2023-05-12T07:37:31-05:00 2022-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2021-07-01 942210447 AMPLA HEALTH AMPL 5306744261 935 MARKET STREET YUBA CITY CA 95991 BENJAMIN H FLORES MPH PRESIDENT & CEO 5306744261 2023-05-11 1 BENJAMIN FLORES MPH 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2023-05-11 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z BENJAMIN H FLORES MPH 935 MARKET STREET YUBA CITY CA 95991 93373369 0 X HTTPS://WWW.AMPLAHEALTH.ORG/ X 1973 CA 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. 14 14 783 14 37543 20669 17549015 20400235 62856430 68513297 72475 31339 0 4376319 80477920 93321190 0 0 0 0 56257040 61853191 0 0 0 23179821 24219602 79436861 86072793 1041059 7248397 44466635 58961636 19261726 26508190 25204909 32453446 X 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. 1 0 64020160 0 68513297 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, 2022 HAD 355,237 PATIENT ENCOUNTERS.AMPLA HEALTH PROVIDES PHARMACY SERVICES THAT SPECIALIZE IN PROVIDING AFFORDABLE PRESCRIPTIONS TO OUR PATIENTS. 0 64020160 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 52 0 783 1 1 1 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 MUSTAFA AMMAR MEDICAL DIRECTOR 40.00 X 659465 0 38165 BENJAMIN FLORES CEO 40.00 X 447844 0 36883 KANESHKA ALAMSHAHI MEDICAL DIRECTOR 40.00 X 405072 0 24568 NANAK BOPARAI MEDICAL DIRECTOR 40.00 X 364077 0 35450 KANWAR MULTANI MEDICAL DIRECTOR 40.00 X 277338 0 28834 AMITABH SINGH MEDICAL DIRECTOR 40.00 X 281512 0 19607 DANIEL SIRI DENTAL DIRECTOR 40.00 X 278981 0 2879 KATHY WALKER CFO 40.00 X X 211202 0 34706 CARLOS PERALTA CORRALES COO 40.00 X X 209299 0 34197 CINDY SNELGROVE NURSING DIRECTOR 40.00 X 205265 0 13996 JOHN FLEMING PLANNING & DEVELOPMENT DIRECTOR 40.00 X 149585 0 29912 HORACIO PARAS BOARD CHAIR 0.69 X X 0 0 0 KIM OWENS VICE CHAIR 0.69 X X 0 0 0 DEBBIE PORCAYO SECRETARY 0.69 X X 0 0 0 WENCESLAO VASQUEZ TREASURER 0.69 X X 0 0 0 MARK LUNDBERG PARLIAMENTARIAN 0.69 X X 0 0 0 VAISHALI AUSTIN BOARD MEMBER 0.69 X 0 0 0 DIVINDER K BAINS BOARD MEMBER 0.69 X 0 0 0 J ANGEL CALDERON BOARD MEMBER 0.69 X 0 0 0 ERNEST L GARCIA DDS BOARD MEMBER 0.69 X 0 0 0 ROBERTO GONZALEZ BOARD MEMBER 0.69 X 0 0 0 CARLOS O PALACIOS BOARD MEMBER 0.69 X 0 0 0 JOYCE POPE BOARD MEMBER 0.69 X 0 0 0 LORENZO VALDOVINOS BOARD MEMBER 0.69 X 0 0 0 TENG VANG BOARD MEMBER 0.69 X 0 0 0 3489640 0 299197 100 0 1 0 ECLINICAL PO BOX 847950 BOSTON MA 02284 CONTRACTUAL DATA SERVICES 960150 COMCAST PO BOX 37601 PHILADELPHIA PA 19101 CONTRACTUAL DATA SERVICES 452953 LANGUAGE LINE SERVICES PO BOX 202564 DALLAS TX 75320 CONTRACTUAL HEALTH SERVICE CONSUL 363023 ELITE UNIVERSAL SECURITY 5548 FEATHER RIVER BLVD OLIVEHURST CA 95961 CONTRACTUAL STAFFING /TEM SRV 357717 MALWA DOCTOR'S INC 1420 E ROSEVILLE PKWY 140-217 ROSEVILLE CA 95661 CONTRACTUAL PHYSICIAN 244400 16 20388635 11600 20400235 PATIENT SERVICE REVENUE 621110 