ALIVIO MEDICAL CENTER INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ALIVIO MEDICAL CENTER INC (EIN 36-3661051)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201231369349307928
Schema version
2010v3.7
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)
Timestamp2012-05-15T18:29:31-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

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 Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN363661051EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ALIVIO MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
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 Signed2012-05-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameJOHN BAIARDIName
Phone2127094500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
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 Receipts15880468GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
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 Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees196TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4581017ContributionsGrantsPriorYear
Contributions Grants Current Year4595772ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9935737ProgramServiceRevenuePriorYear
Program Service Revenue CY10637011ProgramServiceRevenueCY
Investment Income Prior Year5307InvestmentIncomePriorYear
Investment Income Current Year3144InvestmentIncomeCurrentYear
Other Revenue Prior Year335320OtherRevenuePriorYear
Other Revenue Current Year644541OtherRevenueCurrentYear
Total Revenue Prior Year14857381TotalRevenuePriorYear
Total Revenue Current Year15880468TotalRevenueCurrentYear
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 Year10394916SalariesEtcPriorYear
Salaries Etc Current Year10570246SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year507929TotalFundrsngExpCurrentYear
Other Expense Prior Year5278029OtherExpensePriorYear
Other Expenses Current Year5392213OtherExpensesCurrentYear
Total Expenses Prior Year15672945TotalExpensesPriorYear
Total Expenses Current Year15962459TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-815564RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-81991RevenuesLessExpensesCY
Total Assets BOY10750524TotalAssetsBOY
Total Assets EOY11175244TotalAssetsEOY
Total Liabilities BOY6658278TotalLiabilitiesBOY
Total Liabilities EOY6936473TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4092246NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4238771NetAssetsOrFundBalancesEOY
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
Expense9593531Expense
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)
Expense350221Expense
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)
Expense405110Expense
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 Program Service Expense10348862TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
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 ActivitiesfalseFundraisingActivities
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
Number Of Employees196NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
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 PolicyfalseWhistleblowerPolicy
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 PersonCAROL S FIXMAN EXE DIRNamePerson
Telephone Number2156651400TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11709 BENJAMIN FRANKLIN PARKWAY STEAddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
TERESA FRAGA
PRESIDENT1.0XX000
ESTHER CORPUZ
VICE PRESIDENT1.0XX000
WAYNE MULDROW
TREASURER1.0XX000
MARY LEBOLD RN
SECRETARY1.0XX000
CARMEN VELASQUEZ
EXECUTIVE DIRECTOR40.0XX373317022000
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
Mark E Kosanovich
Physician40.020500000X
Abdul H Bhurgri
Medical Director40.021116007266X
Donald V Woznica
Physician40.0163123010400X
Thurman C Gills
CFO40.017160700X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1124207TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation39666TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns959FederatedCampaigns
Government Grants4358187GovernmentGrants
All Other Contributions236626AllOtherContributions
Total Contributions4595772TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code624100BusinessCode
Total Revenue Column10637011TotalRevenueColumn
Related Or Exempt Function Income10637011RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10637011TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3144TotalRevenueColumn
Exclusion$3,144ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

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 PCCM900099263004263004
FEES COLLECTED357939357939
RENTAL INCOME PHARMACY1623016230

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column7368TotalRevenueColumn
Related Or Exempt Function Income7368RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue644541TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column15880468TotalRevenueColumn
Related Or Exempt Function Income11281552RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,144ExclusionAmount

