2024-04-12T13:55:47-05:00 2023-06-30 390758449 WIPFLI LLP 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2022-07-01 942308748 ALLIANCE MEDICAL CENTER INC ALLI 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 SUSANNAH LABBE CHIEF EXECUTIVE OFFICER 7073852306 2024-04-09 1 SUSANNAH LABBE 999009999 1 SOLOMON MARDAKHAEV P01806552 6105653930 2024-03-27 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z SUSANNAH LABBE 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 23568172 0 X WWW.ALLIANCEMED.ORG X 1971 CA OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 14 14 192 14 0 0 8680262 8673276 12530482 14361909 2 421 9908 532566 21220654 23568172 0 0 0 0 13307658 15095668 0 0 0 6902264 7820991 20209922 22916659 1010732 651513 7303168 10477619 1728788 4251726 5574380 6225893 OUR MISSION IS TO IMPROVE THE HEALTH AND WELLNESS OF OUR DIVERSE COMMUNITIES. WE PROVIDE ACCESSIBLE, CARING AND HIGH QUALITY HEALTHCARE SERVICES. 0 0 11786574 0 9510768 MEDICAL PROGRAMS: COMPREHENSIVE PRIMARY MEDICAL SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS - SOME INSURED, SOME WITH MEDICARE, MEDI-CAL, AND OTHERS UNFUNDED. OUR BASIC SERVICES INCLUDE PRIMARY MEDICAL CARE WITH A 24/7 CALL SERVICE. 3234890 0 3203656 DENTAL PROGRAMS: COMPREHENSIVE DENTAL SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS - SOME INSURED, SOME WITH MEDI-CAL AND OTHERS UNFUNDED. OUR BASIC SERVICES INCLUDE ORAL HEALTH. 2206835 0 1973783 OTHER PROGRAMS: AMC OFFERS A HEALTH EDUCATION PROGRAM CALLED "MY BODY IS HEALTHY". THIS INCLUDES SENDING OUTREACH WORKERS INTO COMMUNITY ELEMENTARY SCHOOLS TO TEACH YOUNG CHILDREN NUTRITION, ORAL HEALTH, AND ANATOMY BASICS. AMC ALSO HAS WIC (WOMEN, INFANTS, AND CHILDREN) PROGRAM, WHICH IS A SUPPLEMENTAL NUTRITION PROGRAM FOR THOSE PREGNANT, BREASTFEEDING, AND POSTPARTUM WOMEN, INFANTS, AND CHILDREN UNDER AGE OF 5 WHO ARE LOW TO MODERATE INCOME AND AT NUTRITION RISK. ADDITIONALLY, AMC PROVIDES BEHAVIORAL HEALTH SERVICES TO PATIENTS OF VARYING ECONOMIC STATUS. FURTHERMORE, AMC OPERATES SPECIALTY CLINICS WHERE PART-TIME SPECIALISTS PROVIDE OTHER SERVICES, INCLUDING PAIN MANAGEMENT, CHIROPRACTIC TREATMENT, AND OTHER ENABLING SERVICES. 17228299 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 32 0 192 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X AMY G FAWCETT 7073852306 1381 UNIVERSITY AVENUE HEALDSBURG CA 95448 PHIL LUKS CHAIR 2.00 X X 0 0 0 JESUS LUIS GUZMAN VICE CHAIR 2.00 X X 0 0 0 BEN DURIE SECRETARY 2.00 X X 0 0 0 LYN MURRAY TREASURER 2.00 X X 0 0 0 LAURA ARREGUIN MEMBER 2.00 X 0 0 0 TONY CERVANTES MEMBER 2.00 X 0 0 0 DENA COCHRAN MEMBER 2.00 X 0 0 0 NORMAN FUJITA MEMBER 2.00 X 0 0 0 YOLANDA GIRON MEMBER 2.00 X 0 0 0 EZEQUIEL GUZMAN MEMBER 2.00 X 0 0 0 TANIA HERNANDEZ MEMBER 2.00 X 0 0 0 DENISE MARTIN MEMBER 2.00 X 0 0 0 JOSE JUIS RAMIREZ MEMBER 2.00 X 0 0 0 LISA SCHILLINGS MEMBER 2.00 X 0 0 0 SUSANNAH LABBE CHIEF EXECUTIVE OFFICER 40.00 X 293077 0 9864 ALEX ARMSTRONG