2018-03-08T14:50:09-06:00 2017-04-30 330700332 VASQUEZ & COMPANY LLP 801 S GRAND AVE SUITE 400 LOS ANGELES CA 90017 990 2016-05-01 952810095 ALTAMED HEALTH SERVICES CORPORATION ALTA 3237258751 2040 CAMFIELD AVENUE LOS ANGELES CA 90040 JOSE ESPARZA SR. VP OF FINANCE AND CFO 3237258751 2018-03-07 1 LYNN D BOSTER P00440365 2138731700 206.169.79.50 2018-03-07 15:37:37 PS P 7ED5B94A8C25C9314D98FAB42AC8A3BDDB96ECBC 7ED5B94A8C25C9314D98FAB42AC8A3BDDB96ECBC 2016 2021-01-29 14:40:06Z JOSE ESPARZA 2040 CAMFIELD AVENUE LOS ANGELES CA 90040 594949688 0 X HTTP://WWW.ALTAMED.ORG X 1970 CA SEE SCHEDULE O : TO ELIMINATE DISPARITIES IN HEALTH CARE ACCESS AND OUTCOMES BY PROVIDING SUPERIOR QUALITY HEALTH AND HUMAN SERVICES THROUGH AN INTEGRATED WORLD-CLASS DELIVERY SYSTEM FOR LATINO , MULTI-ETHNIC AND UNDERSERVED COMUNITIES IN SOUTHERN CALIFORNIA.VISION: TO BE THE LEADING COMMUNITY-BASED PROVIDER OF QUALITY HEALTH CARE AND HUMAN SERVICES. 9 9 3358 0 0 0 2810073 29582873 500053552 517605058 2711972 6337387 3205128 4199846 508780725 557725164 0 636218 0 0 186390220 206443042 0 0 1464117 236701337 281062779 423091557 488142039 85689168 69583125 496702569 584158588 198177303 201288455 298525266 382870133 X TO ELIMINATE DISPARITIES IN HEALTH CARE ACCESS AND OUTCOMES BY PROVIDING SUPERIOR QUALITY HEALTH AND HUMAN SERVICES THROUGH AN INTEGRATED WORLD-CLASS DELIVERY SYSTEM FOR LATINO, MULTI-ETHNIC AND UNDERSERVED COMMUNITIES IN SOUTHERN CALIFORNIA. 0 0 327796962 636218 360508306 ALTAMED OPERATES A TOTAL OF 29 MEDICAL/DENTAL HEALTHCARE CLINICS IN LOS ANGELES AND ORANGE COUNTIES; 8 PACE (PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY) CLINICS; AND THREE MOBILE UNITS. THROUGH OUR FQHC SITES, WE SERVED OVER 200,000 UNIQUE PATIENTS IN 2016. ALTAMED PROVIDES INTEGRATED SERVICES ALONG A CONTINUUM OF CARE THAT INCLUDES PRIMARY HEALTH CARE FOR ALL AGE GROUPS, PERINATAL CARE, DIAGNOSTIC LABORATORY, DIAGNOSTIC RADIOLOGY, PHARMACEUTICAL SERVICES, AND PREVENTIVE DENTAL. MORE SPECIALIZED PROGRAMS INCLUDE PEDIATRIC AND ADOLESCENT OBESITY PROGRAMS, CHRONIC DISEASE CARE, AND BEHAVIORAL HEALTH CARE. FACILITATING THE CONTINUUM OF CARE ARE ROBUST EDUCATION AND CASE MANAGEMENT TEAMS WORKING WITH PEDIATRIC, ADOLESCENT, WOMEN'S HEALTH, AND GERIATRIC PATIENTS. 137034924 163407846 LONG TERM CARE. EACH YEAR, OVER 3,500 FRAIL AND ELDERLY SENIORS AND DISABLED ADULTS ARE SUPPORTED BY AN ARRAY OF SERVICES THROUGH ALTAMED'S 8 PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) SITES. SERVICES INCLUDE PRIMARY CARE/GERIATRIC MEDICINE NURSING CARE, REHABILITATION THERAPY, FAMILY SUPPORT INTERVENTIONS, COUNSELING, MEDICATION MANAGEMENT, NUTRITION EDUCATION, SOCIAL ACTIVITIES, AND DOOR TO DOOR TRANSPORTATION SERVICES BOTH TO PARTICIPANTS HOMES AND SPECIALTY CARE MEDICAL APPOINTMENTS. ALTAMED ALSO PROVIDES SPECIALIZED IN-HOME SUPPORTIVE PROGRAMS AND SERVICES THAT ENHANCE THE LIVES OF NEARLY 4,500 SENIORS LIVING INDEPENDENTLY IN THE COMMUNITY OR WHO ARE AT-RISK OF INSTITUTIONALIZED CARE. 14040844 6882349 HIV SERVICES. AS THE ONLY PROVIDER