11675711 135 135 OTHER INCOME 621300 33103 33103 33103 15851429 11708949 0 0 X 320444 179629 140815 6796513 5794205 1002308 1419121 1220189 198932 55833 55833 235130 235130 3374333 1543769 1830564 11084 2917 8167 615386 514230 101156 204277 91010 113267 12296 12296 150598 105233 45365 54495 17531 36964 SUPPLIES 1070718 965849 104869 MAINTENANCE & REPAIRS 64865 36451 28414 TAXES AND LICENSES 14069 7303 6766 529505 346785 182720 14928667 10825101 4103566 0 1773960 2319330 258067 359091 1810850 1939042 153832 174967 3683064 1825027 1323943 1858037 16980 26062 5337632 6676529 1199709 1660662 102141 57323 1301850 1717985 X 3966898 4938907 68884 19637 4035782 4958544 5337632 6676529 922762 0 X X 0 1 X 1 1 1 X 2253892 2949226 3004097 3922898 4191727 16321840 2253892 2949226 3004097 3922898 4191727 16321840 16321840 254 89 203 1455 135 2136 16323976 43519804 0.99990 0.99980 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1863698 487596 1376102 1527938 1046003 481935 291428 291428 0 1858037 X 15851429 0 15851429 0 15851429 14928667 0 14928667 0 14928667 PART X, LINE 2: ALLIANCE MEDICAL CENTER HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE IRC AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC AND CALIFORNIA REVENUE AND TAXATION CODE SECTION 23701D. FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. FASB ASC 740 ALSO PROVIDES GUIDANCE ON DE-RECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE CONTAINED IN FASB ASC 740 IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. THE CENTER HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS OR TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES ACCRUED AS OF JUNE 30, 2017 AND 2016. X X 0 0 0 0 0 0 0 0 0 JOSE CHIBRAS PHYSICIAN 179629 0 0 0 0 0 0 0 0 0 179629 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE ENTIRE BOARD OF DIRECTORS BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C AMC ETHICAL CONDUCT POLICY REQUIRES THAT EACH COVERED INDIVIDUAL REVIEW AND SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY AND, WHEN REQUIRED, A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE INFORMATION PROVIDED ON THE DISCLOSURE STATEMENT IS AVAILABLE FOR INSPECTION BY MEMBERS OF THE BOARD AND AMC'S LEGAL COUNSEL. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS OF ALLIANCE MEDICAL CENTER IS SOLELY RESPONSIBLE FOR THE SELECTION, COMPENSATION AND PERFORMANCE REVIEW OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. THE BOARD WILL PERFORM AN ANNUAL EVALUATION AND COMPENSATION REVIEW OF THE CEO, COMPARING THE INTERNAL SALARY SCALE WITH THAT OF THE CALIFORNIA PRIMARY CARE ASSOCIATION'S ANNUAL SALARY SURVEY. ALLIANCE MEDICAL CENTER'S CEO WILL DETERMINE THE COMPENSATION LEVEL FOR THE CFO, WHICH WILL THEN BE REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF DIRECTORS OR DESIGNATED BOARD COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 AMC'S GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,130,196. MANAGEMENT AND GENERAL EXPENSES 1,258,322. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,388,518. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 413,573. MANAGEMENT AND GENERAL EXPENSES 572,242. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 985,815. FORM 990, PART XII, LINE 2C: ALL REVIEW AND PROCESS FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR REMAINS CONSISTENT BETWEEN YEARS.