112022 REQUEST FORPROPOSALS: Mental-HealthAssistance
Progr:am, Requiring-Certified Counseling/ClinicalServices" City of South Gate
City Clerk's Office
LeNoue,Interim Housing Manager
CA 90280
Attn: Ana
8650 Califprnia Avenue, South
OR
Office of the
Sotai ameCityClerk
JUN 2 2 2022
FILED
378-2009
ati9r!prog/wp
4.363 Tweedy Blvd.
'ujh G4je,.CA 90280
. 32:3
1086
ATT ACHMENT E
AltaMed
QLIALITY CARE Wl'rHOU} EXCEI'TION a
ALTAMED HEALTH SERVICES CORPORATION
Expanding Mental Health Seiyices in a
Federally Qualified Health Center Serving the
City of South Gate
PART I: APPLICATION MATERIAI_,S
Prepared In Response to:
City of Soutl'i Gate ARPA Mental Healtli RFP 2022
Mental Health Assistance Progran'i Requiring Ceitified Counseling/Cliiffcal Services An Ainerican Rescue Plan Act (ARPA) Funded Project
June 23, 2022
PROPnSAlPAGFlnfll3 }4'2/
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Table of Contents
I. Cover Letter 3
PROJECT PROPOSAL
n, Local Presence/History of Serving the City of South Gate 4 In. Diversity that Reflects the Cominunity Served in Staff and Board 5 IV. Staff & Financial Capacity 6
V. Prograin Plan 7
VI. ProgramResponsetoCommunityCOVID-19 10
VII. Irivestigation Statement 11
VIII. Insurance Requirements 12
IX, Additional Informational Exhibits 20
A, Federal Identification Number (Tax ID Number) 21
B. Unique Entity Identifier 21
C. Most Recent Filed Tax Return 22
D. Project & Organizational Budget 89
E. Resumes of Key Program Staff & Orgai*ational Chart 95 F. Brochures and Promotional Materials 102
AltaMed Health Services Corporation *ASG= AltaMed South Gate PROPOSAL PAGE 2 of 113 P1"= 1088
AJtaMed
June22,2022
RE: CityofSouth GateARPA MentalHealthRFP2022
To Whom It May Concern:
AltaMedHealthServicesis pleasedto submititsapplicationin responseto the Cityof SouthGateARPA Mental HealthRFP2022.AltaMedisproposingto leverageitsexistingPatientCenteredMedicalHome(PCMH)capacityto furtherexpandbehavioralhealthservicesatits SouthGateclinicanddevelopadeeperintegrationof theseservices withinitsprimarycarescopebyexpandingits mentalhealthservicestoprovide:
("I) ScreeningandlndividualRiskAssessment
(2) IndividualCounselingand GroupSessions
(3) ClinicalBehavioralHealthServices
(4) MentalHealthEducationand Self-ManagementSkillsDevelopment AltaMedrespectfullyrequests$175,000(aloaded hourlyrateof$84.13) to provideon-sitetrainingfor clinic andbehavioralhealthteam membersofthe PCMHcareteamon usingScreening,BriefIntervention,and Referral to Treatment(SBIRT)to helpidentifyand managepatientswith mentalhealthchallengesandconnectthemto appropriatecareinindividualandgroupsettings.Overthe projectyear,AltaMedwill screen70% ofeligiblepatients andprovideclinicalbehavioralservicesto upto350patientsthroughindividualandgroup services.
Thisprogramwill leverageAltaMed'sexistinginfrastructureandcommunitypartnershipsto provideclose, fully integratedbehavioralhealthservicestovulnerablepatientsinthe Cityof SouthGate,improvingcarequality and reducingthe widedisparityinhealthoutcomesbetweenlow-income,Latinopopulationsandothergroups.This projectwill improvepatientaccesstoandcontinuityof careforall behavioralhealthpatientsandimprovethe ability ofprimarycareprovidersto provideseamlesstreatmentfor patientswithbehavioralhealthandsubstanceabuse needs.Inordertosupporttheaimsofthis project,AltaMedwill coordinatewithcommunityprovidersandlocal healthagenciesservingSouthGateresidentstofacilitatereferralsfor treatmentandadditionalsocial supports.
AltaMedis committedto meetingthe requirementsof the RFPandtheprojectit hasproposedinthis application.TheauthorizedindividualforAltaMedis:
Castulode la Rocha
President& CEO
AltaMedHealthServicesCorporation
2040CamfieldAvenue
LosAngeles,California90040
Phone:323.889.7343
Email:[email protected]
Pleasedo nothesitateto contactTatianaAlvarez([email protected],323.622.2445)and/or NenaDavis (ndavispaltamed.orq,323.889.7343)ifthereareanyquestionsor concernsregardingthisapplication.
Sincerely,
Castulodela Rocha
President& CEO
(AuthorizedIndividual)
AltaMed Health Services Corporation p,,Pa5iAm 3 oflj:, 3u233782a5g7878o581 AltaMed.arg
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Expanding Mental Health Services in a
Federally Qualified Health Center Sewing the
City of South Gate
I. Cover Letter (See Top Sheet)
II. Local Presence/Histoiy of Serving tlie City ofSouth Gate Founded in 1969, AltaMed is a non-profit 501(c%3)Federally Qualified Health Center. Now tbe largest FQHC in Califomia, with 30 ditffcs in LA and Orange Corinty, AltaMed's regional health network provides underserved populations witli a dedicated, patient centered medical home. AltaMed provides integrated services inclriding prin'iary care witli linkages to specialty services, Won'ien's Health, Beliavioral Health, F-IIV Services, Compreliensive Perinatal Services, Dental Care, Social Service Linkages, and Workforce Development. AltaMed's n'iission is, "To eliminate disparities in health care access and oritcomes by providing superior quality healtl"i and hun'ian services through an integrated world class delivery system for Latino, multi-ethnic and underserved comiminities." AltaMed erffiances its work tmorigh tlie provision of ongoing ct'ilfurally- and linguistically-appropriate health education and wellness promotion in collaboration with schools and coiniminity groups.
In 2021, AltaMed served 257,000 unique patients, an increase of 20% since 2018. AltaMed mairxtains a high level of perforinance on its HEDIS measi.ires, outscoring other coirunt'u'iity healtli centers in its effoits to iinprove care quality for its patients. In the last 3 years, AltaMed has scored in the 90"' percentile for Medicaid providers, ensiring 86.9% of its diabetic patients received tlieir aru'iual Hemoglobin Alc screening. AltaMed was in the 90"' percentile for Cervical Cancer Screening and Breast Cancer Screening. Tl'iese goals are in keeping with AltaMed achieving a 4-Star Medicare Rating in the next few years. AltaMed has also worked to iiicrease its behavioral health services, providing depression and ai'ixiety screening foy more than 143,000 adults each of the last 3 years.
AltaMed has extensive experience with large scale awards and projects, including:
(1) Clinical Pharmacy: Originally piloted in partnership witli University of Southern Califoinia (USC) with a $12 million Health Care Innovation Award from the Centers for Medicare & Medicaid Setyices. Patients enrolled in stttdy experienced favorable oritcomes, iiicluding sigiatificant reductions in cholesterol, blood sugar and blood pressure markers within tl'ie first six months compared to control sites (patients receiving usual care). Tlie progran'i resulted in a 20% decrease in Hemoglobin Alc in diabetic patients and reduced overall costs of care. (2) Behavioral Health Integration: In 2014, AltaMed received a $500,000 grant from HRSA to integrate an SBIRT protocol for depression iiito its priinatay care protocol. Since then, AltaMed lias s'iccessfully iniplemented tl'ie program witli ah'iiost 143,000 adults (in 2019, pre-COVID) receiving a depression screei'iing at their first or annrial visits.
AltaMed Healtli Services Corporation *ASG= AltaMed South Gate PROPOSAL PAGE 4 of 113
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AltaMed has setved South Gate for ovet 40 years and in 2018 launched a dedicated South Gate clinic through which it provided 76,795 encounters to 32,027 unique patients in 2020, The same year, AltaMed launched its Faiuily Medicine Residency Prograin, centered at its South Gate clinic with the goal to grow fainily medicine physicians who will provide access to high quality healthcare to meet the needs of the underserved and often vulnerable populations it serves, Through the residency program, AltaMed works with South Gate counity partners to provide inobile health and dental services, health education, health fairs to mpport health insurance renewals, and other community support programs.
Sectiotx Word Count: 496
III, DiversitythatReflectstheCommunityServediriStaffandEoard AltaMed's target patients are vulnerable, underserved populations, with 78% on Medicaid or Medicare and 14% uninsured, Of AltaMed's South Gate patients, 75% preferto be served in Spanish and 89.3% are Latino, This counity has significant disparities in health care access, quality and outcomes: 72,7% live below the federal poverty level and are more likely to be obese (28%), with hypertension (22.8%), or high cholestetol (27,6%), And, 48% of seniors (>65 years old) are rated as in "poor health" by the CaliforniaHealth Survey. The National Survey on Drug Use and Healthl showed that Hispanics were more likely to need substance use treatment (9.9% vs. 9.2%) or suffer from mental illness (18%) in the past year, AItaMed has successfully adopted the National CLAS standards, developing a workforce the majority of whom are bilingual in English and Spanish, and are fainiliar with the lifestyle and cultural diversity of the population, AltaMed"s staffreflects the community it serves, with 75% of staff and 54% of managers from I-Iispanic/Latino backgrounds, AltaMed routinely engages coinnnunity members through the Board of Directors (which is 51% comprised of patients) and various wellness progranns.
AItaMed maintains a Cultural and Linguistics Specialist to educate the staff on culturally and linguistically sensitive service, includiiig conflict management/resolution and presentation/telephone etiquette. AltaMed conducts annual community needs assessments to understand characteristics, shifting demographics, and accurately assesS needs. AltaMed receives patient feedback on services through ongoing satisfaction surveys.
Organizational Chart: See Exibit 9.
Section Wmd Coutit: 240
l Cemerfor BehavioralHealthStatisttcsaiidQuality. (2012).Resultsfrom the20H Nationa[SurveyonDrug UseandHealth: Summary ofnationalfindings (I-nE PublicationNo. 8MA 12-4713,NSDUI-ISeriesH-44). Rockvi]le,MD: SubshinceUseandMental Health Services Administration.
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IV. Staff & Financial Capachy
AltaMed employs over 3,000 professionals and support staff across its LA and Orange County clinics. AltaMed's South Gate clinic is served by 13 physicians and 6 dentists, in addition to support staff that includes nurses, dental hygienists, medical and dental assistants, and administrative staff. The South Gate clinic also houses AltaMed's Family Medicine Residency Prograi'n, with a team dedicated to expanding services to the South Gate cotnmunity through mobile medical and dental services and wellness education.
The Behavior Health Team, which will oversee this project, is led by Dr. Sandra Pisano (Licensed Clinical Psychologist) and Zares Soto (Manager, Behavior Health) (see enclosed resumes). They will lead to the team to provide:
(1) ScreeningandIndividualRiskAssessment
(2) Individual Counseling and Group Sessions
(3) Clinical Behavioral Health Services
(4) Mental Health Education and Self-Managemerit Skills Development Funding will support key staff to help expand behavioral health screening, treatment, and education at AltaMed ;South Gate (ASW), including a Licensed Clinical Social Worlcer and Patient Navigator, The LCSW will provide direct behavioral health services for participants with mild to moderate alcohol or substance use disorders, anxiety, and/or depression and support referrals to community or inhouse providers for patierits with severe disorders or additional, long terin counseling needs, They will also ensure complete screenings for participants, following up on positive PHQ-2, AUDIT or DAST-10 sereens.
The PatientNavigator follows up with patients after receiving an initial positive screen, connects them with the LCSW for appropriate additional screening, and sets appointments with the LCSW or additional services/specialties, following up with patients to ensme appointments were attended, They also connect patients with any external social service needs such as housing, food, family support (i.e. Women Infant & Children services), The PN will also support accurate perfotmance assessment by appropriately tracking progrann encounters and patient demographics. The Grants Manager will support program reporting and administration.
With strong systeins to support timely and effective implementation of all its progranxs, AltaMed successfully manages a portfolio of over 90 contracts with federal, state, and local agencies and approximately 20 private foundation grant agreements, several awards exceed $100,000 per year. All tequire fiscal accountability, traclmg and moitoring of progtam data, continrious quality iniprovement, and reporting activities. AltaMed has over 50 years of experience developing programmatic and financial reports and lias built a sound administtattve frameworkto perfom regular reporting functions. AltaMed progrann directors, managers and AltaMed Healtli Services Corporation i ASG= AltaMed South Gate PROPOSAL PAGE 6 of 113
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coordinators have extensive experience working closely with data and finance staff to prepare required teports to funders in compliance with grant and contract agreements. In addition, AltaMed has extensive experience delivering services according to a defined scope of work, within pre-determined timelines and according to project plans/schedules and within a set budget.Thesesystemswill ensureAltaMed meetsthereportin@requirem@ntsof ARPA, including using monthly dashboards and ledgers for program activity and to manage accounting expenses.
AltaMed traclcs and manages finances on the basis of fund accounting, using an accrual basis for financial reporting purposes. AltaMed's financial management accounting system is Micro Information Products (MIP) which reports the operations of each prograin or grant in a separate cost center in the form of revenues and expenses (budget amounts vs outlays), This allows AltaMed to effectively maintain accurate financial reporting by prograin/cost center and funding source across the organization, At the end of each month all baic accounts are reconciled, grant revenues are reviewed, month-end journal entries are posted and monthly reports are prepared anddistt'buted to eachof the Pro@ai'n Director, Fiscal(Grant) ManagerandSeniorBxecutive in charge of progranis. The Prograxn Director and Fiscal ((3rant) Manager track and monitor program objectives, budget compliance, and repoiting activities for this project using the Grant Managementtool. The tool, populated with both financiaf and program data, notifies staff about upcoming reports and ensures that boththe Annual Reports and Performance reports are submitted prior to deadlines, AltaMed's federally funded programs are reviewed annually by progratn officers from HRSA, SAMHSA, and other funding agencies based on these financial and program reports,
Each month, AltaMed's Board of Directors receives a comprehensive package which includes financial statements and analysis for review of the overall financial health of the organization. AltaMed undergoes an independent annual audit of its financials by the fitin Vasquez & Company, LLC (Certified Public Accountants and Business Consultantsi to ensure thatAltaMed hasmet an public andfederalguidelinesfor accountingandfinancial mansBement Sectkm Word Count: 729
V Programs Plan
As an FQHC, AltaMed has a robust Behavioral Health program in its coinmunity clinics.
However, due to the COVID-19 pandemic, AltaMed's resources for behavioral health have been reduced and the demands on these services have increased. AltaMed's existing services include usingtheevidence-basedmodelScreening,Brief Irxterventton,Referralfor Treatment(SBIRT)to screen patients for depression/anxiety using the Patient Health Questionaire-2 (PHQ-2/PHQ-9).
However, with limited resources, AltaMed often refers these patients to the LA Department of A]taMed Health Services Corporation *ASG= AltaMed South Gate PROPOSAL PAGE 7 of 113
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Mental Health for additional services, With the proposed program, AltaMed will leverage this infrastructure to expand and 6nhance its behavioral health services. Funding will support a full tiirie LCSW and Patient Navigator, to provide clinical behavioral health services, including:
A. Universal Screening for Depression/Anxiety: All ASG* patients, 18 years or older, will be screened during annual visits using the PHQ-2, ASG served 32,000 patients in 2020, with more than 19,000 eligible adults, While 1 LCSW will not be able to support the complete need at this clinic, by implementing the universal screening, AltaMed can asseSsthe patient needs and refer them to treatinent either by the LCSW inhouse or through community partners, All patient screeners are available in Bnglish and Spaish with translation services available for 140 additional languages.
B, Substance Abuse Screening: AltaMed also has pioneered a progtam, COMBAT, which linlcs patients with substance abuse challenges with behavioral health services as part of an overall clinical approach to reduce inappropriate use of opioids and other substances. In order to effectively expand this program, AltaMed will also workto create worlcflow to screen for alcohol and substance abuse usii'ig Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST-10), EPIC will be used to identify patients with OUD risk factors based on their prescription history, age, chronic conditions, and other risk factors, including prescriptions for both opioids and/or benzodiazepines/gabapentin and referrals for pain management.
C. Intenention/Treatment/ReferraJ: If patients screen positive, on the PHQ-2, (AUDIT or DAST-10 in Year 2), they receive Brief Intervention from their physician and refetral to LCSW.
Patients with rnild/moderate anxiety/depression work w'th the LCSW on a 6-8 week cognitive behavioral therapy course. These sessions may be conducted in person or through telehealth services, either individual or group sessions. Patients with substance abuse are referred to the COMBAT program, where the Navigator links an LCSW and a medication assisted treatment (MAT) provider to help the patient use closely monitored medications (i,e. buprenorpe, naloxone, etc,) to reduce substance abuse.
D, Communitv Support Linkages:,The Patient Navigator They will call patients before and after visits and ensure patients retnain engaged koughorit the prograin and connect patients with social services for housing and food insecurity,
E, Community0ptreach&Education:LeveragingtheFatnilyMedicineresidents'inSouth Gate, the Behavioral Health team wffl workwith the mobile health unit and communication teains to publicize the mental health resources available for South Gate residents, including individual session, group sessions, self-management support, etc.
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South Gate Mental Health Screening Process:
s
a
gi
Goals & Outcomes: By tlie end of the project year, June 30, 2022, AltaMed will:
(l) Screening and Individual Risk Assessment:
Expand the SBIRT i'iiodel at ASG, ensuring 70% of eligible patients receive a depression/anxiety screening using PHQ-2.
Complete a clinic workflow assessment and development for adopting universal screening with AUDIT-C, DAST-10, and ASAM
(2) Clinical Behavioral Health Services/Individual Counseling and Group Sessions:
Provide clii'iical behavioral liealtli services using cognitive behavioral therapy ii'i individual counseling and grorip sessions for up to 350 patients (3) Mental Health Education and Self-Management Skills Development:
Provide con'ununity outreacli to increase awareness of mental health challenges and their relation to chronic illnesses such as diabetes, hypertension, arthritis, high cholesterol, etc.
Provide monthly social media outreacli posts to inctease mental health and emotional management
Collaborations: Since June 2015, AltaMed l"ias been pait of an ii'inovative program called LA Healtli Neighborhood wl'ffch created a network of primary care and behavioral health providers in South Gate and other LA areas., iixcludiiig LA Department of Mental Health, Alrna Fainily Services, Mela Counseling, Soutlieian California Alcohol and Diug Programs, Aegis Treatment Centers, and LA Centers for Alcoliol and Drug Abuse,
Budget: See Exhibit 9D.
Fully Burdened Rate: AltaMed's fully burdened liourly rate for the proposed project is AltaMed's in-kind suppoit as noted on the budget, will be provided by its operatiorial expenses. AltaMed will not be using ARPA funds for any of its in-kind services.
Section Word Couiyt: 736
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Vl. PrograniRespometoComniumtyCOVID-19
AltaMed's program is in direct response to the COVID-19 needs of the South Gate coinmunity. In tlie last 2 years, community liealth centers have helped to fori'n a significant portion of the nation's response to the COVID-19 pandeinic. The National Association of Cotninunity Health Centers (NACHC) repoits that between April 2020-April 2021, coininunity health centers tested over 12 million patients for COVID-19 and provided over 13 n'iillion vaccinations, with 49% of vaccinated patients self-identifying as part of a racial or ethnic minority2. During the height of the pandeinic, AltaMed perfott'ned more tlian 5,000 COVID-19 tests per week, one of the higliest of all conununity health centers in California. AltaMed consistently demonstrated lffglier positivity rates in its tests results, likely due to tlie population served being primarily low-income, essential workers. AltaMed lias also been a key provider of COVID-19 vaccinations, larinching a telephone help liixe to reach orit to patients to encourage vaccine awareness and compliance. This Help Line also received calls to l'ielp assuage patient concerns and schedrile appointments. AltaMed's patient base also swelled from 237,000 to 270,000 in ruider one year, as many individuals lost their l'iealth insurance or found themselves newly eligible for Medicaid due to a significant reduction in income.
Despite this impact on the healtli of the country, more tlian 1,600 con"imunity health centers were forced to close during COVID-19, exacerbating an already heavy burden on remaining healtli centers. NACHC reports that between 2010 and 2019, coini'nunity health centers served 10 inillion more patients than in the decade before. As witli most conununity l'iealth centers across tl'ie country, the vast majority of patients served are below 100% FPL (68% nationally,
72.7% at AltaMed South Gate) and rely heavily on governinent health insurance programs. As a key element of the health care fabric for the underserved coiui'nunity in Los Ai'igeles and Orange County, AltaMed clinics are located in areas of high need, offer comprehensive primary care services, provide services to all patients regardless of their ability to pay.
Telehealth: In addition to facing increased medical risk, patiei'its also faced increased mental health challenges, putting additional straiii on AltaMed's Beliavioral Health services. In respoi'ise to the COVID-19 paiidemic, AltaMed accelerated its effoits to build its telel'iealth infrastructure. In 2020, AltaMed adopted Vidyo, a video telehealtli platforins that is integrated into EPIC, AltaMed's electronic healtl'i system to facilitate patient encounter documentation, practice management, case management, and billing. AltaMed enbanced its viitiial care model to serve patients' clinical visits and ancillaiy suppoit, including health education, cl'iroi'iic disease care managen'ient, and pharmacist assisted medication therapy management. Over the last two years, AltaMed provided 44% of medical encounters and 49% of beliavioral l'iealth encounters virtually, Tis transition l'ias helped to increase capacity dtie to the number of ii'idividuals whose 2 NACHC April 2, 2021 Report based on data from https://bphc.hrsa.qov data from April 3, 2020-April2, 2021 AltaMed Healtli Services Corporation *ASG= AltaMed Soutli Gate PROPOSAL PAGE 10 of 113
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economic situation changed because of COVID-19, AltaMed also expanded its home based care services for the most vulnerable patients, with over 400 seniors with chronic medical conditiots receiving at home care visits from a physician and nurse, These patients were selected due to their high risJcmedical conditions and had recently been discharged from tJhehospital. By providing at home services, AltaMed helped to address the key risk factors present to older patients during the COVIID-19 pandemic.
The proposed program will help patients in greatest need, As an FQHC, AltaMed serves comi'nunities that were already facing economic and social hardships and these were exacerbated by tlie COVID-19 pandemic, By providing these services at the South Gate clinic, AltaMed is offering these services from a trusted and well-frequented provider in a known, easy to access location in South Gate, The proposed program will increase mental health access in low-income cominunities, educate Latino patients about mental health and substance abuse services, and address health care disparities and outcomes by allowing patients to receive consistent mentai health screening and easy access to in person or telehealth services in 1:1 or group sessions, These outcomes reflect the COVID-19 community priorities of the City of South Gate and also align with AltaMed's own mission and goals,
Sectioyi Word Count: 669
Vll. Imestigation Statemetgt
AltaMed certifies that is is not now or nor has it been the subject of a public or private audit or investigation due to potential or alleged financial misnianagement.
AltaMed I4ealtli Services Corporation *ASG= AltaMed South Gote PROPOSAL PAGE 1l of 113
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Vill. Insurance Requiremems
AltaMed Health Services eg3 that it w'll provide and maintain at its own expense an extension of its certificate of insurance that meets the following requirements:
* Worker's Compensation: A program of Worlcer's Compensation insurance or a Stateapproved Self Insurance Prograi'n in an amount and form to meet all applicable requirements of the Labor Code of the State of California, including Employer's Liability with $250,000 liits, covering all persons ptoviding services on behalf of AltaMed and all risks to such persons under this proposal.
Commercial General and Automobile Liability Insurance - This coverage to include contractual coverage arxdautomobile liability coverage for owned, hired, and non-owned vehicles. The policy shall have combined single limits for bodily injury and property damage of not less than one inillion ($1,000,000) dollars.
AltaMed further certifies that each suchpolicy of insurance shall:
* Be issued by a financially responsible insurance company or companies adtnitted and authorized to do business in the State of California or which is approved in writing by the City.
* Name and list as additional itisured the City, its officers and employees.
Specify that such insurance acts as primary insurance.
Contain a clause substantially in the following words: "It is hereby understood and agreed that this policy shall riot be carxceled nor material(y changed except upon thirty (30) days prior written notice to the City ofSouth Gate such cancellatio'rx or material change." Cover AltaMed operations pursuant to the terms of any contract, including the AltaMed's indemnity obligations thereunder
Please see encIoseda s@gB;pfficertificate of insurance provided for previous workwith the City of South Gate. If funded, AJtaMed will enact insurance coverage as stated above in compliance with the program requirements.
AltaMed Health Sexvices Corporation *ASG= AltaMed South Gate PROPOSAL PAGE 12 of 113
1098
CERTIFICATE OF LIABILITY INSURANCE
DATE IMNUDDIYYYY)
auaum3,2020
PRODUCER
HUB International Insurance Services, Ink',
600 Corporate Polnte, 8TE. 600
CulverCity, CA95230
Phone (3'lO) 5(!1-5900/ Fax (866) 248-6053
CA 001 Lie. # 0767776
TH18 0€RTIPtC,AT! IS laaUED 48 A MATTER Or INFORMATION ONLY AND CONPffR8 NO RIGHT8 UPON THti CIRTIPI(:ATE HOLD!iR. THIS t,ERTIPl €,ATE. DOES NOT AM!iND, EXT90 0R A1TERTH5 €:OV!RAa! AFFOR(X:O B'l TH! POLI(,188 BELOW.
1N8URER8 APFORDING COVERAGE NAI(+#
AM aBaT
RATINtl
INSURED
ALTAMED HEALTH SE:RVICE8 CORPORATION
2040 CAMFIELD AVE
LOS ANGELE8, CA90040
1N8URERA! BE7AR18KMANAGEMENT
AlJTHOnlTY 0!i5007 A- 8
1N811R!RBi
kSURERCi
COV1RAGE8
IN!iR
tTR TYPE OF INelURAN(,! POLI(lYNuMB!R POLIC!Y!FFE!(:TIV! oats (MMIDD/YYYY)
POLICY!XPIRATION
DATE IMMIDD)YYY'Q L1MIT8
A
(lffNffRAuliABILITY
H(,L-20-044 07/01/2020 07/at/2021
I_AI.HOCOuRTl&N(!a $2,000,000
(JOOMMgRCIAlaENERAlLiABILITY (fflNL AaOR!-GAT!i $4,000,000 'O(,ttlR € C1A1M8MADE '
MHO!JP (Anyone
person) $5,000
J P51)IONAI& ADVINJtlRY $2,000,000
J
DMlAGmTORIN"TID
PR)JIB!i8 ?8 ocmbtance) $100,000
aEN'l A(fflMGA'ffl LilT APPtffia PER:
[]FK)LICY € PROJEaT € l(X.
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M!J)104! PROFE-!1810NALllAEllLffY
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oscmprtoriopopsnpriotvsltocpnr;slexctusiouspr>t'tosvesoonssuev/spscuu_pnovtstoys ' RE: Community Development Block Grant Agreement - Coronavirus (CDBG-CV) Funds. City of South Gate, officers, agents, employees, and volunteers are named as additionally insured with respect to tegal liability arisJng out of the healthcare services provided by the Insured under contract with the certifk,ate holder, Coverage is primary & non<ontributory. Waiver of subrogation applies.
CERTIFICATE HOLDER
CITY OF SOUTH GATE
ATTN: HUMAN RE80URCES / RISK MANAGaaENT DIV1810N
8850 CALIFORNIA AVE.
SOUTH GATE, CA 90280
SHOULD ANYOFTHE ABOVi DE8CRIBED POLICIE8 BE C:AN(:ELLED BEFORE THE E) €PIRATION DATE THEREOF, THE INSURER APFORDING COVERAGE WILL ENDEAVOR TO MAll 30 DAY8 NOTICE TO THE
CERTIFICATE HOLDER NAMEDTO THE LEFT, BUT FAILURE TO DO 80 8HALL IMPOSE NO OBLIGATION OR uABllffY OF ANY KIND UPON THE INSURER, ITS AOENT8 0R,REPRE8ENTATn/E8.
AUTHORIZED REPRE8BNTATNE
$d,, '
RosemaryPudbli
HUB Intemational Insurance Servkes
G'ANaELLATION 'UCI!iPT 10 DA'ffl FOR NON-PAYMINTOP PRIM[IM PROPOSAL PAGE 13 of 113
1099
BETA Risk Management Authority ('!3ETARMA")
A Pub2ic Entlty
AMENDMENT
STJPPLEMENTAL MEMBF,R - GENERAL LIABILITY ONLY
':..''<.;ffihc;i4N4#l56i:J,);
{y:,i';'{=ne.ps=t':oa4i.:t:a:;:g
Amendment No:
H492-07
Issued to: AltaMedHealth Services Corpoiation
Effective Date: 07/01/20 at 12:Ola.m. Expiration Date: 07/01/21 atl2:01 a.m, Additional Contribution: Per Contract It is understood and agreed that coverage afforded by Section 3 (Bodily Injury and Property Damage Liability) and Section 4 (Personal Injury, Advertising Injuryand Discrimination Liabiiity) of this Contract is extended to:
CityofSouthGate,its officers,employees,agents,aridvolurtteers as a Supplemental Member pursuant to Section 7.2, but only for legal liabffity arising out of the acts, errors or omissions of the Named Member or a Subsidiary solely in tlie performance of the following contract w'th the Named Member or Subsidiary:
CommunityDevelopmentBlockGrantAgreement- Coronavirus(CDBG-CV) Funds ThisAmendmentdoesnotextendcoveragefor theacts,errorsoromissionsof CityofSouthGate,its officers, employees, agents, arid volunteers.
This Amendment extends protection to the Supplemental Member listed above prior to any applicable insurance, other coverage or self-insurance and will not seek the contribution from any insurance, other coverage or self-insurance available to the Supplemental Member.
ALL OTHER TERMS, CONDmONS AND EXCLUSIONS REMAIN UNCHANGED.
Authorized Representative ofBETA
HCI,-H492(02/19) PROPOSAL,q,@pE14 of 113 DateIssued: July 01,2020 aia[) 1100 ALT AHEA-01 QVAlrlE7
DAYffi(MMIDD/'I'/YY)
8/3/2020
THIS CERT}FICATE l8 18SUE:D AS A MATTER OF INFORMATION ONLY AND CONFER8 NO RIGHT8 UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEaATIVELY AMEND, EiXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLtClE8 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON8TITUTE A CONTRACT BETWEEN THE 188UiNG INSURER(S), AUTHORIZED REPRE8ENT ATIVE OR PRODUCER, AND THE CERTIFICATE HOLDE:R, )MPORTANT: If the certifiaate holder is an ADDITIONAL. INSURED, the policy(ies) must have ADDITIONAL lN8uRED provlalons or be endorsed, If SUBROGATION 18 WAIVED, subject tO ttie terms and COndltlOns Of the p0fiC9, certain polk,les may requireanendorsement. A statement On this aertificate does not confer rights to the certlflcate holder In lieu of such endorsement(s). pRoouc,R Llcense# 0767778
Culver City, CA-HllB International Insurance Services Inc. 6s0u0imCoeorpoorate Points
Culver City, CA 90230
iUVo'
?HON-
(JVC, I fo,M):(310) 588-6900 ljA,xo):(310) 568-9098 i
JiJ!! fB8i
INSURER($) APFORDINCI COVERACit. NAIC #
ihsunega:Liberty Mutual Fire Insurance Company 23036
1N8URBD
AltaMed Health Services Corpomtion
AltaMed Health Network Inc,
2040 Camfield Avenue
los An@ales, CA 90040
INellR!R B ;
1N8URERC:
INelURER D :
1N8UR!R ff i
INSURER P i
eOVERACiEjl CtJtTIPICATE NUMBER! R!V1511C)N NlJuRtJ!
THIS 18 TO CERTIFY THAT THE POLIC1E8 0F INSURANCE LISTED BELOW HAVE BffEN 188UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD lN€ lC;ATEO. NOTWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOROTHERDOCUMENTWITHRE8PECTTO!/VHlOHTHiS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIEIED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLIC1E8. L1M1T8SHOWN MAY HAVE BEEN FIEDUCED BY PAID CLAIMS. iN8R
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EACHQC(,LIRRENCE $
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DED l l RETENTON$ """'-"-' $
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AND EMP10Y98' LlABlllTY YIN
L;j,4gaPoC,'fng'a'83%0g%',"§EcUT" €
gff6A?'?ioA'or?;pem'riossbetow
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WC2-816-007186-010 . 4/1/2020 4/1/2021
" ItTKTlJTEI IErE.L.EACH40(:IDENT s 1,000,000
E,L,pl8EA85-EA EMPLOYEE$ "1,000,000
E.L.Dl8EAat_- POLICYLIMIT $ 1,000,000
RDEeaCaRolPmTl0mNuOnP :PAvTe:OoNp8m/eLOnet AB?'K)loCNk8 /Ve!ranlrlj8(!,CORCi 1(H, AddRlonal %markg Schedule, maybealtachod Ifmoi'espace Isrquired) "30 Day NOO w/ 10 days for Non Pay
fiPFFalPIC.AT! Halt)ER CAN €,ELLATION
City of South Gate
Human Resourms/Rlsk Management DMslon
8860 Callfornla Avenue
8outh Gate, CA 90280
8HOuLD ANY OF THE ABOVE DESC:RIBED POLICIE8 BE CAN(:aED BEFORE X:ThogW'.;W#.o":o':H':7g*is:'sc= wiLLBEDELIVERED IN
AIITHORIZED REPRE8ENTATlVEi
LJA2,..,
I
- + -aa- sy aa-alHh
ACORD 26 (2018/03)
1101
WAIVEROFOURRIGHTTOR!aOVERFROMOTHERaEt4DOR85MENT -
CALIFORNIA
we have the rfght to reaoverourpaymeritsfrom anyone Ilable ror an Injury aoveredby thm po(lad, We will not erifOraeOurrllt agalnatthe pOraonOrorganJzatlonnamedin tha 8alledule, (rhb 8greefnentapplleaOnl9to the extentthatyouperformworkunderawruten contraetttiatrequlresyoutoob(alnthleagreernentrramus,) You must matntalnpayiul( remrds aocuratetysegregallngthe remuneratlonof your emptoyeeowhlie enqaqed Iri thework desadbed In the Schedule,
The addl€lOnafpremlum for thls endoraernentshall be 0% Of the Callfornla workers' eompensatlo)i premllnTl otherwfeedue on auahremuneration,
80hedtlla
Add)tlonalpremJumlaapsoentoftheOalffornlaManualWorkersOoinpensatlonpmmriirn, 8ub%attoamlnlmum premlumchargeof$
PemnnorOr@ahlzatlon Jpb DsmorlDtlOn
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appllmble atateblanketwatwfa
pmm)umahargOIt)OllOdb7 Ubmty mat Mffl InalFanoe conipany 'iesae %raltaahmenttoPol*ayNo.WC2-615-007165-O"lO EbotlvaDals04/1/20 Issuadto AttaMedHaalth6kuvloaaCorporatlon
Ptwdum 0
WO 04 03 08
Edi 04/19fH
PROPOSAL PAGE 16 of 113
I)DTh 1102
ALT AHEA-01 HFARMANf
DATEIMMIDDNYY-Q
8/3/2020
THIS CERTIFICATE l8 188uED AS A MATTEFI OF INFORMATION ONLY AND CONFER8 NO RIGHT8 UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL)C1E8 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE IS3U1NG INSURER(8), AUTHOR12ED REPRESENT ATIVE= OR PRODUCER, AND THE CERTIFICATE HOLDffR.