THAT OFFERS A COMPREHENSIVE MEDICAL HOME SPECIALIZING IN HIV CARE FOR LATINOS IN LOS ANGELES, ALTAMED OPERATES A TOTAL OF FIVE HIV PRIMARY CARE CLINICS - FOUR (4) IN LOS ANGELES COUNTY AND ONE (1) IN ORANGE COUNTY. IN RESPONSE TO THE AIDS EPIDEMIC, ALTAMED LAUNCHED HIV SERVICES IN 1986 TO PROVIDE CULTURALLY-COMPETENT ACCESS TO CARE TO COMBAT THE DISEASE IN ITS PREDOMINANTLY URBAN LATINO SERVICE COMMUNITIES. SINCE THEN, ALTAMED HAS GROWN TO BECOME THE LARGEST PROVIDER OF BILINGUAL HIV MEDICAL SERVICES IN LA, SERVING OVER 1700 HIV PATIENTS EACH YEAR, AND A NATIONAL LEADER IN HIV PREVENTION SERVICES TARGETING LATINO MEN WHO HAVE SEX WITH MEN. ALTAMED OFFERS A FULL CONTINUUM OF CARE THAT INCLUDES: HIV TESTING & COUNSELING; LINKAGE TO CARE/ PATIENT NAVIGATION; MEDICAL OUTPATIENT; MEDICAL CARE COORDINATION; TREATMENT EDUCATION; BENEFITS ASSISTANCE; MENTAL HEALTH SERVICES AND INTERVENTIONS; NUTRITION COUNSELING; MEDICATION ADHERENCE; ANAL CANCER DETECTION/TREATMENT; DENTAL CARE; HOME-BASED CARE; AND SUPPORT GROUPS. ALTAMED ALSO IS AN ESTABLISHED LEADER IN HIV BIOMEDICAL PREVENTION SERVICES AS A PROVIDER OF PRE-EXPOSURE PROPHYLAXIS (PREP) MEDICATION TO REDUCE THE RISK OF CONTRACTING HIV. ALTAMED'S USE OF INNOVATIVE, CULTURALLY-TAILORED OUTREACH CAMPAIGNS HAS SOLIDIFIED ITS STANDING AS A PREFERRED LATINO, GAY- AND YOUTH-FRIENDLY HIV SERVICES PROVIDER. 5047178 3867032 (I) YOUTH SERVICES. ALTAMED PROVIDES AN ARRAY OF YOUTH SERVICES TO OVER 1,500 AT-RISK TEENS AND YOUNG ADULTS IN MEDICALLY-UNDERSERVED COMMUNITIES EACH YEAR. SERVICES INCLUDE: PREGNANCY AND STD PREVENTION PROGRAMS, FAMILY PLANNING, HEALTH EDUCATION AND INFORMATION WORKSHOPS, LINKAGES TO CLINICAL SERVICES, CASE MANAGEMENT FOR PREGNANT/PARENTING TEENS; PARENTING EDUCATION; SUPPORT FOR PARENTING TEENS TO HELP THEM STAY IN SCHOOL; AND LIFE-SKILLS DEVELOPMENT. ALTAMED ALSO PROVIDES INTENSIVE TUTORING FOR HIGH SCHOOL STUDENTS, MENTORSHIP, GUIDANCE INTO COLLEGE AND TECHNICAL SCHOOLS, AND WORKFORCE DEVELOPMENT WITH CAREER PIPELINES IN THE MEDICAL FIELD. 5047178 3867032 483919908 1 1 0 1 0 0 0 1 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 1 3023 0 1 3358 1 0 0 0 0 0 1 1 0 0 0 0 X 9 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X JOSE ESPARZA SR VP OF FINANCE AND CFO 3237258751 2040 CAMFIELD AVENUE LOS ANGELES CA 90040 FERNANDO DE NECOCHEA BOARD CHAIRMAN 1.60 X X 0 0 0 EFRAIN TALAMANTES BOARD MEMBER 1.60 X 0 0 0 MARIA GRIMALDO CONSUMER BOARD MEMBER 1.20 X 0 0 0 GREGORY VALENZUELA CONSUMER BOARD MEMBER 1.60 X 0 0 0 ADOLFO CHANEZ BOARD MEMBER 1.60 X 0 0 0 GLORIA CARRILLO ZAMORA CONSUMER BOARD MEMBER 1.20 X 0 0 0 SHIRLEY DETTLOFF VICE CHAIRPERSON 1.60 X X 0 0 0 RICARDO ROBLES TREASURER 1.60 X X 0 0 0 LILIANA RAMIREZ CONSUMER BOARD MEMBER 1.20 X 0 0 0 CASTULO DELA ROCHA JD PRESIDENT & CEO 40.00 X 1119710 0 146798 JOSE U ESPARZA SR. VP OF FINANCE & CFO 40.00 X 518038 0 10400 MARIE TORRES SR.VP OF GOV'T RELATIONS 40.00 X 406818 0 10400 MARTIN LEE SEROTA MD SVP, CHIEF MEDICAL OFFICER 40.00 X 560262 0 10400 ZOILA ESCOBAR SR.VP