ALIVIO MEDICAL CENTER INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
ALIVIO MEDICAL CENTER INC (EIN 36-3661051)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-03
IRS object ID
201121239349300902
Schema version
2009v1.7
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)
Timestamp2011-05-03T10:17:51-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

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 Date2009-07-01TaxPeriodBeginDate

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)
NameTeresa WoodsName
TitleSr. AccountantTitle
Date Signed2011-04-29DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone2127094500Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts14857381GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
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 Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees209TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4228041ContributionsGrantsPriorYear
Contributions Grants Current Year4581017ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10090125ProgramServiceRevenuePriorYear
Program Service Revenue CY9935737ProgramServiceRevenueCY
Investment Income Prior Year13992InvestmentIncomePriorYear
Investment Income Current Year5307InvestmentIncomeCurrentYear
Other Revenue Prior Year609756OtherRevenuePriorYear
Other Revenue Current Year335320OtherRevenueCurrentYear
Total Revenue Prior Year14941914TotalRevenuePriorYear
Total Revenue Current Year14857381TotalRevenueCurrentYear
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 Year10308913SalariesEtcPriorYear
Salaries Etc Current Year10394916SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year159339TotalFundrsngExpCurrentYear
Other Expense Prior Year4588164OtherExpensePriorYear
Other Expenses Current Year5278029OtherExpensesCurrentYear
Total Expenses Prior Year14897077TotalExpensesPriorYear
Total Expenses Current Year15672945TotalExpensesCurrentYear
Revenues Less Expenses Prior Year44837RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-815564RevenuesLessExpensesCY
Total Assets BOY11157217TotalAssetsBOY
Total Assets EOY10750524TotalAssetsEOY
Total Liabilities BOY6142054TotalLiabilitiesBOY
Total Liabilities EOY6458278TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5015163NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4292246NetAssetsOrFundBalancesEOY
Mission DescriptionALIVIO MEDICAL CENTER IS A BILINGUAL, BICULTURAL ORGANIZATION COMMITTED TO PROVIDING ACCESS TO QUALITY, COST EFFECTIVE HEALTH CARE TO THE HISPANIC COMMUNITY, THE UNINSURED, AND THE UNDERINSURED, AND NOT TO THE EXCLUSION OF OTHER CULTURES AND RACES. THIS MISSION IS EXPRESSED THROUGH THE PROVISION OF SERVICES,ADVOCACY,EDUCATION AND RESEARCH AND EVALUATION PROVIDED IN AN ENVIRONMENT OF CARING RESPECT.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangetrueSignificantChange
Expense8973983Expense
DescriptionThe Community Health Center was established to provide quality, affordable health care to the local community. The comprehensive services include primary outpatient medical care, obstetrics and gynecology, diagnostic services, nutrition services, behavioral health services, education and prevention programs, as well as other supporting services.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense350446Expense
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)
Expense230156Expense
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 Exp1432798TotalOfOtherProgramServiceExp
Total Program Service Expense10987383TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
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
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees209NumberOfEmployees
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
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 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 PersonCARMEN VELASQUEZNamePerson
Telephone Number7732541400TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12355 SOUTH WESTERN AVENUEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60608ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 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
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
CARMEN VELASQUEZ
EXECUTIVE DIRECTOR40.0X3790570204196
Thurman C Gills
CFO40.0X15589500
Mark E Kosanovich
Physician40.0214386012301X
Abdul H Bhurgri
Medical Director40.0210242012301X
Gaetano F Perego
Physician40.019697808102X
Donald V Woznica
Physician40.015515808102X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1311716TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation245002TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns1280FederatedCampaigns
Government Grants4394667GovernmentGrants
All Other Contributions185070AllOtherContributions
Total Contributions4581017TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT FEESDescription
Business Code624100BusinessCode
Total Revenue Column9935737TotalRevenueColumn
Related Or Exempt Function Income9935737RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9935737TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5307TotalRevenueColumn
Exclusion$5,307ExclusionAmount

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

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column335320TotalRevenueColumn
Related Or Exempt Function Income335320RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue335320TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14857381TotalRevenueColumn
Related Or Exempt Function Income10271057RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$5,307ExclusionAmount

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)
Total950522Total
Program Services308793ProgramServices
Management And General641729ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7469629Total
Program Services6219973ProgramServices
Management And General1120882ManagementAndGeneral
Fundraising128774Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1344194Total
Program Services636756ProgramServices
Management And General693821ManagementAndGeneral
Fundraising13617Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total630571Total
Program Services473480ProgramServices
Management And General147050ManagementAndGeneral
Fundraising10041Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total206577Total
Management And General206577ManagementAndGeneral