IMF'ORTANT: If the certifk,ate holder Is an ADDITIONAL )NSURED, the policy(ies) must have ADDITIONAL INSuRED provisions or be endorasd.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certlflcate holder In lleu of s ah endorsement(s), PRoO,E, tjcense#OM9329g
81P Insurance 8ervk,es - Temecula
2,,':::%;zRt;gA110
BgpHciHeidiFarmani
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!H6NAte, IS'a,Ext): (961) 385-3850 If:'f:,No)i
I
tm !i8'l.: heidifQ gsipbrokers.com
IN)UFIER(a)AFFORDINGG'OV!RACi! NAIC:#
1HBuyBH4,Philadelphia Indemnity Insurance Company 18088 lN8uRED
AltaMed Health 8ervk,es Corporaflon
Attn: Office of Compliance & Risk MHmt
2040 Camffe}d Aye
Commerce, CA 90040
ixsups*s : RSUI Indemnity Company 22314
lN8URffiR C :
INSURER D ;
INE!UFliRE i
lN8uRER F i
(j)VERA(,F9 GPRTIFICATEi NuaflBER: REVI!!IION NlJIRfJ!
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE: L18TED BELOWHAVE BEEN 18SUED TO THE IN8URED NAMED ABOVE FOR THE POLICY PERIOD INDICATE:D. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 188UED OR MAY PERTAIN, THE lN8uFlANCE AFFORDE[) BY "n-IE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS, EXCLU810N8 AND CONDITIONS OF SLICH POLI('1E8. LIMITS SHOWN MAY HAVE BEEN RF_DUCEDBY PAID CLAIMS. 1N9R
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x PHPK2118943 4/11/2020 4/11/2021
COMBINED81NCILELIMIT (Es t) $ I,000,000
BODILYINJURYIPer(iaraon} fi
BODILYINJURY(PeracoMenl')$
7z 5ER
let:ff )ml FGE $
$
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-X
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x OCCtJR
(:LAlMSaE NHA249836 7/1/2020 7/1/2021
EA(.HCK,C,URRENCE ," 10,000,000
AGGREGATE , 10,000,000
DED i IRETE:NTON$
$ WORKER8COMPel8ATlON
ANDEMPLOYalS' UABILITY Y IN
fflLlSUa4-WUtjR"ao"n"€
j'{r(A:WW:ERATK)N8 below
N/A
189ATlm'l IgrE.L.EACHA(.CIDENT $
E.L.DISEASE- EAEMPLOYEEe
E.L.DIE+EASE- POLICYLIMIT $
cDi':y"o't""sou""';;oapteloiAsm/LOC:an:nonbsseimWspioicyb:usra,cntirtovoTu%hbzzelmtlonaamutenmaamrkaeaseahseoaualea.imaaoy:a%tiaicnh;aumnmmaonrispisom ncontmd,aBreemenlor memorandum of undemtanding per attached fonn CA 20 48. 8uch Insurance as is afforded by this polk,y atmlf be primary, and any Insurance carded by City shall be excess and noneontrlbutory per attached form PI-MANU-'1. Nod-payment of pium, '10 days' noffm and 30 days' no&e for all others as per pollcy temis and aondHlons.
GERTIFK,ATE HOIDER (,ANCELLATION
City of 8outh Gate
Human Resourr:es/Risk Management Division
8060 California Avenue
South Gate, CA 90280
I
8HOULD ANY OF THE ABOVE DE8CRIBED POLICIE8 BE CANCELLED BEFORE THE EXPIRATION DATg THEREOF NDTICE WILL BE DELIVERED IN A(.CORDANCEWITH THE POLICY PRO'ffi810NS.
AUTHC)R12ED RURE9FJITATn/E
,y
ACORD 26 (2016/03)
1103
POLICYNUMBER: PHPK2118943 COIWIE-RCIALAUTO
CA 20 48 02 99
THIS ENDOR8EMENT CHANGE8 THE POLJCY. PLEA8E READ IT CAREFUlLY.
DESIGNATED INSURED
This endorsement modifies Insurance provided under the following:
BIJSINESS AUTO COVERAGE f-ORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is Indicated below.
Endorsement Effective:
08/03/2020
Countersigned By:
(Authorized Representative) Named Insured:
Altamed Hea!th Services Corp.
SCHEDULE
Name of Person(s) or Organlzatlon(s) :
"City of South Gate, offimrs, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or memorandum of understanding. (if no entry appears above, information required to complete this endorsement will be shown In the Declarations as applicable to the endorsement. )
Each person or organization shown in the Schedule is an 'insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form.
CA 20 48 02 99 @ Jnsurance 8enices Offlm, Inc., 1998
PROPOSAL PAGE 18 of 113
Page I of 1
1104
PI-MANU-i (01/00)
THIS ENDORSEMENT CHANGES THE POLI(;'Y. PLEASE READ IT CAREFULLY PI-CA-004 Primary And Non-Contributory Clause Endorsement PI-CA-004
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
PRIMARY AND NON-CONTRIBUTORY CLAUSE ENDORSEMENT
This endorsement modifies insurance provided under the followings BUSINEiSS AUTO COVERAGE K)RM
The following is added to SECTION IV-B[7SINESS AUTO CONDITIONS, B. General Conditions, 5, Other Insurancei
The insurance provided by this policy for any additional irisured endorsement attached to this policy is ptimary when prJmary coverage is required in a written contract,
In addition, we will not seek contribution from any insurer when insurance on a non-aontributinq basis is reguired in a written contract for any additional insured endorsement attached to this policy.
B'or coverage to apply, the written contract must have been executed prior to the occurrence of "loss."
This endorsement supersedes anything to the contrary.
All other terms and conditions of this Policy remain unchanged.
PROPOSAL PAGE 19 of 113
1105
ALT AMED
ALTAMED HEALTH SERVICES CORPORATION
Expanding Mental Health Semces in a
Federally Qualified Health Center Serving the
City of South Gate
PART n: ADDITIONAL INFORMATIONAL EXH[BffS
AltaMed Healtli Services Coi-poration
PROPOSAL PAGE 20 of 113
*ASG= AltaMed South Gate
1106
ALTAMED
IX. ADDITIONALINFORMATIONALEXHIBITS
A. FederalldentificationNumber(TgxlDNu/fiber):
AltaMed's federal employer tax identification number: 95-2810095 B. Unique Entity Identifier
AltaMed's federal unique entity identifier: D3DTJBVZRVB8 C. MostRecentFiled TaxReturn
AltaMed's most recent tax return for tax year 2018 is enclosed.
Please rtote: AltaMed willprovtde its riext US 990 as soon as it is available.
AlbiMed Healdi Serviceg,Corporation *A8G= AltaMed South Gate PROPOSAL PAGE 2'l of 113
71'l,- 1107
2949817701504 I
CHMGE OF ACCOUNTING PERIOD
OM!I No 164ff- €1047
/ 2019
Oplna8npteo!liuobnll6 '.
kY :lf,' 2019 andendlng D'.EC 3: Lt 2i)19
'C Name of'grganization "==-""
,ALTAMED HEAI?H SERVICES CORPO)EIATION
D Employer Idamifiaation number
95-2810095 6affliness as
Numffieraridatreeffi (orP.O.boxdmail16netdeltveredtostreetaddrsss) 2040 C'AMFIHLD AVEE
Room/suite E Telephone number
(,323 )72!;#.q7!ql
Cv ortown, state or orovince, country, and ZP or foreign postal code @ atmsrmpbs 857, 449, 331 * fi6,i mGELES, CAJ 90-640 - ' H(a) is this a group retum forsubordlnates? C]Yes [X]NO
H(b)hamisubominaieqinatuaeer'i € Yes € No
If 'No,' attaoh a list (ass instructions)
H(c)Groupexemptionnumber 2
pNameandaddreaeofprinoipaloffloer:JOEiEi'E8PARZA
2040 CMFIEI,D AVENUE, Lag MGELES, CA ,Q%O
J Isoi(c) I ( j
i4 (inssrtno.) Ll 4947(a)(1)oi LJ Waj
urrr)p! / /v v W.AL'J ['d :nil) . OR(iI . . ./
I .-)a(Yeariifformation: 19 70iIM stateof)egaldomicile: CA Plirtllsiimmary II.
1 Briefivdesonbelh*oraanization!smtsaionormosts+gntficantacfrvmes s: gE SCHEDULE 0 - :"-:'-" '- '- - ' I
2 C,heokthiabox > LJiftheorganizationdmconhnusditsoperationsordaiHiosedofmorethana6%ofitsn'itassets :i Numberofvotinamernbersoftheooverningbody(PartVl,linela) 3 12 4 Numberofindependentvotingmemberaofthegoverningbody(PartVl,lrne1b) 6 Totalnumberofindividualaemployedinoalendaryear2019(Partl!qiliRWki)[email protected]@ e Totalnumberofvoiunteera(estimate ifnecessary) ReceivedLiBBank- usa 7 a Total unrelated business revenue from Part Vlll, column (O),lrne 12 '} 4R bNelunre!atedbuainesataxableincomefromPormgGl0'Tiltnea9 A,,l, i. . 4 i2
6 " a 3'7'02
e o
7a ---- - -'155 ,170.
7b , ,,, j.54,170.
' it!IUV 3 U 20
a Contributions and grants (Part VIO, line th)
9 Progmm service revenue (Part Vlll, Itne 2g)
10 Inveatment income (Part Vlll, column (A), lins 3, 4, and 7d) b ogdenlU'l 11 0therrevenue(PartVlll,column(A),lines5,8d,8a,9c,lag,antllie) 12 Toialreverwe-addlinesethrou4hll(mustequaLPartVlll,mlumn(/%),lriel2) 2TI Prior"leBr Ourrst Yes
29,929,784. 2i,sO:i,igs,
652,690,235. i '454,709,183.
, 12,489,Q18. 41,ale,800.
I5,9J3i 5256. 5,ffl3,608.
%-!;09- 1,951q1. 522',397,789.
13 GrantsandsrnilaramountspaidlPartlX,column(A),lrnesl-3) % Benehtspaidtoorformmbera(PartlXioolurnn(A)Jna4)
15 8alarim,othercompensgtion,employeebenefita(PartlX,mlumn(A),hnss5-10) l&i Pmfeasionalfundraising feea (Part IX, column (A), ine lle) bTotalfundraisin@expensesg'artlX,column(D),bne25) > :2,:3*s,ss"7. 741,450. 472,750.
0. 0.
266,050,842. 192,688,709.
0. 0.
17 0therexpenses(PartlX,aolumn(A),)ines11a-11d,11f-24e) 18 Total expenses Add lines 18-'17 (must equal Part IX, column (A), hne 25) 19 Revenuelessexp*nses.Subtraotluaie1Bfromhne12
3Q7,9Qp_,690.
654,751-,982. 465 , 738 , 685.
47,342,l'il. 56 , 6!)9 ,10 4.
20 Tota} assets (Part X, bne 18)
at Totalliabiltbes(PartX,line28)
22 Net assets or fund balanoea SubtraatIne21 lrqmIne 20 Beginning ofOunenlYsiair g0d@f%ar
860,392,869. 897 , IS).0,595.
,,335 , 2.27 , 62,1,. 32i §,,')59,510.
s2s,iass,z*s. 56 3 , 66t);'085.
p'€€-t If I Signature Block
uriderpcnalll(is Ofpcr)tlr)/,l da(Jat!i €11!ltihavc a)lamtnodtill!l raluni, inokidingamimpanying adul%andslatamentS,and 10 tllO5(1(itOfm)/knOWIOdgOandboltm,nc tnie.mnacl and comolete. Deatiratlon of preparer (other thin offiaer) is bam on all mfortnabon ofwtrichpreparerhasp.nyknovledga.
Sign
Here
k Q%[
y JO!9!
v X :/H. 5 :r I_il//xal
N%Mffir - - a -/ -- X- ' Date"
I E,SPARZA, SR. VP OF FIRM(J AND CIO
f Typsorprintnameandtitle
Paid
Pnnt/Type piepamr's name
Lffl D. BOSTER prapr,u!)r
l)ate I
l1/2C/20
Icbm IJ
d
seX*mployea
PTIN
POO440365
Praparar Fun'sname > VA8QU!J & COMPANY LrP- Frrm'pEIN>33-0700332 Use Only Fum'saddress >-G6L5E5 N,CEE,NTcARAL9lA2VEN?Jo3 E,St!a1550 Phoneno.(213 ;. !73-1700 A4av the IRS dscuas this retum with the preparershown above? (st"e tnshucttonsi LXJ Yes Lj Nq tmiooi ot-ao-ao LHA For Paperwork Reduction Act NoUc*, see the separateinstrucUona. Fonn990(20j9) 1108
Form 990 (2019) ALTAMED HEALTH SERV:ICES CORPORATION
p8tatement 6f Program Eleniice Acoompliahments
Check il Schedule O containsa responseor noteto any %rietn thts Part Ill 1 Bnefiy degribe the organization's mtssron
TO ELIMINATE DISPARITIIS IN HEALTH C'ARE ACCESS AID OUTCOMES BY SUPERIOR ITY HEALTH At'iD HUM)J 81RVI M
IN'fflGRA WORLD-(:'IiA8 DELIVERY SY8 LAffNO, I-ETHNIC
95-281QO95 Pg(la2
[X]
2 Did the orqanizatton undeirtake any significant program servtces during the year wht# were not listed on the pnorForm990or990-EZ'? [Jres[X]NO
If 'Yes,' describe these new services on Schedule 0
a Didtheorganizationaeaseooriducting,ormakesignrfcantdiangesinhowitconduots,anyprogramaervices? ayes [XJso If 'Yes," dsacribe thele otianges on 8aheduh> 0
4 Dasoribe the organization's program servce accomplishments for eaoh of Hathree largest program serviaes, as measured by expenses Sedton 801(a%3) and 501(0)(4) organtzattons are requrrsdto reportthe arnauntof gtants and allocattons to others,the tota(expenses,and reysnue, d , for each service
4a (Cade ) (e+ipsnsaa $ 3%19 I 271 8 7*. tnoludlnggiaiila@t@ 7 ; .i; >(R*NnueI -98--17 -9-8; -8 CLINICS - AIAMB,D OPERATES A TOTAIi OF 29 PRIMARY CARE AND DENTAIi m'JITS OFFER MEiDICAIi, DENTAL, HIV 8BRVIC:B,8. MD COMM?jNiTY OUTRHACH. IN 74,000 CHILDREN AND JUDUIi'J'S. ALTAXB!D PROVIDB9 IVtJBaRATED EIERVICE8 'rHAT HEAIiTH, B!!iHAVIOML HmAM'H, WOMtN ' 8 HEALTH, A!n 'GIRIA!RIG <jM3 COITIONS. OTHER ' SERVI<:38 fNCIiUDE LABORATORY TE'JT'lNa , ' MDIOLOGIC ah (Oods )(&ixpensai$ 128 s 702 g 008 a Inoludlngyanteel j%DtJLT3 ARE gUPPORTED BY M ARRAY OJ' SERffC,E8 'fflROUGH AJ.,TMjED ' B 8 PROaRAMS OF ALL-4WCLDSIVE CARE FOR THE ELtaIiY (PACE) ! SITmS. E!:RVI@Eg 'fNCLt7DE PRIMARY CARE/GERIA'!RIC MEDICINE, mSnSTG CA)u n, REHABILITA'PION THERAPY, FAMj:tY SUPPORT Ia'RflNTIONS, COtfNgELIl fG, ))a:DICAt'ION " AqEMFJT, NUTR:[:T19NEDTJCAff03 ,EQ(:':tAli 'ACT:CVIT: <me, "naou aPmtoocg DOOR" TRANSP5RTATION EiERVICES BOTI !t TO PAR!!ICIPAfig' HOME AHD SPECIALTY CARE MEDICALi APPOINTMFalT8- AI!TJ!XEJ ALSO PROVIDJ3-3 8PECIALIZED IN-HOME BtJ?PQRTIVE P:R5GRMS AND 8ERVjClg THA'I' ENHANCE T)HE I,:tVES OF WE,ARLY 4,500 8mNIOR8 IiIVffle :lCNDlPEaEffiLY IN THE CO)5MUNITY OR WHO ME AT4ISK OF :DiSTITUTlONAL:C2E GO C,ARE.'
) (Flevanuea 27z 709, 059. )
EXPERIENCE AS A RYAN WHI'['E PART C
CIiIENT8 jALIiY THROtJQH HI'V MDIC'AIi
P I PR
CS IN LO3 MGILBS
4a (Code ) (g+ipenaas4 7 y 3 6 2 t 0 91 * Inoluflnggianmol ffinOVIDa, ALTAMlt) 81RVE8 2,000
83,RVICE8, AND , 00 S THROUGH
ALTAME-D OPIRATHS FOtTR 4 HIV MEDrCAL O'?JTP-A-'r-:
AND ORANGE CO[ThTTIES. ALT HIV SERVICE8 D 8ION INCLUDEg T)RADITIONAr.i AND BIOMEDICAL HIV PREVENTION, MEDICAII CARE, MFJTAL HEALTH N i + # # # # # # %# f € ffl # # m # -l # f # # ## # # % %# 1. 0% # k * ff ffl jl A %# l jl-am ffi I II M(I W d %+ SERVICE,S n9 A ONE-STOP MODEL TO LATn\X AND OTHHR UND!gaV POPt7LATfONS
4d Other program sentcea (Descnba on Schedule O.
expanubl 4z 487, 768
as Totalprogramssrvioe@ponses) " m"4d'59Q9,"'5d7'9i694* ) (Flawnua$ 2,039,448.)
032(1020f-2040
18121119 795952 10042
SEE SCHEDULE O FOR CONTIATION(S)
2 pkQM3eW%9A!!'W*1LTH SERVICES COR10042-1
Form990(2019)
2t=4 1109
Part kV 'Checklgst of Flequired Schedules
Yes No
a
4X
B
7 8X
g
10 lla X
* letheorgantzatrondeaanbadrnseotion501(a%3)or4947(a)(1)(otherthanapnvatefoundation)? // aYes,' complete Schedule A
2 lstheorganizaUonrequiredtocompleteSchsdu/e8,Sdimu/eofOontnbutorJl 3 Ddtheorgantzattonengagarndrret,tortndireatpolilioalcampaiOnaatniitiesonbehalfoforinoppositiontomndidatesfor pu51t(iOffl€le? /f 'YH,' COmr)klteSQhmukl C, Partl
4 Seallon601(o)(a)organlzatlona,DrdtheorHarttzation engagein labbying activnies, or have a eeotion 501 (h)election in effsot dunng the tax year? If 'Yes,' complete SThedule O, Partll 8 lstheorgantzationaseotion501(c%4),801(a)(6),or501(e%6)organizationthatreaeiveamemberahipduee,assessments,or srmrlaramounts as definetl in Ftevonue Procedure 98-199 /f 'Yes, ' complete 8dtedule O, Part Ill 6 Drdtheorgangattonmatntatnanydonoradviaodfundaoranygimilarfundaoraooountsforwhichdonorshavetherightto provrdeadvceonthedistrrbutronorinvestmantofarnountsinsuahfundsoracmunts?//'Yes,'comp/ete8chedu/eD,Part/ B 7 Drdtheorganizattonrecweorholdaaonservationeasement,inoludingeaaementstopreserveopenspace, the enwonment, histona land areasi @rhistorio structurea? If 'Yak, ' NmQtete sr;hmUteD, Part // 8 olotheOrgan2atlOnmalntaln00IIeatl0n60fWOrksOfart,hlat0nOaltreaaur0a,OrOtharslml)araaset8?/f'Ys,"oornp/ate Schedule D, Part Ill
9 olotheorganizatlonreportanamountlnpartx,linezt,rorescroworcustooialaccountllabimy,ssrveasacustoolanror amountsnot Itstedtn PqrtX; orprovrdecredrt aounselrng, debt management, aredit repair, ordebt negotiation servces? If "Yes," COMPLETES;heduleD, Part /V
to oiothe organization, dtreotly or through a related OrganlZatlOn,hold assets In donor-restricted endowments ar In quasi endowments? /f 'Yak,' aOmptete 8Ctedule D, Part V ll Iftheorganrzatton'sanewertoariyofthefollowrngquestionsiishYes,'thenoompleteScheduleD,PartsVl,Vll,Vlll,IX,orX aeiapplioable
a olelth00rganlzatlOnrepOrtanamOuntf0rland,bulldlnOe,aridequlprnentlnPartX,IlneilO?/f'Yes,'Camp/ete8CtiedufeD, Part Vl
b Drdtheorgantzationreportanamountfor rnveshnents - other securities in Part X, line 12, that ia 5% or more of ds total aSaet8 reported In Part X, Itne te' /f'Y €lB,' Cam/:)k3t0Sahedule O, Part Vll o Dd theorganrzatcnreportanamountfortnveetmenta-programrelated in Part X,line 18, that m 5% or more of its total a8setg reported In Part X, Irne16? If 'YW, ' CampletesChedule D, r"art V/// d Didthe orqanizalionreportanamountfarOttier aesetain,Part x,!ne ts, that Is 5% Ormore Of tia total assets reported Iri PanX, Ime 261 /f'Y&'S,' COrnpl€ihk8Chedute D, Part LX
e Dtd theorganrzatton report an amount for other liabilities in Part X, line 25? tr"Yes," complete Schedule D, Part X f Dldtheorgantzatran'aseparateorconsoltdatedfinancialatatementsforthetaxyearincludeafootnotethataddreasea the organization's Itabilrty forunmrtatn tax posRions under FIN 48 (Asc 740)9 /f 'Yes,' aomptetessheai{eD, Part X 12a Didtheorganrzattonobtainseparateirndependentauddedfinancialstatementsforthetaxyear?/f'Yes,"comp/ete Schedule D, Parts X/ and X//
b Wastheorgantzatronrncludedrn oonsolrdated, independent audded financial statements for the tax year'> lt'YO8,'aridIfthe anrzaxlOnanswehm"NOa tO Ilne 728, ttmri rx>mpletlngSCh0dute D, Partsi Xlend XIIIS OphOnal 18 lstheorganaattonaschooldescnbsdu'isedion'l70(b%1)(A)(ii)?/f"Yes,":'omp/eteSch@du/sE 14a DtdtheorgantZattonmarntaianofftce,employees,orag(IntsoutsideofthstJnitedStates? b Didths organkat+onhaveaggregaterevenuesor experiaesof more than $10,000 from grantmaking, fundraaing, buainess, tnvatrnent,andprogramservtaeadivttresoutstdethe LlnitedStates, oraggregate foreign investments valued at $100,000 ormore91f'Yesi'completeS;hedubF,Partsland)V 14,X
16 DldtheOrganRatl0nrep0rtOnpBrt)x,colutnn(A),llnBBlmOrethan$5,0000fgrantBOrOtherassl8tanoetOorfOrany foreignorganrzaten?/f'Yes,' comphteScheduhF,Parts// andN X 16 oiotheorganizatronreportonpartixicotumnioiiiines,morethanssiooootaggqategrantsorotheraasistanceto orfOr foretgn indwiduals? lf'Y8S, ' COrnpreteSChmUle F, Parts ///and /V 17 Didtheorganizationrepoitatoteiormarethanstsiooootexpenaesrorproreasionaitunoraisingservicesonpartix, column (A), lines a and 1 le? /f "Yes,' complete Schedura G, Part / 18 Didttieorganvationreportmorethan$1sioOototaiofrunoraisingeventgrossinoomeanomntnbutionsonpartviii,hnes lc and 8a? /f 'Yes,' completeSchedule G, Part //
19 Dtdtheorganrzattonreportmorethan$15,OClOofgrossinaomefromgarningaotivitieaonPartVlll,Im9a7/f'Yes,' wmplete STheduki G, Part ///
20 a Dmtheorganizattorioperateoneormarehosprtalfaoi1ities?/fYes,'comp/eteSct+edu/eH b If 'Yes' to Ine 20a,dtd'the organtzabon attach a copy of naaudded finanoial statements to the retum) 21 Dtdtheorgangatcnreportrnorethan$5,a00ofgrantsorotherasststancetoanydomestiaorganizationor domeatio govemment on Part )X, column (A), line 19 /f 'Yes,' complete Eh:,hedule/, Parts / and // 11b
llo
iia X
lla X
11f X
Ib X
iab X
is X
m X
let
16 17
18 X
10 20a
20b
21 X
Fomi990,2019) gazooa tit-go-ati
3 1812111!9 795952 10042 rXf?oTh%'L!%V"jffi Yr!31" oqRR'cEScoR10042-1 1110
:ormggo(aotsi) AL!MED HEALTH EIERVICES CORPORATION
IPartlV ehecbiistotnequiresschedures(continues)
Yes NO
22 0ld the organlzatlon report mare than $5,(X)0 0f granta m other assratan(}e tO Or10r dOmOatlCiindrviduals On Part 1X, oofurnn (A), line 2') if 'Yes," complete 8dredub /, Parts / andfll 23 Did the *rgsnization answer "Ye8" tO Part Vll, saloon A, line Cl,4, Or 5 about compensation Of the organization's current andformerofjcers,drreotorsitnistees,keyemployaes,andtugheatcompeneatedemployess? If'Ys,'%mplOte Schedule J
22 23 X
24b
28a
24a Did the organrzationhavea tax-exempt bond issuewith an outstanding principal amount of more than !3100,000 as of the lastdad oftheyear, that Wag issued.afterDaosmber31, 20029 If 'Yss,' anaWarllneB 24b thmugh24d and COmplete Schvlula K If'No,' go to bne 25a
b Did the organization invest any proceeida d tax-exempt bonds beyond a temporary penod exception9 a oiatheorganizat<nmaintainanesorowatt.ouritothsrthanaretundingeaarowatanytimeouringtheyeartooereaae any tax-exempt bonds'7
d Did the orgarmatton act as an 'on behalf of" issuer for bonds outstanding at any time during the year? 28a 8eotton 801(c)(3), 801(0)14), and 601(o%29) organizations. Did the organization engagei in an excssa benefit transaotian with a disqualified person during the year') If'Yes,' complete Schedule L, Pail / b 18the organization aware that it engaged In an exoess beneim transaction WdH a disqualffled person In a prioryear, and that the transaction has not been reported on any of the organization's pnor Forms 990 or 990-E:Z? If 'Yes,' complete Schedule l, Pal /
26 DidtheorganizationreportanyamouritonPartX,Iine6or22,forrocaivablesfromorpayablestoanycurrent Orformer OrtiOer, directori trustee, key employee, creatorOr foundsri aubatantial oontributor, or 35% controlled entity or family member of any of thsse persons? If "Yes,' compiete 8chedure L, Part // 27 Dtd the organrzatron provrde a grant or other aastatarice to any current or former offk,er, dirg%r, trustee, key employee, oreator Or founder, eubatantial t,ontributor Or employee thseOf, a grant 8el00ti0n committee member, or to a 35% controlled enbty (including an employee theireoQ or family member or an'y Of theme persons? /f 'YO8,' Camplate 8Th@duta t, Part /// 28 Was the organzatton a party to a buarness transaotion with one of the follomng parties (see 8ahedule L, Part IV inatruotions, for appliable filing thresholds, conditions, and exceptions) a Aaurrentorformeroffiasriairector,tnusteeiheyempioyeeicreatororrountier,orsubstantiaicontribuior';nr 'Yes,'comp[eteSchedulaL,PartlV -
b Afamll7rnembeirofan71ndlVldualdeson5eidlnllneaBa?/f'Ys4'comp/m08C7eoutet,Part{V o A35%mntrollederitQofoneormoreindivtdualsand/ororganizationsdeaonbedinlines28aor28b')/f 'Yes,' complete Scheduh L, Part IV
R9 oidtheorganaationreoetvemoyethan$2s,Oo0innon-cash:ontnbubons?/f'Yss,'mmp/atesctiesumM 30 oidtheorganizationreoeiv*mntributionaorariihititorcaitreaauresiorothersimiarassetsiorquaiirieeiaonservabon aontnbutions? If 'Yes," wmpleteScheduh M
81 oiotheorganizationiiquiomeiterminateiordmsolveariooeaseaperations';i/r"yes,"comp/atescheouieNipartt sa Didttieorganizationse!liexthangsidzposeofiortransfermorethan25%otrtsnetaasets?/f"Yes,'compmte Schedule N, Part If
H Didtheorgamzationownl0096afanentitydisregardedasseparatefromtheorganizatonunderFlegu!aliona sections 301 770j-2 and aOl 770ak3'j ff'Yes,' complete Sr'hedula R, Partl 34 Wastheorganizationre!atedtoanytax-exernptortaxableenirty?/r"Yes,'eomp/eteSchedu/eR,Part//,///,or/V,and pBrf 9 Imp 7
38a (>dthe orgaruzatianhave a aontrolledentttywtthrnthe meaningof section 512(b%l3}? b If"res" tO Irne 35a, did ths organization mOOwe any payment from Or engage ri any transat,bon With a t,ontmlled entity withinthe meaningof aection5ffl(b%1a)'?If"Yes,' wmplete 8ahedu(eR,Part V,brig2 355 :W 8eotlon 801(al(3) organlza €ions. Dtd the orqarnzatron make any transfers to an exempt non-chamab)emiated orgarmatron9 /f"Yes,' wmplete Schedule R, Part V, fine 2
37 Did the organrzatton conduat more than 6% of its activitiea through an entity that is not a related organization and that 18treated aa a partnership tor fedeml InOOme taX purpoaea? If 'Yes,' ZrrptatOSchedub R, Part V/ % DldtheorganlzatlOnCOrnpmteScheouleoandprOVIdeeXplanatlonsilnSthedut0ofOrPartVI,hne811bandl9? Notei Alt Forrp 990 fifers are required to oomplete 8chedyle 0 p 8tatementiRegaming0ttierlFI8rilings'andYaxCompliffin6e 26b
mX
27 gEki X
:19 X
$2
&IX
MX
aha X
so X
Check if &,hedule O contains a responeei or note to any line in this Part V 87 q. X
Yes No
ia EnterthenumberreportedtriBoxClofFomil098 Enter-O-ifnotapplicabki la 3644 lc x
b EnterthenumberofFormsW-2Gino{udedlnlrne1a Enter-0-ifnotappliaable lb o @ Dtd the organizatton OOmp0/ Wlth baokup WlthhOldlng nJ!e8 far reportable payments O vendors and flpOTlf t)le gamFlg (gambling) winninps to pnze winners7
932004 01-H4a
4 Form99012019)
18121119 795952 10042 rN#oM'9a4l"affi"" SE'lCES COR10042-1 1111
7omi990(20f9) ALTAMED HJ-ALTH SERVICES CORPORATION
IPartVl ttatementsRegard!ngOtherlRgrilingsand'T'axeompliance(continuel
9.5-2810095 PAGES
Yes No
2a I 3702
70 8a
ah
%X
3b X
J
8a X
ah X
x
x
2a EnterthenumberofemployeesreportedonFoimW-3iTransmmalofWagearidTaxStatements, filed forth* calendar year ending with or within the year covered by this return b If at least one ts reported on line 2a, did the orqanization file all required federai employment tax returns9 aiotei rtthe aum ortinea laand 2a iagreaterthan 250, you may be required toe-tde (see instrumions) 3a Didtheorgarmatton have unrelated business gross FICK)fflOof $iOOD or more during the year? b ll"Yers,'hasitliledaForm9';40-TlorUnbyeafllf'No'tolne3b,pmvtdeanexp?anatrononScheduleO 4a At any time dunng the calendar year, did the organization have an intereet in, or a signature or other authorty over, a financial account in a foreign country (such as a bank account, securities sccount, or other financial account)? b If"Yes,'enterthenameoftheforeigncountry >
See rnstructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Finanoial Aoaounts (FE)AR). 8a Was the organuation a party to a prohibRsd tax sheRer transaotion at any time duririg the tax year? b DtdanytaxablepartynotifytheorganizattohthatRwasorisapaitytoaprohibitedtaxsheltertranaactcn? o If "Yes" to Irne5a or 5b, did the organgation file Form 8886-T? ea Daas the organization have annual groas receipts that are normally greater than $ioo,ooo,and did the OrganlZatlOrisoliod any aontrrbutieins that were not tax deduotible ae charitable aontnbutions? b If'Yes,' did theorganization include wlh eveiry aolcitation an express statement that such contributions or gifts were riot tax deductiblsi'?
