ALIVIO MEDICAL CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ALIVIO MEDICAL CENTER INC (EIN 36-3661051)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-10-15
IRS object ID
201322889349300632
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-10-15T12:23:09-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MITCHELL & TITUS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE BATTERY PARK PLAZAAddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN363661051EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ALIVIO MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% CARMEN VELASQUEZInCareOfName
Name ControlALIVNameControl
Phone7732541400Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1966 West 21st StreetAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60608ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCarmen VelasquezName
Titleexecutive directorTitle
Date Signed2013-10-14DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameKEVIN FULLERName
Phone2127094500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnXAmendedReturn
Name Of Principal Officer PersonCARMEN VELASQUEZNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12355 South Western AvenueAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60608ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16118584GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.aliviomedicalcenter.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1988YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionAlivio Medical Center is committed to providing access to quality, cost effective health care to the Hispanic Community, the uninsured, the underinsured,and not to the exclusion of other cultures and races.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees218TotalNbrEmployees
Total Nbr Volunteers13TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year4595772ContributionsGrantsPriorYear
Contributions Grants Current Year5756662ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10637011ProgramServiceRevenuePriorYear
Program Service Revenue CY8958299ProgramServiceRevenueCY
Investment Income Prior Year3144InvestmentIncomePriorYear
Investment Income Current Year7051InvestmentIncomeCurrentYear
Other Revenue Prior Year644541OtherRevenuePriorYear
Other Revenue Current Year735303OtherRevenueCurrentYear
Total Revenue Prior Year15880468TotalRevenuePriorYear
Total Revenue Current Year15457315TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10570246SalariesEtcPriorYear
Salaries Etc Current Year11311734SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year146197TotalFundrsngExpCurrentYear
Other Expense Prior Year5392213OtherExpensePriorYear
Other Expenses Current Year4948334OtherExpensesCurrentYear
Total Expenses Prior Year15962459TotalExpensesPriorYear
Total Expenses Current Year16260068TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-81991RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-802753RevenuesLessExpensesCY
Total Assets BOY11175244TotalAssetsBOY
Total Assets EOY11270432TotalAssetsEOY
Total Liabilities BOY6936473TotalLiabilitiesBOY
Total Liabilities EOY7648402TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4238771NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3622030NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE COMMUNITY HEALTH CENTER IS COMMITTED TO PROVIDING ACCESS TO QUALITY COST EFFECTIVE HEALTH CARE TO THE HISPANIC COMMUNITY, THE UNINSURED, THE UNDERINSURED, AND NOT TO THE EXCLUSION OF OTHER CULTURES AND RACES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense7156011Expense
Revenue7156011Revenue
DescriptionThe Community Health Center was established to provide quaility, affordable health care to the local community. The comprehensive services include primary outpatient medical care, obstetrics, gynecology, diagnostic services, nutrition services, behavorial health services, education and prevention programs as well as other supporting services.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense433422Expense
Revenue433422Revenue
DescriptionThe Chicago Family Case Management program 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.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense390789Expense
Revenue390789Revenue
DescriptionTitle X - Family planning services provides maternal/child primary health care services, obstetrics, gynecology, case management, health education, and family planning counseling to pregnant women and their families.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp1639066TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev1652928TotalOfOtherProgramServiceRev
Total Program Service Expense9619288TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees218NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCARMEN VELASQUEZNamePerson
Telephone Number3128296304TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1966 WEST 21ST STREETAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60608ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
TERESA FRAGA
PRESIDENT1.0XX000
ESTHER CORPUZ
VICE PRESIDENT1.0XX000
WAYNE MULDROW
TREASURER1.0XX000
MARY LEBOLD RN
SECRETARY1.0XX000
VINCENT ALLOCCO
MEMBER1.0X000
GIACOMO MANCUSO
MEMBER1.0X000
PETER MARTINEZ
MEMBER1.0X000
MARTINA MUNOZ
MEMBER1.0X000
SOCORRO VELAZQUEZ
MEMBER1.0X000
Aleiandra Perez-Tamayo MD
2nd Vice President1.0XX000
Ann Garcelon MD
member1.0X000
Nancy Villagranca
member1.0X000
Olga Lozano
member1.0X000
Nancy Villafranca
Member1.0X00
Olga Lozano
Member1.0X00
CARMEN VELASQUEZ
EXECUTIVE DIRECTOR(Ex Officio)40.0425512041221X
DORA GARCIA
ASSOCIATE DIRECTOR40.015720132048X
Mark E Kosanovich
Physician40.020394202714X
Abdul H Bhurgri
Medical Director40.0223898027451X
Thurman C Gills
Finance Director40.0178092015500X
WEN-HO YANG
PHYSICIAN40.016714312445X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1355788TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation131379TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns294FederatedCampaigns
Fundraising Events138600FundraisingEvents
Government Grants5320410GovernmentGrants
All Other Contributions297358AllOtherContributions
Total Contributions5756662TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code624100BusinessCode
Total Revenue Column8958299TotalRevenueColumn
Related Or Exempt Function Income8958299RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue8958299TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column451TotalRevenueColumn
Exclusion$451ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities596321Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities589721Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities6600Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column6600TotalRevenueColumn
Related Or Exempt Function Income6600RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Gross Income Fundraising Events138600GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events138600CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses71548FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column67052TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID MANAGED CARE PCCM900099440949440949
FEES COLLECTED900099215132215132
RENTAL INCOME9000991170011700

