LAGUNA BEACH COMMUNITY CLINIC INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- LAGUNA BEACH COMMUNITY CLINIC INC (EIN 95-2637633)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-01-30
- IRS object ID
- 201700309349301030
- Schema version
- 2015v3.0
- 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 | 2017-01-30T16:16:51-06:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 330155525 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HBLA CERTIFIED PUBLIC ACCOUNTANTS INC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19600 FAIRCHILD STE 320 | AddressLine1Txt |
| City | IRVINE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92612 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | 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 | 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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THOMAS C BENT MD | PersonNm |
| Person Title | MEDICAL DIRECTOR | PersonTitleTxt |
| Phone | 9494940761 | PhoneNum |
| Signature | 2017-01-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | EDWARD E BENOE | PreparerPersonNm |
| PTIN | P00032866 | PTIN |
| Phone | 9498332815 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | THOMAS C BENT 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 | $2,664,160 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | 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 | 38 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $9,051 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,163,818 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,867,675 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,147,355 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $736,026 | CYProgramServiceRevenueAmt |
| PY Investment Income | $10,480 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,575 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$8,027 | PYOtherRevenueAmt |
| CY Other Revenue | $16,583 | CYOtherRevenueAmt |
| PY Total Revenue | $2,313,626 | PYTotalRevenueAmt |
| CY Total Revenue | $2,625,859 | 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 | $1,635,384 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,479,342 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $76,248 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $598,412 | PYOtherExpensesAmt |
| CY Other Expenses | $652,768 | CYOtherExpensesAmt |
| PY Total Expenses | $2,233,796 | PYTotalExpensesAmt |
| CY Total Expenses | $2,132,110 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $79,830 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $493,749 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,905,160 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,410,785 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $336,932 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $351,343 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,568,228 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,059,442 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O FOR MISSION STATEMENT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,882,295 | ExpenseAmt |
| Revenue | $736,026 | 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. NINETY PERCENT OF LBCC PATIENTS ARE LIVING BELOW 200% FEDERAL POVERTY LEVEL; APPROXIMATELY 62% LIVE IN SEVERE POVERTY (2015 OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT UTILIZATION REPORT). 40 PERCENT 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. AN ESTIMATED 10% ARE HOMELESS. 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 GAPS IN THE SAFETY-NET. -CARE THAT IS ACCESSIBLE BOTH LINGUISTICALLY AND GEOGRAPHICALLY. -HIGH QUALITY CARE.LBCC IS ONE OF ONLY THREE CLINICS IN SOUTH ORANGE COUNTY, AND IS THE ONLY OF THE THREE TO OFFER THE FULL RANGE OF PRIMARY CARE, WEEKEND HOURS, AND WALK-IN AVAILABILITY. HIGH ACCESSIBILITY IS A CRITICAL FACTOR IN EMPOWERING PATIENTS TO TAKE CONTROL OF THEIR HEALTH AND SUCCESSFULLY PURSUE REGULAR AND PREVENTIVE MEDICAL CARE. COST TO PATIENTS IS A KEY ACCESSIBILITY ISSUE FOR THE LOW-INCOME POPULATION WE SERVE. PATIENTS PAY WHAT THEY CAN AFFORD, BASED ON A SLIDING FEE SCALE AND ABILITY TO PAY. WE HAVE SEVERAL PROVIDERS WHO ARE BI-LINGUAL AND SPEAK SPANISH FLUENTLY. OUR WAIT UNTIL NEXT AVAILABLE APPOINTMENT AVERAGES LESS THAN TWO WEEKS, ENABLING PATIENTS TO DEVELOP A PERSONAL RELATIONSHIP WITH THEIR PHYSICIAN. THE CLINIC IS LOCATED WITHIN WALKING DISTANCE OF A MAJOR TRANSPORTATION HUB AND A DAY LABORER WORK SOLICITATION SITE.THE GOAL OF LBCC'S COMPREHENSIVE CARE PROGRAM IS TO PROVIDE QUALITY MEDICAL CARE AT LOW-COST IN ORDER TO IMPROVE ACCESS FOR THE MOST VULNERABLE. LBCC OFFERS A RANGE OF SERVICES INCLUDING URGENT CARE, PREVENTIVE CARE, AND CARE FOR CHRONIC CONDITIONS: -URGENT CARE ACTIVITIES: AVAILABLE SIX-DAYS PER WEEK, INCLUDING WALK-IN AVAILABILITY WITH NO APPOINTMENT. THE SCOPE OF DIAGNOSIS AND ACUITY RUNS THE SPECTRUM FROM SIMPLE COLDS AND INFECTIONS TO POTENTIALLY LIFE THREATENING CONDITIONS SUCH AS ACUTE ASTHMA, OUT OF CONTROL DIABETES AND HYPERTENSION, AND CHEST PAIN. -PREVENTIVE CARE ACTIVITIES: ENCOMPASSING PREVENTIVE AND PRIMARY CARE, WITH SUCH ACTIVITIES AS VACCINATIONS, AGE-APPROPRIATE SCREENINGS, AND WEIGHT AND BLOOD PRESSURE MONITORING. -CHRONIC CARE ACTIVITIES: PATIENTS ACHIEVE BETTER CONTROL OF CHRONIC CONDITIONS BY ACCESSING HEALTH CARE REGULARLY. WE OFFER PROGRAMS FOR THE LONG-TERM CARE OF HIV/AIDS, DIABETES, AND HYPERTENSION, AMONG OTHERS. OTHER CLINICS IN THE AREA DO NOT OFFER SPECIALIZED SERVICES SUCH AS DENTAL OR HIV/AIDS PROGRAMS, MAKING LBCC TRULY A "MEDICAL HOME" WHERE PATIENTS CAN ACCESS A WIDE RANGE OF CARE AT A FAMILIAR AND CONVENIENT LOCATION, AND WITH A SINGLE PHYSICIAN. ANTICIPATED OUTCOMES INCLUDE: -REDUCED COST OF MEDICAL CARE AS PATIENTS ADOPT LBCC AS A MEDICAL HOME AND PURSUE PREVENTIVE CARE AND ANNUAL EXAMS, THEREBY MINIMIZING EMERGENCY ROOM VISITS. -INCREASED ACCESS TO LOW-COST, MEDICAL CARE AND GOVERNMENT-FUNDED CARE. -IMPROVED HEALTH AND REDUCED MORTALITY AND MORBIDITY RATES. | Desc |