7 0rganiutionsthatmayrsaeivededuotibleooritrtbutlonaunderseatlon170(aA a Didtheorganizattonreaeivaapaymentinexeassof$75madepartlyasacantnbulionandpartlyforgoodsandservicesprovmedtothepayor':1 7a X b If"Yes,"drdtheorganizationnotifythedonorofthevalueofthegoodeorserviaesprovided'? 7b X 0 Did theorganization8011,eixt,hangei or otherwisedispose of tangible personal praiperty far WhlOhd WASrequired to fde Form 8282'?
d If"Yes," indioate the riumber of Forms 8282 filed during the year j 7d j e Drdtheorganizatton reawe any funds, directly Orindrredly, tO pay premiums on a personar benefit contract? 70 f oidtheorganiza5on, duririg the Veari pa} premiumsi directly or indirectly, on a personal benefit contrad? 7f g lftheorgamzationreceivedacontributionofqualifiedintelleotualproperty,didtheorgarnzationfileForm8B99asrequired? 7g h lfthaorgangationreceivedacontnbutionofaaraiboatsiairphinesiorothervehiciesisitttheorganizationtiieapormiOgs-O'i 7h 8 8ponsorlngorganlzattonama)ntalnlngdorioradvisedfunds.Didadonoradvsedfundmaintainedbythe aponaonng orgarirzatton have exceag busrnem holdings at any time dunng the ysar') 9 Sponsoring organizations maintalnlrig donor advised funda. a Drdthe sponaonng organization maka any taxab(e distributions under sadion 496f)') b Dtd the sponsoring organization make a distnbution to a donor, donor advisor, or related person? 10 8eoi{on W1(a%7) organizations. Enter
a Inrtratton fees and aaprtal mnmbutions included on Part Vlll, hne 12 b Gross recerpta, rncludsd on Form 990, Pgt Vlll, line 12, for publia use of club facimiee 11 8eetlan801(a)412)organlzatione.Enter
a Ciross ux,ome ltom membera or sharehokler8
b (3rossrncomefromothersources(Donotnetamountsdueorpaidtootheraourceaagairst amounts due or recetved from them ) 11b
12 a 8eatlon 4947(a)[1) non-exempt aharltable trusta, Is the organaation flhng Form 990 in lieu of Form 1041') b if"Yesi" entertheamountOf tax-exemptinterestrecervedOracmied duringtheJeer l120 I 1$ matlon a014a%Q qualified nonprofit tmalth Insuranae laauers. a lstheorganiationlicensedtoissuequalifiedheaRhplansnmorethanonemate? Note. See the nstmtians for additional riformation the organiatim must report on Schedule 0 b Enter the amount of reserves the organization re required to maintain by the states Fl whidi the organization is Icenaeo to issue qualified heath plans
c btertheamountofreservesontiand
14aDrdtheorgantzattonremiveanypaymentsfortndoortanningaervimsduringthetaxyear? X b if"Yes, hasitfiledaForm720toreporttheaepayments"?lfaNo,spmvmeanexpmnationon8chadu/eO 16 18theOrganiZatlOnauble0tt0theseatl0n496otaXOnpa7rnent{8)Ofrn0nethanJ,000,0001nremuneratl@nOr exwss paraohute payment(s) dunng the year9
If 'Yak," see instruotiona and file Form 4720, &,hedula N 16 Istheorganrzattonanedtx,ationalinmitutronsublecttothesemon49a8exaisetaXonnetinW.stmentinoorne? If'Yes,' oomplete Form 4720, StQedule O.
is X
is X
FOr990:2019)
1la
J
932006 01-20-2t)
5 18121119 795952 10042
1112
Form990(g019) ALTAMED HEALTH SERVICES CORPORATION 95-2810095 PaqeO pGovemanae, Managemsnt, and Disokosureroreach "tes'responsetotrnesathmughybbetow,anororaat*>oresponse TOIlne 88, 8b, Or 10b bekiW, den(;nbe the ClrCum9tancea, prOaH8eS, OrChangfJ8 an EjChe.dltla 0 8 €uslrRtru;tl0n8 Cheek if8o)-edu)e (;) containt Q re@ponse or note to any line in this Part Vl 8eation A, aoverning BOdj/ and IWaiis;iHvui*u(
[X]
Yes No
la
12 -2- X
3 4
8 e
?a Eriterthenumbeiofvotingmernbarsofthegovemingbodyattheendafthataxyaar 12 If there are rnateria)differgnaes in voting rights among members oftha governing body, or d the governing body dekigated broad authority to an executive committee or similar eommittee, explain on 8cheduls O. b Entert%numhgofvotingmemberainaludedonlinelaiabove,whoarsindependent lb 2 Did any officer, dveator, trustes, or kQ employee tiaVe a (amily relationship or a business relationship wth any Other offioer, director, tnustee, or key employee?
a Did the organizatron delegate control aVet management duties custornari)y performed by or under the direct aupsnnsion of officers, dirsotora, trustees, or key ennployees to a management oompany or other psrson9 4 DidtheorganizationmakeanysigrifflrcantchangeetoitsgovemingdocumeritssricetheprlorPorrn990wasfiled? 8 Didtheorganizationbecomeawareduringtheyearofaaignffimntdiversionoftheorgqnization'sasseta? 8 Did the organization have members or stockholders?
7a Didtheorganizalionhavemsmbers,atoakholders,orotherpersansiwhohadthepowertoeleotorappointoneor more members ofthe governing body?
b Me any governanoedOOISIOnsOf the organtzatron rsservedto (or sublect to approvalby)rnemtiere,8tOCktiOlderS, Or persons other than the governing body"? 75
0 Didtheorganizalioncontemporaneouslydocumarittherneetingsheldorwrittenactionsundertakenduringthayearbythsfaflowing:
a The govsrnmg bady?
b Eaoh aommittse with authonty to aot on behalf of the governing body? 9 's there t.ny offi-,or, director, trustee, or key employee listed in Part Vll, Section Ai who cannot be raaohed at the 12rpnlZalOrl'8 ri@iling address? /f"Yes,' pmvrdhthenamesendaddrewsqs on Sdiedu!e 0 Sect on B. Dolic'es(rhrasecbonamquestsinrormatu:inaboutpoiic*snotrequireobytheintemaihvenuehrie) 7@
s
oaX
ab X
x
x
x
x
x
x
x
m, X
ia X
14 X
15a X
iab X
10 b
11 a X
10a Did the organaation have looal chapters, branchee, or affiliates? b If "Yes," did the organization have written policies and proceduiea goveming the activrtiea of suoh ohaptere, affiliatw, and brariches to enaure lhei; operaUons are oonarstem with the organization's exempt purposes? f1a HaatheorgariizatwriprovrdbdaaomptJstempyofthieForm990toallmsmberaofJtsgovemingbodybekirefilingthaform':) b DastribeinSaheduleOtheproaess,fany,usedbytheorganizationtoreviewthisFomr990 lb Didiheorganizaiiontiaveawnttenaonflictofintereatpoiicy7/f'Noi'goto/irie73 b WereOtflCOra,dtrectorsi Ortrusteaeiand ka9 amp(O}eesraqutred 10 discloseannual§ mtereststhatcou!d(pve riseto aonfllc(89 1% X (, Did ths organization regularly and conaistenUy morinor arid enforce aompliance wdh the po{ioy") If 'Yes, ' desr:nbe in Schedule O howthis was done
'ffl Did the organizaton have a written whistlebtower poliay? 14 Did the organizatcn have a wntten document retention and destruotion polioy9 18 Did the process for determining compensation of the following persons inolude a review and approva) by independent persons, cqmparabil§ data, and contemporaneous substantmtion afthe dehberation and dooision? a The organkation's CEO, Executive Direotor, or top management official b Other offlcers or key employeea of the organization
}l "Yes" to hne 1 etaor 15b, desanbe the pmcess in Sahedule 0 (see mstructions) l&i Didthearganizationinveatin,contributeasetato,orpartiaipateinalointventureorsimilararrangamentwitha t@xable entity during the JOarl
b If 'Yes,' did the organization follow a wnttsn polcy or procedure requirnig the orqanwtion to evatuate its panopation InlOlnt venturearrangements under applcable federal tax law, and takestaps to safeguard the organization's exempt (itqtus wm respect to such arran(laments"
Section (i- Dlsclosure
i7 LmthestateswithwhiahaaopyofthisForm9gOiaraquiraotoberiieo>CA fla Sectione!104requiresanorganizationtoniakentaFormsl023(1024orl024-A,ifapplie,abte),990,and990-T(8eation50i(c)(3)sonly}available fo[I]rpuo'wcnnwspeeb@s'iteon lndEX]'femhoWathyeor':s'waedbesfithee8eava[X]lableucpohnearkeqaul'ok:tafapply € oiher(axptamorisahesurao) 10 Describe On Schedule 0 whether (and d SO, hOW)the organization maoe h governing docurrients, oonflrm of interest pOlQ, and financial statements availa51e to the public dunng the taxyear.
ao statethenameiaoaressianoteiephonenumberoithepersonwhoposaassestheorganizationosboomanoreooma) JOSB 3SPARZA, SR. VP OF F:niAWCE AND CFO - 323-725-8751 2040 CAXF:CBLD AnNOE, LOS ANGEIiES, CA 90040
Yes No
10a X
93'a(Wibl4Ds20 Form 990 (2019)
6 18121119 795952 10042 r'?ffl#d'>4M9'BtY'FOL' su'c" coR loo42-1 1113
Employees, and Independent Contractors
Check if 8ohaduleOcontairHsareapanseor noteto anylinevnthisPartVll [J 80mlOnA, OffiaersiDireotoraiTrusteesiKeyEmployeeaiandHiphastOompenaatedffimployees la Complete this table for all persons rsiquired to be listed Report aompenastton for the calendar year endrng mth or wrthrn the organization's tax year.
Lmt all Ofthe OrganfatiOn's current offiaera, olreOtors, trustem (whsther indivmuals ororganrzations), regardless Ofamount or oompenaatian Enter-(! Incoiumns (D)i (E)i and (F) n no oompenaation was paid list sll of the OrganlZatlOn'a ourrsnt key employees, If any 800 ihstructions for definrtion Of'key employee.
Lllt the organizabon's five ourrenthigtiest compensated employe# (Otti8r than an OfflOer,dlnaOtor,trusteei or key ernproyee) who received repon able aompensafion (Box 5 of Form W-2 and/or BOX7 of Form1099-M180) of more tmn $100,000 from theorganrzation and any related organizattons.
I bat all Of the organization's %rmer officers, hey eimptoyees, and highest Compensated employees WhOrseived mare than $100IOOO Of reportable compensation from the orqanzatiori and any related organizations.
Ll8t all Of the organization's former dlreetOrs or trustees that reoeived, in the aapaaity aa a former director Ortrustee Ofthe organization, mare than fi*o,ooo arteportable compensafton from the organizmion and any related organizations See instruations for the order in whch to list the persons above [Jchaohthisboxiineiihertheoraariizationnaranvretateo araanizationaomoensatsd ahvcurrentorricer,ciiremor,ortrustea. , (A)
Name and tale
(a
Average
hours per
week
(lrst any
hours for
related
orgar'nzations
below
line)
(a)
Position
(do not ahaek mtim thaul one
boat. unlss poison b both an
offl-iv ard a dliacki/Vuel@e)
(D)
Reportable
compensation
from
the
organizat<n
(W-2/1099=M180)
€E)
Fleportable
compensation
from related
organizations
(W-2/1099.MIS0)
€P)
E:stimated
amount of
either
compensation
from tHO
organization
and related
organaatione
!
b
J!
N! a
!
m
k
t
ha' !
(1) F!}R?WDO DB HE(:'O(:'HHA
BOARD CHA:!RMN
1.60 .X x 0. 0. 0.
(2 ) RICMOO ROBLgg
BOARD VIC!, CHAIR
1. 60
x x 0. 0. 0.
(3 ) !QRIA aRIMALDO
CON6tXE,RBOARD ME!JalER
1.20 x 0. 0. 0.
('4) (ffl!laOR'! VjffiER5St7EIJk "
(X)N8UMBR!IOARD ME!a!!R
:L.60
x 0. 0. 0.
<s) ADD)C+)FOcHANlz
!10AR5 ')'RBA8tiRBR
1.60 x x
I
0. 0. 0.
('6) HADIA NiVkB3N
CON51UMERBOARJ)MEMBER
1. 20
x 0. 0. 0.
( ? ) )tARa Vl(,TOR
BOARD SECRETARY
1 . 60
x x 0. 0. 0.
( e ) aogn hvmog, ae
BOARD XgHBER
1.60 x 0. 0. 0.
(9) tillAANA ffllR)!18
aONS(7MER!XARD MDBBR
1.20 X 0. 0. 0.
(10) HECTORamffii6 -'
BOARD MuBER
1.20 X 0. 0. 0.
(11) JOEiEMt GOiZ
CON8WER j30ARD NmgR
1.20 x 0. 0. 0.
(12> LU(:Y HEuBRA
CONgtn4)!IRBOARD MWBR x 0. 0. 0.
(13'> CAB!'U&O DELA'ROC'RA, !7.0,
PRNE11D3NT& CIO
40.00 x
I
1,282,212. 0. 174,406.
(14 ) MRIJi TOuE8' " p
8VP, (IOV REL & 00MX RBCH I x 426,234. 0. 18,571.
(15) 8083 tt. 38)PARZA p
BVP FINANCE & CIO x 578 , 589. 0. 19,050.
(16) ZOILA E8(!OBAR 40.00
SIVP, CHIRP ADXIN OflIegR x 516,701. 0. 23,800.
{17) ANNA TRAN 40.00
SR,gTRAffaY EXBC'U'!lVm x 727,094. 0. 31,858.
e:igotiy oi-toaa
7 Fomi 990(2019)
18121119 795952 10042 t4tl!'!'g?u'k!L"A'& iLY'AT" qp,avzcgscoR lOo42 I 2,[',
1114
:orm990{:;019) ALTAMED H)-ALTH FiERVICE8 CORPORATION 95-2810095 paqeO 'f'art Vl1'8eatlonA, Offlaeraioireators, TrusiaeaiKeyEEmyloyeeaiandHlghestqompansated ampioyees(contnuea) (A) (B) (O) (D) €E)
Nameandtltle Average Poamon (donotohmkmoieihaii tine RePO)table Reportable hoursper 50X.unleu psieonis bathan compensation compensation week dnU4flf ardadFeel@(ANfflt00) from from related
(lrstany the organlZmlOnri
hoursfor orgariization (W-271099-M180)
(W-2tl009-M180)
€P)
Estimated
amount of
mher
aompensation
from the
OrganlZattOn
and related
organizations
Irl.lelliaitaeid% sat=l = .a,
(xe) WARY ANH aaavng 40.00
EVP, €:HI&? OPIRATIHG OFFIC
(19) HENRY HOLat7JN
51VP, GMERA).i 00VHaBT,i
(20) DARJJN M(!JkCHLAN
79; IPA OPBRAffON
t21) JIIQUIO CA81GtJf8
VE', HBDI(AL DJ:RECt'OR, PACB
(22) RAYMOND 3. uOWE
ffi, C'H:UP !)u'ORMTION O!'!':tCER
(23} PAuAM NAGHDmC'HI
HOePl"!AL18T
40.00 40.00
40.'00
40 .'00
40.00 X 747,716. 0. 11,012.
x 617 , 318.
x 619,42:1.
448,124.
x 421,886.
x 419,794.
9., 151,412.
0. 52,725.
0. 37,613.
0. 51,884.
*ii ,9, 43,563.
ib 8ubtotal )> 6 * 805, 089.
o Totalfromcantlnuat}ondieetatoPartVlli8aatlonA > o.
aTotal(addlines1bshdla) > 6i805,089*
2 Totalnumberofmdividuals(inaludingbutnotlimitedtothoselimedabove)whonicewedmorethan$lO(,CIOC)ofrepobble mmpansation from the organization > . .
0. 615,894.
0. o.
0. 615 , 894.
527
Yes No
a
1 X
4 -X
I
a
I
ffi
x
(A)
Name and bueineea addreaa
(B)
Deamption of eervit,es
ANVIL CON8TRUCTtON COMPMJY n'JC.
8895 RESEARCH ffi,., IRVINE, C.A 92618 CONSTRUCTION
CHILDRRNS' HOSPITAL LA MID (.RP INC. , 3701
WILSHIRE BLVD., Bff 600, Lag ANGEIiES, CA MEDICAI, SERVICES VINCOR CONSTRUCTION INC.
2651 SATW STREET, BREA, CA 92821 (:'ON!gTRUCTION
WHIff, )mORIAL MEDICAL CEN!'Ea
Pa BOX 842176, I108 ANaELES, CA 90084 MEDICAL SERVICES
>HARMEDQUE8T PHJ!BJdACY 8ERVICIS INC.
Pa BOX 9236, BREA, CA 92822 PHARMACY !gERVICXS
2 Total nunibsr of independent coritraatora (inoluding but not Innded to those Imteii atxive) who received more than til00,000ofoompenaationfromtheor4anizatio(i @ 494
simooaoi-z-a
18121119 795952 10042
Form990(2019)
8 pm?o'!a'?&!\Aff?"" 8"c' coR10042-1
1115
Check if Schedule O aontains a response or note to arw lire rn thts Part Vlll {A>
Total revenue
{B) '
Re!ated or exempt
function revenue
€a
Unrelated
business revenue
1 a Federated campaigna
b Member5hip dims ,
c Fundraising events
d Re!ated organizations
e Government grants (contributtons)
f Allothermnlributions,giM,grants,and
similar amounts not included abova
g Noneach eonVibulleni IneludaJ Ill lltih Is- If
'ia ar l'
r
I
0 I'l J,
21,!'ill,19L
i'na*uih'+
1% ia
il
a
4 It -:1b
le 403,el5,
ld
le 17,948,ffO,
if 3,148,703,
Ig $ :)74,7Q1,
h Total, Arlrl lin@'s5alf 2
2 g MNAClgD CNkN aBRVZOBJl
Bualneas Oode #ll Ilrviaa , i -i I -
g:i4100 336, 44J 260, 336,44!i,260,
5 pxrzhm rEffig 624100 118,260,923, lie,260,923,
o
d
e
f Al) other program service revenue
R Total. Add,lineg2a-)f , iii ,, 2
454,709,it)3 #
3 Investment inaornei (including dtvidends, tnterest, and othersimilaramounta) >
4 lncomefrominvestmentoftbx-exemptbondproceeds >
8 RoyaRies ?
14,;171,107, 155,170.
e a Gross rsnts
b Less rental expenses
c Rental inmme or (loss)
ea
(i) Real (l Peraonal
6b
60 a Netrentalinaomeor(loss) , ,, k
' 7 a Gross amountfrom sales of
assets other than inventory
b Leseii aOsit€iTother basis
and sales expenses
o Gainor (loas)
7a
(i) Secuntmg (iT)Other l'
324,737,835.
7b 297,990,142,
7@ 26,747,693,
d Nm gain or (loss) . 2
" 26,747,693, 26i747i69i,
8 a GrOSSrncoma from lundraisrng events (not
inJuding$ 403,815, @(
aontnbutzns reported on line 1(:). 8ee
PartlV,line'l8
b Less directexpanaes ,
8a li024,519,
ab 1,531,745,
c Net income or (loss) from fundraising events > -507,226, 0 a Gross income from gaminq activma Sse
Part IV, Itns 1R ,
b Less, direat expennr"q ,,
00 a a " ) + 4 " 0
.n O II %, I !l 1171
tt r 1,1 a J
10 ' " o a)' s
alv,iilUr At
Ob
o Netinaomeor(kiss)fromgamingacbvitiee 2
10 a Gmss saleiei of inventory, less rsturns
and allowances
b Lest oost of goods sold
10a 38,527,286.
105 35,529,655,
a Net inaome or (loss) from sales ql ipv@ntory >
2,997,631, 2,9j?,6jl,
II B IN(!OMEI !)R(X AHI Ii:Jia
B OTHER COHTRAC' !9ERVICES
Buginem Code
900099 1,212,166, 1,212,166,
624100 1,050,034, 1,050,034.
0 RB?tFND/R)DIMBRffl4WT/D!aPOSIIT 100099 ""416,003, 41'6,003, d All other revenue
__e Total.Addlines?1a-l'ld ,,,_, - k 2 , 6a7fl, 201 s i s b 21 522,397,789, 4E17,132,710, ' 155,170.
95-2810095 Page9
9320(19 (+l-$!tl-V
18121119 795952 10042
Form990(2019)
1116
990 AI?AMED HEALTH 8ERffCBS CORPORATION 95-2810095
Section (c)p)and601(c)(4)organr;tabonsmustwmplete cofumnh Allotherorganrzatrongmustcompletecolumn(A) Citieck if eqhedule O oontaina a responae or note to any line in this Part IX Do not Indude amounbreporhxl on //net eb,
7b, 8b, 9b, and 10b of Part Vlll,
Ll
(A}
Total expensea
(B) '
Program servige
expenses
<O)
gMeann5remxepnekn's'ea
472,750. 472,750.
6,805,089. 6,805,089.
147,298,309. 146 , 221, 600. 1,076,709.
3,903,624. 3 , 875 , 746. 27 , 878.
24,564,552. 24i386,008. 178,544.
10,ii7,135. 10,043,681. 73,454.
i,018,286. :L,Oi8,286.
703,033. 703,033.
12,204,387. 12 ,199 , 419,
I
4,968.
, 4,681,486. 4,674,932. 6,554.
2,421,210. 2,419,008, 2,202.
5, 641, 455. s, 64:i,, 455.
2,560,759. 2,560,759.
l"i , 454 , 468. 11,454,468.
3,452,964. 3,444,3;36. 8,628.
I
123 , 826 , 785. i23,826,785.
5:L , 722. 51,722.
41,911,993. 41i91i,993.
22,980,575. 20,661,163. 1 , 767 , 720. 551,692.
39,668,103. 37,962,216. 1,290,6!S9. 415 , 228.
465,738,685. 4!)9,579,694. 3,813,134. 2,345,857.
1 Grantsandolherasaataneatodomastcorganizatian:
and domestic govarnmsnts. 8ea Park iV, line 21
2 Grants and other aasistanos to domestc
individuals, 8se Part IV line 22
3 Clrants and other assistanae to foreign
organizations, foreign govsmrnents, and foreigr
individuals 8ee Part IV, lines 15 and 16
4 Benefits paid to or for members
5 Compensation of currerit offcera, directors, i
truBtees, and ksy employeess
e Compensation not included above to disqualified
persons (as defined under section 4958(f)(i)} and
parsonsdescribed msection495$%3%B)
7 0ther sialaries and wages
s Pension plan accriials and contribiilions (include
sealion 401(k) and 403(b) employer contributions)
0 0ther employee benefits
1 0 Payroll taxes
tt Feesforservices(nonemployees)a
a Management
b Legal
a Acaountrng
d LObbying
e Professronalfundraming semaes. See Part IV, line 17
f Investment management fees
g Other (If linellg an'iounte+iaeeds10% of Ime25,
column (A) amounI )iatline 11g expensesonSt,h O.)
z2 Adverhsing and promotion
13 0ffca expenses
*4 Information teohnology
18 Royalties
i6 at,cupanay
17 Travel
18 Papents of travel or *ntertalnment expenses
for any federal, state, or local public offiaral8
19 (xnferences, oonventiona, and mee5nga
20 Interest
2'l Payments to affiliates
22 Dsprecmtion, depletion, arid amortization
23 Insurance
g4 0tharexpanaes.ltemizee;xpensesnotcovered
above (List mrscellanaous expenses on Itne 24e. If
line24e amount 8XOeedS10oAOf line 25, column(A)
amount, lietline 24ee+ipenseson 8cheduleO.)
g 8PECIALTY SERVICES
b PROVISION FOR INCOME TA
, MEDICAL S'!,RVICES
g ADMINISTRATIVE Ei$RVICES
e All other expenses
gs Tolalfunailonalexpaases.Addlinealthrough24e
as Joint ooate.Complete this line onlyfl theorgamzatton reportedinaolumn(B)lointcosisfromacombmad
aducalional campaign and fundrarsing solci(atton.
Ohedihsra) air(allowlng80P984(qf+OW8-?!I €l)
932010 01-2040 Form 990 (2019)
18121119 795952 10042
1117
%rm9GlOr:2019) ALTj'D HEAL!'H BERVICES CORPORATION
' Par1 Balanw Sheet iX i
Cheek if 8dieduie 0 mntaina a resoonss or note to any ltne ffl thre Part X 95-2810095 paqell
.Lf
M)
Beginning of year
I
i 1 0ash-non-interest-bearing
2 8sviriga and temporary cash nveatments
3 Pledges and grants receivable, net
4 Accounts receivable, net
8 Loans and other receivabkis from any current or formsr offcer, drredor, tiuatee, key employee, oreator or founder, substantial contnbutor, or35% controlled entity or family member of any of these psrsons 0 Loana and other receivables from other dtsqualthed persons (as defined under eieOtlOn*9sEi(f)m),and personsdesaribedIn a*ctton 068(03<3XB) 7 Notes and loans recervable, nst
e Inventonea for sale or use
9 Prepaid expenses and deferrad charges
10a Land,buddings,andequipment,costorother
butno, Complaro r'nrr Vl nl tl(itipq,15ils c+ 10a 381, !500, 09S * 57 ,372,740. 1
2,615,053. 2
7,051,327. 3
25,976,970. 4
-4-1-,as's, z-gs: a
8 6,048,000. 7
i,622,836. 8
6,092,245. g
i a41 , , ; 1 (( I ., r %, r:
229=,22=4=, 17i:
.>* !,
10(!
-, , -.=-!J
: b Less' aacurnulated depreoration 10b :105,595,149. -iYs-,g?i-aJ4'as. ' ll Investments-publialy'tradadseourrtres
12 Investments-otheraeourdies 8sePartlV,linell
13 Investments-program-related SsePartlV,linell
, 14 liitangibhi assets
18 0ther assets See Part IV, hne 11
16 Total assets. Add knee 1 through 15 (must equal Itne @3) 428,170,624. 11 399,350,444.
12 , 2!)3 ,"429. 12 i5',333',297.
13 14
42,510,175. 16 40,130,680.
860,392,869. is 897,610,595.
17 Aocounts payable and accrued sxpenses
18 Grants payable
ffl Defsmid revenue
B Tax-eixempt bond Iiabilrttes
2i Egrow or custodral aacount liabilQ Complete Part IV of Schedule D 22 LOan8 and Other pa7abmB tO any Wrrent or formerofficer, dlrOfflOr, trustee, key empkiyae, areator or founder, eubstaritial aontnbutor, or C15% 13 13,921,542. 17 118,162,871.
is
16,79s,sss. fla 16,880,667.
174 , 869 , 249. m i81,435;441.
l 21
controlled entity or family member of any of these persons 23 8eoured mortgages and riotes payable to unrelated tFnrd partres 24 Unsecured notes and loans payable to unrslated third partma as Otherliabilities(inaludingfederalincornetax,payablestorelatedthird partiea+ and Other liabilities+ net included einIrnea 17-24) Complote Part X of Schedule D
28 Tota} Ilabllltles. Add lines 17 throuqh 28
m
' 9.220,612. m 12,066,183.
24 _ 420 , 360. H _ 404,348.
335';227,621. as 328,9!%',510.
organimtionaihatioiiowluaascese,eheahhere k' LXJ '
and complete linea T/, 28, 3E!, and 83,
27 Net assets wrthout donor restnotrons
28 Net aasets with donor restnattons
CkganmtlonsthatdonotfollowPA6BASO96a,cheakhere > €
and aomplete 11nes # through 33.
-5-2-1-,3-6a9-,1-76:!17
- - _.-.- - .J
563,668,298.
3 , 796 , 072. u 4,99:L,y8y.
!29 Ciapitalstockortrustprn'iarpaliorcurrentfunds
30 Paid-inorcapitalsurplus,orland,building,orequipmentfund Bl Retained earnings, endowment, accumulated income, or other funds a2 Total net asseta or fund balances
&l %tal liabihtieaand net asseUi/fundbal.ant,es
B
so
31 525 ,165 , 248. 32 568,660,085.
860,392,'869. 33 897,61Q,595.
porm990(,,aisi:
932(111 tN4(1-2(1
18121119 795952 10042
1118
porm990(2019) ALTAMED HEALTH E3ERVICEB CORPORATION
pReconclliation of Net Assets
Check if Schedum O aontans a response or note to any Irne rn thrs Part Xi 1 522,397,789.
2 465,738,685.
3 56,659,104.
4 525,165i248.
a -i4,866,515.
8 7
8 9 i,702,248.
10 568,660,085.
1 2
3 4
a
e
7 8
9 Total revenue (must equal Part Vlll, cofumn (A), Ime 12) Totai expenses (must equal Part !X, column (A), line 25) Revenue less expenses 8ubtraot line 2 from line 'l
Net assets or fund balances at beginning of year (must equal Part X, lirie 32, oolumn (A)) Net ilrlreakzed gairis (losses) on invastmerits
Donatad servioaa and uae of faci)ites
Investment expenses
Prior penod adlustments
Otherohanges in net assets orfurid balances (explain on Schedule O) Net assets or fund balances at end of year Combine lines 3 throuqh 9 (muat equal Part X, line 32, column (B))
l!Finaricial 8tatementsandReporting
Check if 8chedulei O contains a response or note to any line m this Part Xll 95-2810095 Pagei12
Yes No
%J
b x
2b -Xl
2c x
-l
aa x
u
8b x
i AcoountingmethodusedtopraparetheForrn990, € Oaah [X]xccruat € oier Ifthe organization changed its method of accouriting from a prior year or ohecked "Other,' explairi in 8chedule 0 aa Were the organization's financial statements compiled or re'viewed by an independent acaountant? If "Yes,' oheok a box below to indicate whetherthe finanoial statements forthe year were compileid or revieiwed on a separats basis, consolidated basis, or both
[]separatebasia € consoiioateobasie [Jaothconsoiioateaanoseparatebasis b War*theorganrzatlon'sFinancialstatementsaudnadbyanindependentacaountant'? If "Yesi,' check a box below to rndicate whether the financial statements for the year were audned on a saiparme basis, mnsohdated baas, or both
€ Separatebasis [X]consoiioateobaais € Bothaonsoldatedandseparatebasm c kl"Yea"to line 2aar2b, does the organizationhavea cornrnitteethat assumesrespont,ibilr§ for overnightof the audtl remw, oroornpilatcn ofits finanaial statements and selechan of an independent amountant'> If the organizabon changed erlher ds oversightprocess or selgtion process dunng the tax year, explain @n8ahedule 0 3a As a resuR of a federal award, was the organization required to undergo an audit or audits as set forth in the 8ingla AudR Act and OMB OiroularA-133?
b 1f'Yesi"didttieorganeationundergotherequiredauditoraudite?iftOeorgariizat+ondidnotundergotherequiredaudit or audits,explainwhy on 8chedu)eO and $sanbe pny steps taken jo undergo auoh qdlta %rm990 2019)
a3@12014-20
18121119 795952 10042
12 ?oQ%94f'!ff'gr YYj" SERVICES COR 10042-1
1119
8CHECaUlE A
(Porin 990 or
Dapartmenl t lha Tieaaury
Intainal *nue 8eivias
Public Charity Status and Public Support
Complete tffhe organlution Is a am,tion 801(c)(3) organization or a aeotlon 4947(a)(1) nonexempt charitable trust.
> Attaoh to %rm Ha or Form 99042.
> ao to www.irs.gov/Porm990 for Inatruatlons and the latest Information, Name of the organlmtlon
OMB No t646-(1047
2019
Open to PtlbllO
Insp@etlon
ffmployei Identlfiaatlon number
ALTAMED J{EAI!'H SERVIC'ES CORPORATION 95-2810095
lPartl I FleasonlorPubl!c5harityltatus(qtiorganizationgmustcompletethispart)8eeinatruotions Thlemn:at0iohnBisOhnlo;oanvperimvaltoenroofu@n:ua:@iohnesbleooarau:eoiotliasl1o(pnoorfrianhesuihther:duaghc:lz e [J Aschootdescribedinseattonl7(l(b)(1%A%li),(Atlaeih8cheduleE(Form990or990-EZ)) 3 [X] A hospdal or a oooperative hospital sarvics organization desgibed in section 170(b)(1)IA)(iii). 4 Cl A medical research organization operated in conlunctiori with a hospdal describedin sieation17olb)(1)(A)(ilQ.Enterthehoapdal's name, ody, and state
s [:] An organization oparated for the beneff of a college or unrverstty owned or operated by a governmental unt desonbsd rn sectlon 170(bXl1(AXivi(CompletePartll,)
6 [1 A federat, state, or looal government or governmental unit desoribed in section17$%l%A%v). 7 [1] v organizatzn that normatly receives a substantial part of ris support from a governmsntal unit or from the general publz deegnbed In aacllon 170(b)ll%A%vl), (Complete Part II)
a !21 Aaommunitytruatdeaaribedinseation170(b)(1)IA)(vli(OomptetePartll) 9 € Anagricultgralrasearchorganizationdesanbedinffieotlonl70(b%1%A%lx)operatedinconlunctionwrlha{and-grantcollege or university or a non-land-grarit college of agnculture (see instvations). Enterthe name, taty, and state of the college or universdy
to [J borganizationthatnormaiiyreo*ives:(i)morethanasiasoritssuppartrromcontributions,membershipreea,anagrossreoeiptstrorn amivdies related to ds exempt funatroris - aub1ect to e:ertatn axceptrons, and (2) no more than 33 1/3% of its support from gross inveslmant inoorne and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975, 8ee aectlon 60%a%!), (Coinp(eta Part Ill.)
ff a An organization organized and operated exclusivsdy to test tor public safety See ssatlon 609(a%4). 12 € Anorganizmionorganizedandoperatedexolusivelyforthebenefitof,toperformthefunotionsof,ortooarryoutthapurposesofoneor more public§ aupported organizationa desonbed in seotlon [9(a)11) or ssat!on 8091a)(2), See seatlon 60@a)(3}, Cheok the box in linea 12a through 12d that descn5es the t)/pO Of supportlng arganEltton and complete lines 12e, 12f, and 1 2g. a C] Typel.Asuppartingorganizationoperatad,superviasd,orcontrolledbybsupportedorganizabon(s),typcallybygivrng the aupported organsation(s) the pawer to regularly appoint or eled a malonty oftha direotors ortrustaes oftha supporting organization, You must complete Part IV, 8mtions A and B. b € TypeJ1.Asupportingorganizationeuperviaedoraontroledinwnnscffonwithrtaaupportedorgariization(s),byhaving control ormanagernent of the supporting organization Vested in the same peraona that oontrol or manage the aupported organization's) You must aomplete Part IV, Seal}ons A and C, C € Typolllfunctlqnallyintegraled,Asupportingorganizaborioperatedniconnectionwlh,andfunationallyintegratedwilhi its aupported organization(s) (see ristruations) You must complete Part IV, auctions A, D, and E. a € Typelllnon-funotlonallylntegrated.Aaupportingorganizationoperatedaimnneationmthdssupportedorgar'uzation(s) that is not functionally integrated, The organizaUon generally must satisfy a distribution requirement and an attentiverieas requirement (see instrudions) You must aompl*te Part N, 8eotlons A and D, and Part V. e [J OheckthisboxirtheorgaruzabonreceivedawnttendeterminatianfrornthelR8thatitisaTypel,Typell,Typelll funationally integrated, or Type Ill nonfunotionally integrated supporting organization f Enterthenumberofsupportedorganizatrons
a Provide the followrria inforrnatiar about the suooortsd oraanizattonts) - At Alaab s# si ixzm4;bA liil Gllil ' jrur Ylll%l /J ymahzahpq iMlsth*niaa nmtlon flated liil Ami'ii rh* al ma*aai 4yi)Amountof osier support(seemstrualiona)
ill INal I10 VI I)llilpllt lltll
argbnization
pll 9111 pnl I JQ %II Illilal%fflllW I
(descnbsdm hnes1-10
@bovaiseeHatz}1p4aij
lfmiii'ffi6mAT'iffi7o-6ffiiiFl llT//llllulllll lit llllffllljlgl7 support(seeinatruo)iona) Y-as- = No '
TOtal
LHA Far Paperwork Redudlon Ant h OtlCO,see the Inattuotions mr FOmi 990 0r ogO-EZ. 93202?09-28-19 8Ch0dute A (Faun miO Or 9go-EX) W19 1120
(Completeanl9If 70uOtieeikeidttieibOXOnline6, 7, Dr8 0f PartI ar Ifthe organizationfarledto qualifyunderPartIll, If the organization ila to qualify underthe tests listed below, pfaase compfetePart lil, Section A. PubJm eupport
(a)2015 (b>zote (a) 2017 (d)2018 (e)20t9 (r)r(!ii
/
/
/
/
/ '='
/
/
......l... .