INTERIM CEO 25.00 X 66028 0 1254 AMY FAWCETT CONTRACTED CFO 15.00 X 0 0 0 DEENA TRUCCO ULUDEMIR HR DIRECTOR 40.00 X 156571 0 27643 CASSANDRA HELLER PHYSICIAN 30.00 X 193923 0 13576 ANNA EKSTROM PHYSICIAN 40.00 X 206247 0 18137 SETH AMMERMAN PHYSICIAN 30.00 X 200006 0 7947 CAREY ROBERT TERRY PHYSICIAN 30.00 X 188088 0 27813 ANDREW LANE SR DENTIST 40.00 X 200536 0 28422 JOAN CHURCHILL FORMER CHIEF EXECUTIVE OFFICER 40.00 X 157239 0 3956 1661715 0 138612 31 1 1 0 WIPFLI LLP PO BOX 3160 MILWUAKEE WI 532013160 CFO & FINANCIAL CONSULTING 512095 MEDICUS IT 100 NORTH POINT CENTER EAST ALPHARETTA GA 30022 IT CONSULTING 260759 WRITE CHOICE 2205 LUNDY LANE BETTENDORF IA 52722 GRANT WRITING & COMP 234243 SCANSTAT TECHNOLOGIES PO BOX 791522 BALTIMORE MD 212791522 IT CONSULTING 154011 ELAINE SUNDBY PO BOX 318 GOLD RUN CA 95717 IT CONSULTING 106930 5 4913336 3759940 429180 8673276 NET PATIENT SERVICE REVENUE 621300 14361909 14361909 14361909 421 421 SPP REIMBURSEMENTS 621300 222238 222238 MEANINGFUL USE INCENTIVES 621300 104060 104060 206268 206268 532566 23568172 14688207 0 206689 X 554437 554437 161195 161195 11813291 11246938 566353 371677 344373 27304 1282861 1154958 127903 912207 810977 101230 183026 183026 119470 119470 650715 650715 2391538 813894 1577644 7429 7429 287376 158282 129094 935771 55913 879858 344244 264948 79296 8090 6596 1494 142180 80567 61613 456982 342703 114279 85224 21435 63789 SUPPLIES - PHARMACEUTIC 913068 913068 SUPPLIES - CLINICAL 498071 498071 340B EXPENSES 363663 363663 REPAIRS AND MAINTENANCE 148387 71497 76890 285757 80416 205341 22916659 17228299 5688360 0 62639 9184 2873343 2816576 857487 450809 1518101 2391731 248286 183274 5509227 3044603 1743312 2464624 0 2161421 7303168 10477619 1728788 2090305 0 2161421 1728788 4251726 X 5248873 5667836 325507 558057 5574380 6225893 7303168 10477619 651513 0 X 0 1 X 1 1 1 X PART I, LINE 3: ALLIANCE MEDICAL CENTER, INC. IS A NONPROFIT PROVIDING HEALTH CARE SERVICES TO SOCIALLY AND ECONOMICALLY DEPRESEED SECTORS OF SONOMA COUNTY IN CALIFORNIA. ITS EXEMPT STATUS WAS APPROVED UNDER IRC 509(A)(1) AND 170(B) (1)(A)(III). IT IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL AND THEREFORE IS NOT REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2844439 1166398 1678041 2096314 1878205 218109 568474 568474 2464624 OPERATING LEASE RIGHT-OF USE ASSETS 2161421 2161421 OPERATING LEASE LIABILITIES 2161421 2161421 X 23568172 0 23568172 0 23568172 22916659 0 22916659 0 22916659 PART X, LINE 2: THE CENTER IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAVE BEEN GRANTED TAX-EXEMPT STATUSES BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2023 AND 2022, THE CENTER HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. X X 1 0 0 0 0 0 0 0 0 SUSANNAH LABBE CHIEF EXECUTIVE OFFICER 291287 0 0 0 1790 0 8268 0 1596 0 302941 0 0 0 ANDREW LANE SR DENTIST 196608 0 0 0 3928 0 6938 0 21484 0 228958 0 0 0 ANNA EKSTROM PHYSICIAN 201750 0 0 0 4497 0 