2019-06-17T10:03:10-05:00 2018-06-30 680037990 GILBERT ASSOCIATES INC 2880 GATEWAY OAKS DR STE 100 SACRAMENTO CA 95833 990 2017-07-01 942210447 AMPLA HEALTH AMPL 5306744261 935 MARKET STREET YUBA CITY CA 95991 BENJAMIN H FLORES MPH PRESIDENT/CEO 5306744261 2019-06-07 1 KEITH R GLEN P01317613 9166466464 2019-05-28 207.231.71.251 2019-06-07 15:34:15 PD P 6945AA45E2A4D6609A435EBA012900DEADB11BA3 E3152073A5A10C551B4FB59E07D8A80CB564240A 2017 2019-02-21 02:37:17Z BENJAMIN H FLORES MPH 935 MARKET STREET YUBA CITY CA 95991 59217993 0 X WWW.AMPLAHEALTH.ORG X 1973 CA AMPLA HEALTH STRIVES TO PROVIDE HIGH QUALITY MEDICAL, DENTAL, SOCIAL ANDEDUCATIONAL HEALTH SERVICES THAT MEET THE UNIQUE NEEDS OF ALL PATIENTSESPECIALLY THOSE WHO ARE MEDICALLY UNDER SERVED INCLUDING FARM WORKERSAND OTHERS WITHOUT FINCIAL RESOURCES. 15 15 475 0 0 0 9385427 503018 40846138 58675047 23174 39928 0 0 50254739 59217993 0 0 0 0 36764346 39937568 0 0 0 13668250 16380536 50432596 56318104 -177857 2899889 31333396 32088065 15475578 14138479 15857818 17949586 AMPLA HEALTH STRIVES TO PROVIDE HIGH QUALITY MEDICAL, DENTAL, SOCIAL AND EDUCATIONAL HEALTH SERVICES THAT MEET THE UNIQUE NEEDS OF ALL PATIENTS ESPECIALLY THOSE WHO ARE MEDICALLY UNDER SERVED INCLUDING FARM WORKERS AND OTHERS WITHOUT FINANCIAL RESOURCES. 0 0 44994230 58675047 AMPLA HEALTH PROVIDES MEDICAL SERVICES AND BASIC DENTAL SERVICES TO LOW-INCOME AND MIGRANT PATIENTS. IT ALSO PROVIDES HEALTH AND PRENATAL INFORMATION TO LOW-INCOME AND MIGRANT INDIVIDUALS, AS WELL AS, SUPPLEMENTAL FOOD TO ELIGIBLE LOW-INCOME WOMEN. FISCAL YEAR ENDED JUNE 30, 2018 HAD 300,029 PATIENT ENCOUNTERS. 44994230 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 48 0 1 475 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X VERONICA RICHTER 5306744261 935 MARKET STREET YUBA CITY CA 95991 HORACIO PARAS BOARD OF DIRECTORS - CHAIR 0.69 X X 0 0 0 J ANGEL CALDERON BOARD OF DIRECTORS - VICE CHAIR 0.69 X X 0 0 0 ELIZABETH SKELLY BOARD OF DIRECTORS - TREASURER 0.69 X X 0 0 0 MICHELE WALTERS BOARD OF DIRECTORS - SECRETARY 0.69 X X 0 0 0 MARY JANE GRIEGO BOARD OF DIRECTORS - PARLIAMENTARIAN 0.69 X X 0 0 0 KIM OWENS BOARD OF DIRECTORS - MEMBER 0.69 X 0 0 0 CARLOS O PALACIOS BOARD OF DIRECTORS - MEMBER 0.38 X 0 0 0 WENCESLAO VASQUEZ BOARD OF DIRECTORS - MEMBER 0.38 X 0 0 0 ERNEST GARICA DDS BOARD OF DIRECTORS - MEMBER 0.38 X 0 0 0 MARK LUNDBERG MD BOARD OF DIRECTORS - MEMBER 0.38 X 0 0 0 LILIA CHILDS BOARD OF DIRECTORS - MEMBER 0.46 X 0 0 0 ALEJANDRO LUQUIN BOARD OF DIRECTORS - MEMBER 0.46 X 0 0 0 ROBERTO GONZALEZ BOARD OF DIRECTORS - MEMBER 0.46 X 0 0 0 DEBBIE PORCAYO BOARD OF