Oalendaryear (or fiscal year beglnnlag in))
1 Gifts, grants, contnbutions, and
membership fees received (Do not
include any "unusual grants ")
2 Tax revenues levied for the organization's benefit and e:therpaid to orexpended on its behalf
3 Thevalueofsentiaesorfaciltties
furnished by a governmental und to
the organization without charge
4 Total. Add lirios 'I through 3
8 Theportionoftotaloontributioris
by each person (otherthan a
governmental urllt or pubm,ly
supported orgamzation) inokided
On tin*1 that exceeds 2% af the
amount shown on line 1i,
oolumn (f)
6 Publk,aupport.aubtiaouines*omiinei
8eotlon B. Total Support
Oalandatyaat(otlltmal yearbe@InningIn))
7 Amounts from line 4
8 Grass inoome from interest,
dividends, payments received an
smumiss loans, rerits, royanies,
and income freim similar souroea
9 Net income from unrelated business
(a)2015 (5)2016 (o}2€)17 / " (d)2046 4e)2019 (f)Total
/
/
i
/ -'
/
/
'121 .
14 18121119 795952 10042 po',i%l!'f'' BER'cEB coR loo42-1 1121
BPeHazd5111Bltu@[email protected]:aifeorAoL%gaAMnl:aDrloHnsEADLesTcHrllbSe €aP)O(2RA) TION.
(OompleteonlydyoucheckedtheboxonlrnelOofPartloriftheorganizabonfatledtoqualifyunderPartll lftheorganrzationfailsto (O) 201 7 (d)2018
(fl Total
Computat on of
ent income far 2C)19 0ina 1
ant nicome from 2018 8c?
aupporttests fftheorganrza
an3G1/3% thtsboxandsloph
support 201&lftheorganrza
not 331/3% aheckttusb
If the gganmtion did not
sCl
15 18121119 7 5952 10042
1122
8cheduleA(Fo7nl990or990-q20ig AIiTAMED HmALTH SERVICHS CORPORATION p Supporting Organiiarions
95-2810095 Paq@4
(C,ompAeteonly ifyou checked a box rn Itne12 on Part I Ifyou cheoked 12a of Part 1,complete Sections A and B ItyOu oOeoked 12b Of Part 1,complete se0tlOri8 A and C lBau oheOked 120 0f Part 1,complete Sea.'ionsA, D,andE ItyOuChecked12d OfPart1,completelections A andD,andcompletePartV). ii Section A. All Supporting Orgamzations
'i Yes No
1 Are all of the organzation's supported organizations listed by name in the organization's governirig doauryieirlt8Tlf'NO,"CkMOnbelnPart'glhOWttH3StlppOrl0d0flJanlXatl0n8ar0deBl9nated lfdea(gnatedb7 CkJSaOrpurpOSe, dW,rlbe the da!JlgnatlOn /f hlritOrla and rx)ntlntJlng r€ilatlanahlp, eXplNn 2 Drd tne organization have any supported organizatiori that does not have an 1F18determination of statua under aemion509(a%l) or (2)? If'Yes,' explarn//} Part Vl how the organizatron dehermrned that the supported orgamatron was descnbed in seatron 509(a)(1) or(r>)
3a Didtheorganizaiiorihaveasupportedorganizationdeacnbediseetion501(c)(4),(6),or(8)l/f'Yes,"answer (b)and(a)below
b olofheeirganlZatZn00nrlrmttiateiaetiBupp0rted0rganizatl0nquallrledunderaem(On50l(0)(4),(5),Or(8)arid satisfied the publio support tests under section 809(a)(2)? If'Yes,' describe in Pan Vl when and how the orgawatron made the determrnatron
0 Didthsorgariizatianenaurethatallsupporttosuchorgamzationswasusedaxcluaivelyforseotionl70(e)(2)(B) puiOs6a') /f 'YOEk,"eXplaln In Part Vi What aOrltfOj8t?ie Organrl&tlOnput In plaH tO OnStlte8uCh uie 4a Was any supported organization not organzed in the uriit*d Statss ('foreign supported organizahon")'? If 'Yes,' and if you bhacked 12a or 12b rn Part /, answer (b) and (C) below b Didthearganizattonheveuftimatecontmlanddiscretiontndecidingwhethertomakegrantatotheforeign supported organization? If'Yes,' desCnbe (n PartVl hOWth0 0rgamatlOn had w* COntrol0nddlSCretlOn despde berng aontrolled orsuperirsedbyorin conneahon wrth rts supported organrzahona o DidtheorganizationsupporLanyforeignsupportedorganizationthatdoesnothaveanlRSdaterminaten undsr sections 601(a%3)and 5C19(a)(1)or (2)') 17"Yes,' explarn inPart Vl what carols ttie organzation used to enauie that alleupport to the forergn supported organrzahon was used exdusmly k>rseatron ?70(a)(2)(B) purposes
6a Dtdtheor@anizatianadd,substitute,orrernoveanyeupportedorganizationadunngthetaxy@ar71f'Ygs," answer(b)and(c)berow(rfapplrcabte) Also,pmvrdedetailrnPartvr,rnckiding(OthenamasandE!N numbers Of ttR 8uppOrtadOrganlZatl0n8 added, substltuted, Orr €nmOVed,(jp the reek)n8 fOreaah SuChact/On, (m)tfie authontyunder the organaatron'a organarng documentauthon;angsuch wtion, and pv) how the achon was or;xmphshed (such ashy amendment to the orgawwg dx;umen0 b Type I or T%ze II only. Was any added or substituted supported organgation part of a class already designated rn the organtzation's organiztng document?
c 8ubstltutlons only. Was the substitution the resutt of an event beyond the organgaton's wntml? 0 Didthearganizationprovidesupport(whetherintheformofgrantsortheprovimonolserviaesorfaalties)to anyone Other than (OitS supported organizatioris, (ii) ind+wduals that are part of the ahantab)e Olas8 benefited by one or more of its supported otganizationa, or (iii) other supporting organizations that also support or benefd one or more of the filing organization's supported organizatcns" /f'Yes,' pmvrde detad rn PartVl.
7 DKIthe organization provide a grant, iOan, coqenfflationi Or oU"iersimilar payment to B substantial oontributor (08 definedinsechon4958(o)(S%0)), afamilymennberOfa 6ubsitantffll contributor,ora 35% controlkidentrt7 wTh regard tO a substantial oontributar? ff oYes: compiete parti orsctaauio t. yom ggoor990-Q 8 Did the orgarnzatcn make a loan to a disqua(ified person (as defined m secban 4958) not described in Ime 7? /f'Yes,' complete Partl of(x,hedute L (Form 990 or990-E4 ga Was the orgsnrzation contro(led direotly or indirectly at any bme during the tax year by one or more disqualified persons as defined in semion 4946 (other than foundation managers aruJ organizaUons descnbed insection 509(a%1)or (2))? If 'Yes,'pmvtdedetailinPart Vl. b Drd one or more dtsqualified persons (as definsd tn line 9a) hold a controlling interest ni any entity in whiah the supporting organization had an interest? /f 'Yes," pmrde detailin Part Vl. o Did a dsqualifmd person (as defined in Irne 9a) have an ownership interest in, or derive any peraonal benefd tram, ASSETSIn WhlChthe eiupporting organization al80 had an interestg /f "Yes,' provme detmln Part Vl, 10a Was the organtzation sublst,t to the excess busrness holdings rules of eechon 4943 bemuse of aeation 4943(Q (regardtng oertatn Type II supportrng organrzations, and all Type Ill non-functionally integraffld supporting organi;mtions)? /f 'Yes,' answer 10b below
b Did the organization have any exoeas busneaa holdings in ttie tax yearl (Use Schedule C, Form 4720, to detemrne whether the at,aruzatrw had excess busmss holdrnps } 10b %hedule A (Form 990 or 9tlO-EZ', 2019
I
I
, - .J
.,,j
932014 a9-28-19
16 18121119 795952 10042
1123
-3oheduleA(Form990or990-EZ)20i9ALTAMED HEALTH gERVICES CORPORATI.Oq. 95-2810095 Paqe5 IPartIV' SupportingOrgan.izations(r,nl,nl,R,1)
11 Hastheorganzationaeceptsdagiftoroontnbutionfromanyofthefollowingperaons9 a Apersonwhodireallorindireotlycontrolsieithera)oneortogetherwithpersorisdeseribedin(b)and(c) below, the goveming body of a suppoMd organizatiori?
b A jam-ly member cifa person describeid in (a)above?
r, A35%controned*nhtyofapersondescribsdin(a)Or(b)a55Ve?/f 'Yes'tOa,b,OrC,pfieiVICb dhtad4Q.F:97Vl. 8eation.D. Type 18upporting Organizations
1 Dd the drrectors, trustees, or membership of one or more supported organizations havethe power to regulady appornt or elsct at least a malorQ of the erganrzation's direotors ortrustees at all times during the taXyeah If'NO, ' dOSanbeIn Part Vl hOWthe wppOrtm argmlZatl0n(8) erte:.tmty Operatm, wpeNmd, Or wntmlledtheorganizalion'saatnntres lftheorganizahonhadtrtorethanonesupportedorganqabon, describe how the powem to appont andlor remove directors or txAees hem allocatedamong the supportM organtzatons and what conditrona orrestnctions, if any, apphed to such powem during the tax year 2 Didthe organizationoperate for the benefRof any supported organization other than the aupportsd organrzatian(e)that operated, supervised, or controlled the supporting organization9ff 'Yes, aexplarnrn PartVl how pmvtdrng such benefrt camad out thepurposes ofthesupported>rganizabon(s) that opemted, supervised,ora;introlledthesuppMingorlanrzabon
8emion C, Type II 8upporting Organ'zations
1 Wereama3orityoftheorganization'sdirgtorsortrusteeisdunngthetaxyearalsoama1orityofthedirectors ortrustaea of each of the organization's supported organization(e)?/f'No, ' dasnbe in Part Vl how contml ormanagement oftha supporting organrzatronwas vested rn the samepemons that controlled ormanaged the suppMed orgawatron(s)
8ection D. All Type Ill Supporting Orqanlzations
Yes No
l1a
11b
llo
Yes No
J
,,,,,i 1
Yes NO
.j
Yes No
1 Didthe organization provide to each of its aupported organizations, by the last day of the fdth month of the organtzation's tax year, (0a wntteri nottce describtng the type and amount of support provided during the pnortax year,(q)a 00PVof the Form 990 that waa most recently ftled as afthe date of nabfication, and (iii)copies of the orgamzatton'sgovermng doouments in effect on the date of notificahon, to the e+dent not previously provideid? 2 Wereay of the orgarnzqtton'aoffiaers, drrectors, or trusteea either O)appointed or eleoted by the supported organization(s)or (ii)serving on the governing body of a silpported organizatiori? /f 'M), " explarnin Part Vl how theorganaatrw maintained a dose and wntrnuous workrngrelatcnship with the suppmed orgaruzahon(s) 3 By reason of the relationship desonbeidin (2),did the organization'a supported arganizatione have a signifrcantvoioe in the orgarisation's investment policies and in direoting the use of the organization's 'lna0meoraaaetaatalltlrne8duringthetax}ear't/f'yes,VssanbO/nPartVlth0m/atti00@anl2at/Ori's - asup(x>rtedorganiutronaplayedin thismgard 1 2
3 qedio,n E. Trype Ille !unctionally Imegrated Supporting Organizations 1 Check thabw nexttothe method that the organtzatginused to satisfy the rntegmrPart Test during tfia yes(see Instruotioris). a € 'rheorganizationaatisriaathepativitiesreat,compreteiineatiaiow b € Theorganizat+oritatheparentofeaahofitssupportedorganqatiorm compteteiinesbebw 0 € rheorganizationsupporieoagovernmentaienmy >scnbeinpartvihawyousupponmagovemmentenmy(seainstruc 2 AotrvitresTest. Answer (a) and (b) below. Yes No
a ozsubstantianyartoftheorganization'sactivniesounngthetaxyagroiremiyturtheriheexemptpurposesor the aupported organization(s)ta whidi the organization was rmponsive? If 'Yes,' than rnPart VI Identffy those supported organizatione and explain how theseachvtbes diteahl furthered thvrexempt purposes, /IOWthe organrzatronwas msponsnte to those supportm orgarnzahons,andh>w the organzzabondetemined that these actwrtresconstrtuted aubstantralh,rallofits adivtties b oidtheactivnieaoescnbedin(a)aonstnuteaatiwieathatibutrortheorganzation'sinvoivernentiorieormore ofthe arganization'aaupported organizahon(s)would have been mgaged in? If "Yes,' explmn in Pay3Vr the masons kir the organrzats:in'aposittonthat rtasupported organimton(s) utould haveengaged in these achvitresbut hrthe organrmtron'a invalvernerit
3 Parent eifSupported Organizations Answer (a) snd (b) below. a Didtheorganizationhsvethapowertoregularlyappointorelectama)orayofitteotficersidiraotors,or inistees of each ofthe supported OrgatilZatl0ns9 Pmvme aetatis fil Part Vl. b Didttie organlzatlOnexerois a aubstaritiai degree OfdireotiOnOVerthe policies, programsi and actlVities of eaoh otitasupportetlor(Harm,akins'?lf"Yes,'desanbeinPartVltherolepjayadbytheorganrzatronrrithtsreqard. gstogson,tsse 8ahedule A (Form 990 or 9tiO-EZ: 51019
I
Qa
I
9 J
aa
3b
17 18121119 795952 10042 rmf'9i'WN'WAT" qo'R'c' coR 10042 -1 1124
'icheduleA(Form99(or990-EZI2019 ALTAMED HEAIiTH !9ERVICJ3S CORPORATION 95-2810095 Paqe8 Non-Funoflonally Integrated 609(a)(3) 8upporting Organizations i LjCheckhateiftheorganizationsatisfiedthelntegralPartTestasaqualifyingtruatcnNov20,1970(explaininPartVl),heinstructions.All Other TV(X) tl! non-functionally intsrated supporting oraanrzattona must €X)nnolete !3eatlona A thrOLIOh E.
Part V Type Ii
8aallon A - Adjusted Net Ihoome (A) Prior Year
1 Net short-temi capital gain 1
2 Recoveriesof p7ioriyeardistributions 2
?J OthsrHrossinmme(aeeinstruotions) o
4 Add lines 1 through 3 4
8 Depreciation and depletion 5
6 Portion of operating expenses paid or mcurred for productiori or aollecton of gross income or for management, oonaervation, or __ maintenance of property held for productron of rno(ime (see instruottons) e _7 0thsrexpenses(aeeinstructions) , 7
-& Adjusted Net Inoome (subtrad lines 5, 8, and 7 from line 4) 8 8eatlon B - Mlnlmum Mast Amount (A) Prior Year
1 Aggregate fair market value of all non-exempt-use aaseta (see instructions for short tax year or assets held far part o! year) a Averaqemonthlyvalueofseaurities la
b Average monthly cash balances To
o Pair market value of qth@r non-exempt-use assets la
d Total (addlines la, 1b, an<l1€:) ld
e Dfsmunt claimed for blackaga or other
,,(4glp,@,(explairi gi ils(adui Pnil Vl), " -' Kl i'4*< :a' ia 4'J ' i I '! i I
" a%-" Pi ' I" AS il
2 Aoquiaition indebtedness applcable to non-exempt-use asaets 2 s 8ubtraotline2frornline'ld e
4 0ashdeemedheldforexernptuse Enterl-1/2% ofiine3(lorgreateramount, sea instructions) 4
8 Net value of no>exempt-use assets (subtract line 4 from line 3} 6 0 Multiply line 5 by 036. e
7 Reooveries of pnor-year diatributions 7
& MlnlmiimA(.e)et4rrlotmt{addlinertolineh) a
Sstlon 0 - D}atrlbutable Amount
1 Ad1uetednet rncomefor pnor year(fromSedronA, Irne8, CiolumnA) 1 Q Enlar 85% of linei 1 2
G Mirumumassetamountforpriaryear(fromSectionB,linen,OolumnA) a a ,qntergreateroflins2oriine3. 4
6, Ineiomelax impopedin prior year 8
8 0lstrlbutableAmount.Subtractline5fra'mttne4,unlesssublectto emergenoytemporaryreduotion(seernfflhuatrons). 6
7 LJcheabhereirthecurrentyearistheorganzation'atirataaanon-runctionaiyintagr*eovypeiiisuppontngorgiinizaiion(see In(itructionai
8ohedula A (Poim 990 or NO-g ml9
932tl:18 0(1-a5-19
18 18121119 795952 10042 r?a5#d!f!atW'!)rYY!T" q'R'cEB coR10042-1 1125
8chedu)e?(Form99i)or990-PZl20l9 ALTMED HEALTH SERVIC!:S CORPORATION 95-2810095 Paosi7 lPartV i
' Type II I Non8eation D - D)stributlons
1 Amounts paid to supported organizatians to accomplish exempt purposes ' 2 Amounts paid to peHorm agUv§ that directly furthers exempt purposes of supported wgantzations, rn excess of rncome from ac5tnly
3 Administrative expenses paid to apomphah exempt purposes of suppoited oiganizations 4 Amounta paid to aaquire mempt-use assets
8 Qualified set-aside amounts (prior 1R8 apprgval rsiquired) 0 0ther distnbutions (dos:'ribs in Part Vl) See instruotons. ' 7 Total annual dlaVlbutlons, Add hnes 1 thraugh 8
a Distributions to attentwe supported organizations to whioh the organizaton is responsive (providedetailsinPart Vl) See instructions
0 Distributableamountfor2 €l19from8eatronO,Itne6
10 Ltrle 8 arnoqnt divrded by Ine 9 arrlount
8*mlon i- Distribution Alloaatlans (see instructions)
(l)
ixcese Distributions
(€1)
Underdlatrlbutlons
Pre-!aOl9
* Qistributable amount for 201 9 from Section O, line 8 2 llndardistributions,ifany,foryearspriorto20l9(reasonableaauserequired-explainin Part VQSeeinstructio@s I
I
B kxtiesMietnbcitioriecarryoverlrtany,to201D -l
Q Frqidt,4,,,, 0- I
5 I ram i'Olb i if %bi"
o From2016
d FromEl7
e Frqn)2018
f Total of lines.3a through e
g Applied to underdietribulions of pnor yeam
h Applied to 2019 distnbutable amount
I Car7overfrorn20l4notapplied{seeinstrudions)
J RemainderSubtraotlines3g, 3h, andBifrCimSf.
4 Distnbutiorisfor2019from8ectionD,
lins7 $
a Applied to underdistnbutions of pnor years
b Appliedto2019distribuUibleiamount
g Remainder Subtrskit lines 4a and 4b from 4
5 Remainingunderdistiibutionbfuryein.ipiiuilu2019,if
. any 8ubtraot lines 3g and 4a from line 2 For result greater than zero, explain in Part Vl. Bee inatruattona
6 Flemainingunderdiatributionsfor!019.eubtraatlines3h
@nd4b from line 1 For resuit greater than zero, explain iri Part W, See instruations
7 Exaessdlstrlbutionscarryovartoa'0.Addlrnesal
and 4o,
B Breukdownofllne7' i ) i ' aa a *
' %i
u Exucyfruiri20l5 I pi i i% iA i o . " I)a
b E+icer,afro(qpgly _, _ I 'l 0 * a " 11) J ' a a i ' r a Ila '" . ", " i 0 E+ceaafiuni201?
d E+icessfrom2018
e E+taeas from 2019 I
9t%lOg709-R6-10
18121119 795952 10042
!module A (Form fflX) ot 9kEq H19
19 1126
scileduleA(Form990or990-E2}2019 AIiTAMED HEALTH gERVICES (:'ORPORATION . 95-2810095 Page8 p8upplementallnformation.provioetheexphiriationsrequiredbypan)1,linelOipartir,tine'izaori;rb,partiii,iineia, Part IV, 8eotcn A, Snss 5, 2, 3b, 30, 4b, 40, Ba,6, 9a, 9b, 9o, 51a,11b, and 1%, Part IV, Section 8, linea 5 and 2, Part IV, 8eotion O, line 1, Part IV, 8ection D,lines 2 and 3; Part IV,Beckon E,lines lc, 2a, 2b, 3a, and 3b, Part V,line 1, Part V, Section B,line le, Part V, 8ectlOn D, lines 5i s, and 8, and Part V, 8eotion g Irnes 2, 6, and 8, QaO Completei this part forany addAioiial information (See instructions )
9:X)at €19-H.ffi 8ohedub A (Form 9'90 or9gO-EX) 2019
20 18121119 795952 10042 Ad?j'AaA5eW'DrY'i'OT-'T'FTQT':RVICEE3 COR10042-1 1127
8CHEDUlE C
(Form 990 or 99042)
OOpffl*iilaiitia Tieaaury
Intemat ftevanue 8enice
Political Campaign and Lobbying Activities
For Organlzatlona ExemptFrom Income Tax Under sectiori 6011c) and seotion 6e7 >compieteirtheorganbationisamaribmbetow. >attschtopormegoorpormoeo-ez. > Go to www.lrs.gov/Form990 for instruatlons and the latem inlormatlon. 1 Open to publk,
)nspaatlon
If the organlzaUon answered "Yes,' on Form NO, Part IV, line 8, or Form 990-!Z, Part V, line 46 (PolRlcal Campaign Activities', than *Seimion501(c)(3}organizations OomplelePartsMandB,DonotcompletePartl- €; *8ection501(o)(olherthanseation50i(o)(3))organizations CompletePartskAandCbelow DonotaomplmePartl-B 0 Section 527 organizabons Complete Part JiAonly
*f the organization answered "Yes,' on Form 990, Part IV, 11ne4, or Form 990-EiZ, Part Vl, 11ne47 (LobbyingActMtl*a), then * 8eotion 60%0)(3) orgarmations that have filed Fortn 5768 (eleiction under section Bat(h))i Complete Part 11,ADo not oomplete Part II-B *8ectian50%c%3)organaationslhathaveNOTfiledForm5788(eleationundarseation501(h))'CompletePartll-B DonotcompletePartll-A If the organization answered "rea," On Fmm ggO, Part IV, 11nO5 (Proxy TaX) (Ose separate Iristruottons) Or Farm goo-aZ, Part V, line asa (Proxy Tax) (see aeparate Instrucllona), then
0 8eation 601(o)(4), (5), or (ellorqanixations. (<rpp)eta Part Ill Name of organization Eimployer IdenUf!cation number
AIT'MED HEAIITH 8ERVI(:'ES CORPORATION 95-2810095
Complete if the organization is exempt under section 801(0) or iffi a'ae6d6ii'Cj ui'yvuJzaliyn. IParti-Al 1 Provtdeadescnptionoftheorganization'sdirectandindirectpoliticaloampaignaativitiesinPaThlV ?. Poltttoal oampatgn activity expenditures
a Volunteerhoursforpolitioglaampaignactivdies
IPartl-Bl Completeiftheorganizaiionisexemptunderaection50t(c)43), I Enter the amount of any excise tax incurred by the organization under section 4955 2 Entertheamountofanyexoisetaxincurredbyorganiatianrnanagsrsundersaotion4955 a If the organization inouned a section 4955 tax, did rt fde Form 479.Ohr ttus year';' 4a Was acorreotion made?
LJ Yes LJ No
CI]Yes C] No
l #abA"lY-;j" d;oorimbep;n;ear,fVthi organizationis exemptundersection60$), exceptseation60'l(c%h). 1 Entertheemountdirectlyexpendedbythefitingar(1anizationforseation627a+tennptfunationactivities ?. Entertheamountofthefilingorganization'sfundsoontnbutedtootherorgantzationaforsection627 exempt funation activities
8 Total exempt fundion expanddurss Add lines 1 and 2 Enter here and on Form 1j20POL, line17b
4DidthefilingorganizationfilePorm11m-POLforthrsyear" LJves LJso B Enter the names, addresaes and employer identrftcahon numbar (EIN) of all geeition 527 political brganaations to which tlis flling orgamzaUon made payments For aaah organization listed, enter the amoigit pard from the filing OrganlZatlOn'a funds. Also entei' the amount Of pOiibaal contributnna recaved that were promptly and direatly delrvmed to a separate palittcal organization, suoh as a separate segregated fund or a politioal action committea (PAC) If idddional space is needed, provide informatiari in Part l'/ (a} Name (J Addrma (c) EIN ' (d) Amount pad from
fiting organzation'a
funds If none, enter -O-,
' (e) Amourit of polmoal
contributions reaeived and
promptly and directlV
delivered to a sepafflte
politiaal organbation.
ff none, enter -OFor Paperwork Reduction Aat Nottt,e, see the Inatruotions for Form Ha or Ha-EX.
LHA
8t,hedule O :Form 990 or 990-EX) 519
EKl2a4i Tr-as-to
41 18121119 795952 10042
1128
8aheduleO(Porm990or990-EZ)2019 ALTJ'a41D HEALTH SERV:CCE8 CORPORATION 95-2810095 Page2 p Completeiftheorganizationiaexemptunderaemion801(o%9)"mrTd"iilffidPorm670B(electionunder section 801(h)).
A Check > u Ifthe filing organizatioh belongs tO an affiliated gmup (and list in Part Iv agh affiliated Qroup member's namei address, elN, expenses, and share of dxoesa lobbyinH expendituras).
s Check > [J ffthellligor4anizationcheckedboxAand"Iimfedcoritrol"proviaionsapply (a) Fi(uig
LlmltonLabbylngExpend}ffirea organizmion's
(Theterm "exp*nditurea" means amounts patdor inaurradJ totals (b) Affiliated group
totals
Total lobbying expenditures to influence public opinion (grasaroots lobbying) Total lobbying expenditures to influence a legislative body (direct lobbying) Total lobbying e+tpendttures (add lines 1a and lb)
Other exempt purpose expendrtures
Total exempt purpose axpenddures (add lines 1a arid ld) Lobbying noritaxable amount. Enter the amaunt from the following table in both columns. lflh*amountonllnele,ooluntn(a)or(b)Ia: Thelobbylngnontaxableamountls:
Notover$600,000
Over$60€),000butnotover$1,000,000
Over$1,000,000but net Over$1,600,CIOO
Over$1,600,00Dbut not over $17,000,000
Over $1 7,000,000
20% of the amount on line le
1100,000 ph.is15% of the excessover$500,000
$175,000pkis10% oftheexcess over$1iCIOOiOOO.
t+226,ODDpkis 5% of tha excessover $1,500,OCKI
$1,0€)O,QOO
g araasroots nontaxa51e amount (emer 26% Of fine 1f)
h Subtramlinelgfromlinela llzoraorless,enter-0-
i Subtraat line if lrom line 1o If zero or lass, enter -O- § Ifthereiaanamountotherthansraoneith*rlrnelhorlineti,dJtheorgamzmionfileForm4720 reporting saation 491j tax forthis year? []YeaCJNo
4-Year Averaging Period Under 8eatlon 601(h)
(8omeorganmUons that nmdea section 80%h} ateetion do not hava to oomplote all of the flve columns below. am the separate Instructions for lines 2a through 2f.)
Lobbylng Ixpeiidlturea During 4-Yeiir Averaglng Perlod
Oalendaryear
(or fmoal year beginning in)
(a)2D18 (b}20'l7 €0) 2018 (d)2019 (e) Total
_2s 5qbbyingnontaxabkiamount
b Lobbyirig ceiling amount
(150% of lino aa, column(o)}
o Total)obbyinHspendttur*s
d Graasroots nontaxable amount
e Grasiaroots ceiling amount
(ta)% of line 2d, column (e))
_ f Clra4(i(<xitak)bbynq expendlturp
Schedule O Pmam 990or -QmlO
a32(142 11-28-19
18121119 795952 10042
42 pil!3dUe?A"I"fBt'f't!L'H BER'cEs CoRloo42-1
1129
election under section 601(h)
(U) (b)
Yes No Affi@unt
x
x
x
x
x
x
x
x
x 32, i274.
32, 1,274.
X"
I
Foreaah 'Yes" res(xinse on lines 7a thmugh lt befow, prmde in PartNa detar!ed descriptu>n ofthekibbying activity
1 During the year, did the filing organization attempt to influence foreign, natcnal, state, or loaal legislation, including any attempt to influence publio opinion on a legislative matter or referendum, through the use of
a Voluntesrs9
b Paidstafformanagement(includecompensationinexpenaasreportedonlirieslcthrough1i)? @ Madla advertisements?
d Mailingstornem5ere,legislators,orthepublrc7
e Publcations, or published or broadaast atatementa?
f Grants to other organizations for lobbying purposes?
9 Dffeot OOntaOt With legislators,their ataff81 govemment officials, or a legislative bray? h Rallies, demonajrations, aemnara, conventions, speeahes, )ectures, or any similar means? I Other aativnies?
l Total Add lines aR,through li
2a Did the aotivitiesin line1 oauaethe or@anizauon to be not desaribed in asction601(c)(3)? b lf'Yes,"enterthearnountofanytaxinaurredunderseation41ffl a If"Yes,"emerthearnountofanytaxincurredb7organizationrnariagersurideraeK)tion4912 d )fthafdinaorQanizattonrncurredaseattorl4912tax,dtditlileForm4720forthlayear') ffl Completegfth*organizationisexemptundersemion!501(a%4),seotion60l(di(5)iorstatlon 501(o)(6).
a Yes No
1 Wereaubstantiallyall(90%orrnore)duesreaeivednondeduotiblebyrnembera? 1 2 Did the organization make only in-house lobbymg expenditurs of $2,000 or less? 2 _ 3 Didthe.arqallization@q(qeto parryoverIqbbyirigandpolitical<annp@iHrl aclivlty exp(inditureafromthe pnoryear?. 3 4 Complete Ifttte organization 18exempt under aemion 601(0)(4),seOtiOri501{0){6),Or8€imion 80'l(c%0)and if either (a)BOTHPart III-A, lines1 and 2, are answered"No" OR (b)Part III-A, line 3, is answered "Yes."
1 Dues, assessments and simrlar amounts from membsra
rl Sectioril82(e)nondeduotiblelobbyingandpolrttoalexpenditures{doneitincludsamountaofpolit)pal expenses for whk,h the section 627(fl tax was pald),
a Current year
b Oarryover from last ysar
@ Total
B Aggregateamountrsportedinsgtion60a3(e%1%A)notcesofnondeduotrblesectanlB2(a)dues 4 1
If notiaes were aent and the amount on Ine 20 exceeds the amount on line 3, what portion of the exoass does ths organaation agree to aarryoverto the reasonable estimate of nondeduatible lobbymg and palitcal ei-peqddure next year" 4
Q Tixa:ilea.nountofiobbyinqandpo)Qiotiexpendrhires(aeeinstruations) iiiiiiizzii*i 8 IPartl/ eiupplementa Informal.on
Provide thr desgnptieins requirea for Part iA, Irne 1, PanI-B, line 4, Partl-C,line 5: Part It-A (afhliated group hat}, Part 114 lines 1 and 2 (age instructions)i and Part II-B, line 1 .Alao, complete tPIB Dart tor any additional information PART II-B, IilHB 1, LOBBYIATG ACffVITIESt
MOUNTS WERE PAID TO LEGISLA'!IVE CONSOLTANTS FOR LOBBYING ACTIVITIIB. gaaoe ii-as-is
18121119 795952 10042
!mheduto O €Ponn 990 or -EX) 2019
43 pia3?aAL"#a!W'BtW'f0'a"" ssR'c' coR lOo42-1
1130
:FmH9E9:UI EDI OePvunenk61lm Treasury
ImemalPlevanueemwae
OMB No 164!i-0047
2019
Oepvunenk 61lm Treasury
Imemal Plevanueemwae
Name of the organlutlon
Suppl41!X"i'kU!1 rinam,ial Statements
P!"t?V','i:near, V,';'9,o:8a, 1"', 2,al?::,':l'j,'€ a,'l'lr,';W",t'l%b, k Attach to Form WO.
)ao to www.lrs.Hov/Form990 for instruations and the latest injorrrlatlon, Opeh to Public
Irlspeatlon
Employer identHlaatlon number
ALTAMHD HEAIiTH J3ERVICES CORPORATION 95-2810095
L!!!!J OrqanizationsMaintaimngDonorAdvisedFundsorOther3imilarF'undsorAiints.compieteitthe organization answered 'YO8' On Farm 990, Part IV, lire 6 (a) Donor advised funds (b) Funda aria other aooounta
€ Yes € No
1 Total number at end of year
2 Aggregatsvalueofcontributioristo(dunngyear)
a Aggregatevalueofgrantafrom(duringyear)
4 Aggregate value at end of year
6 Dtdtheorganizationinformalldonorsariddonoradvlsorainsrdinglhatthsassetsheldatdonoradvaedfunda are the organaation's property, 8ubleat tOthe orgariizatcn's eXOluBlV0legal COntrOri e Didtheorganizationimormallgranlses,donors,anddonoradvisorsinwmingthatgrantfundsmnbeusedonly far charitable purposes end net far ttua benefit or the donor OrdOnOrsdvmor, or for any other purpose OOnferring ar:mli"rmSsobnseerv'afieob"enn:a'?aemems.cgmpieteirtheargahiutionanswereo'avea"onpormgCJY'a No € Protemionofnaturalhabnat aPreservationofacertifmdhisto;cshudure € Praservation of open sipaoe
2 0ompletelines2athrough2difthaorganizationheldaqualifiadconservationoontnbulionsitheformofaconservationeaseBgntonthei last day of the tax year Held at1heE3doftje Tax Yaar
aTatalnurnberofwnservatianeaaaments 2a
b Total aoreage restncted by conservation easements
0 Number of conservation easemsnta on a certified historio structure included in (a) d Numberof conservation easements included in (o) aoquired aftsr 7/25/Oel, and not on a histone struoture listed in the National Regmter
3 Numb3rofconservationeasementsmodified,transferred,released,extinguished,ortermmatedbytheorganixsRionduringthetax year
4 Nurnberofstateswherepropertysublscttoconservationeaaerneritislocated 5 Doea ttte organization haVe a written poltcy regarding the perEdia marutoring, inspection, hamling of valationa,anden!oraementofiheconservationeaaemenlsdholds'> Dyes [:]H 6 8taffandvolunteerhoursoeVOted tO morutonngi inspectingitaridlingOfviotations,andenforoingoonservationeasementsduring the Year 7 omountotexpenseainaurreoinmonnoringiinapemingihanotingotviotationsianaentomrngoonservationeasementsounngtheyear 8 Does eadi oonaervatron easement reported on line 2(d) above satrafy the requirements of seation 1 TO(h)(4)(B)(i) andseotion 170(hX4XBXii))
9 In Part Xilt, destribe how the orqaruzation reports aonservatton easementa in its revenue and expense statement and balanae sheet, and include, rfapplioabte, the text of the tootnotetothe OrganlZatlOn'Sfinanaal atatements ttiat deaaribmi the or4anizahon's aacountltiq for a;inservatron easementa
Organizations Maintaining Collections orArti HJstork.al Treasures, or Other?;fmiarAaaets. [J Yes C! s
Complete if the organization answered "Yes" on Form 990, Part IV, luie 8 la if ttie organization elected, as pemmted under FA8B ASO 968, riot tO report in ns mvenue statement and balanoe sheet works Ofart, hiatoriaal traasuresi Or other similar assets held tor publio exhibrtion, education, or researdi In furtheranae of pubba sarv+ae,provme in Part Xlll the text of ttte footnote to Us finanaial statements that deeoribea these Remsi b If the OT'ganl2atl0nelaoted, as pernnmed under F/1E3B/'!!30 988i iO rap(Xt In Ita reven aTa[eTTlentand b81anOe8heeR rka Of art, h+etonaal treasuresi Or Ottieirsimilar assets held for public exhitmion, eduoa!oni Orresearoh in turtherarxie Ofpublia servloe, provide the following amounts relating to these dems
(l) Revenue included on Form 990, Part Vlll, line 1
01) AAsets iriakided in Form 990, Part X
2 lftheorgatuzabonrece+vedorhetdworksofart,historicaltraasures,orotherannilaraasetsforfinanaalgain,provide the follomng amounts required to be reported under FASB A8Ci 958 relabng to these itenna:
a Revenue included on Form 990, Part Vlll, line 1
b Assets irlcluded In Form 990, Part X
LHA For Paperwork Reductlon Aot Notloe, see the (natructlons for Form 990, >$
zii-=
Schedule D (Form 990) 201!