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)
Total952600Total
Program Services579283ProgramServices
Management And General373317ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7768890Total
Program Services6004280ProgramServices
Management And General1676649ManagementAndGeneral
Fundraising87961Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total7529Total
Program Services0ProgramServices
Management And General7529ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1207940Total
Program Services640013ProgramServices
Management And General555248ManagementAndGeneral
Fundraising12679Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total633287Total
Program Services485055ProgramServices
Management And General141455ManagementAndGeneral
Fundraising6777Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total166671Total
Program Services0ProgramServices
Management And General166671ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total40283Total
Management And General40283ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total38469Total
Program Services20000ProgramServices
Management And General17320ManagementAndGeneral
Fundraising1149Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total119181Total
Program Services32392ProgramServices
Management And General85029ManagementAndGeneral
Fundraising1760Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total362189Total
Program Services48773ProgramServices
Management And General311656ManagementAndGeneral
Fundraising1760Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total133579Total
Program Services48299ProgramServices
Management And General84296ManagementAndGeneral
Fundraising984Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total61633Total
Program Services33535ProgramServices
Management And General27773ManagementAndGeneral
Fundraising325Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total301624Total
Program Services5298ProgramServices
Management And General296326ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total537845Total
Program Services34500ProgramServices
Management And General503345ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total66611Total
Program Services34566ProgramServices
Management And General32045ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
LAB TESTS AND ANALYSIS128177127532645
STAFF DEVELOPMENT/EDUCATION36705323664339
DUES AND SUBSCRIPTIONS247051393810767
BAD DEBT10022251002225
PAYROLL PROCESSING FEES5149351493

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2320823Total
Program Services1206807ProgramServices
Management And General719482ManagementAndGeneral
Fundraising394534Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15962459Total
Program Services10348862ProgramServices
Management And General5105668ManagementAndGeneral
Fundraising507929Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY379736BOY
EOY403921EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY360295BOY
EOY151395EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1130680BOY
EOY1095838EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1715854BOY
EOY2430780EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY81167BOY
EOY60601EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY121456BOY
EOY91966EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12604692LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6827665LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5910548BOY
EOY5777027EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY877499BOY
EOY1010729EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY173289BOY
EOY152987EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10750524BOY
EOY11175244EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1760283BOY
EOY1814037EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY52937BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4145058BOY
EOY3942436EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY700000BOY
EOY1180000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6658278BOY
EOY6936473EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3092246BOY
EOY3238771EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1000000BOY
EOY1000000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4092246BOY
EOY4238771EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10750524BOY
EOY11175244EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-81991ReconcilationRevenueExpenses
Reconcilation Other Changes228516ReconcilationOtherChanges
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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis423147OtherCostOrOtherBasis
Book Value423147BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7333687OtherCostOrOtherBasis
Depreciation3612129Depreciation
Book Value3721558BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1074047OtherCostOrOtherBasis
Depreciation194875Depreciation
Book Value879172BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3686298OtherCostOrOtherBasis
Depreciation3020661Depreciation
Book Value665637BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis87513OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value87513BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5777027TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLINE OF CREDITDescription
Amount$1,180,000Amount
FieldValueIRS element (for citing)
Total Of Amounts1180000TotalOfAmounts
Total Revenue15880468TotalRevenue
Total Expenses15962459TotalExpenses
Excess Or Deficit For Year-81991ExcessOrDeficitForYear
Net Unrealized GL On Investments228516NetUnrealizedGLOnInvestments
Total Adjustments228516TotalAdjustments
Excess Or Deficit Per FS146525ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt16108984TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments228516NetUnrealizedGainsInvestments
Revenue Not Rptd F990228516RevenueNotRptdF990
Revenue Subtotal15880468RevenueSubtotal
Total Revenue Per Form99015880468TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt15962459TotExpensesEtcAuditedFinclStmt
Expenses Subtotal15962459ExpensesSubtotal
Total Expenses Per Form99015962459TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
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 (5 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
3733170000000220000395317000
Mark E Kosanovich
205000000000000205000000
Abdul H Bhurgri
211160000000072660218426000
Donald V Woznica
1631230000000104000173523000
Thurman C Gills
171607000000000171607000

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 Board of Directors reviews annually the compensation of the CEO. The CEO evaluates compensation of key employees every two years.
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 5Unrealized gain on investment $ 228,516Other Changes in the net assets

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