STRATEGIC DEV & COMM 40.00 X 384636 0 10400 JENNIFER SPALDING SR.VP CHIEF OPERATION OFFI 40.00 X 455401 0 9824 JACQUELINE RITACCO SR.VP CHIEF ADMINISTRATIVE OFFICER 40.00 X 377646 0 10400 ANGELA ROBERTS VP, FACILITY DEVELOPMENT & MGMT. 40.00 X 364525 0 10084 CRISTIAN RICO MD DIRECTOR, REGIONAL MEDICAL 40.00 X 372699 0 10400 ALEX CHEN VP, MEDICAL DIR QUALITY & SAFE 40.00 X 323417 0 10400 HENRY HOLGUIN SVP, GENERAL COUNSEL 40.00 X 456660 0 0 ESIQUIO CASILLAS DIR., REGIONAL MEDICAL SENIOR CARE SERVICE 40.00 X 395287 0 10400 5735099 0 249906 359 0 1 0 CHILDRENS HOSPITAL LA MED GRP INC 3701 WILSHIRE BLVD STE 600 LOS ANGELES CA 90010 MEDICAL SERVICES 17960775 WHITE MEMORIAL MEDICAL CENTER PO BOX 842176 LOS ANGELES CA 90084 MEDICAL SERVICES 7967007 UNITED MEDICAL IMAGING HEALTH INC PO BOX 491149 LOS ANGELES CA 90049 MEDICAL SERVICES 4871364 TOTAL CORPORATE SOLUTIONS 20335 SOUTH WESTERN AVENUE TORRANCE CA 90501 ADMINISTRATIVE SERVICES 3974196 CITY OF HOPE NATIONAL MEDICAL CENTER PO BOX 30219 LOS ANGELES CA 90030 MEDICAL SERVICES 3708648 320 824322 28461964 296587 277447 29582873 MANAGED CARE SERVICES 624100 365348704 365348704 PATIENT FEES 624100 152256354 152256354 517605058 6337387 6337387 368050 824322 2486673 -2118623 -2118623 37261956 34737851 2524105 2524105 OTHER CONTRACT SERVICES 624100 1958102 1958102 INTERCOMPANY REVENUE 900099 1601767 1601767 REFUND/REIMBURSEMENT/DEPOSIT 900099 241537 241537 -7042 -7042 3794364 557725164 523923527 0 4218764 636218 636218 6049660 6049660 159299737 158426943 872794 4059724 4046769 12955 25701172 25619156 82016 11332749 11296585 36164 1664791 1664791 7045312 7045312 2982505 2980577 1928 6395799 6395799 2407745 2407745 11447985 11447985 3335295 3332929 2366 SPECIALTY SERVICES 135942782 135942782 MEDICAL SERVICES 45179256 45179256 ADMINISTRATIVE SERVICES 18755890 17514020 1093223 148647 MEDICAL SUPPLIES 10192830 10192716 114 35712589 35405456 307133 488142039 483919908 2758014 1464117 18478933 6201436 64748528 6018435 4349629 4817397 39794233 41690350 20602056 24714839 13172744 11603316 1017954 821233 3425541 1108934 224501290 69246037 135316572 155255253 144003880 295326114 5131380 6565324 46661119 30035957 496702569 584158588 78626440 89882531 6216912 1541646 109512688 107032168 2749063 2075971 1072200 756139 198177303 201288455 X 295873182 380624246 2652084 2245887 298525266 382870133 496702569 584158588 69583125 14761742 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 1 1 41318 1 1 455245 496563 0 PART II-B, LINE 1: AMOUNTS WERE PAID TO LEGISLATIVE CONSULTANTS FOR LOBBYING ACTIVITIES. 1406918 X X X 0 34804225 34804225 56073970 8570166 47503804 68552653 17308919 51243734 65070442 43366952 21703490 155255253 ASSETS LIMITED AS TO USE 24286246 CONTRIBUTION RECEIVABLES 2357840 DEPOSITS 2543366 DUE FROM RELATED PARTIES 848505 30035957 INTEREST RATE SWAP 756139 756139 X 608046639 14445681 37540585 51986266 556060373 1664791 1664791 557725164 523701772 37224524 37224524 486477248 1664791 1664791 488142039 PART III, LINE 4: ALTAMED HEALTH SERVICES IS A