2022-05-16T14:49:19-05:00 2021-06-30 680037990 GILBERT CPAS 2880 GATEWAY OAKS DR STE 100 SACRAMENTO CA 95833 990 2020-07-01 942210447 AMPLA HEALTH AMPL 5306744261 935 MARKET STREET YUBA CITY CA 95991 BENJAMIN H FLORES MPH PRESIDENT/CEO 5306744261 2022-05-16 1 BENJAMIN FLORES MPH 999009999 AMANDA H WILLIAMS P01281212 9166466464 2022-05-16 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z BENJAMIN H FLORES MPH 935 MARKET STREET YUBA CITY CA 95991 80477920 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. 14 14 539 14 0 0 11223871 17549015 58979380 62856430 127293 72475 0 0 70330544 80477920 0 0 0 0 48643988 56257040 0 0 0 20208539 23179821 68852527 79436861 1478017 1041059 36103762 44466635 12622946 19261726 23480816 25204909 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 60413020 62856430 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, 2021 HAD 349,532 PATIENT ENCOUNTERS. 60413020 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 53 0 1 539 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 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 OF DIRECTORS - CHAIR 0.69 X X 0 0 0 OWENS KIM BOARD OF DIRECTORS - VICE CHAIR 0.69 X X 0 0 0 CALDERON J ANGEL BOARD OF DIRECTORS - VICE CHAIR 0.69 X X 0 0 0 FLORES BENJAMIN CEO 40.00 X 429326 0 34523 PERALTA CORRALES CARLOS COO 40.00 X 216153 0 20427 WALKER KATHY CFO 40.00 X 187128 0 20760 PORCAYO DEBBIE BOARD OF DIRECTORS - SECRETARY 0.69 X X 0 0 0 FLEMING JOHN PLANNING & DEVELOPMENT DIRECTOR 40.00 X 155241 0 18616 SNELGROVE CINDY NURSING DIRECTOR 40.00 X 192749 0 19884 SIRI DANIEL DENTAL DIRECTOR 40.00 X 294830 0 21744 AMMAR MUSTAFA MEDICAL DIRECTOR 40.00 X 662559 0 26114 VASQUEZ WENCESLAO BOARD OF DIRECTORS - TREASURER 0.38 X X 0 0 0 ALAMSHAHI KANESHKA MEDICAL DOCTOR 40.00 X 406403 0 23452 ASAFA OLUSOLA MEDICAL DOCTOR 40.00 X 378349 0 18588 AUNG THINN MEDICAL DOCTOR 40.00 X 374024 0 22913 SANDHU SARTAJ MEDICAL DOCTOR 40.00 X 396294 0 22854 GANESAN THIYAGU MEDICAL DOCTOR 40.00 X 389294 0 22104 LUNDBERG MARK MD BOARD OF DIRECTORS - PARLIAMENTARIAN 0.38 X X 0 0 0 VAISHALI AUSTIN BOARD OF DIRECTORS - MEMBER 0.69 X 0 0 0 PALACIOS CARLOS O BOARD OF DIRECTORS - MEMBER 0.38 X 0 0 0 GARICA ERNEST DDS BOARD OF DIRECTORS - MEMBER 0.38 X 0 0 0 DIVINDER K BAINS BOARD OF DIRECTORS - MEMBER 0.69 X 0 0 0 VALDOVINOS LORENZO BOARD OF DIRECTORS - MEMBER 0.46 X 0 0 0 GONZALEZ ROBERTO BOARD OF DIRECTORS - MEMBER 0.46 X 0 0 0 POPE JOYCE BOARD OF DIRECTORS - MEMBER 0.69 X 0 0 0 VANG TENG BOARD OF DIRECTORS - MEMBER 0.69 X 0 0 0 4082350 0 271979 100 0 1 0 IRIS TELEHEALTH 114 WEST 7TH ST SUITE 900 AUSTIN TX 78701 CONTRACTUAL TELEPSYCHIATRY 545742 SOLUTIONS 4 COMMUNITY HEALTH 1037 MAIN STREET PEEKSKILL NY 10566 CONTRACTUAL MANAGEMENT 