DIRECTORS - MEMBER 0.69 X 0 0 0 THOMAS KELEM BOARD OF DIRECTORS - MEMBER 0.69 X 0 0 0 BENJAMIN FLORES CEO 40.00 X 319003 0 28635 TIFFANY ROBERTSON CFO 40.00 X 74922 0 5285 CARLOS PERALTA CORRALES COO 40.00 X 162466 0 16441 DANIEL SIRI DENTAL DIRECTOR 40.00 X 225618 0 23199 MUSTAFA AMMAR MEDICAL DIRECTOR 40.00 X 627610 0 31973 KANESHKA ALAMSHAHI MEDICAL DOCTOR 40.00 X 346479 0 20458 ARUN KUMAR MEDICAL DOCTOR 40.00 X 363134 0 36145 THINN AUNG MEDICAL DOCTOR 40.00 X 347623 0 26634 KANWAR MULTANI MEDICAL DOCTOR 40.00 X 331709 0 15060 ALPINA MULLICK MEDICAL DOCTOR 40.00 X 339098 0 30058 3137662 0 233888 71 0 1 0 GE HEALTHCARE FINANCIAL SERVICE PO BOX 641419 PITTSBURGH PA 15264 CONTRACTUAL DATA SERVICES 673618 IRIS TELEHEALTH 807 WEST AVE AUSTIN TX 78701 CONTRACTUAL TELEPSYCHIATRY 622696 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 CONTRACTUAL PHYSICIANS 502966 YUBA SUTTER HOSPITALIST GROUP 726 4TH STREET MARYSVILLE CA 95901 CONTRACTUAL PHYSICIANS 292000 MENDOCINO MEDICAL 235 N PLUMAS STREET WILLOWS CA 95988 CONTRACTUAL PHYSICIAN 197195 12 500068 2950 2950 503018 PATIENT REVENUE 621110 35060939 35060939 FEES FOR SERVICES 621110 23009965 23009965 PPS RATE ADJUSTMENT INCOME 621110 604143 604143 58675047 39928 39928 59217993 58675047 0 39928 X 1515152 1303031 212121 31107935 25891109 5216826 770864 641081 129783 4360683 3633266 727417 2182934 1819475 363459 8284038 6681653 1602385 589516 300358 289158 1403117 714888 688229 265877 128567 137310 202586 24418 178168 1626235 947086 679149 276779 78570 198209 SUPPLIES 2226637 1958999 267638 BAD DEBT 604144 412360 191784 OTHER EXPENSES 576734 293846 282888 LICENSES 196157 99942 96215 128716 65581 63135 56318104 44994230 11323874 0 1642282 1342556 2415052 824987 471255 418821 4888954 9357797 125910 132910 1003203 702895 38211893 18903794 20391088 19308099 395652 0 31333396 32088065 5607461 5615662 143094 9868117 6652268 0 1727455 15475578 14138479 X 15046947 17889586 810871 60000 15857818 17949586 31333396 32088065 2899889 -808121 0 X X 0 1 X 1 1 1 X 7945138 7477500 9214813 9385427 503018 34525896 7945138 7477500 9214813 9385427 503018 34525896 34525896 287 660 2920 23174 39928 66969 680627 4124736 4210422 7574444 16590229 51183094 222059599 0.67460 0.72180 X 3153747 3153747 23907373 10286700 13620673 10844414 8617094 2227320 306359 306359 19308099 LINE OF CREDIT 1727455 1727455 59217993 0 59217993 0 59217993 56318104 0 56318104 0 56318104 X X X 0 0 0 0 0 0 0 1 0 BENJAMIN FLORES CEO 313003 0 6000 0 0 0 17098 0 11537 0 347638 0 0 0 CARLOS PERALTA CORRALES COO 162466 0 0 0 0 0 4904 0 11537 0 178907 0 0 0 DANIEL SIRI DENTAL DIRECTOR 