2,168,239.
>$
-JL!L..
achsdub D (Form 990) 20ffi
44 18121119 795952 10042 po&k!\ASi'g!!"!?' Yr'!T"' oqF'R'cEBcoR10042-1 1131
Pm Ili i Organizati
d [X] Laan or exchange program
-ichadule[(Form99i))20a9 ALTAME:D HEALTH SERVICES CORPORATION 95-2810095 Paqe2 ins MaintamingColfedons of Art, Historicalrreaj7ej, or other SimilarAssets(continuei 3 U8uig the Orgarization's atquisttion, aoOassron, and other reaOraa, OHeck any Of the following that make signi?oant use Of da collection darns (ched< all that apply).
a [X] Public e+thitmion
b € Soholarly researdi
c m Preservationforfuturegenermions
4 Provideadeacnptionoftheorganization'scolle:'tionsandexplainhowtheyfurthertheorganization%exemptpurposeinPartXlll, 6 During the year, did the organization soliod or recstve donations of art, histoncal treaauresi Or other similar assets to be sqld to raise funds ratherthqn to ),e maintained as partof theorganization's colle<itton? € Yee l Escrowand€:ustodialArrangements,compieteittheorganizationanswereti'yes'onpomiggo,partiv,iineg,or reported an amourit on Form 990, Part X, Irne 21
la lstheorganizationTha@ant,trustee,austodianorotherintermedraryforcontnbutionsorolherasaetsnotmcludsd on Form 990, Part X")
b If "Yes," explain the arrangement in Psrt Xlll and oamplete the following table, [ No
C]Yes C:I No
Amount
lo
ld
1s
if
LJ Yea LJ No
€
Complete If the organization answered 'vex' Ori Farm 990, Part IV, line lla See Porni 99), Part x, ltne io, Desoription of property (a) Cioat or other
basis (investment)
(b) Cost or other
basis (other)
(o}Acaumulated
depreciation
(d} Booli value
la Land 40,549,471. 40,549,471.
b Buikinga 16,435,715. 8,750,097. 7,685,618.
c Leaseho)d improvements i20,623,963. 31,8521556. 88,77i,407. d Equipment 106, 389, 862. 64,992,496. 41,397,366.
e Other !97,501,084. 97., 50) .,084.
Total.Addlirieqlqthp:iuq)i5e.'(Column(d)mustequatFomfAO,Part.X,ooruiatn(B),hslOc) , 2 275', 90< 11946. 8ahedule D (Form 990) 2019
93205! in-02-fil
18121119 795952 10042
45 1132
at,heduleD ALTAMED HBAIiTH SERVICES CORPORATI(X!J 95-2810095 Investments - Securities,
0omplete dthe or@anizatmn answered "Yes" on Form 990, Part IV, tine 11b. See Form 990, Part X, line 12 3 (a) Deaaripiionof sacuntyor aategay(maiuaingnameoiavuiny) Ib) Book value (o) Method of valuation Cast or end-of-';ear market valus (1) Friancial derivatives
(!2} Closely held equity interests
(3) 01tmr
.(A)
(El)
(C:)
(D)
<E)
(F)
(Q)
(H) a
7otal.',((, 'ol.(h) mimt squalForm 990, Partj, col. (B) Iino12,) > I 0 * Is kk* I " i a *r r
Investments - Program Related.
Coriblete if the oraarigation ariswared 'Yes" on Form 990, Part IV, line 11o, :3se Form E)90,Part X.linb 13, (a) Description of rnv*stment (b) Book vafue Io ) Method of va!uation Cost or end-oThiear market value (i)
(a)
(I)
(4)
(6) '
(6)
.(7)
(at
(9i ,
7otalJQtil.Ib)musteqiialForm990,PartX,001.(B)li.ne13,),J, I , i'ii+r +t r . i ' < " a ' I
......,,,,11
(a) Deacription ' (b) Book vatue
(1)
. if)
'- (3) ' "'
(4)
IIS)
<6)
(7)
<a>
(9)
.To$l, (Column(b)mustequal.Fom990,PartX,col (B)line18) 2 p other lia5ifitie8.
Complete ifthe organization answered 'Yes" on Form 990, Part IV, Ine 1ie or 11f See Form 9GX),Part X,line 25. 1, (a) Descnptcnofliabr!Q ' , '= (b)Bookvah.ie
(1) Federal incorr;e taxes .
' (z) " Ib r'ri mESTRAt'ffi SWAY a 404,348.
#)
14)
(6)
(6) _
(7)
(8)
to>
rotbi.(cohmn(b)mustequaipomvio, partx, CO/ (a)pre:is) 'a y 404i348.
2. Liabilffly for uncenain taX posrtions In Part xill, provide the text Of the footnote tO the organization's finanaial staternenta that reports the orqqnization's liability for un4ertain.ta+t positionsund<ir FASsASC:740 Cheakhereif the textot thefogtpoteha,4§e@nprovided in Part Xlll [X] eohadule D (Form 990) E19
9a208:1 10-02-19
46 18121119 795952 10042
1133
Sch<iduleD(Forrn900)20')9 ALTMBD HEALTH 8ERVI(!3:B CORPORX'ION ,, 95-2810095 page4 Reoonciliation of Revenue per Audited Financial 8tatements with Flevenue per Retum.
Complete if the organization answered 'Yes' On FOnn990, Part IV,line 12a * Totalrevenue,ganiri,andothersupportperauditedfriancialstaternents 1 544i30l,230h Q Amountsincludadonhne1butnotoriForm9JO,PartVltliline12 a Netunreaiizedgains(laasas)ohiriveatmonts :b -14, 866 i 508. b Oonated aervicoa end use of faailRies 2b
0 Reooveries of pnor year grants 2a
a0ther(DescribeiriPartXlll.) 2d 38,685,14e*
eAddlines2athrougJd 2e 23i818,640.
3 Subtraotline2efromfina 1 a 520 T 482, 590.
4 AmountsincludedonForrn990,PartVlllilinel2,butnotonliriel a lnvestmentexpensssnotinciudedariForm990,PartVlll,Iine7b 4a 703,033a b 0ther(Desorib0inPartXlll) 4b 1,212,166i
oAdd)inea4aand4b sr:, 11915,1990
a ajotalrsveliue aaarinessanaoa.rrhrsmustequarrorrnrigo, partt,hneye'i a 522 / 397, 789 * %aonciliation ofExpenses perAudited Financial 8tatements with Expenses55r %tiirn.
Complete rfthe organization answered "Yes' on Fon 990, Part IV, line 12a i Totalexpensesandiossespsrauditedfinanoialstaternents "- i 50<), 806, 393 * g Amounts inoluded on line 1 but not on Form 990, Part IX, lirie 2!S. a Donated servcea and use of facilities 2a
b Prioryearad3ustmerits ab
oOtherlosses EI€}
aOthsr(DeiscribemPartXlll,) 2d 37i061f400*
eAddlineia2athrough2d !2e 37,061,400*
a 8ubtraalinai2efromlinel s 463i 744,993 *
4 Amounts inaluded on Farm 990, Part IX, line 25, but not on lie j a a lnvestmsntexpenseanotirialudedoriForm99CI,PartVlll,Iine7b 4a 703 i033* b Oiher(DesaribeinPartXlll) 4b , 1, 290, 659 s
a Addlineia4aand4b 4a 1, 993, 692 ii
s rot4 uxpeneeaq<i4lipas!land4c.17h)8mustequair-amggo,parti,irneza>. ,.3.... 4.§i,738, 685h lCanXll 8upplementallnformatJon. a"
ProviCle the descnptzns required for PartII, Ines 3, 5, and 9, Part Ill, Ivies la and 4; Paffl IV,lines 1 b am 2b, Part V, line 4, Part X, line 2, Part XI, Iinesa'dand4b,andPartXll,lines2dand4b Alsocompletethisparttoprovideanyadditionalinformation PART I:II, LINE 4t
AL4'MED HEALTH SERVICIS IS A WON-PROFITORGMIZATIO4 THAT PROVIDESgUALITY HEAI,THCARmAD HUMANSJ,RVICE8TO THE UaE,R8ERVED(9MMUNI4.. 49UTHERN OAIiI?ORNIA THE ORGANIZATIO!';T R3COGNIZES THE THERAPEUTIC EFFECT OF CUIiTURAIiIiY R!ILEVANT WORKS OF ART a THEIR EFFECT ON P)TIEfi8, DONOR8 AND MEMBER!9 0F THE PUBLIC.
A!9 PART OF ITS HOLIS!'IC APPROACH TO HIAIITHCARE, THE ORGANIZATION HOIiDS A SIGNIFICANT COI,LA!CTIOH OF ART BY A DIVERSE uGB OF EMERGING, MID-CAREER AND BSTABLISHED ARTISTS BASED IN LOG ANGgIiES, AS WELII AS CHI(JBO/A ARTISTS, AND INTERMTIONALIiY RECOGN:IZEDARTIST8 FROMMEXgji.4'pIN aa AMERICA, ASIA i THE UNIffl) STATES FOR THE :PtTRPOSE OF EXHIBITION 16 gagos<10-!}2.10 Schedule D (%rm 990) 2019
47 1812111979595210042 ,,iJl3pdg;4n9i,5%i%?8t 71{j*LTH SERVICESCOR10042 1 1134
PRESENTATION ffilOUGHOUT ITS CIiINICS AND OTHER OF' ITS HEALTH SERVICB6t CJN'j'ERS.
THIS AJPROACH HAS BEJJ INSTRUMENTAL IN GIVING ALTAMED PATIENTS A (:'ALM, CURATIVE EiIROmENT AI.iZilVIATING STRE,SSEt AS80CIATED WITH BE:taNG IN A CIilNICAIi SETTINa.
Att'AMED BELIEVES TH)T BVERYONB, REGARDIi!SS OF A(E, RACE, GENDER, OR 80(:'IAL 8TAATDING,HAS THE RIGH!' TO E)a"ERIENCE ART IN THEIR !NVERYD4Y...,LIFE.
PART X, L:)HE 2 i
THE CORPORATION gUALIFIEg A!';! A TAX EXEMPT ORGMIZATION WDER THE INTERNAL REVENUECOD!!:SECTION 501<C)(3) AND CALI70RN:CA REVEWE Am.',4TION CODE 23701D.
THE CORPORATIONHAS gVALUATED Iff TAX POS1TIOW8 AND THE CM-RT41NTYAS TO WHE'fflER THO9E POSJ:ffONS WILL BE SUSTAINE'D IN THE EVJJT OF g.4UD:[,T BY TAX:INGAUTHORITIR:SAT THE FEDBRAII ANJ) STATE LEVRLS. THJ3:PpgY T4 POSJCTIONS WALUATED REIiATE TO THE CORPORATIOAT CONTIED Qt7ALIFICAffON A8 A TAX-EXEMPTORGdIZATION MID WHETHERTHERE ARE UaEIiATED Bp@.;.NISSINCOME ACTIVITIES THAT WOUIID BE TAXABLE!. MAGBMENT HAS D3TEfflIg:ET .gL INCOME TAX Pa!ITIONS NIL)i MORJN LIKELY THAN NOT (>50%) BE 8USTAn9ED UPON PiO'ENTI4 AUDIT OR EXAMINATION; THEREFORE, NO DISCLOEURE9-FUg'HR'pAIN INCOME TAX POE+ITIOHS ARE REQUIRED
THE CORPOaxTlONFILES :rmporros ng'rtms IN THE o's !lDEp3,g:tsq;CTION AND THE EITATH OF CALIFORNIA. WITH FEW EX(JPTIONB, THE CORqIOQ.....IS NO IIONGER SUBJECT TO U.S. FEDERAIJ AND STATE EXAMINAffONS BY T'g.4U'ffiORIffES FOR YEARg BEFORE 2015.
Schedule D (Form !!m) ml9
9:lt06a TO-a2-19
18121119 795952 10042
48 1135
Schedule D 2019 AIiTAMED HEALTH BERVICES CORPORATION
lnformation
95-2810095 6
PAR'r )a, IilNE 2D - OTHER ADJU3TME,NTt :
IN!ERCOMPAWY REVENUE
COST OF GOOD !gOLD-PHAj'lMAaY
F[THDRAISING EXPENSEEI
TOTAL TO SCHEDULE D, PART XI, LINE 2D
1,623,748.
35,529,655.
1,531,745.
38,685,148.
PART XI , LINE 4B - OTHER ADJUEiTMENTS !
INCOME FROM ALTAMED AGEMENT SERVI('ES ILa i212,166.
PART XII, IiIfl 2D - OTHER ADJ(TSTMENTS:
PHARMACY COST
FtTffi)RA18ING HXPW8E8
TOTAL TO 8CHEDtJLE D, PART XI I, LINE 2J)
PART XII, LINE 4B - OTHER ADJUSTTSi
BXPMSE8 FROM AIA'AMED MAGEMENT SERVI(JS LLC
-. 3ffi,529,655.
1,531,745.
.....-.. 77,061,400.
1, 290 , 659.
932(18!i 10-02-19
18121119 795952 10042
!kheduhs D (Fonn 990) mffl
49 rfad!A9\'AiBt'f'f0" sE'EEB coR 10042-1
%T7
1136
??r:E9D9H1 EFf
C)apartment of lm Troaaury
Inlsrnal Rsvenus 8erviv
21[Jrjig
::=i.':b'o I
Employei identification number
95-2810095
Name of the orgariizaton
8tgtement of Activities Outside the United St""
> Complete if the organization answered "Ym" on Form 990, Park IV, line 14b, > Attaah to Form NO.
> Go to www,lra,gov/Form990 for Instruotions and the latest Informatlon O)rlEl h 0 15i 8-0047
ALTAMID HEALTH aaVICEB CORPORATION
J GenerallnformationonAativitiesOuteidethelJnHed8tates.compreteittheorgarizationanswersa"Yes"on Form 990, Part IV,line 14b
1 For grantmakers, Does the organization maintain records to substantiate the amount of itei grants and other assistanas, thegrantees'ellglbilyrortheHrantsorassiatance,ahtitheaeleotiononteriausedtoawardthsgrantaorasaletance'? € Yes [Jho 2 Porgrantmakers.DesanbeinF}artVtheorgamzatron'spmceduresformonitoringtheuseofitsgrantsaridotherassistancaoutsidethe Llruted States
5 AgtivitieroerReaion.(T*efallowinoPartf,IineBtablecanbeduolioatedifaddnanalspaaeianeaded,) " (ffi)Region ' Ib) Number of
offics
In the ragiein
(e) Number of
:me,:Ta
in!oendent
oontraotoffl
in the rQion
(d) Aotivities oonducted in the region
(by type) (such a8, fundraising, pr>
gram servioea, inveatmenta, grants to
raoipients looated in the region)
(e) If aativrhl listed in(d)
18a program servloe,
desonba speafc type
of serviae(a) in the region
(f) Total
e+tpendrtures
for and
rnvestments
in the region
NORTH AMBR)COA -
(:'JkXADAJ !aXICO,
BUT NOT THE WITED
eTAffg € 2
t)ROGRAM ffBRffCBB /AR'!
EXHIB!T AX) FtTNtlRAIa:UIG
M!' NXH:t!lIt' Pan
FU)iDRAI81N<l/BU81)12!gg
ZNVBB'!MmNT. 158 528,
a a Subtotal 0 2 158,5;18.
b Total from continuation
aheieta to Part I
o o 0,
e Totals (add lines Ga
arid ab) D 2 158,528,
JA For Paperwork Reduce on Act Notlae, see the Instructions for Form 99K1. 8t.hedule F (Torin 990) 2019 gagoyi io-ig-to
50 18121119 795952 10042 pm5P?A$4"jl'O 'Yt'!'T' SmR'cEs coR 10042-1 1137
SduleF(Fomr990)20j9 ALTAMED mT!{ !gERVT-CES CORPORATION 95-2810095 ltb;HallkWllum.tiiNJlliyLthan$5,ODD F'atllCanbedupbCgtadfaddm8paeeana0 €h'd. %qe2
(b)fRSmdesedi@H
and EfN (dapple) '
(O) Regcn
(d}Pu@oseof
grarft
(e}Amount
of msh grard
(f)Marof
h dsburmngnt
(g)Amotmot
nonmsh
aSSf!itanTh
(h} Description
of mix;ash
assistance
(i} Method of
rduatm (book, FMV,
appraisal, oUier)
I
I
o
o
m
o
2 EntertOtJi!umbCr(Jia,ipiaiilvigoiumhuiiilialfflgiLiuvv(lialaie a,4igaJmbltanli!l.ry llivruiiyiuuunhy,ivuuzaJmlm-vxeiiipl bythe 1RE3,orlor*hch thegrantee or(alnm has prowded asa,ion 501(c%3)equivaJenB bUkw 3 Entertotalnurnberofotherorqannsoresmdas
!dwdgle F(Fam ffl)l
$a32 10-t2-19
1138
SdieduleF(Form99 €Q20l9 ALTAMFJ) HEALTH SERVICRt CORJ'ORATIO2f 95-2810095 Part m ain he dmhmed if aiia soace is needed
Payee
{a) Type of grant ore (b} Regan
(c)Nurnbe'of
re
€d)Amountof
msh grant
(e) Manner of
cash dabursernent
(f) Amoum dt
nonh
(9) DeaCnption m
nonh assstance
(h) Method of
vakiabon
(book, FMV,
appr., othed
I
I
I
o
o
r
m
o
5$ 10-12-19
aihbJulo r F mug Q ai ty
1139
1 Was the organgation a U 8 transferor of property to a foreign corporation dunng the tax year? /f 'Yes," the OrganizatK}n maybe requlred tO h/OFan 926, Retumb7 a L18 TrWl!l%rorOf Pr0pM7 tO 61FOrelgn Corpomtion (sea Instnidnns forForm 926) € Yes [X] No
2 oiotheorganlzatianhaveaninterastlnarorelgntrusiouringthetaxyear'/f'Yes,'t/ieotgsirirzsion mapk reiquffied tO aeparat61f hleFarm3520,AnnualRetum TO Report7fffinSadlOnS WithFOrOQn Trusts and RecaiptofCartarn Foreign Grfla, andlorForrn 3520-A, Annua?lnhrmatron Return ofFzrgn Ttust With a U S Owner(me Inatruchons forFoms 3620 and3520-A, don't file with Paw 990) 3 Did the organization have an ownershq> intsrest in a forsign corporation during the tax year? If 'Yes,' theorganqatranmayberequtradtohleForm547ilrHormatronRatumofuS PemonsWtthRmpectto Certarn Foreign Corporations (see Instruabons forRusrn 5477) 4 Was the organization a direot or indired sharsholdar of a passive foreign investment company or a qual4ied electing fund diiring the tax year?/f"Yeb,' the organrzatron may be required to file Form 821, Inhmatron Return bya Shareholderof a Passive Foreign Investment (,ompanyorQualihed EleabngFund (see /nsfructions forForm 8621)
B Didtheorganizationhaveanownerahipinterestinaforeignpartnershipduringthetaxyear?/f'Yes,' theorgatmatorymaybemqurmdtoNeFom8865,ReturnofUS PersonsW)thRespacttoCksrtar Forergn Partnerships (see Inatrtu.tions hrFom 8885)
6 Did the organixatxsri have any operations Fl or related to any boyootting countnes during the tax year') If 'Y!re," rh0 arganmltlC:in ffiaj/ be requlr €3d tO Separat €4y 1118FOm 5773, IntvnahOnaf BaJCOtt RefXirt (sate Instructions forForm 5713, don'thla Wh Form 990)
Dyes [X] NO
€ Yes [X] No
C]Yea [X] No
€ Yes [X] No
CJ Yes [X] N@
8ohedule Fl(Porm 990) 2019
93207410-12-19
18i21ll9 795952 10042
1140
St,heduleF(Form99p)20i9 ALTAMED HEALTH SERVTCES COR!"ORATION 95-2810095 Paqe6 p ffiupplemental lnformat!on
prOVloethe infomiation requlreid by Part 1,line 2 (monitoring Offunds)i Part 1,line a, oolumn (Q(accounting method, amountsi Of investmenta vs expendrlvs perregion),PartII, Ime1 (aocountingmethyl, Part Ill (accountin9 method); arid Pari Ill, aolurnn (:,) (estimated number of recipients), as appli>b)e !Usa complete this part to pmvrde any additional information, See inatrumions 9!12075 ltl-ffl4 8cheduks P 4Form 990) 20affl
54 18121119 795952 10042
1141
SCHEDULE a
{Farm 990 or 99042)
Dapatrnent oTthe Tybssury
Inlemel Revenue Bantim
Name of the orgamutiori
8upplemental Information Regarding Pundraising or Giaming Activlties ComplOtO If the organlzstlon answered "Yea" On Farm ffi)l Part IV, fine 17, 18, Or19, Or if the organization sritared mare than$l5,000 on %rm 990-EX, Ilne ea. k Attach ks Form Ha or Form 990-EX,
@ do L- WWWiro y. '.T oi iiiDDO fui liistruatlons and the latest information.
OMEI No 1846-0047
2019
Open to Publlc
Irispeatmn
AIiTAMED HEAIITH SERVICES CORPORATION
Employer IdentHlaatlon number
95-2810095
p Fundrai8ingAOtiViUe8.Oornpleterftheorgangationanswered'Yes"onForm990,PartlV,lmel7 Form990-EZfilarearenot required to oomplete this part
1 lndicatewhethertheorganizationraisedfundsthroughanyofthefollowingaativdies Ciheckaflthatapply a C] Mailsoliaitations e € 8oltcitattonafnongovernmentgrants b C] lmemmandemailsolicdations sotianqtioriorgovemmentgrants o € F'honeaoliadatione g€ specianuniraisingevents
a C] In-pereansolicitations
2 a Did the organization have a written or oral agreement wdh any individual (ingluding officers, directors, trueteaa, OY keyernployeeellstedinForm990,PartVll)orentrtyrnconneotronwrthprofesstonalfundraisrngeervtaes? [1 Yes a No b If"Yes,'list the 10 highest paid indivrduals or entities (fundraisers) pursuant to agreements urider whtgh the fundratser Is to be cornpenaated at least $6,000 by the organization
IQName and address of individual
or entity (fundraiaer) (li) Amivit%t
Tl'!9S;'oi
NaVe eua!odV
(IT t@l (X
mntnb'iUons?
(lv} Grosa reoeipta
from actwity
t!'IoArmreotauinn'eda:)
fundmiaer
tisted in col (l)
t(ov?oArnrfflotaulnntedpabid
organaation
Yes NO
Totaf >
3 List all statea in whidi the organization is registered or Icensed to solicit contributions. or has been notified it is exempt from registration orlicensing
LHA For Paperwork Reduction Aat Notk.e, see the Instructions for Form 990 or € 0-g, 8ahedul* a 4Form 990 orffll-E!Z) ml9 9320at 09-fl'l9
55 18121119 795952 10042 r?mfa'l!'!at'W'2I2r'l'FF'TH SIRVJ-CE8COR10042-1 'lt4l 1142
ache;luleG(Form990or99Q-lZj2019 AliTAMEDHEAIiTHSERVICESCORPORATION ... 95-2Q.1009!; Paqp@ ffl FundraisingEvent8,Oomplete'ifthei organizatcnanswered N!lesjl OnFamv990, PartIV,line18iorreportedmorsthanstei,ooa Of tundraising event oontributiOns and grOsi8 income Ori porm 99C-EZ, Itnes 1 arid 6b Llet events With gross receipts gr*aterthan ss,000 1 Gross reoeipts
!> Less. Contnbutions
8 Gross income (line ! minus line 2)
(a} Event #1
FOOD & W:n'iH
TASffNG
(k)) Event #2
GALA
(a)Otherevents "
4 (d) Total events
(add 001.(a) through
col (c))
{sventtype) 5eventtype) '(total number)
665,665. 602,798. 159,871. 1,428,334.
281,190. 122 , 625. 403,815.
384,475. 480,173. 159,871. 1,024i519.
4 Cash pnzes
6 Nonaash prizes
0 Rent/faorlity coats
7 Food and bevsages
8 Entertainment
9 0ther direat sxpenaes
459,811. 361,791. 8 , 301. 829,903.
913. 2,i73. 3,086.
106 ,186. 64 , 741. 25,995. 196,922.
312,221. 111,948. 77,665. 50i,834.
10 Dinsot expense summary Add lines 4 througti9 in oolumn (d) > li wel1qcameaymrnary%btraotltne10fronnhnaa,polumn(d} >
1, 531 ,' 14!).
-507,226.
L!!!!U Gaming.compieteirthaorgangationanswaresavea'onp:irmgao,partiv,iineie,orreporteomorethan $1 6,000 on Form 990-EZ, line 8a
I
j Gyosp revenue
(a) Bingo 4b)Pulltabs/Instant
bingo/prograssve bingo (C) Other gaming
(d) Total gaming (aad
ml. (a) throuh 001. (O))
2 Cash pnzes
a NOnCa8ti pnzes
4 Rent/facility costs
Q Other direct expenses
e Volunteer labor
LJYea'%
C] No
LJ Y %
[1 No
LJy*s%
Cl NO
7 DirectexpensesummaryAdd lines2through5 inoolumn(d) >
8 Netqqmin(lirloomesummary.Subt7aotline7 frarliline_i.,column(d} 2 9 E:nteirthe state(s) in which the organization oonducts gaming activrties alatheorganizahontcenseotoaonductgamingaaiivmesineaohorthesaatatesy LJyes LJNO b If 'No: explarri
tOaWereanyoftheorganaation'sgaminglioensesrevoked,suspended,orterminateddunngthetaxyear? ='LJ'Y*a Ljho b If 'Yes,' expkin:
gaataem.ii-is Schedule(l IFvm Ha m!m-EX) W19
56 18121119 795952 10042 ?cao!a!'ffl!rYYtL' BER'cEs coR loo42-1 1143
95-2810095 Paqe3
LJ Yes t.i No
8cheduleG(Form99(Ior990-E2)2019 ALTAMED HEALTH 8ERVICES CORPORATI0N 11 Doeatheorganixationmnductgarningaativdieswithnonmembers"? lsi lstheorganizationagrantoribenefiaiaryortrusteeofatrustioramemberofapartnershrporotherentityformed to admtritater ahantable gaming?
la Indioate the percentage of gaming aotivrty oonduoted tn:
a The organization's faaility
b An outstdei faailtty
14 Enterthenameandaddressofthepersonwhopreparestheorgantzation'sgaming/specmleventsbooksandrecordr Name >
Address >
18a C)oes the organization have a contram mth a third party from whom the arganizahon receives gaming revenue? blf"Yes,"enterthaamountof;)amingrevenueracsivedbytheorganization >$ of gaming revenue retained by the third par§ > $
c If "Yes," enter name and address of the third party
and the amount
Name k
Addraas k
la Gamvg manager information
xame k
Gaming manager compensation r $
Desanptionofaervioesprovidad >
€ Yes € No
€ Yea[JNo
€ Direator/officer C] Employee € Independent mntractor
17 Mandatory distributions
a Is the organization required under state law to make ctmrdable diahibutions from the gammg proceeds to retain the state garnlrig Ikierise?
b Enterthe amount of distributions required under state law to be distnbuted to other exempt orgarnzations or spent in the tax
Part ProVldethe explanatiorisrequired 5!/ Part 1,line2b, columns (iu)and (v),and Part Ill, lines 9, 9b, 105, 15b, 'f5o, 16, and 17b, as applicable Also provide any additional information, See instnuationa € Yas[No
99808309-11-1!1
57 eohedule O (Form 990 or 990-!2) B)19
ptAru'""" smR\"EB coR lOo42-1 18121119 795952 10042
1144
8ahedule a (Form 990 or 99042)
9!1!1084(14-al-fil
18121119 795952 10042
58 r'Nt5fao'2iffr9a'J'!'&oYr+LTHsERvzcEscoRlo042al
1145
lllltllld niivyiiaa} Gaa OIIAI
Name ofthe gi
Grants and OUier)'!qaii<znr'p to Organizations,
Govemmems. and Indnriduals in the United States
Imaeh toFmn 990.
2019
OpmtoP'ubne '
kispmtim
Pmp%ycr:J..iiiiCCii ,U.ii..,..ilim
ALTAMED HEALTH SERVICES CORPORA'ION 95-2810095
[X]Yes € NO
IPart l I GeneralInformglioti 4AIIaid&&lb mid am
1 Daeatheorganrnnremrdstosubstantatetheeutmuntofthegrantaor,thegrantees'ehgibi!qforthegantsoreesistmioe,andtheme$on aitataused to awardthe grantsorass'7
2 DeecnbeinPartlVtheorqann'spmaduresformondonnqthetaaofqranttindsinthe[kiibedStates m (kants *ns nthsi Am-ii i,,, , Irl'lnmrvtl;i niglwi;azfianfi flnllrliiiiiH51l5 Cove'rnmenta-Completedttie organion answeretj'Yes" on Forni990,Paat!V,lne2t, forany reciothatwdmorethanf6.0(X} Partllbaduolcmddaddlsoacesneedm 1 {a) Nameand address ofon
or govemment
(b) EtN (e) RC sechon
(d applmble)
(d)Amountof
cw,h gyaast
{e}Amountof
rxx'h
asse
(f) Method of
valuahon@xxik.
FMV, apprasal,
oUier)
(g) Descnphon m
mncash
(h)Purposeof(7am
or asststance
jam IN XE!m
2548 mX!mJ,E AVENm,
I,(X, WICH, CA 90815 45-4825887 501(C)(3) 25 000. 0, tlOOK amincx 'm msptiy
m mFDagXRVED
:'o'nm.
CCF co'm 'rm" 'tram
221 SCCTH !'IG[TEROA !!>'! ffZ!!'E 400
LOG AXaLBSi CA 90012 95-4774698 501{C)(3) sa,ooo, a, BOOK amiticx HEAT."ffi nzsp'yy
m m € iRStmli
C:QmujllT:.
atARL)!15i R DRff 31ff OF
MEDICrNR a SaENCK - 731 X-120TH
8T, - L(X" ANQETJS, CA 9(1059 95-615177 4 10,(}00. a, KIOK RmQJCE m'ffl DI5?ARI'ff
D? tmomts
commmz'ms,
COAL'mON 01' ORANGB CODN'ff
COjWmIff aimC! - 515 X M
PA!IK DR-, gmTR 225' - 8ANTA 36,
CA 92701 95-2900725 5oztc)(3) :l0,000. 0, BCXX
RmXFCE HRALTH DISPjkR!ff
Th i!m";!
tm!S,
@0jg'fi i('Q0 C!ffiC)O PA'J'R!OTCO
INC - 6035 PjkCl!IC BTIVD -
mW'!ON ?jmK, 03 90255 81-1048949 5(11 €(!)(3) 10 , (H)0, 0, BOOK ma iTH DI!!iPARffi
!N tBRfERV)!D
o'rrng,,
EQUALITY CAKilFOi JJ5iT'!ffffi
3701 HniBHm!. Wish 8UIT!1 725
'LDB MG"'aS, a 5'Ool0 fit-0430008 501((!)(3$ s,ooo, 0, BOOK tx mm' DIffARIff
rH ?JND!WERVED
t -
o
o
r
2 Entertota!numberofsamn50l(c%3)andgoentor7n1stedinthebneltable 3 Entertotal raimbe oF ather otmtzabms batsd at fe Iraq I bibm WI01 626-11 59
Schmute l (Form 990} {2119)
1146
!3chedusl(Fomi990) ALTAMED HRALTH SERaVICES CORPORA?ION 'Partu CordtnlfflUonmf"v-lm'-M"'%'f'L'a'Jitia*%0rilt?vnniLl&k-illJftrgul:fi0n'ii.lthffitl-m0d':tna!!l[- uk=l(%rmffi),Partll) 95-2810095 Paqe 1
@I) EIN (c) IRG' sedxxi (d)Armuntof (e) Amoum at
a!9SitStanae
if)Methodof
valugbon
(book, FMV,
appram ofher)
Purpose of gmt
o
o
LA PLAZA DB aCTL'NRA Y ARTE8
5t)1 N u 8T
LOSI jkNaja €190012 75-305128J1
IAffi ?IrJ INSTITUTE YO7ffi CIND!A
PROJECT - Pa BOX 60557
47-501024 € 501(CH3)
mxxzcm cy vrwrms
a 94559
aTlOati ffgJ'jk[C mmlC;ui
AJISOaAffON/X!!r Ti HISPANIC Hff
1920 L St! m SUITE 725
N!m YORK NY 1001?
200 N sp STREJT m:iom 1633
LOSI jkN(&BJ, CA 90012 9!i-4044565 501(eR3)
5 000-
50 000,
35,000.
