2022-05-06T19:53:13-05:00 2021-06-30 464016990 THE PUN GROUP LLP 200 EAST SANDPOINTE AVENUE SUITE 600 SANTA ANA CA 92707 990 2020-07-01 952833205 FAMILY HEALTH CENTERS OF SAN DIEGO INC FAMI 6195152300 823 GATEWAY CENTER WAY SAN DIEGO CA 92102 RICARDO ROMAN CFO 6195152300 2022-05-06 1 RICARDO ROMAN 999009999 FRANCES KUO P02057020 9497778800 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z RICARDO ROMAN 823 GATEWAY CENTER WAY SAN DIEGO CA 92102 307294427 0 X WWW.FHCSD.ORG X 1970 CA PROVIDING QUALITY HEALTH CARE SERVICES TO THE UNINSURED AND UNDERINSURED 10 10 2436 315 52757 51757 50700402 56714648 221011087 249282207 993960 -1347920 3588460 970873 276293909 305619808 0 0 0 0 146935523 157515126 0 0 3097 70565557 73320394 217501080 230835520 58792829 74784288 353153184 437320216 62886536 72176492 290266648 365143724 FHCSD'S PRIMARY MISSION IS TO PROVIDE COMPREHENSIVE, ACCESSIBLE AND QUALITY HEALTH CARE SERVICES TO ALL INCOME LEVELS WITH A SPECIAL COMMITTMENT TO LOW INCOME MEDICALLY UNDERSERVED INDIVIDUALS. 0 0 184044279 248852404 PRIMARY AND DENTAL CARE SERVICES AND AIDS PREVENTION -THROUGH US HEALTH AND HUMAN SERVICES WITH THE ASSISTANCE OF GRANT FUNDING. PRIMARY CARE AND DENTAL CARE ARE PROVIDED TO THE SOCIALLY DISADVANTAGED. ALSO, THROUGH US HEALTH AND HUMAN SERVICES, AIDS EDUCATION AND INSTRUCTION ON PREVENTATIVE MEASURES ARE PROVIDED. 184044279 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 96 0 1 2436 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 CA X RICARDO ROMAN CFO 6199064603 823 GATEWAY CENTER WAY SAN DIEGO CA 92102 BARBARA CARR BOARD CHAIR & MARKET PLANNING COMMITTEE CHAIR 2.00 X 0 0 0 BERTHA GARCIA BOARD MEMBER 2.00 X 0 0 0 CAROL WESLEY BOARD MEMBER 2.00 X 0 0 0 DANIEL GUILLEN BOARD AUDIT SUBCOMMITTEE CHAIR 2.00 X 0 0 0 FRANK ESPINOZA BOARD MEMBER 2.00 X 0 0 0 JOSE R DE LA GARZA BOARD MEMBER 2.00 X 0 0 0 MELANIE MOOMJIAN BOARD MEMBER 2.00 X 0 0 0 SEAN MATHEWS BOARD DEVELOPMENT SUBCOMMITTEE CHAIR 2.00 X 0 0 0 WALTER SCOTT BOARD VICE CHAIR 2.00 X 0 0 0 WAYNE R ANDERSON MD BOARD TREASURER AND SECRETARY 2.00 X 0 0 0 ANDRES GUTIERREZ CHIEF INFORMATION OFFICER 40.00 X 360251 0 28910 RICARDO ROMAN CHIEF FINANCIAL OFFICER 40.00 X 493910 0 51879 FRAN BUTLER-COHEN PRESIDENT/CEO 40.00 X 1223143 0 58328 LISA DUNCAN VP OF NURSING & COMPLIANCE 40.00 X 182769 0 30918 DAVID WHISENHUNT VP - PHYSICAL FACILITIES 40.00 X 209689 0 41532 NARAYANADAS C VAKAMUDI CHIEF TECHNOLOGY OFFICER 40.00 X 237694 0 28200 KHAWLA SULEIMAN-QAFITI CHIEF OF PEDIATRICS 40.00 X 253016 0 26000 JANET ADAMIAN VP OF PROGRAMS AND SYSTEM 40.00 X 252998 0 39241 SAMIR RANJAN CIO 40.00 X 267673 0 19500 JEFFREY GERING VP OF PLANNING & SUPPORT S 40.00 X 290453 0 26747 DONNA BAKER SR VP AND GENERAL COUNSEL 40.00 X 323260 0 63349 IBRAHIM SAWAYA DENTAL DIRECTOR 40.00 X 403830 0 30918 JOE A SEPULVEDA CHIEF OF PSYCHIATRY 40.00 X 441657 0 64879 CHRISTOPHER GORDON CHIEF MEDICAL