SONOMA VALLEY COMMUNITY HEALTH CENTER: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SONOMA VALLEY COMMUNITY HEALTH CENTER (EIN 68-0286382)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201343189349306809
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)
Timestamp2013-11-14T16:46:54-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN941585562EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PISENTI & BRINKER LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1201 FIRST STREET SUITE 208AddressLine1
CityPETALUMACity
StateCAState
ZIP Code94952ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN680286382EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SONOMA VALLEY COMMUNITY HEALTH CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSONONameControl
Phone7079396075Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1430 WEST NAPA STREET SUITE FAddressLine1
CitySONOMACity
StateCAState
ZIP Code95476ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCHERYL JOHNSONName
TitleCEOTitle
Phone7079396075Phone
Date Signed2013-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRAYMOND POUNDSName
PTINP00459430PTIN
Phone7077629900Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHERYL JOHNSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1430 WEST NAPA STREET SUITE FAddressLine1
CitySONOMACity
StateCAState
ZIP Code95476ZIPCode
FieldValueIRS element (for citing)
Gross Receipts3945878GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SVCHC.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1992YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionPROVIDING HEALTH CARE SERVICES, ESPECIALLY TO THE UNDERSERVED, REGARDLESS OF ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees59TotalNbrEmployees
Total Nbr Volunteers12TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1370885ContributionsGrantsPriorYear
Contributions Grants Current Year1159618ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3081867ProgramServiceRevenuePriorYear
Program Service Revenue CY2785701ProgramServiceRevenueCY
Investment Income Prior Year2428InvestmentIncomePriorYear
Investment Income Current Year-65940InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year4455180TotalRevenuePriorYear
Total Revenue Current Year3879379TotalRevenueCurrentYear
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 Year2680331SalariesEtcPriorYear
Salaries Etc Current Year2926475SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY20000TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year20000TotalFundrsngExpCurrentYear
Other Expense Prior Year1600379OtherExpensePriorYear
Other Expenses Current Year1575543OtherExpensesCurrentYear
Total Expenses Prior Year4280710TotalExpensesPriorYear
Total Expenses Current Year4522018TotalExpensesCurrentYear
Revenues Less Expenses Prior Year174470RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-642639RevenuesLessExpensesCY
Total Assets BOY2338224TotalAssetsBOY
Total Assets EOY1854534TotalAssetsEOY
Total Liabilities BOY619886TotalLiabilitiesBOY
Total Liabilities EOY778835TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1718338NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1075699NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMISSION - TO PROVIDE ACCESSIBLE QUALITY HEALTH CARE TO THOSE WHO NEED IT, ESPECIALLY THE UNDERSERVED.VISION - TO BE RECOGNIZED AS A LEADER IN PROVIDING PATIENT AND COMMUNITY CENTERED CARE IN COLLABORATION WITH OTHER ORGANIZATIONS. SONOMA VALLEY COMMUNITY HEALTH CENTER IS A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION ORGANIZED TO PROVIDE HIGH QUALITY HEATH CARE ACCESS TO THOSE IN NEED, REGARDLESS OF ABILITY TO PAY, LOCATED IN SONOMA, CALIFORNIA. THE HEALTH CENTER PROVIDES ROUTINE HEALTH ASSESSMENTS, PHYSICAL EXAMINATIONS, TREATMENT AND PREVENTATIVE SERVICES. EXPANDED SERVICES INCLUDE URGENT CARE, SPECIALIZED PROCEDURES, PRE AND POST OPERATIVE CARE AND FOLLOW-UP. THE CENTER ALSO OPERATES A MOBILE MEDICAL VAN WHICH MAKES SITE VISITS TO THE LOCAL SCHOOLS, EXPANDING SERVICES TO CHILDREN IN NEED.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense1932586Expense
Revenue2044066Revenue
DescriptionFAMILY PRACTICE SERVICES. THE HEALTH CENTER PROVIDES MEDICAL CARE SERVICES FOR INFANTS THROUGH ADULTS, WITH EXTENDED DAY AND EVENING HOURS AND IS OPEN 6 DAYS PER WEEK. SERVICES INCLUDE ROUTINE EXAMINATIONS, IMMUNIZATIONS, PHYSICALS, URGENT CARE AND DIAGNOSIS, AND TREATMENT OF ACUTE AND CHRONIC ILLNESS. THE HEALTH CENTER ALSO OPERATES A MOBILE MEDICAL CLINIC, A CONFIDENTIAL TEEN CLINIC, AND OTHER ENABLING SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense312840Expense
Revenue314024Revenue
DescriptionCOMPREHENSIVE PERINATAL SERVICES: THE HEALTH CENTER PROVIDES PRE- AND POST-NATAL OB SERVICES AND EDUCATION TO PREGNANT WOMEN. NURSE EDUCATORS AND NUTRITIONISTS ARE AVAILABLE FULL TIME TO SUPPORT PATIENTS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense305462Expense
Revenue255818Revenue
DescriptionBEHAVIORAL HEALTH SERVICES. THE HEALTH CENTER PROVIDES BEHAVIORAL HEALTH SERVICES UTILIZING A PART TIME PYSCHIATRIST, 2 PART TIME PSYCHOLOGISTS AND 1 PART TIME LICENSED CLINICAL SOCIAL WORKER. THE HEALTH CENTER ALSO HAS A SUBSTANCE ABUSE COUNSELING PROGRAM STAFFED BY PART TIME CERTIFIED SUBSTANCE ABUSE COUNSELORS PROVIDED THROUGH A CONTRACT WITH THE DRUG ABUSE ALTERNATIVE CENTER.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Revenue171793Revenue