35 00tl131,259,
10 flOO,
3350 TWuDY BLTh
SOU'!E GATH, CA 90280 95-1457660 501(C)(3)
23-7384)570 501(C)(3)
TRua7 ED?XA!IOJff MAT!ai
540D N miMIC WTh 'fiff5 M
15 Among, (Jk 90022 95-4384333 501<C)(3)
9a2241
04-€11-19
10 000,
25 000,
10 000,
60 0 , BOOK
ut wnxasmvm
0 , K) €)K
I
0 , BOOK
D,EKa
0 . BOOK
RaJCR affl DIG)?AR!ff
n'i UealER5
[TIR51-
'rn mqnmasmavm
nf UaBRSmli
00)WmIffES
REDtK'K HEjkLff DISPART't'Y
rx um+mvxo
REDUC'E uTu DIS%TY
u [SERVJm
(VMMma'nES
O,BOOK
Rm)m! mTH DISPARJ:TY
ffl iER'lBR'VJm
1147
Schemelprm990) ALT!AXED HEALTH SBRVICES CORPORATION
'Patll Cuuliitualluiiu/aaaiuLszuuJauts Aimisdanoe'lvauiiiaimbii:aandOryniri*ianqinffiplgiittmSbdes(Schmulel(Form990),F%atll) 95-2810095 Paqe 1
{a) Nameam address €!d (b} EIN (e) IRC sscbon
d appkaab!e
(e) Amount of
non-ash
Q Mgthod af
valumon
Descnpbon of (h) Purpose of grar4t
or asssmce
o
o
m
o
1320 EA!9T 7i STREET !gmTE 26a
46-2140915 '501(C)(3) s,ooo,
THE auI!ORNIA mCO STODI!J
LaNG BJUkat, CA 5)(}815 27-4994817 501(C)
!tB fflI'J'Y OF Gt)JkDALAJARA
AVER:Ca IN - 201 g(X PIGCEtOA
"J')fflODORE ROOSiT HIGH 8CaOOL
8C:HOTajHm M 456 8 )gkWS
M - LOSi ANGELISI CA 9(}033 95-6002576 501(C)(3)
a8ITY OF aLI?Oau Bi
201 JlffiOR DLL * 15agO
fl, a j47;10 94-6002123 501{e)(3)
'VIN €JN!' pRI('R ART ffiSHUM
FOmfDATION - 1301 AmDA CBSAR
CHAVEZ - m PARK CA 91754 ' 33-0368470 501(C}(3)
5 , OaD ..
s,ooo,
19,000,
5 0DD,
12,500,
0-l ffl i'J'2g8
a,KXX
O,X)OK
O,BOOK
O-!K) €)
O,BOOK
ffl mmERSEffED
.REmJCE HEALTH Dlm"JlRIff
!LN usumsmvm
REtRJCE JtEALTH DISIJAR)'ff
m mmmtgmtvxn
WI WDERIERVm
srJ
ffl4l
04-01-ffi 61
QraTh: 4alu l Fuiiii !s=ig
1148
Schedule IFomi 9'90) (2oig) ALTAME'D HEALTH SERVICES CORPORATION Pst II) can be dupbd f qrJdnal spccc r; rluJbJ
(a} Type d grant or assoe fM kiioeir cd l?_l Jlmtanint n! 1J41 A vr'* r& v'iyz_ ' l-l AIL-II- -J - -t- --I--- JJ% -- - _ll - - -I* - -_-- - _ _ Ip+ 10 %%T0I ff u I
reapisrds
1%-l syt - W 11 & I-II
cash garA
luJ n I uiM IL VI I 1111 laish ass
pq ivmu ui vaiuauuii
$ook FMV, appra, otha)
pl uipu or nOngaSn aSS+!JaFl(2
o
o
m
o
INl &lppWOfn'&rl(ivaJt,uRjld(allkibJila4tUajffljPaftJfi!2,Pmj; €1,l2ni::'!rrf"@Jl 9ml02 '10-$19
95-2810095 Paqe2
&hedule t (Form @Jl)(2019)
1149
80HEEDULE J
(Form 990)
Dapslmmil dTthe Treasury
Intemal Flgvanu* 8srvios
Compensation Information
For certain Offlaers, Dkaatora, Truateea,Key Employees, arid Highest OuiiipuiiouluJ CiiiHla:/(l(10
> Complete Ifthe orgonlzatlon answered "Yes" on Form 990, Part IV, line 23. )htbiah to Formffl),
2 go to www.irs4eiv/Form990 for ln4truotlops and ihe latest inforrpatlon.
Name ofthe organizatron
AIITAMED HEALTH SERVICE8 CORPORATION
IPartl 'l QuestionsRegardingCompensation
OM!I NO 154!i-0047
2019
Open to Public
InapeoUon
Employer Idantlfk,ation number
95-2810095
Yes
15 T
2 x
4a
4b x
b
6a
6b
9a
at)
7 T
i
a
9 No
M C:heokthe appropriate 5ox(esi)Kthe organizatiori pmvided any of the followmg to or for a person listed on Form990, Part Vll, 8eotion A, Irne'ia Complete Part Ill to provide any relevant InrormatlOnregarding theae dame [Jpiratciasaorchartertravei C]Housingallowanceorreaidericeforpersonaluse € Travelrorcompanions [JPayrnentaforbusinessuseofpersonalresrdenoe € Ta+iindernnification and qross-up payments € Hsatth or social alub dues or inauationfees [X]oistiretionary spending atxiount [J Personal ssrviaea (auChafflmsidi chautfeur+ Chat) b If any of the boxes on line ala are chegked, did the organizatcn follow a wrdten polcy regardin0 payment or reimbursernentor provision of alt of the expenses described above"?If 'No," aomplete Part Ill to expbxin 2 Didthe organization require substantiation pnor to reimbursing or allomng expensea incurred by all directors, trustees, sind OfflOer8, mcluding the CEO/Executive Director, ragardng ttiO itema Checked 5n Irneia';' ,J
3 inaiaatewhioh,sanyiotthetoiiowingth*organizationuaedto*atabbshth*smpensationdtheorgargation'a 050/Eixeoutive Direotor Ohsiokall that apply, Do not cheok any boxes for m*thoda used by a mlatad organaaban to *atabliah compensation ofth* OEa/Exeautive Diregtor,butexplain in Part Itl [ncompanaatiancommttt*e [X]Wnttehempkiymentaontraat
[ninoepeinasntoornpansabor+consurtant [X] Oompensatronaurveyoratudy [!lp@rmggoorotherorganizatime mApprovalbythsboardoraampenaabonoornmrttea 4 ounngtheyearidioanypemeinlistedonForm990iPartVlli8eattonAilinelaiwithrespeottothefiling organcation or a related organrzatron.
a Receivea severam,epayment or diange-of-control payment? b Partioipatein, or receive payment from, a supplemental nonqualdted retirement plan"? c Participate in, or receive payment from, an equq-based compensation arrangemsnt"? If 'Yesl to any of lines 4a-o, Itstttte peraons and provtde the app%cableamounts for each darn rn Part Ill onl9 aeotion 91(a)(8), sol(c%4), and 801(a)(29) arganlzatlona must aompl*te Uns 5-9. fJ ForpersonslistedonForm990,PartVtl,SeationA,linela,dtdtheorganizationpayoracarueanycompensatton contingont on tho revenues of
s The organrzatton?
b Any related arganvation'>
If'Yes' on line 6a or 5b, degnbei tn Part Ill
a ForperaonsliatedonForm990,PartVll,8ectronA,Iine1a,didtheorganizattonpayoracarueanycompansatlon contingent on the net eamrngs of
a Theorgamzation9 '
b Any related organzatcn?
If'Yes' on luie ea or 6b, dssanbe rn Part Ill.
7 ForpersonslistedonFomi990,F'artVll,8eatronA,lrnela,dtdtheorganizaUonprovideanynanfotedpayments not daaanbed on lines 5 and 8? If"Yes," describe rnPart Ill 8 wereanyamouritsreporteoonrormgeoipanviiipaiooracorueopursuanttoacontractthatwasaubiecttothe initial aontraot exception deacried In Regulatzns 80atlOnss.49sa-4(a)(3)? ff aYea,"deaoribe In Part (II 9 If 'Yes' on Irie 8, did the organization also fCillowthe rebuttabla presumption procedure deacnbed i [email protected](0)'?
LHA For Paperwork Reduotion Aat Notiae, see the Instruatiorm for Form 990. x
x
x
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x
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8t.mdula s' (Forrn 990J2019
e:igiii to-aisg
18121119 795952 10042
63 1150
.edu.tiJ (Form 990) 2m9 ALTAMED mWTH SERVICE8 CORPORAJ'ION 95-2810095 m-dlll t temf_ fiiroeto_ Yru__ _ Ray Gmnlaia and a* f!nea+ Cmmaa I 4eiii di iAliaaaal)z ?1'l!all66 s# aiaiaimxy-it p44 M yasza4 Foreach ttaxlnndualwhose co must be reported on SdukiJ, report ampensabonfmmthe om on row(i) and hoiii ivj uipiiib, JThsd n the bons, m row (Q Do nat Istanyuabetmt amit bstad ai Form990,%rtVll
Note: kaim d#hxmw. B)@-(m)fOreech bmed gimum mustequatttmtotal amount d FOffil990, pmtvii, eemxiA, hnela.apphcabternn (D)and (E)arnountsforthat nd (B) Braikdown of W-2 and/or 10!all!3C coon (C) Fremnt and otherdeiferred
oompensabon
@) Norde .
benehbs
(E) Total of oolurnns
(B)@{D)
(F) Cxmipsnsation
n column (B)
reportedasdefemed
on pnor Form 990
(QBase
compmsation
4iQBonus &
mcerdtve
a:irnpensabon .
{iU)Other
reportable
mmpenon
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804,253. 314,444. 163,515. 166 , 759. 7 , 647 . jl,456,618. 0.
0. 0. 0. 0. 0.1 I 0, 0.
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(iQ
332,159. 73,548. 20 , 527. 11,200. 7,371. 444,805. 0.
0. 0. 0. 0. 0. O. 0.
(0
00 417,825. 127,276. 33,488. I 11,200. 7 , 850. 597 ,639. 0.
0. 0. 0. I 0 ,' 0. 0. 0.
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385,019. 114,999. 16 , 683. 11,200. 12,600. 540,501. 0.
0. 0. 0. 0. 0. 0. 0.
(I)
(a)
557,628. 155 ,103. 14,363. 0. 31,858.j j 758,952. 0.
0. 0. 0. 0. 0. 0. 0.
(t}
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577,125. 143,449. 27,142. 10,050. 962. 758,728. 0.
0. 0. 0. 0. 0. 0. 0.
(Q
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4F30,144. 116,956. 19 , 618. 141,200. 10 , 212. 768,73[1. 0.
0. 0. 0. 0. 0. 0. 0.
(Q
(n)
, 403,70i. 80,001. 135,719. 4,269. 48,456. 672,146. 0.
0. 0. 0. 0. 0. 0. 0.
(l)
(ii)
347,998. 68,987. 31,139. 11,200. 26,413. 485 ,737. 0.
0. 0. 0. 0. 0. 0. 0.
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335,416. 'l'l,393. 9,077. 9,742. 42,142. 473 , 770. 0.
0. 0. 0. 0. 0. 0. 0.
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, 288,148. 28,200. 103 , 446. 4,076. 39,487. 463,357. 0.
0. ""O, 0 . 0. 0. (l 0.
(Q
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(Q
(n)
(Q
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(Ji)
(A) Name and The
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I ) CA!O DELA ROCHA J.tl
PRESmENT & CBO
m GOV REL & Cm Mal I
(4 ) ZOm ESCOBAR
SVP am.F jkDm OFFICER
45) m W
SR STRATEGY EXECUTIVE
7 ) EENRY !!OLGUm
W n5A OPERAt'Iaf
(9) EtaQU'IO CjJ"IWkS
VE' M)KDICAL DCTaR PACE
(20 uYMOND B T.i(XfB
HOSPITALIS'!
9321i2 1041-19 64
Schedute J (Form99g)jaCn9
1151
SahadtdaJ 201GI ATJTAMED HEAT-TH SERVICR8 COR!'ORATION 95-2810095 PWtnl $lWWdalkdOfffiaaOn
ProvM*the gmmon, expmataon, ord reqimed forPartl, 5a, jb,3,4i, 4b, 4e, 5a,5b. k6b, 7, smd8, am for Part II-AbooornpJeteths partforanyadal irdormabon PART I, IiINE IA :
ALTAa) MAINAINS A DISCRffIONA!ff 8fflSTDnK. ACCW FOR OFFICERg, KEY WItOYEJS A6 0TmmS a THE COMPANY ALIiOWg A CERTAm A)![0$ TO EE USm) AT THE DISCRETION OF THE PA FOR BUSINESS EXPENSES SUCH AS AUTOj!!OBlbE EXPMSES ANY AMOWTS ?JSED FROM THE DISCRETIONARY ACCOW'[' ARE TAXED TO THE RECIPIENT AS PART OF THEIR COMPENSATION.
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PMT I, LINE 4B :
SCa)ULE J:AT ffiE PREgffi TnB 'ffi!!: PRESIDENT AND CEO IS ELIGIBLE FOR THE ORGANIZATION'S 8UPPLBME!AL EXECIVE RE'!m PLAN (SERP) i in!iG O? THI!g PIa I!') DISCRE,TIONARY AND ASSETS OF THE PLAN ARE SUBJECT TO THE CLAIMS OF 5ITOR8 RETIRJ! AND O!'HBm DEFERRED COMPENSATION INCLUDES !>155,000 PAID TO THE (SmP) n'T CALENDM YEAR 2019.
S'WIOR VI(J !u8jJ)j!aNT & GENERAL Cam8m, OF ALTANED H!UWTH SERVI(AS IS ELIGIBLE TO PARTICIPATE IN h;H ATaTAMED syubisu buNG-TERNI crivz PIIAN (457F ELM). IN 2019, ALTAMEIJ (;UkTRlHUffi) 6130,000 TO HIS 457F PLAN. THE PURPOSE OF THIS PLAN IS TO RHTAu m EXECUTIVES
Sdiedu!eJ (Fmn 990) 2019
932113 1(1-21-19
1152
Pmvtde , on, at dtaOns reqt for Partl, hne la, Ib, 3,4a, 4b, 4e-,5a, 5bi6fl 6b, 7, and 8, and forPartll-!'J'io I-OI'JII)11-&ffi uii.a Hi.ii I riaiiuiy iJJlbuiiJ inruiiimluii o
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PART I, LINE 7 :
SCHEDULE AT :ALTAMEf) MAIffiAINS A DISCRETIONAR'! j!!(;UTAVjt Am DIRECTOR LEVEL BOWS PROGRAM THAT ATaRDS la:jMTlVj< t.:(JM!"WSATION RASED (at AUHlj!,Vjalja4T U! CERTAIN ORGANIZATIOaL OBtTJ!CTffiS INCLUDIWG FIMCIAL, OPHRATIONAL, QUALITY Am MISSION OBJECTIi8 WR:[NG Tmi FISCAL YHJm. MEMBERS OF Tn EX&:UTlVj< AND DTJECTOR L)WnSHIP TRAM ARE EVAItUAffi) ANNUALLY FOR THEIR ABILITY TO MEET THOSE ORGAHIuTIONAL O&TECT TO AmtnrE AT ihcmtaivz m, IF ANY, FOR THE FISCAL YEAR. OffitALL ALTAMBD 8T AC!IEVE SPECIFIC FINANCIAL GOALS BEFORE AN'! ihczwrivxS €, BE EARNED AND :PAID.
&heduhe J 4Fonn990l 2119
affll3 10-21-19 66
1153
M K I
(Form 9SQ l
DepamtalThe7msury I
liiiuuialniiwiiujyviiaie I
2019
Open to Public
1nspeeUm
' e+a lal sa -sb -- -laqas Ila fllullaugn me
95-2810095
Name ofthe organgabon
&ppLmaiL.il liJdml;it;yii u T is rii;mpl niaiii1i
> rfimplmrb V#iP orgara:minn mqivpmrl 'Yd Ori FOffll99D, PBFt g kn :'k F%vtk &bmlplkami pytata#iw, qnrl ain;5 additJoiyl iiifuiniJuii hi PzlVL
)Attadz to Fonn 990. 2 rz +h wwwjr=i4ua/r ummffl iui iiuilauaaiuii.b &lliJ llab lsilv.hL iidui mssliuii.
ALTAMm) mUW'ffl 8ERVICE8 COBJaORATION
Partl Bondlmuaa s PART VI !'OR COIiUMN8 (Al AND (F) CONTINUATIONS (a} lssuer name Itsl Isstsr EIN tel aJ81P a {dl Date musd (sil imiim tvu_ Hl tinn rif ni W [hmaits_ d fl-I nh %_h*lf Itl Dnyl lal a- a@e% I da p ul Q M lal --a- 00#j -- - - -- -- -
ol smer
Yes No Yes No Yes No
CALIFORNIA HEALTH
A FACILI'['IES Fnt[ANCING AUT 52-1643828 NONE 10/01/15 118760000.
FnWCE ACQ,CONSr
fflOVATION & EQU x 'X x
CALIFORNIA STATEWIDE FINANCE THE COST
B cummuNlTlBE I)BVEIiOPMKNT M_u'4jS lj;/ 14/U-/ '/,UIZ,UUU. OF ACQ , CONSTR'UCTI x X x
CALIFORNIA HEALTH
c FACILITIES FI(jNG A)UT 52-1643828 NONE 10/30/18 20000000.
FINANCE CAPITAL
PROJECTS AND PAY x x X
D
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IF
A B c D
1 Amourd of bonds redired 20 , 939 , 831. 2,172,373. 4,3a6,521. 2 Arnoum of bonds legdy defeasa:l
3 Totm prooeeds of issue 119,505,444. 7 , 012 , 500. 20,276,392. 4 Grossprooeedsnreservefunds
5 Capfkakzedmterestlrrxnpros
6 Prosgirdumir+gasa'ows
7 Issuanai fmrn proceeds 1, 707 , 227. 127 ,748.
o vrett ennancemau tram prtxs
!l VVOrKf4 (;?lplu!l eXpt}nglllffa@ Ir(Xn prl;Kteal3
10 Cap)tel apend from prOeem 113,974,568. 7,012,500. 10 , 234 , 931. 11 0therspentpma 3,500,000.
12 0therunspentpro 323,649. 9,913,713.
JOnR
'kj T ear OT &lgm!a CgmplefOFl
Yes No Yes Ns> Yes No Yes No
14 Werethebondsissuedaspartofarefundingmueoftax-exemptbonds(or, d issued prwto 2018, a aimint refunding issu4? x xI
x
15 Werethebondsssuedaspartofarefundingsaueaftaxablebmds(or,f issued pnorto 2018, an advan> rdunding mus)9 x x x
16 Hasthefinalalloamonofproceedsbea'imade? x x x
4ffi Ij*** as *mssi **z a-aas4z I-l 01118 v +a-i iyy41iea II ugn ulH u9ai uzauta It liail IMI ) auvquau.. LIIA.!111$ai JIJI e.aii ub AU8up41 l u le final alloon ofpms? x x x
LHA rui P4aaffiuiknatluaia'LJ4ul.aUldJiub&uiaarui ruiasa 67 CMlNel iM
Sdiedute K [orm 990)jDl9
932i21 10-flM9
1154
h B (:
Ya+ No Ysa No Y45!3 No Yes
f f
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x x x
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% % %
% % %
% % %
Y Y V
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ALTAMED HEMiTH SERVICKS CORPORAffON
1 Wastheorganonapartnerinapahemy,oramernberofanLLC,
WhlJi vm taJ pu4ibily Tiriaii liy ldXaeXempt bCFldS?
2 #othary{ecanangmier'il:iLliiLiiiayamulLiiiHniiJeliubiiimbu'-isu LorJ-niiarixd proHily
3a Arethereanymanagernentorservceaxitradsthatrresukripre busnass use of bond-finan property
b lf'YesatoBne3a,doestheorgananroutmelyaigagebondcounseloratheroutside c Arethereanyresemdiagreemntsthatrmyresunnprbusnessuseof bond-fed property?
d lf'Yes"tolrne3c,doesthenrengagsbondcounmorotheroutsJe 4 Entertiepercerbgeoffui@ncaipropertyuaedinapnvatebuusaby enhhesotherthanasecbon50l(s'%3)orgarorastorkxm k
S € ikvi llu;' uwil ur &ianced property used in a pmmte bus use as a readtof umdated hade orbusiness aah'vdy ed an by yourorgan, amther sedhon501(4(3) organn, orasteorkxm governrnerd k
6 Totmormm4and5
7 Duab LII€!ILuiiJ uu iiiuul Uiu Hinulu .ia(:IJ!afy IJI ylllHlll lvbl'i 8a Hastherebeenasaleordmposmonofanyaftheband4inpropertykianongovemmental person otherthan a 50?ic)(3) organn sincethe boms were ed? b lf"Yes'toline8a,a'iterthepercentageofbond-cedpropmtysoklmdsposed a !f 'las" to line 8a, was any remadm adion taken pu'suardto Reguta5ons seehons 1-141-12 and 1 145-2?
0 14ailtllltulul4llahOllWl4uPll llllffi'Qdlffl'QfllmfhRt""'Q'ld6ad bonds offs asue are remadmted in zwdh fm requirementsunder naQllahuiau mdona 1111-12 and I 14%')
%rt N Arbftrage
li B C D
1 HastherfiledForm8038-T,Arb%bme,YieklRedunand Ye No Ysi No Ym No Yes No Y Y Y
)aaenBuq Fl Llell m %Dgrage nae i &
X IN-TIO-'KgIFje 1. QKJIIN. TOIIQWF)gWPIY (
a Rebatenotdueyet? x x x
b torebate? x X x
c No rgbgte due? x x x
If 'Yes' to IF)O2C, pmvJe in Pat Vl the date the ramte on was gertor
3 lsthebondaaiearmeesue? XI XI IX I
95-2810095 Pi 2
0 e3flfi TO-28-ffl Sd.muffiK ponnffi})2079
1155
Schedule K (Form990) 2019
Part IV Atbhr (cmhnued)
ALTAMED HEALTH 8ERVICES CORPORATION 95-2810095
A B C D
qa riasuworganonormegoveasueremereaintoaquaJffied Yes N5 Yes No Yes No Ym hedge wth respedtofie bond issue') x x x
b Narmi of pmvtg BANK OF '!TE nST
c Term of hedp 15.00(k0000 I
u Vva- trttt ne(Ige Sllpel'Fnp-l A
@ Vlla2s Ine neage I&? A
e* kllJas -s- -* _a*.-*J . - - -.-_-__a _______s _____ iia 'f 17 i.l-d VVlffte 91(JleS InVeSla0 In a FIIIK l(iK;)" ink A A b Name of
e Term of GIC
d WasthesafeharborforastablstungthefarmvakeoffieGICsabefied? @i Waira mnu nms_ nrnr.ae as4arl ham -sss vu-hslahlei +xmmz v-swusA') Y Y ? - - - +- + + - 7 §l + + Pll d %0#WW W7 u all m 0€ #saasai IXal I IQI a 7)JH'l aJlJ I J)1
? um 4'h m *tsflThhM sis+kThie$i! liidffi ?ffll I@u 64 ## *aj)as+ I)ja 0###ffi j i I IW &l g; %ll p Iul I itaiyuat ie m 11!l I plWuia5 &lJ II KJI UWI 41Te tequfajUJllS lJt smctxn 148') x X x
o
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s - j!II) TltQt JIG YW fig Tea No
x x x
m
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PaffV ProeedursiJ.-UiiiTxiliisriiiu:iGiii.i AJuu
federal tac requhmentsaretims%i mentrmi and comded through the voluntary Ju:iii'iy qi<i iiviiL pi4iaui ir bvlr-iviiigdieiliuii l.!)II 'l avsiilabk uiiJai 4iplil Part Vl 'iiili1l- =-ii i il -l JiJvi iiaiaffan.r'rav'ida mJiuuiiJ iii/uiuii rui IU!puii.au.i IL) Llulillzlllal.i ul &l*vdule K See instrdcns BCE!D X, PART I, BOND ISSUES
(A) ISSUER NAME: CALIFORNIA HEALTH FACILITIES FINANCING 'A'U!"5m-Iff F) DBSCRIPTI(W OF PURPOgE
FIaNCE ACQ , CONST , RENOVATION & EQUIPPING OF CAP. PROJ . & REFI A PRIOR LOAN (A) I8m!R HA)B: CALIFOm[A STAffWIDE CO)WJNIrIES DEV!LOPW AUt'HORITY F W8CRIP'['IOW OF PURPOSE:
!WCE TH! COST OF ACQ,CONSTRUCTION,IiROT/ & EQUIPPIWG OF ?ACILITIES (A) ISSUER XAME: CALIFORNIA HEALTH :rxc:azayzns yrc:aic AUTHORITY F DESCRIPTION OF PURPOSE:
FINANCE CAPITAL PROJECTS AND PAY COSTS OF INE!JRANCE
THE I88UER HAS FILED WO 80388 FOR THIS ISSUE. THE ISSUE PRICE FOR THE NOTES <DM'ED SEPTEMBER 29, 2015) IS 117,200,000; THE ISSUE PRICE FOR THE BONDS (nATED O(:'TOBER 1, 2015) IS 9101,560,000
Sa!EDULJ X PART I-A (F)
a!?Zl 1048-19
SEE PART VI Sm'PLEMEffAL INFORMATION MET
Schedule K(Form990)2019
1156
Scheduk=K(Form!JQ2019 ALTAMED HEALTH EiERVICES CORPORATION 95-2810095 PartVl !hrpplamcntal rns'n:rnatinIn r'll I!l+i ISdl Ill!II 11141If l!l11111,4111 II I 71It lu%lII II I II 4%111111II all!il %I iil orhedil* K % dl$(ylQ (rnrlH THE PRIOR LOAN WAS ISSTJED ON FEBRUARY 14, 2011.
8 €!!B:DULE K PART 1-A (x) &
DIJ'FKRENCE B3 PMT I
[GS ON BOW PROCEEDS
PART zz LINE 3
(J) AND PART II, LINE 3 IS DUE TO INTEREST
o
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SThULE K PART III-A, LINE 7
TESr MAY NOT EXCEED THE AMOUNTO!' PRIVATE BUSINRSS pq@ AND/OR tmRELATED TRADE OR BUSINESS USE. ACCORDINGLY, ffi J)MOUNT OF PRrVAff PAmS FOR THE REPORTING PRRIOD DOES NOT IXCnD THE MOt7NT STATED IN PART III-A IiINE 6. THE ORGANIZATION uS NOT TT?JTa'T'AXW AN ANALYSIS OF Tom PRrVATE SECURITY TESr ffiTH RESPECT TO THE BONDS, AS -'J'-HE- i OF PRIVATE BUSINESS USE AND/OR mTED TRADE OR BUSINESS REPORTED rN PART III-A LINE 6 IS NOT IN EXCJ3'SS OF AMOUNTS PERMIrTED UNDER SECTION 145 0F THE CODE
SCUIJ K PATY IV-A, LINE 2 €B)
'ffl! € REFUaING PORTION OF THE BONDS HAS ffi 'ffi!a 6 -MONTH 8PWDING EXCEPTION TO REBATE.
SCHEDULH K PAR'P II-C LINE 3
DIFFERENCE BEN PART I-C (E> AND PART II-C, LINE 3 IS DUE TO INEREST EARNINGS ON NOTE PROCEEDS.
SCHEDIE K PAR!' III-C LINE 7
AMOUNT OF PRIVATE PAMS TAKE'N INTO ACCOUNT 'UNDER THE PRrVAT, PAYM!mT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR Um--ffD TRADE OR BUSINESS USE. ACCORDINGLY, 'fflE AM(XmT OF PRIVATE P4YMENT8 FOR
THE REPORTING PHRIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III-C LINE 6. THE OR(IANIZATION HAS NOT UaERTffl AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BOND8, AS THE LEVEL OF PRIVATE BU8D?E8S USE AND/OE TThmm,AffTl TRADE OR BUSnJRSS REPORTED IN PART III-C IIIW 6 IS NOT IN xxcxss OF AMOWTS pm'rrxn WDER smc'nom 145 0F THE F%ge4
!L!2124 Thl&ffl Schedule K (Fonn 990) 2019
1157
Sd"*duksK(Form9EK)I)2 €)19 ALTAMED HRALT!E SERVICES CORPORATION 95-2810095 CODE
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932124 a1119
Page4
!'i.luJJaK ffuuu )AJjV
1158
8CHEDULE L Transactions Wj} €1 M*kv61vJ PorSOn8 oM8No1646-0047 (Porm9Wor990-EZ) >compietavtheorganizationanswereo"vaaaonpormsmoipartiv,iineS!lb, or 28o, or Porm 99042, Part V, line 38a or 40b, 2019 > AttaetttO FOPffl99) or Farm99042. OpOti TO Publla
k Go to www.lrs.gov/Forma)Ofor Instruations and the latest Informatlon. Inepeotlon Employer Idantlfloatlon number
ALTAMED HEALTH SERVICES CORPORAT:CON 95-2810095
ffl ExcessBenefltTraOuctions(sectioneio'i(c)(s)lseotionsot(cH),anosectionso'i(c)(as)orgaiizationsony) Oompleteifthear(1anizatiotarmweredaYes'onForm990,PartlV, ine26aor2!5b,orForm990-EZ,PartV,line40b, Dapanmenl 0t the Traaatiry
Inkemal Flwenua !lervlce
Name orthe organization
(b) Remtianship between disqua!ified
person and orgaruzation (c) Desaription oftransaction
(d) Oorisoted?
Yes No
{a) Name at disqualified person
2 Entertheaniountoftaxinaurredb>theorganitationmanagersordisqualiflodpemorisdunngtheyearunder oaation 4968
3 Entertheamouritoftaxiifanyioniine2,a5ove,reimburaedbyttieorganization p Loans to and/or From Interested Persons.
Comptete Ifthe('rganlZatton answered "Yen' On rOrm 990-EZ, Part V, line 38a or Form 990, Part IV, line 26; Or Ifthe organlzatton reported an arnoynt on Form 990, Part X, line 8, E, or 22 (a) Name of
nitOreated person
(5} Ralationship
with organixation
'(a)Purposo
(+fIOan
(d)coanmoi
(rom the
argent:auoii?
_To From
(e) OrigirBl
prinoipal amount
(f) Balanw due (g) In
, defrult?
[5
(il
!5E'o:
imrri$q?
(l)Written
'agres'nent?
Yes No Yes No Ys No
(AJTtTLO DB LA R SP:talT DO x 14789912. 26454923. )( x X !&QILA D. BE!00!3A ElPtiIT DO X 3,560,000. 3,960,776. x x x JOgE, U. ESPARZjk BPIJIT DO X 3 , 562 , 400. 3,963,446. x x x MARIE S. TORRES SPLIT DO X 4,059,304. 4 , 516 , 290. x x x MARTIN SEROTA gPIiIT DO x 3,405,795. 3,837,036. x x x
T_utul _ , _ _ , _, _ . _ _ > $ 32732471.
L!!!!!J grants Orassmtanaeaenetitingtnt*r*steaP*rsonl.
C+omolete dlh* omanization answered 'Yea" on Form 990, P.irt IV, !me 27 4a)Nameof interestedperson (b) Relationship betwe@n
giterested peraon and
the or(lanization
(m Amount of
assistance
(d) Type of
asastanoe
(e) Purpose of
asstatbnt,e
LHA Fg Papmwork Redumlon Aot N5Lae, see the Inmuetlons for Foam 990 or 990-EX. eohadule L {Form NO or .EZ) mfll SEH PAR'[' V FOR CON!'IATI(X!J8
932131 10-2119
72 18121119 795952 10042
1159
8chedHleL(Form990or990-EZ)2 €l19 ALTAMED HEALTH SERVICBS CORPORATION 4Business TrarmaetionsInvoMngInteremedPersons.
ComDlete if the oraantZatton answered 'YeB" an FOrn1990, Pan (Vi line 28a, :'Bb, Or 280 p,s,-2810095 Paq@2
(a)Nameof interemedperaon (b) Retationship between intsrested person arid the organization
(a) Amount ol
hansamion
(d) Dascrlptiori of
transaotion
(e} Sharing of
organization's
revenues')
Yes NO
<A) NAME OF PERSON$ ZOILA D. ESICOBAR
(C) PURPOSE, OF :T.,OANi BE"I,IT DOLLAR LIFE INSURMCE
(A) NAME OF PERSONI JO!"!E U. ESPARZA
(C) Pt7RPO8E OF IIOAN! EIE'LIT DOLLAR LIFE IN8URANaE
(A) HAM! OB' PlRJONi MARIE El. TORRBB
(C) PURPOS?, OF LOAN! SPIa,T DOLLAR LIFE IN8UMCE
(A) E OF PmRSONt MARTIN SEROTA
(C) PtJRPOSE OF L(W: S:PLIT DOLLAR LIFE INSURANCE
FORM 990 PART X IaNE 5
IN 2011 ALTAMED ADOPTED A SPLIT DOLIa RETENTION AND flOM PLAN (THE PnAM) DESIC4NJ, TO AS3IST AIJTAMED IN RECRUJ:TING 26 RETAINING KEY BXHCUTIVES AND REWARD FUTURE SERVICE. THE PLAN IS DESIGNED TO SATISFY 8ah*dule L (Form NO or 990-EX) 2019
932131 10-21-19
18121119 795952 10042
1160
SgheduleL(Form990or99Cl-EE2a AI'!AMED HEALTH SERVICES CORPORATION 95-2810095 Paqe2 [aupp.. "ifnrmation
(hmpmte this partto provideadtlitionalinformationfor responseato queationaon 8ohedulel (seleinstrpctioris) amamal
THE: FniAIi RlGUIiATION8 DEALn'iG WITH I10AN8 MAD3 TO EXECUTIVES TO PAY PRBMIUMS ON LIFE INEIURANCE POLICIES THRY OW. REPAYMRWT OF THE LOM8 ARE SHCtTR3D BY THE CASH VALUE!9 AND DEATH BENEFITS IN ACCORDANCE WITH TAX AND CAIIIFORNIA LEGAII REQUIRBMENT8. IN ADDITION, THE IiOMB BEAR Iffl'ERE8T AND BECAUSE OF 'ffiE PLAtg'8 DESIGN, ATJTAMED IS EXPECTBD TO BE REPAID Ft7IiLY WITH THE APPliICAElLE FEDERAL RATE OJ' INTERE,ST. THE LOAN8 ARE RI?OR!ED ON PART X AND S(:'HEDULE II.
!)JIAfl1 0441-19
18121119 795952 10042
8ahedu}e l (Form 990 or 990-EX)
1161
SCHEDULE M
(Form 990)
Departmen} of )he Treasury
Inleriial Revenue 8tinnoa
Name'of the organizatiori
NOncaBti Noncash Contributions Contributions OMB No 1648-0047 Complete )f the organizations answered "YOU" an Farm NO, Part IV, IlneB s Or ao. 2019 kAttaohtoPorm990. OpentoPublla
r ao to www,lrs.gov/Porm990 for Instructions and the latest information. Inspection Employer identlflaatlori number
ALTAMED ALTAMED HEALTH HEALTH SERVICES SERVICES CORPORATION CORPORATION 95-2810095 IPartI I 'T'ypesolProperty
[a) (b) €c) (<
0%lg)( d Numberof NoncaehcOntrtbutton Method of determining applicable contributronsor annountsreportedon noncash contn5ution amounts demacontributed Formggo, Par vlll, line19
Art - Works of art X I 15,500.IFMV
M - Htstorioal treasures
Art - Fractional interests
Booka and publiaatrons
Clothing and hausehotd goods
Oars and other vahioles
Boats and planes
Intellectual property
Securities - Pub)laly traded
8acuritiea - Closely held atock
Securities - Partnershtp, LLO, or
truat interests
8etiuntma - Miscellaneous
Qualified conservation contribution -
Histana structurea
Qualified cariservation contnbution-Other
Real estate - Flssidentia{
Real estate - Oommeroral
Rea) estate - Other
(eillectibles
Food inventory
Dru;)s and medical supplies
Tgiidermy
Hiatoricol artifacts
Scientifc speoimena
Amheologiaal artifacts
Oiher > ( gIGNAGE ) X I
oiher > ( FLIGHT VOUCHE ) X 4
Other r ( BABY XONITORS ) X l
Other > ( MARKETING T ) X 2
Number of Forms 8283 received by the organiration dunng the tax year for contributions for whidi ths organization completed Fomi 8283, Part IV, Danes Aoknowledgement 200,00 €).Fi
70,000.FMV
44,985JMV
34;470.B'MV
l'
29 soa Ounng the year, dm the organizat recetve by oomribubon any propsrty reported tn Part i, Imss i through 28, trim it mU8ttiOld far at leastthree years from the date Of the initial aontributton, and which isn't required to be used for exempt purposes forlhe entire holding penod'?
b If"fast' describe the arrangement in Part It
s* Doesthearganizationhaveagiftacceptancepolcythatrequireslherevnwofariynonstandardcontnbutions7 32a Doestheorganaatiorihireorusethirdpartmsorrelatadorganizationstosoliait,process,orse(lnonoash contributions?
b If 'Yes,' describe in Part (1.