OFFICER & CO 40.00 X 469161 0 24552 ALAN ZIEG PHYSICIAN - CHIEF OF OB GY 40.00 X 579128 0 50552 TRAVIS DE MIK PHYSICIAN, OBGYN 40.00 X 395953 0 28200 SANDRA CERVANTES MED DIR-ASST-OBGYN 40.00 X 390192 0 20863 DEBORAH A BIRNBAUM PSYCHIATRIST 40.00 X 370831 0 35318 GARRICK TONG MED DIR-ASST-CHILD PSYCHI 40.00 X 385343 0 41302 CLAUDIO CABREJOS MED DIR-ASST-PSYCHIATRY 40.00 X 433158 0 67302 7964109 0 778490 252 0 1 0 COMPHEALTH MEDICAL STAFFING PO BOX 972670 DALLAS TX 75397 STAFFING AGENCY 2533614 DAVIS AND ADAMS CONSTRUCTION INC 7848 CONVOY CT SAN DIEGO CA 92111 CONSTRUCTION 1111473 JACKSON & COKER HOLDINGS LLC PO BOX 277638 ATLANTA GA 30384 STAFFING AGENCY 848630 NETLIMS NJ LLC 65 CHALLENGER RD STE 125 RIDGEFIELD PARK NJ 07660 LABORATORY INFORMATION 493831 CUMMING 101 PARKSHORE DR STE 100 FOLSOM CA 95630 LEGAL SERVICES 234870 9 49070786 7643862 766795 56714648 PATIENT SERVICE REVENUE 621110 215677284 215677284 PHARMACY INCOME 621110 33604923 33604923 249282207 326699 326699 52757 0 52757 52757 52757 1674619 -1674619 -1674619 -1674619 OTHER REVENUE 621110 918116 918116 918116 305619808 248852403 52757 0 6574137 4357716 2216421 150940989 117177031 33763958 15063938 12044456 3019482 1213347 285029 928318 6662244 2211502 4450742 771350 2000 769350 6717727 1129593 5588134 1188399 186658 1001741 MEDICAL AND PHARM SUPPL 31151196 31097858 53338 OTHER EXPENSES 5895289 12582677 -6687503 115 MINOR EQUIPMENT 3029640 2014710 1014930 OFFICE SUPPLIES 1627264 955049 669233 2982 230835520 184044279 46788144 3097 137942014 184621652 6010849 9469827 40199942 53320981 535358 377076 21906829 26386055 1716397 2329091 3761238 3469129 206279086 56373568 133908039 149905518 933303 1010102 6239215 6430785 353153184 437320216 25521495 31075812 1233374 1313221 36131667 39787459 62886536 72176492 X 288591546 362631086 1675102 2512638 290266648 365143724 353153184 437320216 74784288 92787 0 X X 0 1 X 1 1 1 X 39195768 40398537 40875876 50700402 56714648 227885231 39195768 40398537 40875876 50700402 56714648 227885231 227885231 252440 140310 77384 69530 52757 592421 1561318 1362607 1706703 3270416 1063660 8964704 237442356 0.95970 0.94640 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 48721184 48721184 126667084 35984070 90683014 9539763 4470716 5069047 14619202 9908579 4710623 6731853 6010203 721650 149905518 X 307387214 92787 92787 307294427 -1674618 -1674618 305619809 232510138 1674618 1674618 230835520 0 230835520 PART X, LINE 2: THE HEALTH CENTER HAS BEEN RECOGNIZED AS A NOT-FOR-PROFIT ORGANIZATION UNDER INTERNAL REVENUE CODE SECTION 501(C)3 AND CALIFORNIA REVENUE CODE SECTION 23701(D) AND IS EXEMPT FROM FEDERAL AND CALIFORNIA INCOME TAXES ON RELATED INCOME. FOR THE YEARS ENDED JUNE 30, 2021 AND 2020, THE HEALTH CENTER GENERATED REVENUE FROM AN UNRELATED BUSINESS ACTIVITY AND WAS TAXED ACCORDINGLY. EFFECTIVE JULY 1, 2009, THE HEALTH CENTER ADOPTED NEWLY