44751590 44751590 PHARMACY REVENUE 621110 18056812 18056812 CAPITATION REVENUE 900099 5704895 5704895 68513297 31339 31339 89722 52179 37543 37543 37543 4338776 4338776 4338776 93321190 68513297 37543 4370115 X 1074840 1074840 50254829 39342523 10912306 1525635 1188918 336717 5627782 4347691 1280091 3370105 2586173 783932 149254 149254 74075 74075 13803721 10268928 3534793 651606 121496 530110 344124 64164 279960 1755369 1478387 276982 245132 60413 184719 174923 32615 142308 495242 33606 461636 1800603 1022956 777647 378232 38838 339394 MEDICAL SUPPLIES 3648454 3046714 601740 REPAIRS AND MAINTENANCE 462991 342757 120234 235876 43981 191895 86072793 64020160 22052633 0 7642982 463828 13844331 2833584 1892259 8545120 10709438 132904 366115 903009 1131784 55952006 25140082 23945208 30811924 0 205785 44466635 58961636 8378419 9908270 244772 14236 10638535 14590106 0 1995578 19261726 26508190 X 25204909 32453446 25204909 32453446 44466635 58961636 7248397 140 0 X 0 1 X 1 1 1 X 503018 9835212 11223871 17549015 20400235 59511351 503018 9835212 11223871 17549015 20400235 59511351 59511351 39928 43515 127293 72475 31339 314550 37543 37543 59863444 311265942 0.99410 0.86190 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3749794 3749794 35392926 13766754 21626172 12608591 10961361 1647230 4200695 411967 3788728 30811924 3RD PARTY REIMBURSEMENT PAYABLE 1951358 OPERATING LEASE LIABILITY 44220 1995578 93373509 140 52179 52319 93321190 0 93321190 86124972 52179 52179 86072793 0 86072793 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 0 0 0 0 0 0 0 0 0 MUSTAFA AMMAR MEDICAL DIRECTOR 461300 0 150087 0 48078 0 7433 0 30732 0 697630 0 0 0 BENJAMIN FLORES CEO 443272 0 0 0 4572 0 15250 0 21633 0 484727 0 0 0 KANESHKA ALAMSHAHI MEDICAL DIRECTOR 351690 0 53058 0 324 0 5837 0 18731 0 429640 0 0 0 NANAK BOPARAI MEDICAL DIRECTOR 303356 0 49000 0 11721 0 5439 0 30011 0 399527 0 0 0 KANWAR MULTANI MEDICAL DIRECTOR 236040 0 41041 0 257 0 3205 0 25629 0 306172 0 0 0 AMITABH SINGH MEDICAL DIRECTOR 251679 0 29545 0 288 0 4591 0 15016 0 301119 0 0 0 DANIEL SIRI DENTAL DIRECTOR 254214 0 15531 0 9236 0 1022 0 1857 0 281860 0 0 0 KATHY WALKER CFO 210650 0 0 0 552 0 4237 0 30469 0 245908 0 0 0 CARLOS PERALTA CORRALES COO 192610 0 7418 0 9271 0 4186 0 30011 0 243496 0 0 0 CINDY SNELGROVE NURSING DIRECTOR 184622 0 16196 0 4447 0 3466 0 10530 0 219261 0 0 0 JOHN FLEMING PLANNING & DEVELOPMENT DIRECTOR 136922 0 1849 0 10814 0 2794 0 27118 0 179497 0 0 0 FORM 990, PART III, LINE 2 AMPLA HEALTH STARTED OFFERING PHARMACY SERVICES THAT SPECIALIZE IN PROVIDING AFFORDABLE PRESCRIPTIONS TO OUR PATIENTS. 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 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 CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 10,268,928. MANAGEMENT AND GENERAL EXPENSES 3,534,793. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,803,721.