216418 0 9200 0 0 0 11662 0 11537 0 248817 0 0 0 MUSTAFA AMMAR MEDICAL DIRECTOR 392497 0 235113 0 0 0 20436 0 11537 0 659583 0 0 0 KANESHKA ALAMSHAHI MEDICAL DOCTOR 269038 0 77441 0 0 0 8921 0 11537 0 366937 0 0 0 ARUN KUMAR MEDICAL DOCTOR 283224 0 79910 0 0 0 24608 0 11537 0 399279 0 0 0 THINN AUNG MEDICAL DOCTOR 272743 0 74880 0 0 0 15097 0 11537 0 374257 0 0 0 KANWAR MULTANI MEDICAL DOCTOR 236641 0 95068 0 0 0 3523 0 11537 0 346769 0 0 0 ALPINA MULLICK MEDICAL DOCTOR 262424 0 76674 0 0 0 18521 0 11537 0 369156 0 0 0 PART I, LINE 7 YES, BONUS AND INCENTIVE PAYMENTS ARE BASED ON ENCOUNTER PRODUCTIVITY, WITH 400 ENCOUNTERS BEING STANDARD. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990 WITH THE INFORMATION PROVIDED BY THE ORGANIZATION ACCOUNTING DEPARTMENT. THEN THE COMPLETED 990 IS SENT TO THE CFO OF THE ORGANIZATION TO BE REVIEWED. THE CFO REVIEWS AND DISTRIBUTES THE 990 AMONG THE FINANCE COMMITTEE AND THE BOARD OF DIRECTORS FOR REVIEW AND QUESTIONS AT THE BOARD MEETING. UPON COMPLETION OF REVIEW AND APPROVAL THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO BE MAILED UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION IS DETERMINED FOR THE CEO BY HIRING A CONSULTANT WHO GATHERS INFORMATION OF OTHER CEO'S PAY. THE CONSULTANT THEN PRESENTS THE SALARY RANGES TO THE BOARD OF DIRECTORS WHO THEN WILL DECIDE ON THE COMPENSATION FOR THE CEO. ANNUAL REVIEWS AND ANNUAL SALARY SURVEYS ARE DONE TO MAKE SURE THE CEO IS COMPENSATED FAIRLY. THE ANNUAL REVIEW AND ANNUAL SALARY SURVEY IS DONE YEARLY AROUND MARCH OR APRIL. THE COMPENSATION IS DETERMINED FOR THE KEY EMPLOYEES IS DETERMINED BY HIRING A CONSULTANT WHO GATHERS INFORMATION OF OTHER KEY EMPLOYEES PAY. THE CONSULTANT THEN PRESENTS THE SALARY RANGES TO THE CEO WHO THEN WILL DECIDE ON THE COMPENSATION FOR THE KEY EMPLOYEE. ANNUAL REVIEWS AND ANNUAL SALARY SURVEYS ARE DONE TO MAKE SURE THE KEY EMPLOYEES ARE COMPENSATED FAIRLY. THE ANNUAL REVIEW AND ANNUAL SALARY SURVEY IS DONE YEARLY AROUND MARCH OR APRIL. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO BE MAILED UPON REQUEST. HOWEVER, FINANCIAL STATEMENTS ARE NOT MADE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO BE MAILED UPON REQUEST. HOWEVER, FINANCIAL STATEMENTS ARE NOT MADE PUBLIC. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 6,681,653. MANAGEMENT AND GENERAL EXPENSES 1,602,385. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,284,038. FORM 990 PART XII, LINE 2C NEITHER THE PROCESS FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT NOR THE PROCESS FOR SELECTION OF AN INDEPENDENT ACCOUNTANT HAS CHANGED FROM THE PRIOR YEAR.