'33 If Die orqanization didn't report an annount in column (o} for a type of property for whtch oolurnn (a) is chedted, desaribe in Par< II
LHA %r PapemoM RedllOtiOn Aet NOtlCO, He tml Inskuctiona far Form 990. 8t.hedule M (Fmn 990' 2019 Yes No
I
, -. - J
aoaX
-- -. ,.J
ai X
sh X
9W141 094Y.19
18121119 795952 10042
75 pe!'H SERVICESCOR10042-1
1162
ScheduleM(F5rm990),2019 ALTAMED HEALTH 8BRVICE8 CORPORATION. 95-2810095 Paqe)2 p SupplelMlntaflnf0rmati €)n.ProvdetheinrormationrequiredbyPartl,1ines30b,32b,andl3,andwhethertheorganization is reporting m Part 1,column (b),the numberof contnbuttons, the nutnber of nems reaetved,or a combir+attonof both, Also a6mplete this part far any adddional information.
PART I, OTHER 'YPRS OF PROPERTY:
RECEPTION
(A) CHECK IF APPLICABTJE . X
(B) NUMBER OF (,ONTRIB[7TIONS - I
(C) REVJJUE REPORTED ON FORM 990, PART VIII e 9836.
(D) METHOD OF DETERMININa REVEN[7E$ FMV
912141 09-27-19
18121119 795952 10042
8ohedule M (Form 990) 2019
76 1163
(sPcorHmE9:)UolrEWoO-E41 D6panmento{IhaTtaasury
InlemalFlaveriuo8entice
Nameof the organization
2019
Open to Publla
Inspaation
Employer IdentHiaation number
95 2810095
Supplemental Information to Form 990 or 990-EZ
Comptet* to provlde Information for responses to specific questions on Form € 10 or MO4Z or to provide any addltlonal Information. )Attaah to Form 990or990-EX.
1. qo to www,lrs4lov/Pvm990 for the latest Ipfprzatlon.
ALTAMED HEALTH gERVJ:CHS CORPORATION
FORM 990, PART I, IilNE 1, DESCRIPTION OF ORGANIZATION MISSIONi TO ELIMINATE DISPARITIE8 IN HEALTH CARE ACCBSS AND OUTCOMBS BY PROVIDING SUPERIOR QUALITY HEALTH AHD m 8ERVICES THROUGH AN INTEGRATED WORLD-CLASS DE,LIVERY SYSTEM FOR LATINO, LTI-J!T!mlC MD UNDERSERVED COM[7NITIE3 IN SOUTHEu CALIFOffiIA.
VISTONt TO Bg THE LEADla cuMWuivzrx-baSElD PRO't?IDER O? QUAIiITY HEALTH CARE Am H[TMA!!T El!RVIC'ES.
FORM 990, PART III, IilNE 4A, PROGRAM SERVI(J ACCOMPLIEIHMENTSi SCREENING, J-HARMACY SERVICE8, IH(:'IiOD.TNG MEDIC'AffON MANAGEMBNT AND RECONCILIATION. HEALTH 8ERVICES ARE ALSO SUPPORTED BY'A COaTNlTY OUTRIACH AND HEALTH EDtTCATION TB,AM PROMOTnJG HEALTHY BEHAVIORS AND ADVANC:ATG THE OVERATJL HEALTH AND WELL-BRING AMONG THOSE LIVING IN MBDICALIiY-UNDER8ERVED (:'OMMUN:ITIES.
THE MANAGED CARE TEAM IS aOMPOSHD OF OVER 385 PEOPLE DEDICATED TO MANAGI!ga DB!EGA!'ED RISK FROM HEM,TH PLANE. THIS TBM C!URREN'I'IiY gERVICEl ONE.CIiIENT COVBR4NGOV!,:El230,000 CAP'J:TATE,DIi;VE,Q.-:4N: ;.05.
MaELE8 AND ORANGE COtTAtff. THE MAJOR 'l'mAMS INVOIIVED WITH THB,BE, OPERATIONS COVERi UTILlZAffON MANAGEMWT, CASE AGMENT, CiAIMS ADMINISTRATION, EIiIGIBCIiIff, A(:'COUNTING, INFORMTION TECHNOLOGIES, CONTRACTING, PROVIDER flRVICEg, CREDENTIALINQ, Ct7STOME,R SERVICE, AND C(WIGURATION. FUNCTIOWING AS A COHESIV!, TEM, TfflE DEPAR!!5T8 GOAL IS TO PROVIDE HIGH QUALITY AND LOW COST CARE TO MEMBERS WROIiIiED WITH Ju'l'AMED.
LHA For Papswork ROduOtlOnAOtNOtlsi see ttiOInatruatlons for Form 9oo or emi-EX. &l!11 09-(16-19
'i'i
8ohadule 0 (Form 990or 990-EX)(!20fll)
18121119 795952 10042 P!"AA!'?"!M!!:'}FBi "f'MLTH BER'cES coR 10042-1 9V1 1164
FOu 990, PART III, Iafl 4D, OTHER PROGRAM SERffClSt
YOUTH BERVIC3S - AIITAMBD PROffDE8 d ARRAY OF YOUTH S3RVICIS TO OVER 1,500 AT-RISK ff)J5 MD YOWG ADULTS IN MEDICALLY-UNDERSERVED COMMtmIT:[E8 EACH YF!. SERVI(:'ES INCLUDE: PREGNANCY MD STD PREVEN'flaON
PROGRAMS, FMII,Y PI,ANNING, HEALTH EDUCATION AN'D INIORMTION WORKSHOPS, LliGES TO CLCNICAIi SERVICHS, CASE !WAGEMHNT FOR PREGNAffl'/PARENTING TEENS, PARWffNG EDt7CATION, SUPPORT FOR PARENTING TEENS TO HELP THi STAY IN SCHOOL AND LIFE-SKIIILS DEVELOPMENT. ALTAME:D AIiSO JROVIDE8 INTENSIVE, TUTORJ:NG FOR HIGH SCHOOL STUDENTS, )BNTORSHIE', Gt7I'DANCE INTO COLIilGE 76 TECiICAL SCROOL8, Aa WORKFORCE DB:VJ!LOPMENT WITH CAREER PIPEliINE!"+ IN !'HE ME,DICAL FIELD.
THE ALTAMED INSTITtTTE FOR HEATJTH EQUITY (AIRE) .
THROUGH INNOVATION AND UUja![t)fil!!X JJaAGEMBNT, THE WORK OF THE INSTITUTE IS TO ADDRESS A WIDE ARRAY OF HEALTH IW:EgQUlTIEI THAT DIBJ"ROPORIIONA'TELY AFFEC!T RAC'IAL AND ETHNIC GROU)P8, INCLUDING ADDRESSING THE M'OLTIPIIE 80CIAI, DETERMnJj!)MTS OF HEALTH WHICH IiEM) TO DISPAR:[TIES IN CLINICAL OUTCOMES. ALTAMED'8 PATIEN POPULATION IS OVERWHELMINGLY FROM l
RACIAL/ETHHIC MJ:NOR1TIB8 IN(mUDING IND[:VIDUALS WITH liIMITED ENGLISH PROFICliCY THAT !gUFFER DISPROPORTIONATELY FROM HEAL'!H DISaRlTIES.
THROUGH TfflSLATIONAL RESEARCH, GRANTS, ANJ) gTRAff,GIC PARTNRSHIPS, THE, INSffTUTE IS DEVELOPI[ EVIDENCE-BASED STRATEGIES TO :CMPROVE PATIENT CARE. THE INSTITUTE REPRE8ENTS THE E8TABLISHMEN!'OF CRITICAL RESOURCES TO ADVISE AU!'AMED HEALTH SERVI(:'Ea ON SYSTEMC'ICALLY ADDRE8BINa KEY IS8UES IN HgAIA'H EQUI!['Y BY DEVBI10PINC4 j'a ADVANCING CONEiW8US STRATEGIEg THAT ARE EFFECTIVE, SUSTAINABLE MD THAT CAN BE IMPLEMRaD LOCALIiY.
EXPENSES # 4,487,768.
ffl212 09-0!1-19
INCLUDING es OF Q O.
78 REVERE 9 2,039,448.
Schedule O (Form 990 or 990-EX)12019)
18121119 795952 10042
1165
o
Name of the organixation
ALTAMED HEALTH SERVI(J8 CORPORATION
2 Employer Identlfmation number
95-2810095
FORM 990, PART VI, 83,CTION A, LIMB 2:
THE PRESIDENT AND CEO IS RBIIATED BY MARRIAGE TO THE SENIOR VICE PRESIDEATT & CHIEF ADMINl8TRAffVE OFFICER.
FORM 990, PART VI, SECTION B, LINE 11B:
AIiTAMED HEALTH SERVI(JS CORPORATION'S OU8IDE CPA FIRM MD FINAHCE STAFF PREJ:'ARE FORM 990. THE FORM IS THEN REVIWED AND APPROVED BY BOTH THE ORaANIZATJ,ON'S PRESIDENT AND CEO, AND THE SR. VEaOF F:TNANCEWD CFO. THE FORM IS THEN PROVIDED TO THE FULIi BOARD FOR A(,CEPTAN(:'E BEFORE FIJJING. 70% 990, PART VI, SECTION B, tnJE 12C:
ALTAMED HEALTH SERVICES CORPORATJ,ON ( "AIITAMED" ) MAINTAINS POIiICIE8 THA!' REQUIRE MAL ACuOThEDGMENT OF ALTMED'S CONFLICT OF z!'!!J!;!'r pot;czxs a THE SDSEQUE,NT DISCIIOSURE OF Am SUCH CONFLICTS, AS HECESSJURY, BY ALI, BOARD MEMBERS, EMPLOYEE8 AND AGE!S ("DIEICLOSIHG PARTIES') WHO: A) HAff, THE AUTHORITY TO NEGOTIATE OR APPROVE BU8INESS DECISIONa AND/OR REFE2URALS TO IN'!ITIHS PAID DIRECTIiY OR INDIRECTIiY BY XEDICAR!? AND/OR a)ICAID EIERVICES 7%)m B) RAVE PE,RSONAL, FnWCIAL, AND/OR OTH!Jl INTEREST. DISCLOSING PARTIE8 MUST NOTIFY AND DISCLOSE ANY SVSPECTED OR KNOWN CONFLICTS OF I!f!EREST TO TH!g OFFI(R: OF COMPLIMCE, Am RISK MANAGEMENT("OCRM"). AL-TA@)'S .pOLICIE8 ME REVIEW!D WITH DISCIiOSING PARTIES WALT.iY THROUGH TRAINING VIDEOS AND IN-PER80N PRESENTATIONS, WITH SIGNED ACKNOWLEDGMEffl'Ei OBTAINED WHERE POSSIBLE AND APPROPRIATE.
ALTAMED MAINTAJ:He A DETAIIiED REVIEW
IDEffIFIHD BY ANY DISCIIOSING
REVIEW OF THE C:[RCUMEl'fflCHS,
9322ffl O!1-06-19
gD REVIEW PROCESS FOR ANY POTENTIAL CONFLICTS
JG PARTIJJ. THIS PROCESS INCLUDES FACT GATHERING,
haduleO{Form990 or 990-EX)42019)
18121119 795952 10042
1166
REMIDIATION STEPS TO ADDRESEI SUCH ACTUAIi CONFLICT8.
FORM 990, PART VI, S!gC')C'ION B, LINE 15:
THE EXECUTIV3 L:ULvJMl'l!'J!ME UB' THE BOARD OF DJ:RBCTORS EiERVE8 AS THE COMPBNSATION COMMITTEE 36 REVIEW8 THE PREm)E)JT & CEO'S COMPHNSWION.
ADDlTlaONAIiLY, A NATIONAIiLY RECOGNlZm) INDEPEiNDENTCOMPBNSj%7;qNCOHSUL'fflT FIRM IS ENGAGED TO REVIEW 'fflB PRESIDENT & CEO'!"I COMPIN8ATION.
THE FIRM tn'[>ERTAKES SPECIFIC PROTOCOLS AND OBTAINS ORGAWIZATIOWAL DATA FROM Ht)MEROUEI COMPMIES AND P2ER GROtn"EI AND THEN REaERS A "RE,ASONAB'IiENESS" O:PINrON THAT IE3 PRESEJTED TO THE EXECUTIVE COMMITT)E OF THE BOARD OF DIRBCTORS. THE FIM'l PRCKJ8S INCLtJDES A REffEW OF (,OMPENSATIOH DATA OF 8IM1LARIIY aON8TITUTED COMPMIES, MARKET TRWDS, ffE ORGAN:[ZATION'S PRESENT COMPENSATION PACKAGE FOR THE PRESIDENT & CIO, INCIiUDING CASH MD NOW-CA!gH BENBFITS, AND THE METHODOLOGY AND PHILOSOPHY USED FOR THE -AS-qQWJT A)E !'O'['AL C:'QMPENSATIONANATJYSIS. ADDITIONAIiIiY, MARKETBEiFI!'...,4p...gEqRTJITMENT AND RETWTION TRENDS ARE CONS:tDERHD a EVALUA!'ED. THE FIRM'S REPORT, INCIiUD:CHG OPINIONS ARE PROVIDED TO THE EXECUTIVE; UUl € u.i'.ioff,n OF THE BOARn p? DIRECTORS, WHICH IS COMPRISEDOF FOUR INDEPmENT [email protected] HXECU'rIVE C(MMITffl OF THE BOARD OF DIRECTOR8 I8 PROVIDED WITH EXff,RNAL PEER GROUP DATA THAT :DTCLUDE8 EXECUTIVE COMPJJSATION (IN t7-Ss DOLLAR8 AND MARKET PERCENffLES) OF COMPARABLY SIZID C'ALIFORNIA NOW-PROFIT MD SOME FOR-PROFIT HEAu!'HCARE ORaANIZATIONS. t'HE FIRM'S OPINION!9 ARM BASED ON COMPARABILITY DATA FROM NATIONAL MD REGIONAL DATA BASES, FROM WHICH COMPARISONe OF THE ORGMIZATION'S PRESIDENT & CEO COMPENSATION WITH EXTERNAIJ PEER GROt7P C(MPINSATION IiEVBL8 (:'AN BE MADE, WHICH IS PROVIDED TO THE E,XECt7TIVE (:'OMMfflER OF THE BOARD OF DIRECTORg IN ITS REPORT. THE EXECUTIVE t.:Ulafl!!-!JAR OF 'I'HJffl BOARD OF DIRICTORS IS AL!gO PRE8ENTED WITH DATA THAT COMPARES THE ORGANIZATION'S COMPEHATION PACKAGE FOR THE PRESIDENT & CEO TO THE IiEVEL gaaaiaag-oa-tg St,hedule O (Form Ha or 990-EX) (S!019)
80 18121119 795952 10042 p%02d3J622$@j81q4pTH BBRVICESCOR10042 1 <;[l"P
1167
GENERALLY TARGETED IN THE ORGANIZATION ' S COMPENSATION PHILOSOPHY. BASED UPON THE TOTALITY OF THE DATA CIARNERED BY THE COMPENSATION CON8ULTING FIRM, THE EXEC.[TTIVk UUWl41TTEm O!' THE BOARD OF DIRECTOR!9 IS PROVIDE,D WITH !'HB FIRM'S OPINION AS TO THE "RE'ASONABLENE8S" OF THE PRESIDENT & CEO'S COMPENSATION. THE EXE(:'UTIVE, COMMI'ffiE OF THE BOARD OF DIRECToRS :DBLIBERATES ON THE DATA TO ASSESS WHETHER IT IS APPROPRIA!'E IN RIPRESENffNG COMPENSATION liEVELS MITE SIMII,AR ORGANIZATCONE!, PO81TIONS AND (:'IRCUMSTANCIS An THAT IT REPRESBNTS FAIR MARKET VALUE FOR SFRVICEB REE!IRED ON A RmALlgTlC BASIS. THE EXECUTJM!: (,:OMVll!'!!h'jti Uff THE BOARD OF DIRECTORS ALSO INTgRVIEWS 'ffiH: PRESIDENT & CEO AND CONSIDERS ')'HE ?RESIDWT & CEO'S SE,LP-EVAltUATIONMD OTHERINFORM!ION RELEVANT TO j';[email protected]. pRESIDENT & CEO'S COMPENSATION. THE RXECUT!IVE CCibn'Jioro!h:m Uk' TH:E BOARD OF DIRECTORS THEN PROVIDRg ITS RECOMMENDATIONSTO THE BOARDOF DIRECTORS F(i7HB PR4,qIDlNT & CEO'S COMPENSATION.THE BOARDOF D:CRE,CTORSIS PROV:[DEDw:!:!.HA,7474ABLB INFOmTION AND THE OprNIONS OF"THE EXPE,RT8AND DE;.;[email protected] DI8COSSE8S 80(:'H INFORMATION A 0$"n'JIONS AS IT DJJM[8 NECESSARY TO PROPERIIY A!9SE8S THE COMPENSATIONTJEVELEIOF THE ORGANIZATION'g PRESIDENT & 9pQ, .
THE PRESIDENT & CIO PERIODlCALIiY RECllflS A REPORT FROM MERCER, A NATIONALLY RRCOGNJ.ZED MD INDEPEEJT COMPE,NSATION CON8ULTING FIRM THAT COMPIIi3S COMPENSATION BENCmS j'6 COMPARES THE COMP!JSATION ARfflGJWNT8 OF SIMItAR EXE(:'UTIVES ACROSS THE COUNTRY IN SIMILAR INDtJSTRIES. THE PRESIDE,ff & CEO, WAIiIiY REVIEWS THE FIXED AND VARIABIIE COMPENSATION OF "OTHER OFFICERS OR Kff JMPLOYEES" O? AIiTAMED. TH:CSREVIEW-p 484@! €,M'&NT lmCLUDE8 THE, FOLIiOWING! AN EMPIiOYEE'S CmNT FI)a,D AND VARIABIIE COMPEN8AT1(X'J PAC)KAGEJ MARKET COMPENSATION DATA, NATIONAL AND/OR LOCAIi, OF SIMILMLY CONSTI'l'UTED COMPANIESAND EXE(,UTIVES AS PROVIDq.BY.ME$qERi MARKETTRENDS, NATIONAL AND/,ORLOCAIi7 AN WuUATIOQ OF 7-up-g.;oy.:@4.'s 9:a212 og-as-ui 8ohedukt 0 (Form 990 or 990-E) (2019)
18121119 795952 10042
1168
0 2
Nameof the organaatton amployar Identtflcatlon number
ALTAME:D HE,ALTH SERVICES (:"ORPORATIOW 95-2810095
PH,RFORMANCE I,EVELS FOR THE REIEVM!' PERFOffl(J CYCLE INCLUDING AN EMPLOYEE SELF-REVIEW; M EVALUATION OF ALTAME,D'!g PERFORMANCE I3VEr.,B FOR THE R)LEVMT PERFORMANCE CYCLEj COMPENEiATION DATA OF INTERNAL PEERB? THE METHODOLOGY AHD/OR COMPENSATION PHILOSOPHY USBJ) FOR THE RELEVANT PERFORMAN(,E! CYC,I,El INPUT FROM HW REBOt)R(:'ES; AND, OTHER RELEVANT AN'D TJAWFUII INFORMATION, AS APPROPRIATE.
AFTER REVIEW )a ASSEgSMENT, THE PRESIDENT & CEO WILIi DETERMINE WHETHE'R THE COMPENgATION PROVIDED TO THE JWIiOYEE APPROPRIATELY RmPRmSE,NTS: m CO)dPlNSAffON LEVELS WITH SIMILAR ORGMIZATIONS, POSITIONe AND CIRCtJMSTANCES, AND (2) FAIR MARKET VAIiUE FOR THE 8ERVICES RENDBRED BY THE EMJ)LOYEE ON A REAIilSTJ:C BASIS. THE PRESIDENT & CEO THEN DETnRMINES (:'OMPBNSATION ADJUST!fJJTS, AS APPROPRIATE.
FORM 990, PART 'Vl, SECTION C, L:[NI 19:
BOMB OR ALL OF THESE ITE,MS MAY BE AVAIL)U3LE UPON AH,QtJE8T.
FORM 990, PART XI, LINE 9, CMGES IN NET A!9SETSt
WET I1088 FROM AI!!'AMED WANAGEm SERffC'ES LIiC 1,702,248. 912212 (19(XI-19 Schedule 0 (FormWClor 990-EX)(2019)
82 18121119 795952 10042
1169
WauR
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huiuuailnuauiiuiiSwvi €
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ALTAMED iTH SKRVICE8 CORPORATION
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2019
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ra ALTAMET) MA?JA(?R'NRNT gRIVICES LLC L 1-702-248- ACTUAL MOUNT PAID $ if -- - -- - " ' - - - - - - - - - - a' --- - - --- -- - (4 ALTAMED HRAIITH NE'[MORK INC. A 80,548. AMOUNT ACCRUm) p) ALTAMED m,ALTH NEF;flORK TfflC. D 6,000,000. ACTUAIi AMOUNT PAID €4)
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1174
ALTAMED
j). OrganizatwnalEudget
The proposed prqject budget for the Behavioral Health Services at AltaMed South Gate is included, (July 12-June 30)
In addition, AltaMed's organizational budget for fiscal year 2022 is enclosed, Pleasenote:AltaMed'sfiscal year operatesfrom January1-December31.Additional budget materialswill beprovidedfor thenextfiscal year asSOO?Iastheyare available.
AltaMed Healtli Services Corporation *ASG= AltaMed South Gate PROPOSAL PAGE 89 of 113 Ji> 1175
Project Budget
A. PERSONNEL
Function Enter Salary FTE
Federal
Request
Project Director, Sandra Pisano, PhD (Director, Behavioral Health) Program/Enhanced Servs In Kind In Kind Manager, Behavioral Health (Zares Soto) Program/Enhanced Servs In Kind In tGnd BH Patient Navigator (TBD) Program/Enhanced Servs $ 40,000 i.OO $40,000 Licensed Clinical Social Workers (TBD) Program/Enhanced Servs $ 80,000 1.00 $80,000 Grant (Fiscal) Manager Program/Enhanced Servs $ 68,203 0.20 $13,641 Subtotal $133,641
FRINGE
Benefits (20%) Total
(FICA/SUI -8%; Retirement -4%; Unemployment -0.20%; Workers Compensation - 7%; Medicare -0.80%) $26,728 "Health Insumnce provided as an in-kind by AltaMed using non-Federaf funds. 0160,369 CONTRACTUAL/CONSULTANT SERVICES Unit Cost Qty. Request
Contmcted Services Subtotal $0
EQUIPMENT Unit Cost Qt7. Request
N/A
Equipment Subtotal $0
SUPPLIES Unit Cost Qt9. Request
Computers (2 New Staff) Program/Enhanced Servs $ 1,891 2 $ 3,782 CellPhone($250+ ($50/monthX 12 months)2 Staff) Program/Enhanced Servs $ 850 2 $ i700 Generalofficesupplies,printing,etc. ($68permonthfor 12 months) Program/Enhanced Servs $ 68 12 $ 816 Supplies Subtotal $ 6,298
TRAVEL Unit Cost Qt7. Request
Travel Subtotal $0
1 2
3 4
5 B.
C.
D.
E.
South Gate ARPA Mental Health RFP 2022
AltaMed Health Services
July 12, 2022- June 30, 2023 (1 year)
YFAF2 1
PROPOSAL PAGE 90 of all3
1176
Project Budget
OTHER (Jnit Cost Qt9. Request
Otter Sthtatal $0
SubtobdDired Cashs 1166,667
lndired Costs Request
Irired Rafe (5%) $8,333
"Fmeral IndirectRateZ2.5%' Onl3/5%fSbeingChargediO TILTSg!'alt StMtal Irdtred Costs $8,333
lf75,(NIO
F.
G.
H.
Fully Loaded Hourly Rate:
Total Cost
Total Annual Hours
Ful/yLoadedHouriyRate
$175,000
2080
H.'is I
PROPOSAL PAGE 9'l of 113
1177
ALTAMED HEALTH SERVICES
BUDGET
FISCAL YEAR FROM JANUARY 2022 TO DECEMBER 2022
9,g2E!,366
72 ,29,6
73 ,835
33,!iCi@ ,
394,Q7Q
15,!142!,Ql
10,135,:325
i o,tas,si g
42,33j ,992
14,988,505
13,117.98B
380,00CI
358,777
i:i,og<,g5g
8,744.3Q9
A,!i44,!17:
2,e?8,4a2
p,479,lpp
17!542,99!i
2,Q72.155
4,6Q,2j8
ljlQ,299
i ,824,562
58,Q
722.017
684,629
400,000
(iU5,QOO
z,sgp,ooo
4,5g5,4Q8
85,200
5,793,0@0
122,92!!,
118,133
, Q!,784
309,54@
8,498,0 10
a,i,tei,oz.a
5,576,570
7,538,735
2,222,141
8,232,838
3p8,41 7
211,Q7B
7,483,755
2,Q,!!10
2,570,Q35
i ,428,435
7,4Q,5,101
10.i28,?12
1,756,79!
2,0!4,493
'j34,540
1383,573
i 83,8Qi
1049,105
988,0(!5
294122
308,834
84,052
3,338,8!17
2,858,473
68,710
227,934
88,388,274
!,53e,87i
1277,227
189,657
i,sty,zzg
1,1,50,553
1 ,134,917
2,047,294
184,310
1,842,288
2,437,802
JEt)l-e:A,L+iplVlSLO-NJ
1 ,745,839
27,§g0
21,082
18,883
124 161
2,61p,512
1,482,4i6
1.773,063
13,230,274
5,599,3!)0
3,4 60,658
eg,os@
4 p,287
3,421 122
1 ,065,118
813,48u
501,413
2,390,045
2,645,922
383,186
739,694
219,3(17
335,088
Be,!!42
682,021
763,955
5,216
63,4,?6
4 98,528
442,935
96,117
7,895
45,243
45,410,Qli
i,177,302
400,Qe!(i
.17,814
395,827
58,283
419,081
(i44,717
83,520
738,2;0
811781
444 796
LAC Medical Clinics{Grants
zag,o'rt
188i98J2l1
4189,Qa5
1,!)OU,479
518,827
2,;143!176
4181743
i,;10,301
2,!399,9U5
30t,151
2,!)77,?!1!1
3,844.408
145,348 183.212 12.327
-LACDanbilClinlcs 23,798,628 14,460,441 6',201,474
-OCMedk.alClinicslGrants 621735,328 36,8711120 %,091,203, ffi Dental Clln-lc; 9,'-831,1(16 4,017,a4-1 j,127,l"iJ
6onbitlution
' Maij;ll0'
1 ,689,447
(78,148)
(85,579)
(44,831
(38,Q39)
4,73Q,778
2,538.831
3.283.986
21 .584.983
7.167.064
i ,424,490
11517
97 414
2.190.081
2.712.372
161.351
988.584
4.770.861
83:17jl
1 .886.0;'1
5Q,273
i05.901
(191 ,231
(1,009,109)
(i ,065,421
(299,339)
27.740
84 420
(t,019,832)
,sza,go@
i o.sgs
(24108)
55.184.328
456112
i70,81 5)
311356
330.620
2.974.927
(43,678)
2Q7,984
53.321
(3,271i
3 95,045
(444,798)
(30,193)
4136,613
2,148,137
11 5,878
:,514,837
2,047,8Q4
2,409,398
5,722,71 :
I ,785,Q15
3,730,978
2,979,ROB
1,0!8,41!;
750,QC)9
53(i,981
i ,Q5,357
3 ,750,720
842,991
6:8,008
221,184
485,868
219,987
191,880
1 ,217,701
36,880,tl0
981 ,378
421 ,807
520,979
384,937
751,493
790,173
934 732
4,78!i,298
1 ,874,83j2
29,139
28,964
15,'!p9
1 QQ,421
2,@30,Q5Q
i ,862,:,96
i,Q8,6!)7
5,$30,851
1 ,§5g!Q .
2,97'J,i48
Zl ,370
50,237
2,688,227
gtz,as
798,355
477,i20
5,4i0,841
s,tgs,oza
5,1!!,415
Q2,:52
22?,Q!il
4:8,669
48,:92
37(i,!;08
374,EL53
57,'7Q
72,104
i 12,479
739,735
p08,:,7i
14 450
52,911
32 ,778,788
909,471
408,440
40,383
471,!,05
233,858
375,!i04
p68!104
4E!,441
852,881
810,681
86,177
33 ,999
4,735,843
:,9135)4
3112,195
1 ,6B7,977
2,043,920
2,476,730
4,384,618
45p,971
17,073,006
243,4Q4
.(<o,iao)
393,232
(7,079)
2,p8,959
2,688,A78
1 ,358,653
2 ,089,772
1 ,63:3,809
3,0,39,815
624,85Q
13,962, €134
443,831
280,81a
1,097,089 1,368,877
t,sag,ass 2,099,626
Total Expanses
11,50i ,8Q5
179,583
%6,178
9:,B1!i
%5,E!08
17,458,4:6
11 ,508,857
!1,647,839
31,620,573
11,05,825
1B,403,8'j
439,854
309,600
lj3,57i,010
8,027,860
4,932,487
2,943,Q49
8,701 ,344
19,717,9:2
3.31 8,384
4,! 4z,gts
1 ,402,152
2 ,631,'196
298,225
?,327,820
2,316,582
3 57,314
4 4jl,:84
693,059
4,!059,587
4,978,16j
89,055
328,088
202,258,681
5,603,820
2,505,339
247,854
2,905,839
i,440,874
z,at<,+tg
4,110,4[)8
298.27i
4,02:,343
4 ,994,776
530.973
209,537
29,1!13,064
12,856,842
1 2,058,692
8,594.935
11,3tiO,244
8,333048
16,CX)7,430
3.042,219
71,169,4%
2,485,E!64
1,671 ,382
320,8p5
zo;i,agt
7.547,887
12,228,396
Net Income
(2,333,530)
(1!)7,287)
(92,!3)
(60,020)
(260,939)
(i,8j 4J151
(1,373,332)
(1 ,Oi4,020)
10,711,419
3.522,680
(5,285,634)
(59,854)
41177
(3.476,05t)
716,539
(1,387,613)
(45,617)
(2,222,240)
(2,134,938)
(348,228)
527,271
QCI,05EI
(808,ei34)
(239,823)
(1 ,805,!)02)
(1 ,Q3i.954)
(:57,314)
(44,364)
(28,059)
(1 ,759,567)
(452,663)
(3,855)
(77,017)
(1 3,275,37Q)
(i ,434,738)
(898,881)
271,173
(681,864)
2,7 41 ,070
(804,118)
(1,210,412)
4,&80
(1 ,446,125)
(j,350,368)
(530,973)
(84,192)
(8,384,528)
(1,719,117)
(1 ,67!!,524)
(739,784)
(1 ,868,048)
(507,390)
(i,249,711)
(684,507)
-(8,424;081)
(609,750)
(592,181)
341 isg
(ag,glg)
(i 498,829)
(2,397,290)
589 - F!i-Waw-'1325 N Anaheim
24,3E!7.447 9Q4,438 14,877,581 8,515,449
2,242,074 922,103 571,583 74@,388
t270.977 558.372 519,002 193,603
L874.345 581.227 704,877 388,441
994,41!1 622,i82 97,07! 275,i61
8,880,404 3,719,235 3,141,169
1.512.809 904.553 (72.6081 880.864
2,112,198 894,820 57g,745 844,833
i,772,259 807,790 48',859 694,610
941,524 543,590 728,412 (330,478)
1,994,373 607,598 1,375,401 11,374
3,067,083 1911788 1155,295
1,274,660 710,190 564.470
7.408.030 838.880 1,814,297 4,758,853
2.682.844 813.094 19.367.936
252,%iQ3 2:3,E134 1,982,303
182,i89 183,948 1,441,492
217.418 188.477 1.6gl.797
121.652 129.041 969.949
628,61Q 644,161 4,992,005
i40.738 33.083 t005.768
214.298 200.422 1.682.085
182.219 140.607 1.400.475
215.082 205.728 1.692.792
335.240 214.219 2.532.459
323.122 208.821 2.443.73i
120p33 96,485 926,708
448,205 312.214 :i.au.sgs
5,Oj 9,511
259,971
(170,515)
(17,452)
24 s9
1,868,399
507,043
430,113
371 ,784
(751,288)
(538,086)
623,352
347,952
3,998.434
PROPOSAL PAGE 92 of 113
1178
NeL Income
51 0.207
(805.5331
hh4i :j mill :ffi tie!l' Ijj Iall-I!!HP-liPli(=litlal/1 ?ll+)!'JtilQ'lN WA li a TlllTnaTh tgth 800,000 785,751 54,878 (40,429)
1.341.420 909.335 424.292 7.793
805.198 715.875 199.638 (110.31
43,7B1 5a.spa 15,138 (30.185)
1351,246 154,420 <<,og:i (59,268)
3.i8,202 . A!29,059 92,588 (5,443)
441,625 336,285 98,8% Q,504
350,000 268,741 77,271 5,988
750,pQp 361,780 387,584 20,638
qBp,000 2%,073 91,200 (i,273)
32,640 36,343 8,24(1 (if,943)
4i7,912 359,615 38,100 (29,803)
i,OFil,gOO 824,4h 253,384 3,185
2Q91780 184,529 iiOl928 74,323
+. :;;: -4- -li.;
97 isi
162.772
182,107
sg,337
1 ,195,349' 4BQ,7Q@
15,638
177,370
j+,az;l
4B,3j4
38,452
Q,3t!0 ,
83,E!87
86,625
ul,279
74,812
B,835
8Q,710
208,748
Fl,447
43,670
a4.iss
fi!i8,675
1,OQ3,gD1
1 ,122,34§
242,438
3,Qj8,73R
96.34'l
i,092,884
88.269
297 7fA
236,984
383,G)45
517,008
41 0,637
870,643
46i, €185
53,24 8
534,434
I ,288,583
,,58,g19
zag,tz'r
q98,4,ss
(63,800)
(2D3,2pl)
(185,393)
(42,438)
(1,677,312)
(70,085)
(287,686)
(44,508)
%B7,7B4'l
(97,718)
(87,743)
(75,383)
(60,637)
(120,843)
(76,085)
(20,578)
(118,522)
(205,583)
(4,915i
30,653
(j98.4El5'
lhlii+ a z
lkl'liial?J J?lfl!'FaRlilllR:mJl iami;iiraii'py=rrt;i
500,824 123,323 il75,947)
119,314 12,107 (i8.421
2,799 18,007 (20,805)
9iQ 38,Q31 (36,941)
6,206 21 ,015 (117,223
69.831 53.192 (123.024)
1 30,903
12Q,841
27,391
4,031
7,167
, 22,704
23,829
808,7EN3
744,78!i
188,812
24,838
u,oga
139,925
1 46,853
(390177)
(296,788)
(45,812)
(24,836)
(44,age)
(1 39,925)
(148.853)
48,7:0,46!1
29,')43,622
AQ,/!48,7jiO
a4,za4,gs*
35,557,!%%
:33,448,!162
az,o;i ,791
28,6Q4,320
18,079,240
8,GH5,620
9,683,833
10,59!i,OB2
p,:82,549
11,844,4Q9
8,583,987
7,t49,641
7i725,42!)