ISSUED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. UNDER THIS NEW GUIDANCE, THE HEALTH CENTER UTILIZED A TWO-STEP APPROACH TO RECOGNIZING AND MEASURING UNCERTAIN TAX POSITIONS (TAX CONTINGENCIES). THE FIRST STEP IS TO EVALUATE THE TAX POSITION FOR RECOGNITION BY DETERMINING IF THE WEIGHT OF AVAILABLE EVIDENCE INDICATES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED ON AUDIT, INCLUDING RESOLUTION OF RELATED APPEALS OR LITIGATION PROCESSES. THE SECOND STEP IS TO MEASURE THE TAX BENEFIT AS THE LARGEST AMOUNT, WHICH IS MORE THAN 50% LIKELY OF BEING REALIZED UPON ULTIMATE SETTLEMENT. AS A RESULT OF THE ADOPTION OF ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE HEALTH CENTER DID NOT RECOGNIZE AN INCREASE OR DECREASE IN THE LIABILITY FOR UNRECOGNIZED TAX BENEFITS RELATED TO TAX POSITIONS TAKEN IN PRIOR PERIODS; THEREFORE, THERE WAS NOT CORRESPONDING ADJUSTMENT TO UNRESTRICTED NET ASSETS. ADDITIONALLY, FOR THE YEAR ENDED JUNE 30, 2021, THERE WERE NO ADDITIONAL LIABILITIES RECORDED FOR UNRECOGNIZED TAX BENEFITS RELATED TO TAX POSITIONS TAKEN IN THE CURRENT YEAR. THE HEALTH CENTER CONSIDERS MANY FACTORS WHEN EVALUATING AND ESTIMATING IT'S TAX POSITIONS AND TAX BENEFITS, WHICH MAY REQUIRE PERIODIC ADJUSTMENTS AND WHICH MAY NOT ACCURATELY FORECAST ACTUAL OUTCOMES. THERE WERE NO OUTSTANDING ACCRUALS FOR INTEREST AND PENALTIES RELATED TO UNCERTAIN TAX POSITIONS SINCE THE INCEPTION DATE THROUGH THE YEAR ENDED JUNE 30, 2021. THE HEALTH CENTER HAS DETERMINED THAT IT'S MAJOR TAX JURISDICTIONS ARE THE STATE OF CALIFORNIA AND ALL OTHER STATES WITHIN THE UNITED STATES OF AMERICA. THE TAX YEAR 2021 REMAINS OPEN AND SUBJECTS TO EXAMINATION BY THE APPROPRIATE GOVERNMENTAL AGENCIES IN THE UNITED STATES THROUGH 2026. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS -1,674,618. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS 1,674,618. X 0 0 0 0 0 0 0 0 0 FRAN BUTLER-COHEN PRESIDENT/CEO 1058250 0 148693 0 16200 0 45500 0 12828 0 1281471 0 0 0 ALAN ZIEG PHYSICIAN - CHIEF OF OB GY 496749 0 82379 0 0 0 45500 0 5052 0 629680 0 0 0 RICARDO ROMAN CHIEF FINANCIAL OFFICER 493910 0 0 0 0 0 26000 0 25879 0 545789 0 0 0 JOE A SEPULVEDA CHIEF OF PSYCHIATRY 441657 0 0 0 0 0 39000 0 25879 0 506536 0 0 0 CLAUDIO CABREJOS MED DIR-ASST-PSYCHIATRY 433158 0 0 0 0 0 45500 0 21802 0 500460 0 0 0 CHRISTOPHER GORDON CHIEF MEDICAL OFFICER & CO 457037 0 12124 0 0 0 19500 0 5052 0 493713 0 0 0 IBRAHIM SAWAYA DENTAL DIRECTOR 403830 0 0 0 0 0 19500 0 11418 0 434748 0 0 0 GARRICK TONG MED DIR-ASST-CHILD PSYCHI 385343 0 0 0 0 0 19500 0 21802 0 426645 0 0 0 TRAVIS DE MIK PHYSICIAN, OBGYN 316149 0 55332 0 24472 0 19500 0 8700 0 424153 0 0 0 SANDRA CERVANTES MED DIR-ASST-OBGYN 362136 0 28056 0 0 0 14906 0 5957 0 411055 0 0 0 DEBORAH A BIRNBAUM PSYCHIATRIST 370831 0 0 0 0 0 19500 0 15818 0 406149 0 0 0 ANDRES GUTIERREZ CHIEF INFORMATION OFFICER 360251 0 0 0 0 0 19500 0 9410 0 