| Total Program Service Expenses | $1,882,295 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | 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 | Yes (1) | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | 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 | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 38 | 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 |
| 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DR JORGE RUBAL VIA THE BOARD OF DIRECTORS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| PAMELA LAWRENCE MD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD A KAIN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BILLY FRIED | ||||||||
| CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GEORGE HEED | ||||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ROYA COLE | ||||||||
| CFO | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SUSAN NEELY | ||||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ANNE E JOHNSON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARION JACOBS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BRIAN SADLER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY KATE SAUNDERS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GARY BEVERAGE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JANET CHANCE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DEBORAH ENGLE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN LINK | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| THOMAS C BENT MD | ||||||||
| COO | 30.00 | $114,656 | $0 | $27,025 | Yes (X) | |||
| JORGE RUBAL MD | ||||||||
| MEDICAL DIRECTOR | 60.00 | $204,192 | $0 | $18,512 | Yes (X) | |||
| ADRIANNA NIETO-SAYEGH RN | ||||||||
| CLINICAL DIRECTOR | 60.00 | $127,122 | $0 | $23,515 | Yes (X) | |||
| CHAU NGO MD | ||||||||
| MEDICAL DOCTOR | 30.00 | $116,572 | $0 | $23,240 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $562,542 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $92,292 | 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 |
| Fundraising | $296,838 | FundraisingAmt |
| Government Grants | $32,950 | GovernmentGrantsAmt |
| All Other Contributions | $1,537,887 | AllOtherContributionsAmt |
| Noncash Contributions | $1,203 | NoncashContributionsAmt |
| Total Contributions | $1,867,675 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT FEES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $736,026 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $736,026 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $736,026 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $196 | TotalRevenueColumnAmt |
| Exclusion | $196 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,720 | 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 | $30,720 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,720 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $9,051 | UnrelatedBusinessRevenueAmt |
| Exclusion | $21,669 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,153 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,783 | SecuritiesAmt |
| Other | $1,991 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,370 | SecuritiesAmt |
| Other | -$1,991 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,379 | TotalRevenueColumnAmt |
| Exclusion | $5,379 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $15,300 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $296,838 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $34,527 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$19,227 | TotalRevenueColumnAmt |
| Exclusion | -$19,227 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $5,090 | TotalRevenueColumnAmt |
| Exclusion | $5,090 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $5,090 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,625,859 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $736,026 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $9,051 | UnrelatedBusinessRevenueAmt |
| Exclusion | $13,107 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,989 | TotalAmt |
| Program Services | $115,659 | ProgramServicesAmt |
| Management And General | $7,330 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,101,781 | TotalAmt |
| Program Services | $1,036,121 | ProgramServicesAmt |
| Management And General | $65,660 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,127 | TotalAmt |
| Program Services | $28,041 | ProgramServicesAmt |
| Management And General | $2,086 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,292 | TotalAmt |
| Program Services | $126,046 | ProgramServicesAmt |
| Management And General | $14,246 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,153 | TotalAmt |
| Program Services | $78,326 | ProgramServicesAmt |
| Management And General | $5,827 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,663 | TotalAmt |
| Program Services | $40,082 | ProgramServicesAmt |
| Management And General | $38,581 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150 | TotalAmt |
| Management And General | $150 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,767 | TotalAmt |
| Program Services | $33,479 | ProgramServicesAmt |
| Management And General | $8,288 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,578 | TotalAmt |