NON-PROFIT ORGANIZATION THAT PROVIDES QUALITY HEALTHCARE AND HUMAN SERVICES TO THE UNDERSERVED COMMUNITIES OF SOUTHERN CALIFORNIA. THE ORGANIZATION RECOGNIZES THE THERAPEUTIC EFFECT OF CULTURALLY RELEVANT WORKS OF ART AND THEIR EFFECT ON PATIENTS, DONORS AND MEMBERS OF THE PUBLIC. AS PART OF ITS HOLISTIC APPROACH TO HEALTHCARE, THE ORGANIZATION HOLDS A SIGNIFICANT COLLECTION OF ART BY A DIVERSE RANGE OF EMERGING, MID-CAREER AND ESTABLISHED ARTISTS BASED IN LOS ANGELES, AS WELL AS CHICANO/A ARTISTS, AND INTERNATIONALLY RECOGNIZED ARTISTS FROM MEXICO, LATIN AMERICA, ASIA , AND THE UNITED STATES FOR THE PURPOSE OF EXHIBITION AND PRESENTATION THROUGHOUT ITS CLINICS AND OTHER OF ITS HEALTH SERVICES CENTERS. THIS APPROACH HAS BEEN INSTRUMENTAL IN GIVING ALTAMED PATIENTS A CALM, CURATIVE ENVIRONMENT ALLEVIATING STRESSES ASSOCIATED WITH BEING IN A CLINICAL SETTING. ALTAMED BELIEVES THAT EVERYONE, REGARDLESS OF AGE, RACE, GENDER, OR SOCIAL STANDING, HAS THE RIGHT TO EXPERIENCE ART IN THEIR EVERYDAY LIFE. PART X, LINE 2: THE CORPORATION QUALIFIES AS A TAX EXEMPT ORGANIZATION UNDER THE INTERNAL REVENUE CODE SECTION 501(C)(3) AND CALIFORNIA REVENUE AND TAXATION CODE 23701D. THE CORPORATION HAS EVALUATED ITS TAX POSITIONS AND THE CERTAINTY AS TO WHETHER THOSE POSITIONS WILL BE SUSTAINED IN THE EVENT OF AN AUDIT BY TAXING AUTHORITIES AT THE FEDERAL AND STATE LEVELS. THE PRIMARY TAX POSITIONS EVALUATED RELATE TO THE CORPORATION CONTINUED QUALIFICATION AS A TAX-EXEMPT ORGANIZATION AND WHETHER THERE ARE UNRELATED BUSINESS INCOME ACTIVITIES THAT WOULD BE TAXABLE. MANAGEMENT HAS DETERMINED THAT ALL INCOME TAX POSITIONS WILL MORE LIKELY THAN NOT (>50%) BE SUSTAINED UPON POTENTIAL AUDIT OR EXAMINATION; THEREFORE, NO DISCLOSURE OF UNCERTAIN INCOME TAX POSITIONS ARE REQUIRED. THE CORPORATION FILES INFORMATION RETURNS IN THE US FEDERAL JURISDICTION AND THE STATE OF CALIFORNIA. WITH FEW EXCEPTIONS, THE CORPORATION IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 316,061. COST OF GOOD SOLD-PHARMACY 34,737,851. FUNDRAISING EXPENSES 2,486,673. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES 1,664,791. PART XII, LINE 2D - OTHER ADJUSTMENTS: PHARMACY COST 34,737,851. FUNDRAISING EXPENSES 2,486,673. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES 1,664,791. X X X X X X 0 FOOD & WINE TASTING 380257 145477 234780 322894 28690 189741 339356 ANNIVERSARY GALA 553671 473701 79970 296254 2093 420944 332312 6 258444 205144 53300 62997 1812 150599 338981 1192372 824322 368050 682145 32595 761284 1010649 2486673 -2118623 1 AMERICAN CANCER SOCIETY INC 250 WILLIAMS STREET ATLANTA GA 30303 131788491 501(C)(3) 6000 BOOK CANCER PREVENTION PROGRAM AMERICAN HEART ASSOCIATION 816 SOUTH FIGUEROA STREET 3RD FLOOR FLOOR LOS ANGELES CA 90017 135613797 501(C)(3) 5000 BOOK ANNUAL GALA-HEART HEALTH AMERICAN NURSES FOUNDATION INC 8515 GEORGIA AVE STE 400 SILVER SPRING MD 20910 131893924 501(C)(3) 16250 BOOK NURSING PIPELINE SUPPORT CALIFORNIA COUNCIL OF EXCELLECE 655 S MAIN STREET SUITE 200 364 ORANGE CA 92868 330542335 