MANIFEST MEDEX: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MANIFEST MEDEX (EIN 27-2367522)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-05-15
IRS object ID
201331359349307158
Schema version
2012v2.1
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)
Timestamp2013-05-15T15:04:32-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN330313836EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MACHER & CLARK CPA'SBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13689 ARLINGTON AVENUEAddressLine1
CityRIVERSIDECity
StateCAState
ZIP Code925063938ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN272367522EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1INLAND EMPIRE EHR RESOURCE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlINLANameControl
Phone9516863343Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13993 JURUPA AVENUEAddressLine1
CityRIVERSIDECity
StateCAState
ZIP Code92506ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDOLORES GREENName
TitleEXECUTIVE DIRECTORTitle
Phone9516863343Phone
Date Signed2013-05-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDAVID C MACHER CPAName
PTINP00058198PTIN
Phone9517870330Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDOLORES GREENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13993 JURUPA AVENUEAddressLine1
CityRIVERSIDECity
StateCAState
ZIP Code92506ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2379531GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization OtherXTypeOfOrganizationOther
Type Of Org Other DescriptionELECTRONIC HEALTH RECORD RESOURCE CTTypeOfOrgOtherDescription
Year Formation2010YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTHE SPECIFIC PURPOSE OF THIS CORPORATION IS TO RECEIVE AND ADMINISTER FUNDS AND OTHER PROPERTY TO ADVANCE AND SUPPORT THE ACCESSIBILITY AND USAGE OF ELECTRONIC HEALTH RECORDS THROUGHTOUT THE INLAND EMPIRE REGION OF CALIFORNIA, TO ADVANCE AND SUPPORT THE SUCCESSFUL IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS IN THE MEDICAL COMMUNITY, AND TO DO ALL THINGS APPROPRIATE TO FURTHER SUCH PURPOSE.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year471665ContributionsGrantsPriorYear
Contributions Grants Current Year708666ContributionsGrantsCurrentYear
Program Service Revenue Prior Year634466ProgramServiceRevenuePriorYear
Program Service Revenue CY1670865ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year1106131TotalRevenuePriorYear
Total Revenue Current Year2379531TotalRevenueCurrentYear
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 Year206524SalariesEtcPriorYear
Salaries Etc Current Year406072SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year490237OtherExpensePriorYear
Other Expenses Current Year1848488OtherExpensesCurrentYear
Total Expenses Prior Year696761TotalExpensesPriorYear
Total Expenses Current Year2254560TotalExpensesCurrentYear
Revenues Less Expenses Prior Year409370RevenuesLessExpensesPriorYear
Revenues Less Expenses CY124971RevenuesLessExpensesCY
Total Assets BOY934721TotalAssetsBOY
Total Assets EOY825182TotalAssetsEOY
Total Liabilities BOY427152TotalLiabilitiesBOY
Total Liabilities EOY192642TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY507569NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY632540NetAssetsOrFundBalancesEOY
Mission DescriptionTO ADMINISTER FUNDS FROM GOVERNMENTAL AGENCIES AND COMMUNITY ORGANIZATIONS THAT WILL BE USED FOR THE SUCCESSFUL IMPLIMENTATION OF ELECTRONIC HEALTH RECORDS PROCEDURES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2248780Expense
Revenue1670865Revenue
DescriptionCALHIPSO AWARD, SACRAMENTO, CALIFORNIA AND HEALTH INFORMATION EXCHANGE SERVICE FEES.Description
Total Program Service Expense2248780TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1INLAND EMPIRE EHR RESOURCE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9516863343TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13993 JURUPA AVENUEAddressLine1
CityRIVERSIDECity
StateCAState
ZIP Code92506ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JOSEPH JC LEE MD
MEMBER1.00XX000
LEROY L OUNANIAN MD
SECRETARY/TREASURER2.50XX000
DOLORES L GREEN
EXECUTIVE DIRECTOR2.50XX000
MICHAEL DEERING
MEMBER1.00X000
BRADLEY GILBERT MD
CHAIRMAN OF THE BOARD2.50X000
WILLIAM HENNING DO
MEMBER1.00X000
TAREK MAHDI MD
MEMBER1.00X000
JIM PETERSON
MEMBER1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants677172GovernmentGrants
All Other Contributions31494AllOtherContributions
Total Contributions708666TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionH.I. EXCHANGE SERVICESDescription
Business Code519100BusinessCode
Total Revenue Column1644679TotalRevenueColumn
Related Or Exempt Function Income1644679RelatedOrExemptFunctionIncome