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column470TotalRevenueColumn
Related Or Exempt Function Income470RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue668251TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column15457315TotalRevenueColumn
Related Or Exempt Function Income9633150RelatedOrExemptFunctionIncome
Exclusion$451ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total1176402Total
Program Services579283ProgramServices
Management And General597119ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7887056Total
Program Services6316185ProgramServices
Management And General1486580ManagementAndGeneral
Fundraising84291Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1597302Total
Program Services708167ProgramServices
Management And General881907ManagementAndGeneral
Fundraising7228Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total650974Total
Program Services515190ProgramServices
Management And General128438ManagementAndGeneral
Fundraising7346Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total211293Total
Management And General211293ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total35401Total
Management And General35401ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total605679Total
Program Services223621ProgramServices
Management And General382042ManagementAndGeneral
Fundraising16Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total44574Total
Program Services11140ProgramServices
Management And General25279ManagementAndGeneral
Fundraising8155Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1375111Total
Program Services971094ProgramServices
Management And General402606ManagementAndGeneral
Fundraising1411Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total745002Total
Program Services25084ProgramServices
Management And General718582ManagementAndGeneral
Fundraising1336Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total56784Total
Management And General56784ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total124502Total
Program Services47244ProgramServices
Management And General72347ManagementAndGeneral
Fundraising4911Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total285149Total
Program Services8656ProgramServices
Management And General276493ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total643342Total
Program Services37395ProgramServices
Management And General605947ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total84226Total
Program Services34786ProgramServices
Management And General49440ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBT33184203318420
DUES AND SUBSCRIPTIONS437762640617245125
LAB TESTS AND ANALYSIS674636746300
STAFF DEVELOPMENT/EDUCATION9312324560670