501(C)(3) 10000 BOOK CAPE ANNUAL CONFERENCE CALIFORNIA STATE POLYTECHNIC UNIVERSITY POMONA 3801 W TEMPLE AVE POMONA CA 91768 501(C)(3) 5000 BOOK STEM SCHOLARSHIP PROGRAM CARECEN 2845 WEST 7TH STREET LOS ANGELES CA 90005 953867724 501(C)(3) 6500 BOOK COMMUNITY ENGAGEMENT SUPPORT CENTER THEATRE GROUP 601 WEST TEMPLE STREET LOS ANGELES CA 90012 952466183 501(C)(3) 50000 BOOK ANNUAL GALA CHIRLA 2533 W THIRD ST 101 LOS ANGELES CA 90057 954421521 501(C)(3) 5000 BOOK ANNUAL GALA CITADEL OUTLETS 100 CITADEL DRIVE 480 LOS ANGELES CA 90040 562298145 501(C)(3) 9000 BOOK COMMUNITY OUTREACH EVENT COMITE MEXICANO CIVICO PATRIOTICO INC 6035 PACIFIC BLVD HUNTINGTON PARK CA 90255 811048949 501(C)(3) 20000 BOOK ANNUAL COMMUNITY PARADE & WELLNESS PROGRAM COMMUNITY COALITION FOR SUBSTANCE ABUSE 8101 S VERMONT AVENUE LOS ANGELES CA 90044 954298811 501(C)(3) 7500 BOOK COMMUNITY ABUSE PREVENTION CONGRESSIONAL HISPANIC CAUCUS INSTITUTE 1128 16ST STREET NW WASHINGTON DC 20036 521114225 501(C)(3) 25000 BOOK COMMUNITY LEADERSHIP SUPPORT EAST LOS ANGELES COLLEGE FOUNDATION 1301 AVENIDA CESAR CHAVEZ MONTEREY PARK CA 91754 330034221 501(C)(3) 17500 BOOK GALA EVENT IN SUPPORT OF NURSING PARTNERSHIP EAST LOS ANGELES WOMENS CENTER 1431 S ATLANTIC BLVD LOS ANGELES CA 90022 510204577 501(C)(3) 5000 BOOK RAPE PREVENTION PROGRAM & GALA FAMILIA UNIDA 4716 E CESAR E CHAVEZ AVE LOS ANGELES CA 90022 911898199 501(C)(3) 6500 BOOK COMMUNITY EVENT HOPE 634 S SPRING STREET LOS ANGELES CA 90014 954718409 501(C)(3) 5540 BOOK COMMUNITY SOCIAL ENGAGEMENT INNERCITY STRUGGLE 124 NORTH TOWNSEND AVE LOS ANGELES CA 90063 272133211 501(C)(3) 15000 BOOK COMMUNITY ORGANIZING JOHN BENSON SCHOLARSHIP FOUNDATION INC PO BOX 578 WALNUT CA 91788 461299728 501(C)(3) 10000 BOOK HEALTH SCHOLARSHIP PROGRAM KEEPERS OF THE AMERICAN DREAM 50 F STREET NW SUITE 300 WASHINGTON DC 20001 501(C)(3) 25000 BOOK COMMUNITY EVENT LA OPINION 915 WILSHIRE BLVD SUITE 800 LOS ANGELES CA 90017 571174771 501(C)(3) 5000 BOOK COMMUNITY SCHOLARSHIP FUND LATINO THEATER COMPANY 514 SOUTH SPRING STREET LOS ANGELES CA 90013 954572361 501(C)(3) 7500 BOOK COMMUNITY CULTURAL EVENT LEAGUE OF CA CITIES-API CAUCUS 1400 K STREET SUITE 400 SACRAMENTO CA 95814 501(C)(3) 5000 BOOK COMMUNITY ORGANIZING LOS ANGELES AGING ADVOCACY COALITION 675 S CARONDELET ST LOS ANGELES CA 90057 951641435 501(C)(3) 10000 BOOK ELDERLY CARE EVENT LOS ANGELES CITY COLLEGE FOUNDATION 855 NORTH VERMONT AVENUE LOS ANGELES CA 90029 956207819 501(C)(3) 10000 BOOK GENERAL SUPPORT LOS ANGELES LATINO CHAMBER OF COMMERCE FOUNDATION 634 S SPRING STREET SUITE 600 LOS ANGELES CA 90014 262949706 501(C)(3) 25000 BOOK BUSINESS COMMUNITY PARTNERSHIPS LOS ANGELES PARKS FOUNDATION 2650 N COMMONWEALTH RD LOS ANGELES CA 90027 262358338 501(C)(3) 5000 BOOK WELLNESS AWARENESS PROGRAMS MAOF 401 NORTH GARFIELD AVENUE MONTEBELLO CA 90640 952594166 501(C)(3) 6000 BOOK EARLY CHILDHOOD EDUCATION MEXICAN AMERICAN LEGAL DEFENSE AND EDUCATIONAL FUND 634 SOUTH SPRING ST 11TH FLOOR LOS ANGELES CA 90014 741563270 501(C)(3) 10000 BOOK ANNUAL