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column26186TotalRevenueColumn
Related Or Exempt Function Income26186RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue1670865TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2379531TotalRevenueColumn
Related Or Exempt Function Income1670865RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total406072Total
Program Services406072ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total80Total
Management And General80ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total8100Total
Program Services2400ProgramServices
Management And General5700ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total822Total
Program Services822ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6840Total
Program Services6840ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total36000Total
Program Services36000ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total23653Total
Program Services23653ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total14501Total
Program Services14501ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PLATINUM SERVICE PARTNE13235001323500
ON-SITE ASSESSMENTS261940261940
FIDUCIARY AGENT EXPENSE8714387143
CONSULTING FEES6000060000

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total25909Total
Program Services25909ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2254560Total
Program Services2248780ProgramServices
Management And General5780ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY688641BOY
EOY309828EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY241972BOY
EOY508124EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4108BOY
EOY7230EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY934721BOY
EOY825182EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY39459BOY
EOY192642EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY387693BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY427152BOY
EOY192642EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY507569BOY
EOY632540EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY507569BOY
EOY632540EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY934721BOY
EOY825182EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses124971ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years175034CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year404558CurrentTaxYearMinus1Year
Current Tax Year708666CurrentTaxYear
Total1288258Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years175034CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year404558CurrentTaxYearMinus1Year
Current Tax Year708666CurrentTaxYear
Total1288258Total
FieldValueIRS element (for citing)
Public Support Total1701288258PublicSupportTotal170
Total Support1288258TotalSupport
First5 Years170XFirst5Years170

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)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt2379531TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal2379531RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9902379531TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2254560TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal2254560ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902254560TotalExpensesPerForm990

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionNON CASH CONTRIBUTIONSDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99031500NoncashContribsRptdF990
Method Of Determining RevenuesESTIMATEDMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierNON REPORTING OF REVENUE:Identifier
Return ReferencePART I, LINE 33:ReturnReference
ExplanationRECOGNIZED FAIR VALUE OF SERVICES (OCCUPANCY COSTS) PERFORMED FOR THE ORGANIZATION.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION'S MANAGEMENT DUTIES ARE PERFORMED BY THE MANAGEMENT OF RIVERSIDE COUNTY MEDICAL ASSOCIATION (RCMA) MANAGEMENT PERSONNEL. THE ORGANIZATION REIMBURSES THE RCMA, OR ITS DESIGNEE, FOR THE SERVICES OF ADMINISTRATION AND PROGRAM SERVICE PERSONNEL.
FORM 990, PART VI, SECTION B, LINE 11COPY OF FORM 990 IS SENT TO THE EXECUTIVE DIRECTOR WHO REVIEWS IT AND GIVES IT TO A BOARD MEMBER FOR REVIEW AND APPROVAL BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY OFFICERS/DIRECTORS ARE REQUIRED TO COMPLETE NEW DISCLOSURE DOCUMENTS.
FORM 990, PART VI, SECTION C, LINE 18FORM 990 IS AVAILABLE AT THE CENTER'S OFFICE IN RIVERSIDE, CALIFORNIA UPON REQUEST
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT THE CENTER'S OFFICE IN RIVERSIDE, CALIFORNIA UPON REQUEST
990, PART XII, LINE 2CTHE BOARD CONSIDERS THE FINANCIAL STATEMENT AND TAX RETURN FOR COMPLETENESS.FINANCIAL STATEMENTS AND TAX RETURN

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