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total284878Total
Program Services44329ProgramServices
Management And General209171ManagementAndGeneral
Fundraising31378Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total16260068Total
Program Services9619288ProgramServices
Management And General6494583ManagementAndGeneral
Fundraising146197Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY403921BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY151395BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1095838BOY
EOY847034EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2430780BOY
EOY2622546EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY60601BOY
EOY123491EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY91966BOY
EOY24523EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis13361927LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7101408LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5777027BOY
EOY6260519EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1010729BOY
EOY1260313EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY152987BOY
EOY132006EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11175244BOY
EOY11270432EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1814037BOY
EOY1890896EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY483710EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3942436BOY
EOY3724928EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1180000BOY
EOY1548868EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6936473BOY
EOY7648402EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3238771BOY
EOY2622030EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1000000BOY
EOY1000000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4238771BOY
EOY3622030EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11175244BOY
EOY11270432EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-802753ReconcilationRevenueExpenses
Reconcilation Other Changes186012ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis471567OtherCostOrOtherBasis
Book Value471567BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7325409OtherCostOrOtherBasis
Depreciation3692177Depreciation
Book Value3633232BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1074047OtherCostOrOtherBasis
Depreciation201828Depreciation
Book Value872219BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4490904OtherCostOrOtherBasis
Depreciation3207403Depreciation
Book Value1283501BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6260519TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
LINE OF CREDIT$1,300,000
OTHER LIABILITIES$248,868
FieldValueIRS element (for citing)
Total Of Amounts1548868TotalOfAmounts
Total Revenue15457315TotalRevenue
Total Expenses16260068TotalExpenses
Excess Or Deficit For Year-802753ExcessOrDeficitForYear
Excess Or Deficit Per FS-802753ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt15457315TotRevenueEtcAuditedFinclStmt
Revenue Subtotal15457315RevenueSubtotal
Total Revenue Per Form99015457315TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt16260068TotExpensesEtcAuditedFinclStmt
Expenses Subtotal16260068ExpensesSubtotal
Total Expenses Per Form99016260068TotalExpensesPerForm990

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Annual BenefitNameOfEvent1
Gross Receipts Event1245260GrossReceiptsEvent1
Charitable Contributions Event1122630CharitableContributionsEvent1
Gross Revenue Event1122630GrossRevenueEvent1
Food And Beverage Event144549FoodAndBeverageEvent1
Entertainment Event1675EntertainmentEvent1
Other Direct Expenses Event114809OtherDirectExpensesEvent1
Name Of Event2Golf OutingNameOfEvent2
Gross Receipts Event231940GrossReceiptsEvent2
Charitable Contributions Event215970CharitableContributionsEvent2
Gross Revenue Event215970GrossRevenueEvent2
Non Cash Prizes Event2160NonCashPrizesEvent2
Food And Beverage Event24199FoodAndBeverageEvent2
Other Direct Expenses Event27156OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total277200GrossReceiptsTotal
Charitable Contributions Total138600CharitableContributionsTotal
Gross Revenue Total Events138600GrossRevenueTotalEvents
Non Cash Prizes Total Events160NonCashPrizesTotalEvents
Food And Beverage Total Events48748FoodAndBeverageTotalEvents
Entertainment Total Events675EntertainmentTotalEvents
Other Direct Expenses Total Events21965OtherDirectExpensesTotalEvents
Direct Expense Summary Events71548DirectExpenseSummaryEvents
Net Income Summary67052NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CARMEN VELASQUEZ
208662000216850038500027210466733000
Mark E Kosanovich
203942000000027140206656000
Abdul H Bhurgri
2238980000020000074510251349000
Thurman C Gills
1780920000015500000193592000
DORA GARCIA
157201002760044481892490
WEN-HO YANG
167143001043920061795880

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Line 11The CFO reviews the Form 990 before presenting it to the Financial Executive Committee of the Board of Directors. Upon their approval it is presented to the Board of Directors for final approval.
Form 990, Part VI, Line 12cThe members must disclose if there is a conflict of interest at the annual board meetings. 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.
Form 990, Part VI, Line 15a & 15bThe organization has a process for determining salary compensation for the Executive Director. This process includes the use of an independent consultant, The Merces Consulting Group Inc., comparability data such as 990 Forms of other organizations, and compensation surveys from various sources including the IL Primary Health Care Association and the National Association of Community Health Centers. This information is reviewed and approved by the Executive and Finance committee of the Board of Directors. This process is also used by the Executive Director for other key employees of the organization. Through a similar process we have also developed our internal compensation plan for all employees.
Form 990, Part VI, Line 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, SCHEDULE HALIVIO MEDICAL CENTER, INC. DOES NOT OPERATE a FACILITY THAT IS, OR IS REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL. THEREfore, there IS NO NEED TO ATTACH SCHEDULE H WITH THIS FORM.
Form 990, Part XI, Line 5Prior Period Adjustment $ 186,012Other Changes in the net assets

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