GALA - 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VP OF FINANCE & CFO 370358 0 94767 0 52913 0 10400 0 0 0 528438 0 0 0 MARIE TORRES SR.VP OF GOV'T RELATIONS 297813 0 90955 0 18050 0 10400 0 0 0 417218 0 0 0 MARTIN LEE SEROTA MD SVP, CHIEF MEDICAL OFFICER 460027 0 61182 0 39053 0 10400 0 0 0 570662 0 0 0 ZOILA ESCOBAR SR.VP STRATEGIC DEV & COMM 306532 0 60104 0 18000 0 10400 0 0 0 395036 0 0 0 JENNIFER SPALDING SR.VP CHIEF OPERATION OFFI 351576 0 85750 0 18075 0 9824 0 0 0 465225 0 0 0 JACQUELINE RITACCO SR.VP CHIEF ADMINISTRATIVE OFFICER 294396 0 65250 0 18000 0 10400 0 0 0 388046 0 0 0 ANGELA ROBERTS VP, FACILITY DEVELOPMENT & MGMT. 305168 0 41307 0 18050 0 10084 0 0 0 374609 0 0 0 CRISTIAN RICO MD DIRECTOR, REGIONAL MEDICAL 304091 0 56666 0 11942 0 10400 0 0 0 383099 0 0 0 ALEX CHEN VP, MEDICAL DIR QUALITY & SAFE 279127 0 37290 0 7000 0 10400 0 0 0 333817 0 0 0 HENRY HOLGUIN SVP, GENERAL COUNSEL 408660 0 30000 0 18000 0 0 0 0 0 456660 0 0 0 ESIQUIO CASILLAS DIR., REGIONAL MEDICAL SENIOR CARE S 316680 0 65427 0 13180 0 10400 0 0 0 405687 0 0 0 PART I, LINE 1A ALTAMED MAINTAINS A DISCRETIONARY SPENDING ACCOUNT FOR OFFICERS, KEY EMPLOYEES AND OTHERS WHERE THE COMPANY ALLOWS A CERTAIN AMOUNT TO BE USED AT THE DISCRETION OF THE PAYEE FOR BUSINESS EXPENSES SUCH AS AUTOMOBILE EXPENSES . ANY AMOUNTS USED FROM THE DISCRETIONARY ACCOUNT ARE TAXED TO THE RECIPIENT AS PART OF THEIR COMPENSATION. IN ADDITION, ALTAMED PROVIDES A HOUSING SUBSIDY OF $12,000 FOR THE CHIEF MEDICAL OFFICER. PART I, LINE 4B SCHEDULE J:AT THE PRESENT TIME THE PRESIDENT AND CEO ARE ELIGIBLE FOR THE ORGANIZATION'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ; FUNDING OF THIS PLAN IS DISCRETIONARY AND ASSETS OF THE PLAN ARE SUBJECT TO THE CLAIMS OF CREDITORS . RETIREMENT AND OTHER DEFERRED COMPENSATION INCLUDES $136,398 PAID TO THE SERP IN CALENDAR YEAR 2016. PART I, LINE 7 SCHEDULE J :ALTAMED MAINTAINS A DISCRETIONARY EXECUTIVE AND DIRECTOR LEVEL BONUS PROGRAM THAT AWARDS INCENTIVE COMPENSATION BASED ON ACHIEVEMENT OF CERTAIN ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL, OPERATIONAL, QUALITY AND MISSION OBJECTIVES DURING THE FISCAL YEAR. MEMBERS OF THE EXECUTIVE AND DIRECTOR LEADERSHIP TEAM ARE EVALUATED ANNUALLY FOR THEIR ABILITY TO MEET THOSE ORGANIZATIONAL OBJECTIVES TO ARRIVE AT THE INCENTIVE AMOUNT, IF ANY, FOR THE FISCAL YEAR. OVERALL ALTAMED MUST ACHIEVE SPECIFIC FINANCIAL GOALS BEFORE ANY INCENTIVES CAN BE EARNED AND PAID. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 2015-10-01 118760000 FINANCE ACQ,CONST,RENOVATION & EQUIPPING OF CAP. PROJ.