2021-05-17T13:27:21-05:00 2020-06-30 680037990 GILBERT CPAS 2880 GATEWAY OAKS DR STE 100 SACRAMENTO CA 95833 990 2019-07-01 942210447 AMPLA HEALTH AMPL 5306744261 935 MARKET STREET YUBA CITY CA 95991 BENJAMIN H FLORES MPH PRESIDENT/CEO 5306744261 2021-04-27 1 KEITH R GLEN P01317613 9166466464 2021-04-27 2019 2022-09-23 18:48:47Z BENJAMIN H FLORES MPH 935 MARKET STREET YUBA CITY CA 95991 70330544 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 15 603 15 0 0 9835212 11223871 57903012 58979380 43515 127293 0 0 67781739 70330544 0 0 0 0 42758591 48643988 0 0 0 20969935 20208539 63728526 68852527 4053213 1478017 33969892 36103762 11967093 12622946 22002799 23480816 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 54160988 58979380 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, 2020 HAD 314,743 PATIENT ENCOUNTERS. 54160988 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 40 0 1 603 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 PARAS HORACIO BOARD - CHAIR 0.69 X X 0 0 0 CALDERON J ANGEL BOARD - VICE CHAIR 0.69 X X 0 0 0 SKELLY ELIZABETH BOARD - TREASURER 0.69 X X 0 0 0 OWENS KIM BOARD - SECRETARY 0.69 X X 0 0 0 GRIEGO MARY JANE BOARD - PARLIAMENTARIAN 0.69 X X 0 0 0 PALACIOS CARLOS O BOARD - MEMBER 0.38 X 0 0 0 VASQUEZ WENCESLAO BOARD - MEMBER 0.38 X 0 0 0 GARICA ERNEST DDS BOARD - MEMBER 0.38 X 0 0 0 LUNDBERG MARK MD BOARD - MEMBER 0.38 X 0 0 0 CHILDS LILIA BOARD - MEMBER 0.46 X 0 0 0 VALDOVINOS LORENZO BOARD - MEMBER 0.46 X 0 0 0 LUQUIN ALEJANDRO BOARD - MEMBER 0.46 X 0 0 0 GONZALEZ ROBERTO BOARD - MEMBER 0.46 X 0 0 0 POPE JOYCE BOARD - MEMBER 0.69 X 0 0 0 PORCAYO DEBBIE BOARD - MEMBER 0.69 X 0 0 0 VANG TENG BOARD - MEMBER 0.69 X 0 0 0 FLORES BENJAMIN CEO 40.00 X 411742 0 25652 PERALTA CORRALES CARLOS COO 40.00 X 208153 0 17708 FLEMING JOHN PLANNING & DEVELOPMENT DIR 40.00 X 152052 0 15883 SNELGROVE CINDY NURSING DIRECTOR 40.00 X 174750 0 16765 SIRI DANIEL DENTAL DIRECTOR 40.00 X 287545 0 19311 AMMAR MUSTAFA MEDICAL DIRECTOR 40.00 X 622275 0 20052 ALAMSHAHI KANESHKA MEDICAL DOCTOR 40.00 X 392775 0 20052 KUMAR ARUN MEDICAL DOCTOR 40.00 X 363691 0 20052 AUNG THINN MEDICAL DOCTOR 40.00 X 354015 0 20052 SANDHU SARTAJ MEDICAL DOCTOR 40.00 X 386654 0 20052 MULLICK ALPNA MEDICAL DOCTOR 40.00 X 353340 0 20052 3706992 0 215631 93 0 1 0 IRIS TELEHEALTH 114 WEST 7TH ST SUITE 900 AUSTIN TX 78701 CONTRACTUAL TELEPSYCHIATRY 828425 BRACEWELL PO BOX 207486 DALLAS TX 75320 CONTRACTUAL LEGAL 424780 ZOELLER & PLESS PLLC 1095 EVERGREEN CIRCLE SUITE 200 THE WOODLANDS TX 77380 CONTRACTUAL LEGAL 362500 COMCAST PO BOX 37601 PHILADELPHIA PA 19101 CONTRACTUAL DATA SERVICES 357687 JOSHUA KINNEY 14846 EAGLE RIDGE DR FOREST RANCH CA 95942 CONTRACTUAL PHYSICIANS 218970 13 10835206 388665 23750 11223871 PATIENT REVENUE 621110 40667127 40667127 FEES FOR SERVICES 621110 18312253 18312253 58979380 127293 127293 70330544 58979380 0 127293 X 1971888 1596088 375800 39111328 31657547 7453781 861129 697016 164113 4117219 3332565 784654 2582424 2090269 492155 10966521 8681716 2284805 665479 382113 283366 1973731 1343433 630298 248103 110103 138000 144228 26188 118040 1460423 1009992 450431 244013 42335 201678 SUPPLIES 3148667 2661362 487305 OTHER EXPENSES 511761 199919 311842 BAD DEBT 485404 189625 295779 LICENSES 208400 81412 126988 151809 59305 92504 68852527 54160988 14691539 0 4918073 9153186 1463512 847087 977319 1017129 7304728 5662168 132910 234558 1021894 948250 40151095 21909711 18151456 18241384 33969892 36103762 5214262 6100502 784134 939354 5968697 5583090 11967093 12622946 X 22002799 23480816 22002799 23480816 33969892 36103762 1478017 0 X X 0 1 X 1 1 1 X 9214813 9385427 503018 9835212 11223871 40162341 9214813 9385427 503018 9835212 11223871 40162341 40162341 2920 23174 39928 43515 127293 236830 4210422 7574444 11784866 52184037 257249715 0.76960 0.69450 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3195866 3195866 24191737 12003474 12188263 11681539 9906237 1775302 1081953 1081953 18241384 70330544 0 70330544 0 70330544 68852527 0 68852527 0 68852527 X X X 0 0 0 0 0 0 0 1 0 FLORES BENJAMIN CEO 405742 0 6000 0 0 0 14000 0 11652 0 437394 0 0 0 PERALTA CORRALES CARLOS COO 208153 0 0 0 0 0 6056 0 11652 0 225861 0 0 0 FLEMING JOHN PLANNING & DEVELOPMENT DIR 152052 0 0 0 0 0 4231 0 11652 0 167935 0 0 0 SNELGROVE CINDY NURSING DIRECTOR 174750 0 0 0 0 0 5113 0 11652 0 191515 0 0 0 SIRI DANIEL DENTAL DIRECTOR 272743 0 14802 0 0 0 7659 0 11652 0 306856 0 0 0 AMMAR MUSTAFA MEDICAL DIRECTOR 475222 0 147053 0 0 0 8400 0 11652 0 642327 0 0 0 ALAMSHAHI KANESHKA MEDICAL DOCTOR 347230 0 45545 0 0 0 8400 0 11652 0 412827 0 0 0 KUMAR ARUN MEDICAL DOCTOR 297900 0 65791 0 0 0 8400 0 11652 0 383743 0 0 0 AUNG THINN MEDICAL DOCTOR 317760 0 36255 0 0 0 8400 0 11652 0 374067 0 0 0 SANDHU SARTAJ MEDICAL DOCTOR 345029 0 41625 0 0 0 8400 0 11652 0 406706 0 0 0 MULLICK ALPNA MEDICAL DOCTOR 289500 0 63840 0 0 0 8400 0 11652 0 373392 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 8,681,716. MANAGEMENT AND GENERAL EXPENSES 2,284,805. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,966,521. 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.