DescriptionOTHER PROGRAM SERVICES: SHARED SAVINGS $76,143/MD ON CALL $900/ALL OTHER $9,236.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Rev171793TotalOfOtherProgramServiceRev
Total Program Service Expense2550888TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
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 Fundraising1ProfessionalFundraising
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 Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
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 With109640NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees59NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
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 CEO1CompensationProcessCEO
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 Line1SUSAN TORRES CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7079396075TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1430 WEST NAPA STREET SUITE FAddressLine1
CitySONOMACity
StateCAState
ZIP Code95476ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
TOM ANDERSON
DIRECTOR/MEMBER2.00X000
RICHARD GANTENBEIN
DIRECTOR/MEMBER2.00X000
JOSE ALVAREZ
DIRECTOR/MEMBER2.00X000
PAT HARRISON
DIRECTOR/MEMBER2.00X000
MISTY RUSHING
DIRECTOR/MEMBER2.00X000
MARC SCHWAGER
DIRECTOR/MEMBER2.00X000
PAMELA STEPHENS
DIRECTOR/MEMBER2.00X000
NICOLE VILLANUEVA
DIRECTOR/MEMBER2.00X000
SUSAN DRAKE
CHAIR2.00000X
LAURA STOVALL
VICE CHAIR2.00000X
VICTORIA HALL
SECRETARY2.00000X
LINDA MCTAGGART
TREASURER2.00000X
CHERYL JOHNSON
CEO40.009220901388X
SUSAN TORRES
CFO40.0084873038683X
LINN VEHLING
DIRECTOR OF OPERATIONS40.004388204773X
PATRICIA TALBOT
EX-CEO40.00137613012390X
MARIANNE CLINTON MD
MEDICAL DIRECTOR40.0013396308750X
FieldValueIRS element (for citing)
Total Reportable Comp From Org492540TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation65984TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
DR PAUL AMARA
PO BOX 475SONOMACA95476CONTRACTED MEDICAL SERVICES PROVIDER107160
EZEQUIEL M SANDOVAL
3135 BOEING AVE STE BMCKINLEYVILLECA95519CONSULTANT- EHR104491
PRIMA MEDICAL GROUP
3 HAMILTON LANDING STE 160NOVATOCA94949CONTRACTED MEDICAL SERVICES PROVIDER104077
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants840297GovernmentGrants
All Other Contributions319321AllOtherContributions
Total Contributions1159618TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENU62410026139082613908
OTHER PROGRAM SERVICE624100171793171793
FieldValueIRS element (for citing)
Total Program Service Revenue2785701TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column559TotalRevenueColumn
Exclusion$559ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other66499Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-66499Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-66499TotalRevenueColumn
Exclusion-$66,499ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3879379TotalRevenueColumn
Related Or Exempt Function Income2785701RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$65,940ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total657319Total
Program Services241508ProgramServices
Management And General415811ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1805516Total
Program Services1207282ProgramServices
Management And General598234ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total14684Total
Program Services8638ProgramServices
Management And General6046ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total244596Total
Program Services143886ProgramServices
Management And General100710ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total204360Total
Program Services120217ProgramServices
Management And General84143ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total30000Total
Management And General30000ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total20000Total
Fundraising20000Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total589895Total
Program Services316201ProgramServices
Management And General273694ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total15633Total
Program Services4433ProgramServices
Management And General11200ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total94527Total
Program Services21237ProgramServices
Management And General73290ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total100877Total
Management And General100877ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total279083Total
Program Services150054ProgramServices
Management And General129029ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total5297Total
Program Services1521ProgramServices
Management And General3776ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total21153Total
Program Services6586ProgramServices
Management And General14567ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total103647Total
Program Services28537ProgramServices
Management And General75110ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total41048Total
Program Services31266ProgramServices
Management And General9782ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES166363166363
BAD DEBT9132391323
DUES & SUBSCRIPTIONS366971183624861