| Program Services | $9,841 | ProgramServicesAmt |
| Management And General | $1,737 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,542 | TotalAmt |
| Program Services | $56,432 | ProgramServicesAmt |
| Management And General | $2,110 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,644 | TotalAmt |
| Program Services | $29,600 | ProgramServicesAmt |
| Management And General | $2,044 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| EXPENSES ALLOCATED TO U | $1,956 | $1,956 | ||
| MEDICAL SUPPLIES | $115,774 | $115,774 | ||
| FACILITIES AND MAINTENA | $105,155 | $94,640 | $10,515 | |
| OUTSIDE SERVICES | $91,649 | $3,984 | $11,417 | $76,248 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,890 | TotalAmt |
| Program Services | $112,314 | ProgramServicesAmt |
| Management And General | $3,576 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,132,110 | TotalAmt |
| Program Services | $1,882,295 | ProgramServicesAmt |
| Management And General | $173,567 | ManagementAndGeneralAmt |
| Fundraising | $76,248 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $226,454 | BOYAmt |
| EOY | $368,670 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,613 | BOYAmt |
| EOY | $693,535 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $479,612 | BOYAmt |
| EOY | $190,823 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,807 | BOYAmt |
| EOY | $32,478 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,291,888 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $573,598 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $778,823 | BOYAmt |
| EOY | $718,290 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $256,851 | BOYAmt |
| EOY | $406,989 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,905,160 | BOYAmt |
| EOY | $2,410,785 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $167,092 | BOYAmt |
| EOY | $181,503 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,840 | BOYAmt |
| EOY | $169,840 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $336,932 | BOYAmt |
| EOY | $351,343 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,282,582 | BOYAmt |
| EOY | $1,016,944 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $285,646 | BOYAmt |
| EOY | $1,042,498 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,568,228 | BOYAmt |
| EOY | $2,059,442 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,905,160 | BOYAmt |
| EOY | $2,410,785 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $493,749 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$2,535 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 | $828,505 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,085,348 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,273,677 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,163,818 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,867,675 | CurrentTaxYearAmt |
| Total | $6,219,023 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $828,505 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,085,348 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,273,677 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,163,818 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,867,675 | CurrentTaxYearAmt |
| Total | $6,219,023 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $1,279,985 | SubstantialContributorsTotAmt |
| Public Support Total170 | $4,939,038 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $31,112 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,742 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $33,379 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $33,145 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,916 | CurrentTaxYearAmt |
| Total | $154,294 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $38,292 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,055 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $215 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,140 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,090 | CurrentTaxYearAmt |
| Total | $53,792 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $6,427,109 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $5,673,574 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.76850 | PublicSupportCY170Pct |
| Public Support PY170 | 0.84900 | 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 | $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 |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,110 | BeginningYearBalanceAmt |
| Contributions | $125,000 | ContributionsAmt |
| Investment Earnings Or Losses | $4,892 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,356 | OtherExpendituresAmt |
| End Year Balance | $250,646 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $125,000 | ContributionsAmt |
| Investment Earnings Or Losses | $2,110 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $127,110 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $520,002 | OtherCostOrOtherBasisAmt |
| Depreciation | $297,256 | DepreciationAmt |
| Book Value | $222,746 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $426,886 | OtherCostOrOtherBasisAmt |
| Depreciation | $276,342 | DepreciationAmt |
| Book Value | $150,544 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $718,290 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ENDOWMENT FUND | Desc |
| Book Value | $406,989 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $406,989 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $2,732,252 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$2,535 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $109,078 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $106,543 | RevenueNotReportedAmt |