535417 ECLINICAL PO BOX 847950 BOSTON MA 02284 CONTRACTUAL DATA SERVICES 467260 COMCAST PO BOX 37601 PHILADELPHIA PA 19101 CONTRACTUAL DATA SERVICES 414065 V V C HOLDING CORP PO BOX 840952 DALLAS TX 75284 CONTRACTUAL DATA SERVICES 352241 15 17262722 286293 2501 17549015 PATIENT REVENUE 621110 43852887 43852887 FEES FOR SERVICES 621110 19003543 19003543 62856430 72475 72475 80477920 62856430 0 72475 X 2300057 1826199 473858 44225912 35114487 9111425 1100478 873757 226721 5600198 4446445 1153753 3030395 2406073 624322 11269165 8379701 2889464 948103 594819 353284 2755328 1838996 916332 115244 49250 65994 436792 36915 399877 1426591 802599 623992 278698 30026 248672 SUPPLIES 4273286 3218671 1054615 BAD DEBT 1120062 531156 588906 LICENSES 229033 108612 120421 OTHER EXPENSES 224940 106669 118271 102579 48645 53934 79436861 60413020 19023841 0 9153186 7642982 847087 463828 1017129 2833584 5662168 8545120 234558 132904 948250 903009 47281510 23336302 18241384 23945208 36103762 44466635 6100502 8378419 939354 244772 5583090 10638535 12622946 19261726 X 23480816 25204909 23480816 25204909 36103762 44466635 1041059 683034 0 X X 0 1 X 1 1 1 X 9385427 503018 9835212 11906905 17549015 49179577 9385427 503018 9835212 11906905 17549015 49179577 49179577 23174 39928 43515 127293 72475 306385 7574444 7574444 57060406 279260007 0.86190 0.70870 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3749794 3749794 29230279 12760941 16469338 12933750 10575361 2358389 1367687 1367687 23945208 80477920 0 80477920 0 80477920 79436861 0 79436861 0 79436861 X X X 0 0 0 0 0 0 0 1 0 FLORES BENJAMIN CEO 423326 0 6000 0 0 0 20619 0 13904 0 463849 0 0 0 FLEMING JOHN PLANNING & DEVELOPMENT DIRECTOR 155172 0 69 0 0 0 4712 0 13904 0 173857 0 0 0 PERALTA CORRALES CARLOS COO 216153 0 0 0 0 0 6523 0 13904 0 236580 0 0 0 SNELGROVE CINDY NURSING DIRECTOR 192749 0 0 0 0 0 5980 0 13904 0 212633 0 0 0 WALKER KATHY CFO 187128 0 0 0 0 0 6856 0 13904 0 207888 0 0 0 SIRI DANIEL DENTAL DIRECTOR 291253 0 3577 0 0 0 7840 0 13904 0 316574 0 0 0 AMMAR MUSTAFA MEDICAL DIRECTOR 511468 0 151091 0 0 0 12210 0 13904 0 688673 0 0 0 ALAMSHAHI KANESHKA MEDICAL DOCTOR 355818 0 50585 0 0 0 9548 0 13904 0 429855 0 0 0 ASAFA OLUSOLA MEDICAL DOCTOR 281654 0 96695 0 0 0 4684 0 13904 0 396937 0 0 0 AUNG THINN MEDICAL DOCTOR 340119 0 33905 0 0 0 9009 0 13904 0 396937 0 0 0 SANDHU SARTAJ MEDICAL DOCTOR 327074 0 69220 0 0 0 8950 0 13904 0 419148 0 0 0 GANESAN THIYAGU MEDICAL DOCTOR 266959 0 122335 0 0 0 8200 0 13904 0 411398 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 8,379,701. MANAGEMENT AND GENERAL EXPENSES 2,889,464. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,269,165. 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.