8358 0 9779 0 224384 0 0 0 CAREY ROBERT TERRY PHYSICIAN 185005 0 0 0 3083 0 7830 0 19983 0 215901 0 0 0 SETH AMMERMAN PHYSICIAN 198677 0 0 0 1329 0 7947 0 0 0 207953 0 0 0 CASSANDRA HELLER PHYSICIAN 189734 0 0 0 4189 0 7744 0 5832 0 207499 0 0 0 DEENA TRUCCO ULUDEMIR HR DIRECTOR 155848 0 0 0 723 0 6009 0 21634 0 184214 0 0 0 JOAN CHURCHILL FORMER CHIEF EXECUTIVE OFFICER 62447 0 0 0 94792 0 2500 0 1456 0 161195 0 0 0 PART I, LINE 4A JOAN CHURCHILL RECEIVED SEVERANCE IN THE AMOUNT OF $94,000, WHICH IS REPORTED ON PART II, COLUMN B(III) OF SCHEUDLE J. X 3573 429180 FMV 0 0 0 0 PART I, COLUMN (B): NUMBER OF VACCINE SHOTS DONATED FORM 990, PART VI, SECTION A, LINE 3 WIPFLI LLP CONTRACTED CFO AMY G FAWCETT $182,526 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE ENTIRE BOARD OF DIRECTORS BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C AMC ETHICAL CONDUCT POLICY REQUIRES THAT EACH COVERED INDIVIDUAL REVIEW AND SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY AND, WHEN REQUIRED, A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE INFORMATION PROVIDED ON THE DISCLOSURE STATEMENT IS AVAILABLE FOR INSPECTION BY MEMBERS OF THE BOARD AND AMC'S LEGAL COUNSEL. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS OF ALLIANCE MEDICAL CENTER IS SOLELY RESPONSIBLE FOR THE SELECTION, COMPENSATION AND PERFORMANCE REVIEW OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. THE BOARD WILL PERFORM AN ANNUAL EVALUATION AND COMPENSATION REVIEW OF THE CEO, COMPARING THE INTERNAL SALARY SCALE WITH THAT OF THE CALIFORNIA PRIMARY CARE ASSOCIATION'S ANNUAL SALARY SURVEY. THE ALLIANCE MEDICAL CENTER'S CEO WILL DETERMINE THE COMPENSATION LEVEL FOR THE CFO, WHICH WILL THEN BE REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF DIRECTORS OR DESIGNATED BOARD COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 AMC'S GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 534,946. MANAGEMENT AND GENERAL EXPENSES 418,875. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 953,821. LAB AND X-RAY SERVICES: PROGRAM SERVICE EXPENSES 79,424. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,424. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 32,753. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,753. TRANSLATION SERVICES: PROGRAM SERVICE EXPENSES 57,856. MANAGEMENT AND GENERAL EXPENSES 7,597. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,453. CONTRACTED PROVIDER: PROGRAM SERVICE EXPENSES 108,915. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,915. BILLING SERVICE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 807,323. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 807,323. GRANT WRITING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 242,174. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 242,174. RETIREMENT AND PAYROLL ADMINISTRATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 101,675. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 101,675.