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total4522018Total
Program Services2550888ProgramServices
Management And General1951130ManagementAndGeneral
Fundraising20000Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY670524BOY
EOY283247EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY590902BOY
EOY479966EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY62818BOY
EOY55000EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY210980BOY
EOY202060EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY8215BOY
EOY11175EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY100663BOY
EOY77539EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1582387LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec850459LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY598864BOY
EOY731928EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY95258BOY
EOY13619EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2338224BOY
EOY1854534EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY619886BOY
EOY778835EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY619886BOY
EOY778835EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1634900BOY
EOY966934EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY83438BOY
EOY108765EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1718338BOY
EOY1075699EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2338224BOY
EOY1854534EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-642639ReconcilationRevenueExpenses
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 Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1081269CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years945356CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1056265CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1370885CurrentTaxYearMinus1Year
Current Tax Year1159618CurrentTaxYear
Total5613393Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2616986CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2756270CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3029021CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3081867CurrentTaxYearMinus1Year
Current Tax Year2785701CurrentTaxYear
Total14269845Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3698255CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3701626CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4085286CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4452752CurrentTaxYearMinus1Year
Current Tax Year3945319CurrentTaxYear
Total19883238Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50919883238PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years31130CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11514CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6968CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2428CurrentTaxYearMinus1Year
Current Tax Year559CurrentTaxYear
Total52599Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years31130CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11514CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6968CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2428CurrentTaxYearMinus1Year
Current Tax Year559CurrentTaxYear
Total52599Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3729385CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3713140CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4092254CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4455180CurrentTaxYearMinus1Year
Current Tax Year3945878CurrentTaxYear
Total19935837Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99740PublicSupportPercentage509
Prior Year Support Percentage0.99540PriorYearSupportPercentage
Investment Income Percentage0.00260InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00460PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members1MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Total Lobbying Expenditures IIB0TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) AND THE CALIFORNIA PRIMARY CARE ASSOCIATION (CPCA). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING. ALSO, BOARD MEMBERS AND STAFF HAVE ON OCCASION HAD DIRECT CONTACT WITH LEGISLATORS AND/OR THEIR STAFF.Explanation