& REFI A PRIOR LOAN 0 0 0 B CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 2007-12-14 7012000 FINANCE THE COST OF ACQ,CONSTRUCTION,IMPROVEMENT & EQUIPPING OF FACILITIES 0 0 0 A 6237799 118891328 1719003 80508735 3500000 33163590 1 0 0 1 B 1553533 7012500 7012500 2008 0 0 1 1 A 0 1 1 1 1 1 0 0 1 B 0 0 0 0 0 0 0 A 0 1 1 0 1 0 0 0 1 B 0 0 0 0 1 1 BANK OF THE WEST 15.000000000000 0 0 0 0 0 A 1 B 0 SCHEDULE K PART 1 (D) & (E) THE ISSUER HAS FILED TWO 8038S FOR THIS ISSUE. THE ISSUE PRICE FOR THE NOTES (DATED SEPTEMBER 29, 2015) IS $17,200,000; THE ISSUE PRICE FOR THE BONDS (DATED OCTOBER 1, 2015) IS $101,560,000. SCHEDULE K PART 1 (F) THE PRIOR LOAN WAS ISSUED ON FEBRUARY 14, 2011. SCHEDULE K PART 1 (E) & PART II LINE 3 DIFFERENCE BETWEEN PART 1 (E) AND PART II, LINE 3 IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. SCHEDULE K PART III, LINE 7 AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. SCHEDULE K PATY IV, LINE 2(B) THE REFUNDING PORTION OF THE BONDS HAS MET THE 6-MONTH SPENDING EXCEPTION TO REBATE. CASTULO DE LA ROCHA SPLIT DOLLAR LIFE INSURANCE X 11092434 11941325 0 1 1 ZOILA D ESCOBAR SPLIT DOLLAR LIFE INSURANCE X 2670000 2874332 0 1 1 JOSE U ESPARZA SPLIT DOLLAR LIFE INSURANCE X 2671800 2876270 0 1 1 MARIE S TORRES SPLIT DOLLAR LIFE INSURANCE X 3044478 3277468 0 1 1 MARTIN SEROTA SPLIT DOLLAR LIFE INSURANCE X 3405795 3635444 0 1 1 HENRY HOLGUIN RECRUITMENT LOAN X 150000 110000 0 1 1 24714839 FORM 990 PART X LINE 5 IN 2011 ALTAMED ADOPTED A SPLIT DOLLAR RETENTION AND LOAN PLAN ( THE PLAN) DESIGNED TO ASSIST ALTAMED IN RECRUITING AND RETAINING KEY EXECUTIVES AND REWARD FUTURE SERVICE. THE PLAN IS DESIGNED TO SATISFY THE FINAL REGULATIONS DEALING WITH LOANS MADE TO EXECUTIVES TO PAY PREMIUMS ON LIFE INSURANCE POLICIES THEY OWN. REPAYMENT OF THE LOANS ARE SECURED BY THE CASH VALUES AND DEATH BENEFITS IN ACCORDANCE WITH TAX AND CALIFORNIA LEGAL REQUIREMENTS. IN ADDITION, THE LOANS BEAR INTEREST AND BECAUSE OF THE PLAN'S DESIGN , ALTAMED IS EXPECTED TO BE REPAID FULLY WITH THE APPLICABLE FEDERAL RATE OF INTEREST . THE LOANS ARE REPORTED ON PART X AND SCHEDULE L. X FOR SPECIAL EVENTS 0 277447 FAIR MARKET VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 2 THE PRESIDENT AND CEO IS RELATED BY MARRIAGE TO THE VP OF STRATEGIC DEVELOPMENT AND COMMUNITY SUPPORT. FORM 990, PART VI, SECTION B, LINE 11B ALTA MED HEALTH SERVICES CORPORATION OUTSIDE CPA FIRM AND FINANCE STAFF PREPARE FORM 990. THE FORM IS THEN REVIEWED AND APPROVED BY THE ORGANIZATION PRESIDENT AND SR. VP OF FINANCE AND CFO. THE FORM IS THEN PROVIDED TO THE FULL BOARD FOR ACCEPTANCE BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C ALTAMED HEALTH SERVICES CORP. (ALTAMED) REQUIRES ALL EMPLOYEES TO DISCLOSE, AT LEAST ANNUALLY, ALL SOURCES OF INCOME FROM COMPENSATION OR FROM OWNERSHIP OF EVERY OUTSIDE ENTITY THAT (A) SOLD, SUPPLIED OR PROVIDED SERVICES (B) OPERATED A COMPETING ENTERPRISE OR (C) PROVIDED GOODS OR SERVICES TO ALTAMED IN THE LAST SIX MONTHS. ALTAMED ALSO REQUIRES ALL DIRECTORS TO ANNUALLY SIGN A STATEMENT AFFIRMING (A) RECEIPT OF ALTAMED CONFLICT OF INTEREST POLICY (B) UNDERSTANDING OF THE POLICY AND (C) AGREEMENT WITH THE POLICY. THE CONFLICT OF INTEREST POLICY DESCRIBES HOW ALTAMED WILL RESOLVE POSSIBLE CONFLICTS OF INTEREST. BOARD MEMBERS RESUBMIT CONFLICT OF INTEREST STATEMENTS AS PART OF THE ANNUAL REVIEW OF THE BYLAWS AND MEMBERSHIP. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS COMPENSATION COMMITTEE HAS ENGAGED A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT FIRM TO REVIEW ITS EXECUTIVE AND NON-EXECUTIVE SALARIES. THE FIRM UNDERTAKES SPECIFIC PROTOCOLS AND OBTAIN VAST ORGANIZATIONAL DATA FROM NUMEROUS COMPANIES AND PEER GROUPS AND THEN RENDERS A "REASONABLENESS" OPINION TO THE BOARD OF DIRECTORS. THE FIRM'S PROCESS INCLUDES A REVIEW OF COMPENSATION OF SIMILARLY CONSTITUTED COMPANIES, TRENDS, THE ORGANIZATION'S PRESENT COMPENSATION PACKAGES INCLUDING CASH AND NON-CASH BENEFITS , THE METHODOLOGY AND PHILOSOPHY USED FOR THE ASSESSMENT AND THE TOTAL COMPENSATION ANALYSIS. ADDITIONALLY, MARKET BENEFIT AND RECRUITMENT AND RETENTION TRENDS ARE CONSIDERED AND EVALUATED. THE OPINIONS ARE PROVIDED TO THE BOARD'S COMPENSATION COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT DIRECTORS. THE COMPENSATION COMMITTEE IS PROVIDED WITH A REGIONAL PEER GROUP THAT INCLUDES MOST COMPARABLY SIZED CALIFORNIA NON PROFIT AND SOME FOR PROFIT HEALTHCARE ORGANIZATIONS. THE OPINIONS ARE BASED ON COMPARABILITY DATA FROM NATIONAL AND REGIONAL DATA BASES, FROM WHICH COMPARISONS OF THE ORGANIZATION'S EXECUTIVE COMPENSATION WITH PEER GROUP COMPENSATION LEVELS CAN BE MADE, WHICH IS PROVIDED TO THE COMPENSATION COMMITTEE IN ITS REPORT. THE COMPENSATION COMMITTEE IS PRESENTED WITH DATA THAT COMPARES THE ORGANIZATION'S COMPENSATION PACKAGES TO THE LEVEL TARGETED IN THE COMPENSATION PHILOSOPHY. BASED UPON THE TOTALITY OF THE DATA GARNERED BY THE COMPENSATION CONSULTING FIRM, THE COMPENSATION COMMITTEE IS PROVIDED WITH RECOMMENDED BASE SALARY AND BENEFIT RANGES FOR THE PERIOD ASSESSED. THE COMPENSATION COMMITTEE DELIBERATES ON THE DATA TO ASSESS WHETHER IT IS APPROPRIATE IN REPRESENTING COMPENSATION LEVELS WITH SIMILAR ORGANIZATIONS, POSITIONS AND CIRCUMSTANCES AND THAT IT REPRESENTS FAIR MARKET VALUE FOR SERVICES RENDERED ON A REALISTIC BASIS. THE COMPENSATION COMMITTEE THEN PROVIDES ITS RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS PROVIDED WITH ALL AVAILABLE INFORMATION AND THE OPINIONS OF THE EXPERTS AND DELIBERATES AND DISCUSSES THE RECOMMENDATIONS AS IT DEEMS NECESSARY TO PROPERLY ASSESS THE COMPENSATION LEVELS OF ITS EXECUTIVES AND OTHER EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 SOME OR ALL OF THESE ITEMS MAY BE AVAILABLE UPON REQUEST. ALTAMED MANAGEMENT SERVICES LLC 2040 CAMFIELD AVENUE LOS ANGELES CA 90040 810785877 MANAGED CARE CA 407185 512844 ALTAMED HEALTH SERVICES CORPORATION ALTAMED STATE PAC 777 S FIGUEROA ST STE 4050 LOS ANGELES CA 90017 475260687 SUPPORT AND OPPOSE CANDIDATE CA 527 N/A 0 ALTAMED FOUNDATION 2040 CAMFIELD AVE LOS ANGELES CA 90040 954090420 FUNDRAISING CA 501(C)(3) SECTION 509(A)(1) ALTAMED HEALTH SERVICES CORPORATION 0 ALTAMED ACTION FUND 777 S FIGUEROA ST STE 4050 LOS ANGELES CA 90017 465650824 SOCIAL WELFARE ACTIVITIES CA 501(C)(4) N/A 0 ALTAMED HEALTH NETWORK INC 2040 CAMFIELDAVENUE LOS ANGELES CA 90040 460635843 MANAGED CARE CA ALTAMED HEALTH SERVICES CORP C 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALTAMED ACTION FUND B 150000 ACTUAL AMOUNT PAID