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)
Total553943Total
Program Services349969ProgramServices
Management And General203974ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total47116Total
Program Services8180ProgramServices
Management And General36138ManagementAndGeneral
Fundraising2798Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1311021Total
Program Services1118279ProgramServices
Management And General192742ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total850095Total
Program Services717234ProgramServices
Management And General132861ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total169488Total
Program Services41859ProgramServices
Management And General125065ManagementAndGeneral
Fundraising2564Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total263850Total
Program Services4506ProgramServices
Management And General259344ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total796416Total
Program Services796416ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total86382Total
Program Services38858ProgramServices
Management And General47524ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
LAB TESTS AND ANALYSIS63420624021018
STAFF DEVELOPMENT/EDUCATION1797117971
DUES AND SUBSCRIPTIONS205061671122501545
BAD DEBT662881662881
PAYROLL PROCESSING FEES5236752367

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total175996Total
Program Services175996ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15672945Total
Program Services10987383ProgramServices
Management And General4526223ManagementAndGeneral
Fundraising159339Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY917935BOY
EOY379736EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY73588BOY
EOY360295EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1017629BOY
EOY1130680EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1877661BOY
EOY1715854EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY128108BOY
EOY81167EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY106540BOY
EOY121456EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12177871LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6267323LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6112204BOY
EOY5910548EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY782222BOY
EOY877499EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY141330BOY
EOY173289EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11157217BOY
EOY10750524EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1609231BOY
EOY3082764EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY53978BOY
EOY52937EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4203845BOY
EOY2622577EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY275000BOY
EOY700000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6142054BOY
EOY6458278EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4015163BOY
EOY3292246EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1000000BOY
EOY1000000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5015163BOY
EOY4292246EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11157217BOY
EOY10750524EOY
FieldValueIRS element (for citing)
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
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

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
Depreciation3388615Depreciation
Book Value3945072BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1065769OtherCostOrOtherBasis
Depreciation187400Depreciation
Book Value878369BookValue
FieldValueIRS element (for citing)
EquipmentEquipment

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3355268OtherCostOrOtherBasis
Depreciation2691308Depreciation
Book Value663960BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5910548TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLINE OF CREDITDescription
Amount$700,000Amount
FieldValueIRS element (for citing)
Total Of Amounts700000TotalOfAmounts
Total Revenue14857381TotalRevenue
Total Expenses15672945TotalExpenses
Excess Or Deficit For Year-815564ExcessOrDeficitForYear
Net Unrealized GL On Investments92647NetUnrealizedGLOnInvestments
Other-$200,000OtherAmount
Total Adjustments-107353TotalAdjustments
Excess Or Deficit Per FS-922917ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt14950028TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments92647NetUnrealizedGainsInvestments
Revenue Not Rptd F99092647RevenueNotRptdF990
Revenue Subtotal14857381RevenueSubtotal
Total Revenue Per Form99014857381TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt15672945TotExpensesEtcAuditedFinclStmt
Expenses Subtotal15672945ExpensesSubtotal
Total Expenses Per Form99015672945TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPART XI LINE 8Identifier
ExplanationLOSS FROM OVERPAYMENT OF MEDICAL SERVICESExplanation

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 (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
179057000200000020000004196058325302000000
Mark E Kosanovich
2143860000000123010226687000
Abdul H Bhurgri
2102420000000123010222543000
Gaetano F Perego
196978000000081020205080000
Donald V Woznica
155158000000081020163260000
Thurman C Gills
155895000000000155895000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierForm 990, Schedule J, Line 4bIdentifier
ExplanationThe executive employees participated in a Non-qualified 457B Plan. The participating employess are as follows: Dora Garcia, Associate Director-$15,275, Thurman Gills, CFO-$15,000, Abdul H. Bhurgri, Medical Director-$9,855, Antonia Rodriguez, Program Director-$9,235.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part III, Line 3The Ounce of Prevention program has been discontinued as of June 30, 2010.
Form 990, Part III, Line 4dHome Visiting program-provides education and support to teen moms as well as soon-to-be mothers. Social Services program is a bilingual, bicultural family counseling program that provides crisis intervention, counseling and referral services, and education to an increasing number of families experiencing illness, emotional distress, and depression resulting from domestic violence and victimization. The State of Illinois "All Kids" is a state-wide initiative that makes comprehensive health insurance available to all uninsured children in Illinois.
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.

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