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis177833OtherCostOrOtherBasis
Depreciation146958Depreciation
Book Value30875BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1337784OtherCostOrOtherBasis
Depreciation703501Depreciation
Book Value634283BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis66770OtherCostOrOtherBasis
Book Value66770BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings731928TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt3945878TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal3945878RevenueSubtotal
Other Revenues Not Included-66499OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-66499RevenueNotRptdOnFinStmt
Total Revenue Per Form9903879379TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt4588517TotExpensesEtcAuditedFinclStmt
Losses Reported66499LossesReported
Expenses Not Rptd F99066499ExpensesNotRptdF990
Expenses Subtotal4522018ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9904522018TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierPART XI, LINE 4B - OTHER ADJUSTMENTS:Identifier
ExplanationLOSS FROM PROPERTY AND EQUIPMENT DISPOSAL -66,499.Explanation

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Solicitation Of Govt GrantsXSolicitationOfGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref Fundraising0AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

FieldValueIRS element (for citing)
Name Of IndividualCRISTINE DOHRMANNNameOfIndividual

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1531 CHASE STREETAddressLine1
CitySONOMACity
StateCAState
ZIP Code95476ZIPCode
FieldValueIRS element (for citing)
ActivityFUNDRAISING CONSULTANTActivity
Fundraiser Control Of Funds0FundraiserControlOfFunds
Gross Receipts0GrossReceipts
Amount Retained By Contractor20000AmountRetainedByContractor
Net To Organization-20000NetToOrganization
FieldValueIRS element (for citing)
Total Retained By Contractors20000TotalRetainedByContractors
Total Net To Organization-20000TotalNetToOrganization

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ELIZABETH EMMONS-GOSSELINBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipFAMILY MEMBER OF ORGANIZATION'S FORMER CEORelationship
Amount Of Transaction10143AmountOfTransaction
Description Of TransactionEMPLOYEE COMPENSATIONDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11CEO AND CFO DO AN INITIAL REVIEW OF FORM 990 WITH PREPARER. THIS DRAFT IS THEN MAILED AND/OR SENT ELECTRONICALLY TO ALL BOARD MEMBERS FOR THEIR REVIEW PRIOR TO THE FINAL DRAFT BEING ISSUED. DRAFT IS THEN FINALIZED AND FILED.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY RELATING TO THE BOARD OF DIRECTORS AND OFFICERS IS INCLUDED IN THE BYLAWS OF THE ORGANIZATION. DISCLOSURE OF ANY CONFLICTS IS REQUIRED WHEN A BOARD MEMBER IS ELECTED TO SERVE ON THE BOARD. CEO MAINTAINS CONFLICT OF INTEREST FILE.
FORM 990, PART VI, SECTION B, LINE 15ATHE ORGANIZATION UTILIZES WRITTEN EMPLOYMENT CONTRACTS, COMPENSATION STUDIES AND SURVEYS AND APPROVAL BY A BOARD OR COMPENSATION COMMITTEE. THE BOARD HAS FINAL AUTHORITY OVER THE HIRING, DISMISSING, AND ANNUAL EVALUATION OF THE CEO. THE CEO EVALUATES THE CFO AND THE MEDICAL DIRECTOR. THE CEO REVIEWS THE CALIFORNIA PRIMARY CARE ASSOCIATION (CPCA) ANNUAL STATE WIDE SALARY SURVEY FOR COMMUNITY HEALTH CENTERS TO SET SALARY RANGES AND WAGES EACH YEAR.
FORM 990, PART VI, SECTION C, LINE 18THE ORGANIZATION MAKES ITS FORMS 1023 AND 990 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GOTHER: PROGRAM SERVICE EXPENSES 316,201. MANAGEMENT AND GENERAL EXPENSES 273,694. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 589,895.OTHER FEES
FORM 990, PAGE 12, PART XII, LINE 2CTHE AUDIT COMMITTEE, UNDER THE GOVERNING BOARD'S SUPERVISION, SHALL BE RESPONSIBLE FOR MAKING RECOMMENDATIONS TO THE BOARD ON THE HIRING AND TERMINATING OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS (CPAS). THE AUDIT COMMITTEE CAN NEGOTIATE THE INDEPENDENT CPA'S COMPENSATION ON BEHALF OF THE GOVERNING BOARD. THE AUDIT COMMITTE MUST: (1) CONFER WITH THE AUDITOR TO SATISFY COMMITTEE MEMBERS THAT THE FINANCIAL AFFAIRS OF THE NONPROFIT ORGANIZATION ARE IN ORDER; (2) REVIEW THE AUDIT AND DECIDE WHETHER TO ACCEPT IT; AND (3) APPROVE NON-AUDIT SERVICES BY THE INDEPENDENT CPAS ACCOUNTING FIRM, AND ENSURE SUCH SERVICES CONFORM TO APPROPRIATE GOVERNMENT STANDARDS. THERE HAS BEEN NO CHANGE TO THIS PRACTICE DURING THE CURRENT YEAR.REVIEW & SELECTION OF INDEPENDENT ACCOUNTANT

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