2020-07-02T10:35:44-05:00 2019-06-30 680037990 GILBERT CPAS 2880 GATEWAY OAKS DR STE 100 SACRAMENTO CA 95833 990 2018-07-01 942210447 AMPLA HEALTH AMPL 5306744261 935 MARKET STREET YUBA CITY CA 95991 BENJAMIN H FLORES MPH PRESIDENT/CEO 5306744261 2020-06-05 1 KEITH R GLEN P01317613 9166466464 2020-06-05 207.231.71.251 2020-06-05 16:42:42 PD P 67639D8D55F6B218ED5E382FB77B71D17F0527F1 67639D8D55F6B218ED5E382FB77B71D17F0527F1 2018 2020-04-17 16:48:07Z BENJAMIN H FLORES MPH 935 MARKET STREET YUBA CITY CA 95991 67781739 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 15 512 15 0 0 503018 9835212 58675047 57903012 39928 43515 0 0 59217993 67781739 0 0 0 0 39937568 42758591 0 0 0 16380536 20969935 56318104 63728526 2899889 4053213 32088065 33969892 14138479 11967093 17949586 22002799 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 51530261 57903012 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, 2019 HAD 316,523 PATIENT ENCOUNTERS. 51530261 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 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 37 0 1 512 1 0 0 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 0.69 X X 0 0 0 ELIZABETH SKELLY BOARD OF DIRECTORS - TREA 0.69 X X 0 0 0 MICHELE WALTERS BOARD OF DIRECTORS - SECRE 0.69 X X 0 0 0 MARY JANE GRIEGO BOARD OF DIRECTORS - PARLI 0.69 X X 0 0 0 KIM OWENS BOARD OF DIRECTORS - MEMBER 0.69 X X 0 0 0 CARLOS O PALACIOS BOARD OF DIRECTORS - MEMBE 0.38 X 0 0 0 WENCESLAO VASQUEZ BOARD OF DIRECTORS - MEMBE 0.38 X 0 0 0 ERNEST GARICA DDS BOARD OF DIRECTORS - MEMBE 0.38 X 0 0 0 MARK LUNDBERG MD BOARD OF DIRECTORS - MEMBE 0.38 X 0 0 0 LILIA CHILDS BOARD OF DIRECTORS - MEMBE 0.46 X 0 0 0 VALDOVINOS LORENZO BOARD OF DIRECTORS - MEMBER 0.46 X 0 0 0 ALEJANDRO LUQUIN BOARD OF DIRECTORS - MEMBE 0.46 X 0 0 0 ROBERTO GONZALEZ BOARD OF DIRECTORS - MEMBE 0.46 X 0 0 0 DEBBIE PORCAYO BOARD OF DIRECTORS - MEMBE 0.69 X 0 0 0 THOMAS KELEM BOARD OF DIRECTORS - MEMBE 0.23 X 0 0 0 BENJAMIN FLORES CEO 40.00 X 334488 0 30155 CARLOS PERALTA CORRALES COO 40.00 X 185734 0 17369 DANIEL SIRI DENTAL DIRECTOR 40.00 X 248272 0 23824 MUSTAFA AMMAR MEDICAL DIRECTOR 40.00 X 585408 0 29707 KANESHKA ALAMSHAHI MEDICAL DOCTOR 40.00 X 361183 0 21586 ARUN KUMAR MEDICAL DOCTOR 40.00 X 351189 0 35205 THINN AUNG MEDICAL DOCTOR 40.00 X 320004 0 28066 SARTAJ SANDHU MEDICAL DOCTOR 40.00 X 342795 0 20413 ALPINA MULLICK MEDICAL DOCTOR 40.00 X 313354 0 29088 3042427 0 235413 89 0 1 0 IRIS TELEHEALTH 807 WEST AVE AUSTIN TX 78701 CONTRACTUAL TELEPSYCHIATRY 779676 GE HEALTHCARE FINANCIAL SERVICE PO BOX 641419 PITTSBURGH PA 15264 CONTRACTUAL DATA SERVICES 396740 COMCAST PO BOX 37601 PHILADELPHIA PA 19101 CONTRACTUAL DATA SERVICES 298314 R&S NORTHEAST LLC PO BOX 935485 ATLANTA GA 31193 CONTRACTUAL PHARMACY 249248 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 CONTRACTUAL PHYSICIANS 243185 18 9473783 361429 19997 9835212 PATIENT REVENUE 621110 38711706 38711706 FEES FOR SERVICES 621110 19016389 19016389 PPS RATE ADJUSTMENT INCOME 621110 174917 174917 57903012 43515 43515 67781739 57903012 0 43515 X 1454955 1251261 203694 34220231 28591534 5628697 795214 663873 131341 3898054 3259419 638635 2390137 1999224 390913 12327814 10191003 2136811 607597 351008 256589 1417131 1070327 346804 320842 134558 186284 237619 74155 163464 1545494 938965 606529 204447 73492 130955 SUPPLIES 2790575 2520614 269961 OTHER EXPENSES 935573 253130 682443 LICENSES 223649 60512 163137 TRAINING 184277 49859 134418 174917 47327 127590 63728526 51530261 12198265 0 1342556 4918073 824987 1463512 418821 977319 9357797 7304728 132910 132910 702895 1021894 38600744 20449288 19308099 18151456 32088065 33969892 5615662 5214262 143094 784134 6652268 5968697 1727455 0 14138479 11967093 X 17889586 22002799 60000 0 17949586 22002799 32088065 33969892 4053213 0 X X 0 1 X 1 1 1 X 7477500 9214813 9385427 503018 9835212 36415970 7477500 9214813 9385427 503018 9835212 36415970 36415970 660 2920 23174 39928 43515 110197 4124736 4210422 7574444 15909602 52435769 239116473 0.69450 0.67460 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3153747 3153747 24191738 11199024 12992714 11206990 9250264 1956726 48269 48269 18151456 67781739 0 67781739 0 67781739 63728526 0 63728526 0 63728526 X X X 0 0 0 0 0 0 0 1 0 BENJAMIN FLORES CEO 328488 0 6000 0 0 0 18503 0 11652 0 364643 0 0 0 CARLOS PERALTA CORRALES COO 185734 0 0 0 0 0 5717 0 11652 0 203103 0 0 0 DANIEL SIRI DENTAL DIRECTOR 242152 0 6120 0 0 0 12172 0 11652 0 272096 0 0 0 MUSTAFA AMMAR MEDICAL DIRECTOR 441278 0 144130 0 0 0 18055 0 11652 0 615115 0 0 0 KANESHKA ALAMSHAHI MEDICAL DOCTOR 299909 0 61274 0 0 0 9934 0 11652 0 382769 0 0 0 ARUN KUMAR MEDICAL DOCTOR 300756 0 50433 0 0 0 23553 0 11652 0 386394 0 0 0 THINN AUNG MEDICAL DOCTOR 287014 0 32990 0 0 0 16414 0 11652 0 348070 0 0 0 SARTAJ SANDHU MEDICAL DOCTOR 305185 0 37610 0 0 0 8761 0 11652 0 363208 0 0 0 ALPINA MULLICK MEDICAL DOCTOR 276301 0 37053 0 0 0 17436 0 11652 0 342442 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 10,191,003. MANAGEMENT AND GENERAL EXPENSES 2,136,811. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,327,814. 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.