| Revenue Subtotal | $2,625,709 | RevenueSubtotalAmt |
| Other Revenues Not Included | $150 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $150 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,625,859 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $2,241,038 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $109,078 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $109,078 | ExpensesNotReportedAmt |
| Expenses Subtotal | $2,131,960 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $150 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $150 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $2,132,110 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | TO BE APPLIED TOWARD THE GREATEST COMMUNITY HEALTH NEEDS AS DETERMINED BY THE CLINIC. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT FEE EXPENSE 150. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT FEE EXPENSE 150. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | CINCO DE MAYO | Event1Nm |
| Gross Receipts Event1 | $312,138 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $296,838 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $15,300 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $1,203 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $18,755 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $14,569 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $312,138 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $296,838 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $15,300 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $1,203 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $18,755 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $14,569 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $34,527 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$19,227 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 (2 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 | ||||||||||||||
| MEDICAL DIRECTOR | $204,192 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,512 | $0 | $222,704 | $0 | $0 | $0 |
| ADRIANNA NIETO-SAYEGH RN | ||||||||||||||
| CLINICAL DIRECTOR | $127,122 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $23,515 | $0 | $150,637 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 1 - MISSION STATEMENT: | THE MISSION OF LAGUNA BEACH COMMUNITY CLINIC (LBCC) IS TO PROVIDE EXCELLENT MEDICAL CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. |
| FORM 990, PART VI, SECTION B, LINE 11 | 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 THE 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 | FOR THE EXECUTIVE DIRECTOR, A REVIEW COMMITTEE IS APPOINTED BY THE PRESIDENT OF THE BOARD AND A REVIEW SHEET IS SENT OUT TO ALL MEMBERS OF THE BOARD FOR THEIR COMMENTS OF VARIOUS ASPECTS OF THE EXECUTIVE DIRECTOR'S PERFORMANCE AND AREAS OF RESPONSIBLITY OVER THE PAST YEAR. DATA ON COMPENSATION IS PRESENTED TO THE COMMITTEE FROM VARIOUS SOURCES INCLUDING THE COMPENSATION & BENEFITS SURVEY OF THE CENTER FOR NONPROFIT MANAGEMENT AND MEMBERS OF THE COMMITTEE MAY REQUEST INFORMATION FROM OTHER NONPROFITS WITH A SIMILAR AGENCY. THE REVIEW AND COMPENSATION DECISION OF THE COMMITTEE IS BROUGHT BEFORE THE FULL BOARD FOR THEIR DISCUSSION AND APPROVAL AND THE CHAIR OF THE COMMITTEE PRESENTS THE DECISION TO THE EXECUTIVE DIRECTOR FOR COMMENT AND DISCUSSION. AT THAT TIME, THE PRESIDENT AND THE EXECUTIVE DIRECTOR MAY ALSO DISCUSS GOALS FOR THE COMING YEAR(S). KEY EMPLOYEES: KEY EMPLOYEES ARE REVIEWED BY THE EXECUTIVE DIRECTOR. EXECUTIVE DIRECTOR DISCUSSES AREAS OF CONCERN AND AREAS OF STRENGTH WITH EACH EMPLOYEE DURING THE YEAR AND CONDUCT FORMAL REVIEWS WITH KEY EMPLOYEES ANNUALLY, INCLUDING MEETING WITH THE EMPLOYEE TO GO OVER THEIR ANNUAL REVIEW AND DISCUSS THEIR COMPENSATION PACKAGE. AGAIN, THE CENTER FOR NONPROFIT MANAGEMENT'S COMPENSATION & BENEFITS SURVEY, AS WELL AS LOCAL SURVEYS ARE USED. IN ADDITION, THE EXECUTIVE DIRECTOR MAY CALL SEVERAL OTHER NON PROFITS TO SUBSTANTIATE THE GOING RATE TO ENSURE THE ORGANIZATION REMAINS COMPETITIVE AND HOLDS ONTO GOOD STAFF. PRIOR TO ANY COMPENSATION PACKAGE BEING OFFERED, IT IS REVIEWED WITH THE FINANCE COMMITTEE OF THE BOARD AND WITH THE BOARD OF DIRECTORS. THE COMPENSATION PROCESS WAS USED FOR THE COO IN 2011, CLINIC DIRECTOR IN 2013, AND THE STAFF PHYSICIANS IN 2013. |
| FORM 990, PART VI, SECTION C, LINE 18 | FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC BY REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY REQUEST. |
| FORM 990, PART IX, LINE 24E | UTILITIES AND TELEPHONE: PROGRAM SERVICE EXPENSES 52,993. MANAGEMENT AND GENERAL EXPENSES 3,406. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,399. LAB FEES: PROGRAM SERVICE EXPENSES 47,798. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,798. DUES AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 8,705. MANAGEMENT AND GENERAL EXPENSES 150. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,855. TAXES AND LICENSES: PROGRAM SERVICE EXPENSES 4,774. MANAGEMENT AND GENERAL EXPENSES 20. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,794. REALLOCATION OF EXPENSES ALLOCATED TO UNRELATED BUSINESS INCOME: PROGRAM SERVICE EXPENSES -1,956. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -1,956. |
| FORM 990, PART XII, LINE 2C - AUDIT COMMITTEE: | THE BOARD OF DIRECTORS HAS CONSTITUTED AN AUDIT COMMITTEE AND DELEGATED TO THAT COMMITTEE THE RESPONSIBILITY FOR ENGAGING INDEPENDENT AUDITORS AND MONITORING THE AUDIT PROCESS. THIS STRUCTURE HAS BEEN IN EFFECT IN PRIOR YEARS AND WAS NOT CHANGED IN THE CURRENT YEAR. |
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