389161 0 0 0 DONNA BAKER SR VP AND GENERAL COUNSEL 323260 0 0 0 0 0 44649 0 18700 0 386609 0 0 0 JEFFREY GERING VP OF PLANNING & SUPPORT S 290453 0 0 0 0 0 19500 0 7247 0 317200 0 0 0 JANET ADAMIAN VP OF PROGRAMS AND SYSTEM 252998 0 0 0 0 0 23500 0 15741 0 292239 0 0 0 SAMIR RANJAN CIO 267673 0 0 0 0 0 19500 0 0 0 287173 0 0 0 KHAWLA SULEIMAN-QAFITI CHIEF OF PEDIATRICS 244895 0 8121 0 0 0 26000 0 0 0 279016 0 0 0 NARAYANADAS C VAKAMUDI CHIEF TECHNOLOGY OFFICER 237694 0 0 0 0 0 19500 0 8700 0 265894 0 0 0 DAVID WHISENHUNT VP - PHYSICAL FACILITIES 209689 0 0 0 0 0 25791 0 15741 0 251221 0 0 0 LISA DUNCAN VP OF NURSING & COMPLIANCE 182769 0 0 0 0 0 19500 0 11418 0 213687 0 0 0 DR WINESBURG PHYSICIAN PAY OFF EDUCATION LOAN/CLAIMS X 154641 10859 0 1 1 DR VALDIVIA PHYSICIAN PAY OFF EDUCATION LOAN/CLAIMS X 97430 18159 0 1 1 DR KASANAPALLI PHYSICIAN PAY OFF EDUCATION LOAN/CLAIMS X 14496 0 1 1 DR GONZALEZ PHYSICIAN PAY OFF EDUCATION LOAN/CLAIMS X 60000 38268 0 1 1 DR ALIMONOS PHYSICIAN PAY OFF EDUCATION LOAN/CLAIMS X 113929 56732 0 1 1 DR DEMIK PHYSICIAN PAY OFF EDUCATION LOAN/CLAIMS X 157640 123469 0 1 1 DR NIAZI PHYSICIAN PAY OFF EDUCATION LOAN/CLAIMS X 275000 123089 0 1 1 JOSE MORENO NURSE PAY OFF EDUCATION LOAN/CLAIMS X 10000 6500 0 1 1 377076 X PERSONAL PROTECTIVE EQUIPMENT-COVID 54804 441830 FMV X HAND SANITZER-COVID 23016 322224 FMV X CLEANING SUPPLIES-COVID 219 2741 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS SUBMITTED TO THE BOARD OF DIRECTORS AND MANAGEMENT FOR REVIEW. UPON FINAL APPROVAL, THE FORM IS FINALIZED AND SUBMITTED TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C FHCSD MONITORS AND ENFORCES COMPLIANCE WITH THE FHCSD'S CONFLICT OF INTEREST POLICY BY HAVING A CORPORATE COMPLIANCE COMMITTEE ACTIVELY AND PERIODICALLY PERFORMING AUDITS TO ENSURE COMPLIANCE. STAFF ARE TRAINED ANNUALLY TO REMIND THEM OF THEIR ONGOING OBLIGATION TO REPORT ANY INCIDENT OF FRAUD OR CONFLICT OF INTEREST. THERE IS A HOTLINE TO CALL WHERE THEY CAN REMAIN ANONYMOUS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS OF DETERMING COMPENSATION FOR THE FHCSD'S TOP MANAGEMENT AND KEY EMPLOYEES INVOLVES OUR HUMAN RESOURCES DEPARTMENT. IT IS BASED ON A NUMBER OF CONSIDERATIONS SUCH AS THE NATURE AND SCOPE OF INDIVIDUAL DUTIES, BACKGROUND, EXPERTISE, SIZE, COMPLEXITY OF ORGANIZATION, AND AMOUNT PAID BY SIMILAR ORGANIZATIONS OF SIMILAR SIZE AND TYPE. HUMAN RESOURCES ROUTINELY CONDUCTS SALARY SURVEYS AND PERFORMS ASSESSMENTS OF THE JOB MARKET. THE FINAL DECISION RESTS WITH THE GOVERNING BOARD WHEN THE ANNUAL CORPORATE BUDGET IS REVIEWED AND APPROVED FOR ADOPTION. FORM 990, PART VI, SECTION C, LINE 19 FAMILY HEALTH CENTERS OF SAN DIEGO'S GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 1C: ALL REVIEW AND PROCESS FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR REMAINS CONSISTENT BETWEEN YEARS. 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