7,248,578
8 ,601 ,021
4,077,387
3,728,Q18
2,847,2G18
!6,500,278
5,B55,030
2B.341.158
14.193.817
28,749,478
18.584.618
18.053.809
13.9%.017
12,Q48,993
8,453,i39
,152,Q32
5.867.108
(5,5(10,278)
(5,855,030)
ii ,794:27
9,3!i7,258
20,854,875
13,799,039
if,a23,3(%6
9,669,620
10,827,1518
9,148,298
3,5Q,714
(1 ,E185,530)
1,i69,230
1 ,e!ig,!!4g
1 ,051,738
2,038,217
1 ,!t45,%:3
1,195,957
1 ,137,289
i .099,658
992,9Q8
azg,<iz
331 ,856
344,852
5,083,777
2,882,243
5,1C14,297
4,192,3Q8
3.321 41a
3.570,848
3,058,'140
2,860,714
qi752%)65
i,72lAOj
1248,170
43,859,887
24,510,347
45,534,400
36,2Q4,251
28,251,634
2Q,487,171
25,400,392
23,401,635
14,862fl03
12.934,108
10,107,425
5,070,601
6,433,275
13,714,381
8,OEi0,7[)0
7,305,931
45)61i89C)
8,671 ,399
6,292,875
1,218,337
(4,018,488)
(423.792)
132,000 90.710 41.290
50.000 50.000
14,900,000 2,753,395 7,895,148
860.000 842.B92 17.108
90,710
50,Clan
8,304,852
842,892
41 .290
7.695.148
17.108
eEh'-Al(aYadA6a6#Fmxl
163,805 50,099 (213,904)
485,759 13,515 32,137
297.134 195.250 12.81a
431.730 14.605 53.685
13,4a8 (13,4q8)
7.188 33.382 4.430
111,158 930 (2,086)
170.881 700 (45.581
1330,083 386,667 J47,47EI)
2,803,859 968f)80 (1,207,828)
98.823 67.175 38.104
8"l,562 134,055 54,38i
14.889 818,171 (831,060)
r5.37B.972 447.400
681.660 33.400 134.940
92,388 1,1:X) 193,508)
41430
%,701
as,:tY5
86,447
2,598
7,860
21 ,708
34,988
332,728
731,Cl3z
31 ,777
39,881
181,014
140.522
i8.110
255,:34
695,974
687,76i
532.783
18,008
48,430
133,795
206,569
2,049,458
4,503,871
igs,szs
243,498
992,074
3,824,372
855,583
ffl,818
(255.334)
(84,564)
(82,781)
(32,783)
(18,006)
(3,430)
(:is7gs)
(80,589)
(380,208)
(j,938,880)
4,327
14,502
(992,074)
(s,583)
(111,618)
PROPOSAL PAGE 93 of 1 "l 3
'2'?5'( 1179
wididll'MRwy
14,Q7,023 18,378,860 (33,275,88:)
730,877 309,76') (1,040,%@)
1,78!ii94 577,!70 (?,362,T34)
915,458 iiii,965 (2,027,420)
570,408 425,042 4,550
7,426,798 58:,547 (8,OIQ,343) (8,%)10,343)
3,518,615 398,458 (3,917,070) (3,917,070)
1,515,731 1,112,18B (2,627,920)
4,246,049 1,185,892 (5,431,942)
980,384 4,979,959 (!t,94Q,341)
i,468,368 i87,Q72 (1,(i0,Q4g)-
588,112 272,071 (860184) i860,184)
1,155,580 12i734 (l.g77.294) (1,277,294)
),502,505 277,740 (3,7q0,245). (3,780,245)
871,018 !ioii4g 3gat,ttis) (Q31,158)
2,048,288 275,!!84 (2,q22,170). (2,322170)
2,486,087 Q9,038 (3,475,125) (3,475,125)
Q70,466 848,934 (;,qiCj,400)-
2,384,355 609,842. (2,G173,997)
j,518,907 3i6,301 (1,8:i5,208)
2,167,358 2q4,589 (2,421,947)-
1,409,835 837,089 (2,048,923)
1,663,514 62,267 (1,72!),781) (1,725,781)
3,66!i,943 6,884,QB0 (iOJtQ,02q) (10,!i50,023)
10,496,513 2,728,445 (13,;?24,957) (13,224,957)
343,859 65,Q28 (4(X),187) J409,187)
1,192,854 1,427,900 (2,8g0,554)
1,302,099 217,471 (1,!14,pl0)
1i93,885 5!),645 (1,253,230) (1,253,230)
1,354,723 548,772 (i90l,498)
659,851 1,7pO,215 (2,4p9,865)
1,204,477 64,5'2 (1,289,070)
601,169 2.5!i,884' (858,853)
198,475 iOl7,514 (1,213,989)
876,876 257,85,3 (1134,729)
1,852,811 538,Q74 (2,390,885)
831,594 168,775 (1,CKI0,369)
584,099 4'75,473 (1,059,572)
734,327 310,:§52 (1,044,679)
1 ,224,167 31,858 (1,2!sB,025)
40i,1p3 5:7,5UO (928,703) 255,5!5 59,396 (3M,902) (314,90;J 3,303,678 459,232 (3,782,QjO) (3,762,910)
621,933 21,650 ((i43,483) (843,483)
i,321,181 2,215,100 (3,538,281) (3,538,281)
428,079 8,109,937 (5,681,150)
i,936,990 224,90!i (2,18i,895)
173,344 (173,344)
705,271 393,975 (1,(p9,246)
897,390 898,250 (1,793,840)
z,syetiz 3,41!.340 (@,ogq,ti4z)
i,589,705 i78j,505 (3,351,21t))
i,825,008 2,426,6!18 (4,051,894)
1,739,300 138,494 (1,875,794) 1,098,018 155,948 (1,253,%6) 359,568 12,843 (372,410)
619,298 77,318 (698,618)
405,911 (1,183,206) (1,183,:268)
138,320 (530,547) (530,547)
1,07p,508 (2,540,704) (2,540,704) 251,2!17 (3,3B4,025) (3,384,0251 iC)05,390 (4,413,167) (4,413,167)
817,629 (6,146,510) (6,148,510)
45,214 (238,851) (236,851)
66,892 (1,017,011) (1,Qi7,011)
21,144 (4Q3,720) (463,720)
434,75CI (782,OBi) (762,!)81)
119,680 (908,506) i9a8,508)
1,625,714 (2,888,688)
189,250 (855,577)
1207.750 (2,018,752)
13,823,
33,275,683 1,040,646 236,2:38
2,027,420
995,450
2,627,920
5,431,942
5,940,343
1854,040 1 ,819,400 2,973,997 1 ,83!!,208 2,421,947
2,048,923
2,820,5!!4
1,514,570 1,901,496 2,409,885
1,269,070
856,Ei53
1,213,989 1,134,729 2,390,885 t ,ooo,aae 1.059,572 1 ,04a,s'7g 1,258,025
928,703
6,536,015
2,161,895
173,344
1,099,248
1,793,840
6,090,852
837,803
1,012,923
1,875,794
1,253,966
896,818
2,688,688
855,577
2,018,752
(113,823,424)
(33,275,883)
(1,040,646)
(236,236)
(2,027,420)
4,5!i0
(2,827,920)
(5,431,942)
(5,940,343)
(1,654,040)
(1819,40[))
(2,973,997)
(1.835,208)
12,421,947)
(2,046,923)
(2,620,554)
(1,514,570)
(1,901,496)
(2,409,885)
(1,269.070i
(858,653)
(1,2i3,989)
(1,134,729)
(2,390,(i85)
(i ,000,369)
(1,059,572)
(q,o<4pzg)
(1,258,025)
(928,703)
(5,681.150)
(2,161,895)
(173,344)
(1,099,246)
(i ,793,840)
(8,090,852)
(837,803)
(1,012,921)
(1,875,794)
(r ,:sa,gas)
(698,818)
(2,688,888)
(855,577)
(2,018,752)
113,823,424
Proflt Warp/n 3.47%
PROPOSAL PAGE 94 of 113
1180
ALT AMED
E. ResumesofKeyProgramStaff
Resumes are included for Dr, Sandra Pisano, Director of Beha'vioral Health Services, and Zares Soto, Manager of Behavioral Health Services. Dr. Pisano and Ms. Soto will lead the program and ensure all prograin requirements are met,
AltaMed Health Services Corporation *ASG= AltaMed South Gate PROPOSAL PAGE 95 of 'l 13
1181
AltaMed Org Chart
Btendan Parker
Chief of Staff
Location Code : CORP
Castulo de la Rocha
President And C.E.O.
Headcount : 3081
Location Code : CORP
Span of Control : 11
Cristian Rico, MD
Chief Medical Officer
Headcount 215
Location Code: CORP
Span of Control:7
Henry Holguin
SVP, General Counsel
Headcount : 5
Location Code : CORP
Span of Control : 1
Jose Esparza
SVP Finance & CFO
Headcount : 97
Location Code : CORP
Span of Control : 6
€ NOn EE
* Boxes without span of control have no direct reports
PROPOSAL PAGE 96 of 113
1182
Dr. Sandra Pisano
Licensed Clinical Psychologist
Education
August, 1994 to December 1998
California School of Professional Psychology; Alhambra, CA Doctorate degree in Clinical Psychologywith an emphasis in Health Psychology August, 1994 to December 1996
California School of Professional Psychology; Alhambra, CA Master's degree in Clinical Psychologywith an emphasis in Health Psychology August, 7982to May 1986
Whittier College; Whittier, CA
BachelorofArts Degree in Psychology
Professional Backqround
April20l2 to Present
Director of Behavloral Health-AltaMed Health 8ervk,es Corporation; LosAngeles, CA Founder ofthe Behavioral Health Departmentat AltaMed with an emphasis on integratingbehavioral health services into primary care, Currently invo!vedin several administrativeand clinical duties such as: direct patient care, supervision of limnsed and non-licensedsocial workers, psychologists, and marriage and family therapists. Responsible for overseeingthe Joint CommissionAccreditation processforthe behavioral health department, member ofmedical and executive leadership, research committee, ethics/rights committee, quality corporatecommittee, and strategic planning mmmittee. Currently involved in the development of policies and procedures as they relate tothe behavioral health department, member ofthe patient centered home model team, conduct presentations at pmvider retreats and provider meetings on behavioral health topics, and overseeing the integration of substance abuse treatment into primarymre, Responsiblefortraining newbehavioral health staffon evidenced-based short-termtherapy. Currently provide behaviora(health related presentations to several health pmgrams such as the diabetes group, chronic disease management, childhoodobesity program, and maternalhealth program.Responsiblefor mllecting patient satisfaction surveys and outcome measures. Involved in development and coaching of medical providers,
April 2009 toApril20l2
Prlvate Practice; Long Beach, CA.
Provided a varietyof mental heatthservices in Spanish/Eng1ishthat included: individual counseling, family therapy, couples counseling, child/adolescenttherapy, crisis intervention, EAP services for employees of various insurance companies, and counselingfordisabled workers. Coordinate serviceswith public/private schools, departmentof children and Familyservices, physicians, department of mental health, various insurance companies, and regional centers. Interventions include both short-term and long-term treatment.
Febmary, 2002toApril2009
Clinical Director- Health Psychotogy Medicine,Inc; Long Beach, CA Founded Health Psychology Medicine, Inc,A Professional Psychology Group. The practicewas located on the campus of St, Mary Medical Center. Provideda variety of mental health services in Spanish/English that included: psychological and developmentalevaluations, individual and family counseling, child and adolescent therapy, parenting classes, in-patient consultations, and crisis intervention, Coordinate services with the public school and private school districts, department ofchildren and famlly servi>s, physicians, departmentofmental health, fostercare agencies, and regional centers.
PROPOSAL PAGE 97 of "113
1183
Dr. Sandra Pisano
Licensed Clinical Psychologist
March 2000to March 2002
Clinical Psychologist II- LosAngelesCounty + Unlversltyof SouthernCaliforniaMedicalCenter; Los Angeles, CA.
BilingualClinicalPsychologistintheHighRiskPrematureInfantfoliow-upclinicattheWomen and Children'sHospital.Involvedindirectclinicalservicesto lowbirthweight,medicallyfragile premature infantsandtheirfamilies,Interventionandservicesinciuded:infantandchildassessments,groupparenting educationprogramsin SpanishandEnglish,culturallyappropriatefamilytherapy,conjointtherapy, research,serveas a consultanto thehomevisitor'sprogram,andco-supervisemedical,psychiatricand occupational/physical therapyinterns.
March,1999to March,2000
CltmcalPsychologist- Didi Hirgh CommunityMentalHealthCenter;CulverCity,CA ClinicalPsychologistin theFamilyandChildGuidanceClinic(FCGC).Provideddlrectclinicalservicesto children,adolescentandtheirfamilies,Interventionsincluded:individualtherapy,groupparenteducation programinbothSpanishandEnglish,briefcrisisintervention(6weekmodel),familytherapy,conjoint marriagecounseling,grouptherapyfor children,andsubstanceabusecounseling.Coordinatedservices withtheDepartmentof ChildrenandFamilyservices,probationdepartment,schooldishict,regionalcenter, andothercommunityagencies.
March, 1996to March, 1999
ServiceCoordinator- SouthCentralLosAngeles RegionalCenterforthe Developmentally Disabled, (nc.; Gardena, CA
Providedcasemanagement servicestodisabledadultsandchildren,Primaryresponsibilitiesincluded:
conductedschool,home,dayprogram,andresidentialfacilityvisitsinorderto monitorservices and progress.Involvedin residentialplacementsof adultsandchildren.Advocatefor consumer'srightsin a varietyofmmmunityprogramstoensureproperlevefof careandservi>s, Alsoinvolvedin maintaining properdocumentationasmandatedbythe StateDepartmentofDevelopmentatServim, July,1990to June'1995
Intakeassessmentcoordinator- EastemLos Angeles RegionalCenterforthe Developmentally Disabled;Alhambra,CA.
Providedcasemanagementservicesto developmentallydisabledpersonsandtheirfamilies.
Res:nsibilities included:conductedpsychosocialinterviewswithindividualsseekingeligibilityforregional >nter services;generatea psychosocialintakeassessmentreport;assistfamiliesinobtainingservices throughgenericorregionalcenterfundedprograms;developedan individualprogramplan(IPP); conductedperiodicsitevisitsandmonitoredclient'sprogressandprogrameffectiveness;maintained Medioid waivercasesto statestandards;homevisitsandparentconferences;andassistedsupervisorin trainingnewemployees.
December,1986toJuly1990
Counselor- PlannedParenthood;LosAngeles,CA,
Involvedinmunselingmenandwomenontheirreproductivechoices,psychosocialassessment,andcrisis intervention.Certifiedasa healthcareworker,sterilizationcounselor;prenatalmunselor,andHIV counselor,Involvedin publicrelationsactivitiessuchas representingPlannedParenthoodinseveraltalk showsandoo-hosteda onehourSpanishradiotalk show"En Familia'on RadioKali, PROPOSAL PAGE 98 of 113 1184
Dr, Sandra Pisano
Licensed Clinical Psychologist
Traininq/ Teaching /Workshop
June, 2016 to Present
USC-AltaMed Pedlatric Fellowship Program; currently overseethe fellowship program of21 psychologist rotating in 3 primary care settings with the emphasis ofintegrating & training psychologistin Behavioral Health Integration,
Jan, 2013 to De'c2014
US-Mexico Binational Quit Using Drugs Study-AltaMed/UCLA - substance abuse research study on implementationof SBIRT services in Mexico and California.
Publications/Media
"Causa y Effecto", Downey, CA - Currently co-host a 30 minute Spanish talk show. Discuss a variety of health related topics with an emphasis on community education and engagement, "Trauma and lmmigration", La Opinion Spanish Newspaper, May 20')7, Hochman M, Pisano s,,et at,"Drug Abuse and Mental Health Innovations:How Are Decisions Made at AltaMed Health Serv:ces'?"AbstractpresentedatSocietyforPreventionResearch. May29, 2014, PROPOSAL PAGE 99 of 113
1185
Zares Soto
Manager, Behavioral Health
Mutation
California State University Los Angeles
20'l2 Master of Arts Moderate/Sever Disabilities
2012 Autism Certificate
2004 Bachelors of Arts Sociology
Proffle ,
* Lead the integration of Behavioral Health (BH) services into primary care * Played an integral role in creating, implementing and rolling out the Behavioral Heaith department koughout the organization within Los Angeles and Orange Counties * Manage Behavioral Health Integration substance abuse and opioid addiction Grant * Developed Screening Brief Intervention Refeiral to Treatinent delivery systetn into primary carc sites
* Maintain up to date resporisibilities of implementing, operating and improving Behavioral Health delivery system
* Able to keep a good relationship with outside Mental Health agencies including Department of Mental Health
* Knowledge of Medi-Cal, Medicare, and Managed Care
@ Project management and coordination experience
* Developmentof Policy andProceduresfor Behavioral Health procedures, including SBIRT * Fluent in English and Spanish
Professional Experiepce
AltaMed Health Services, Los Angeles, Ca.
Manager, Behavioral Health July 2017-Present
* Responsibleformanagingdailyoperationsofl3BehavioralHealth(BH)delivery sites within AltaMed
* Responsible for all adnstrative and operational activities associated with AltaMed's BehavioralHealth Department,inr.1ndinB mansBinB1'( behavioral health specialists schedule, assessing performance of support staff, and training * Responsible for the integration and implementation of Opioid addiction interventions program
* Responsible for the ongoing mattagement and supervision of Behavioral I-Iealth contracts with community based organizations, local health agencies, aiid health plans * Responsible for planning, organizing, developing, and implementing Behavioral Health Learning session retreat
* Responsible for creating and managing the budget for Behavioral Health departnnent * Manage, organize and oversee department audits
* Work closely with Regional Centers to assure that referred patients are scheduled for services * Develops and enforces procedures that will facilitate the referral process work flow * Generate and analyze reports to interpret patient satisfaction as well as capacity fill rate and no show rate for clinicians
PROPOSAL PAGE 100 of 113
1186
* Create and manage Behavioral Health clinical guidelines * ASSiStSwith crisis intervention/resolve outstanding questions as needed to guide staff with problem/cmlenge resolution.
* ASSiStSin coaching, training, and professional development of new and existing staff * Attends AltaMed management meetings and Health Plan organization meetings as well as Los Angeles County Department of Mental Health meetings * LeaderofHealthNeighborhoodscollaborativeforLosAngelesServiceAreas3and4 * Conductpresentations to commtinity agencies and public entities regarding services offered at AltaMed
* Conduct presentations to onboarding and existing staff telated to Behavioral Health senices, AltaMed Health Ser'vices, Los Angeles, Ca.
Supervisor, Behavioral Health October 2014- July 2017
* Responsible for managing daUy operations of 12 Behavioral Health (BH) sites * ResponsibleformanagingschedulesoflOBHclinicians
* Responsible for all administrative and operational activities associated with AltaMed's Behavioral Health Deparhnent
* Responsible for the supervision of Behavioral Health Support Staff * Responsible for the integration and iinpiementation of Screening Brief Intervention to treatment (SBIRT) throughout the organization
* Responsible for die ongoing management and supervision of Behavioral Health Contracts with outside agencies and Health plans
@ LeaderofHealthNeighborhoodscollaborativeforServiceArea4 @ Responsible for ming Support Staff
* Complete and conduct annual performance evaluations
AltaMed Health Services, LO!I Angeles, Ca,
Coordinator, Behavioral Health September 2012 - October 2014 * Served a priinary role in the implementation and development of the Behavioral Health program within the organization at six different AltaMed Iocations in Los Angeles and Orange County
* ProjectManager of BehavioralHealth template enhancements into Electronic Health Records (NextGen)
* Provide onboarding training to New Clinicians
Trainings
* 2017-CertifiedinManagementDevelopmentInst'ituteTraining * 2016- Mental Health First Aid training
* 2013- [ean/Six Sigtna overview class,
* NextGen system (Electronic Health Records) Certified
* 2014-CPR/FirstAidcertification
* 2012- Secondary Students Infomiation System Training (LAUSD) * 2011- Formal Welligent system training (LAUSD) a
* 2003-2010-Servedinhiringcommitteeforadministrators,teachersandcounselors PROPOSAL PAGE IO'l of 113
1187
ALTAMED
F. :BrochuresatidPromotiona1Materials
Enclosed, AltaMed has provided screenshots from its website, in addition to sample supportive materials patients may receive including, "Emot'onal Wellness Checklist." Multiple resources are available to patients to manage etnotional wellness, depression, anxiety, substance abuse, avoiding relapse, managing emotions, etc, In addition to English, materials are available in Spanish as well as other languages depending on patient need. Also enclosed are samples of the surveys patients receive after services, including an English and Spanish language versions.
AltaMedHealth Services Corporatioit *ASG= AltaMed South Gate PROPOSAL PAGE 102 of 113
1188
Behaviora Health Services
The loss of a job, a sudden death or feeling
stress quicker than you think. We want you
here to help.
sad. Some events can change your life and build
to know that you are not alone and that we are
If you are feeling stressed or overwhelmed, you can get care with our Behavioral Health team in some of our Los Angeles and Orange County locations. All of our licensed clinical social workers speak English and Spanish and are trained to help you cope with life stressors and get you through a rough time.
AltaMed offers short term therapy to help you overcome any challenge.
IFyou need long term therapy, we can link you to mental health services.
To learn more about our services, call us today at (855) 425-1777 If you are part of the PACE program, contact us at (855) 252-7223 to learn your options for care.
PROPOSAL PAGE 103 of 113
'14'f 1189
If you are in crisis or are experiencing suicidal thoughts, please call the suicide prevention hotline at
(800) 273-TALK (8255).
Find a location near you:
Los Angeles County:
AltaMed Medical and Dental Group - Boyle Heights
3945 Whittier Blvd.
Los Angeles, CA 90023
AltaMed Medical Group - Commerce
5427 Whittier Blvd.
Los Angeles, CA 90022
AltaMed Medical and Dental Group - Commerce, Goodrich
972 Goodrich Blvd.
Commerce, CA 90022
AltaMed Medical and Dental Group - East Los Angeles, Ist St. 2219 E. 1st St.
Los Angeles, CA 90033
AltaMed Medical and Dental Group - EI Monte
10418 Valley Blvd., Ste. B
EI Monte, CA 91731
AltaMed Medical Group - Huntington Park
1900 E. Slauson Ave.
Huntington Park, CA 90255
PROPOSAL PAGE 104 of I I 3
1190
AltaMed Medical Group - Pico Rivera, Passons
6336 Passons Blvd.
Pico Rivera, CA 90660
AltaMed Medical Group - Pico Rivera, Slauson
9436 E, Slauson Ave.
Pico Rivera, CA 90660
AltaMed Medical and Dental Group - South Gate
8627 Atlantic Ave,
South Gate, CA 90280
AltaMed Medical and Dental Group - West Covina
1300 S. Sunset Ave,
West Covina, CA CJ1790
AltaMed Medical Group - Westlake, 3rd Street
2100 W. 3rd st,, Ste. 400
Los Arigeles, CA 90057
Orange County:
AltaMed Medical Group - Garden Grove
'12751 Harbor Blvd
Garden Grove, CA 92840
AltaMed Medical and Dental Group - Huntington Beach
8041 Newman Ave.
Huntington Beach, CA 92647
AltaMed Medical Group - Santa Ana, Bristol
2720 S, Bristol st., Ste, 110
PROPOSAL PAGE 105 of 113
1191
Santa Ana, CA 92704
AltaMed Medical and Dental Group - Santa Ana, Main
1400 N. Main St.
Santa Ana, CA 92701
Social
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(:OVERED
CA140RN1A
COMMUNITY
ENROLLMENT
PARTNER
Residency
Regulatory Notices
Institute for Health
Equity
Policy & Advocacy
Careers
Doing Business with
Us
Contact Us
Givii"'ig
Becon"ie a
Coi-itracted Provider
Terms of Use Newsroom Privacy
(c2022 AltaMed Health Services Corporation. All Rights Reserved PROPOSAL PAGE 106 of 113
rfb1 1192
AItaMed
QUALITY CARE WnelOUT EXCEPTION" Behavioral Health Services AltaMed's Behavioral Health Services team specializes in short-term problem solving, prevention & early intervention, and handling stressful situations. One area of focus is in supporting patients with mild depression and anxiety symptoms - when thoughts and feelings stop you from doing well at home, work, or school. * Individual Therapy
* Child/Family Therapy
* Parenting
* Behavioral Techniques
* Motivational Interviewing
* Bereavement/Grief
* CPSP Services/Post-Partum
Call AltaMed to schedule your
appointment today:
1-855-425-1777
13 AltaMed Locations:
* 1st Street
* Boyle Heights
* Commerce
* Commerce Goodrich
* Huntington Park
* Pico Passons
* Pico Slauson
* South Gate
* West Covina
* Garden Grove
* Huntington Beach
* Santa Ana Bristol
* Santa Aha Main
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1193
YOUR HEALTHIEST SELF
Emotional Wellness Checklist
Emotional wellness is the ability to successfully handle life's stresses and adapt to change and difficult times. Here are tips forimproving your emotional health:
BRIGHTEN YOUR OUTLOOK
People who are emotionally well,
experts say, have fewer negative
emotions and are able to bounce back
from difficulties faster. This quality
is called resilience. Another sign of
emotional wellness is being able to
hold onto positive emotions longer
and appreciate the good times.
To develop a more positive mindset:
€ Remeinber your good deeds.
rl Forgive yourself.
[J Spend more time with your friends.
[] Explore your beliefs aboutthe meaning
and purpose oflife.
Cl Develop healthy physical habits.
REDUCE STRESS
Everyone feels stressed from time to
time, Stress can give you a rush of energy
when it's needed most. But if stress
lasts a long time-a condition known as
chronic stress-those "high alert" changes
become harmful ratherthan helpful.
Learning healthy ways to cope with
stress can also boost your resilience.
To help manage your stress:
€ Get enough sleep.
€ Exercise regularly.
€ Build a social support network.
CI Set priorities.
CI Think positive.
CI Try relaxation methods.
CI Seek lielp.
GET QUALITY SLEEP
To fit in everything we want to do in our
day, we often sacrifice sleep. But sleep
affects both mental and physical health.
It's vital to your well-being. When you're
tired, you can't function at your best. Sleep
helps you think more clearly, have quicker
reflexes and focus better. Take steps
to make sure you regularly get a good
night's sleep.
To get better quality sleep:
0 Go to bed and get up each day at
the same time.
CI Sleep in a dark, quiet place.
Cl Exercise daily.
[1 Limittheuseofelectronics.
CI Relax before bedtime.
[] Avoid alcohol, nicotine, & stimulants
late in the day.
€ Consult a health care professional if
you have ongoing sleep problems.
PROPOSAL PAGE 108 of 113 conUnued on next page
'U'l',
1194
YOURHEALTHIESTSELF EMOTIONALWELLNESSCHECKLIST continued I'I'T
i',i
BE MINDFUL
The concept of mindfulness is simple.
This ancient practice is about being
completely aware of what's happening in
the present-of all that's going on inside
and all that's happening around you. It
means not living yourlife on "autopilot."
Becoming a more mindful person
requires commitment and practice. Here
are some tips to help you get started.
COPE WITH LOSS
When someone you love dies, your world
changes. There is no right or wrong way
to mourn. Although the death of a loved
one can feel overwhelming, most people
can make itthrough the grieving process
with the support of family and friends.
Learn healthy ways to help you through
difficult times.
STRENGTHEN SOCIAL CONNECTIONS
Social connections might help protect
health and lengthen life. Scientists are
finding that ourlinks to otl"iers can have
powerful effects on our health-both
emotionally and physically. Whether
with romantic partners, family, friends,
neighbors, or others, social connections
can influence our biology and well-being.
To be more mindful:
€ Take some deep breaths in throcigh
your nose to a count of 4, hold for 1
second and then exhale through the
mouth to a count of 5. Repeat often.
C! Enjoy a stroll and notice the sights
around you.
CI Practice mindful eating. Be aware of each
bite and when you're full.
€ Find mindfulness resources in yourlocal
community, including classes, programs,
or books.
To help cope with loss:
€ Take care of yourself.
€ Talk to a caring friend.
Cl Try notto make any major
changes right away.
€ Join a grief support groiip.
€ Consider professional support.
Cl Tall< to your doctor if you're having
trouble with everyday adivities.
[1 Be patient. Mourning takes time.
To build healthy support systems:
Cl Build strong relationships with your kids.
CI Get active and share good habits with
family and friends.
[1 If you're a family caregiver, ask for help
from others.
€ Join a group focused on a favorite hobby,
such as reading, hiking, or painting.
Cl Take a class to learn sometl'iing new.
[J Volunteerforthings you care aboutin
your community, like a community garden,
school, library, or place of worship.
CI Travel to different places and meet
new people.
PROPOSAL PAGE 109 of 113
1195
SU VERSIC)N MAS SALUDABLE
Lista de control de bienestar emocional
El bienestar emocional es la capacidad de manejar con 6xito las tensiones de la vida y adaptarse a los cambios ylos tiempos dificiles. Estos son algunos consejos para mejorar su salud emocional:
ILUMINAR SU PERSPECTIVA
Las personas que estan emocionalmente
bien, dicen los expertos, tienen menos
emociones negativas y son capaces
de recuperarse de las dificultades mis
rapidamente. Esta cualidad se llama
resiliencia. Otro signo de bienestar
emocional es poder retenerlas emociones
positivas durante mis tiempo y apreciar los
buenos momentos.
Para desarrollar una mentalidad melS positiva:
CI Recuerde sus buenas obras.
€ Perd6nese a usted mismo.
€ Pase mis tiempo con sus amigos.
[1 Explore sus creencias sobre el significado
y el prop6sito de la vida.
€ Desarrolle habitos fisicos saludables.
Todos se sienten estresados de vez en
cuando. El estrus puede darle una avalancha
de energra cuando mis se necesita. Pero si
el estrus dura mucho tiempo (una condici6n
conocida como estrus cr6nico) esos cambios
de "alerta maxima" se vuelven dariinos en
lugar de Gtiles. Aprender formas saludables
de lidiar con el estrus tambi6n puede
aumentar su capacidad de recuperaci6n.
Para ayudar a controlar su estrus:
Cl Duerma lo suficiente.
€ Haga ejercicio regularmente.
CI Construya una red de apoyo social.
€ Establezca prioridades.
CI Piense positivo.
CI Pruebe los m6todos de relajaci6n.
CI Busque ayuda.
PROCURAR UN SUENO DE CALIDAD
Para lograr hacer todo lo que queremos
hacer en nuestros dias, a menudo
socrificamos el suerio. Pero el suerio afecta
tanto la salud mental como la fisica. Es vital
para su bienestar. Cuando esta cansado,
no puede funcionar de la mejor manera. El
suerio le ayuda a pensar con mas claridad, a
tener reflejos mis rapidos y a concentrarse
mejor.Tome medidas para asegurarse de
dormir bien regularmente por la noche.
Para obtener un suerio de mejor calidad:
€ Acu6stese y levantese todos los dias a
la misma hora.
€ Duerma en un lugar oscuro y tranquilo.
€ Ejercrtese diariamente.
[1 Limite el uso de produdos electr6nicos.
CJ Relajese antes de acostarse.
€ Evite el alcohol, la nicotina y los
estimulantes a altas horas del dia.
[J Consulte a un profesional de la salud si
tiene problemas continuos para dormir.
PROPOSAL PAGE '110 of 113 continiia an la sigulente pigina 1196
SU VERSI('N MAS SALUDABLE LISTA DE CONTROL DE BIENESTAR EMOCiONAL continuaci6n d'S.
3.,'%
7 SER CONSCIENTE
El concepto de atenci6n plena es simple.
Esta antigua practica se trata de ser
completamente consciente de lo que sucede
en el momento, de todo lo que sucede
dentro suyo y todo lo que sucede a su
alrededor. Significa no vivir su vida "en piloto
autom5tico". Convertirse en una persona mis
consciente requiere compromiso y practica.
Aquf hay algunos consejos para ayudarlo a
comenzar.
Para ser mis consciente:
0 Inhale profundamente por la nariz
hasta contar hasta 4, sostenga durante
1 segundo yluego exhale porla boca
hasta contar hasta 5. Repita a menudo.
C1 Disfrute de un paseo y observe las vistas
alrededor suyo.
€ Practique la alimentaci6n consciente.
Preste atenci6n a cada bocado y a
cuando se sienta satisfecho.
[J Busque recursos de atenci6n plena en
su comunidad local, lo que incluye
clases, programas o libros.
HACER FRENTE A LA PERDIDA
Cuando alguien a quien ama muere, su
mundo cambia. No hay manera correcta
o incorrecta de hacer el duelo. Aunque la
muerte de un ser querido puede resultar
abrumadora, muchas personas lo hacen a
trav6s del proceso de duelo con el apoyo
de familiares y amigos. Aprenda formas
saludables de sobrellevartiempos dificiles.
Para ayudar a lidiar con la p6rdida:
[1 Curdese.
€ Hable con un amigo afectuoso.
CI Trate de no hacer cambios importantes
de inmediato.
€ Onase a un grupo de apoyo para el duelo.
CI Considere recibir apoyo profesional.
CI Hable con su m6dico si tiene problemas
con las actividades cotidianas.
[1 Sea paciente. El duelo toma tiempo.
FORTALECER LAS CONEXIONES
SOCIALES
Las conexiones sociales pueden ayudar
a proteger la salud y alargar la vida. Los
cientificos estan descubriendo que nuestros
vfnculos con los demas pueden tener efectos
poderosos en nuestra salud, tanto emocional
como fisica. Ya sea con parejas, familiares,
amigos, vecinos u otros, las conexiones
sociales pueden influir en nuestra biologra
y nuestro bienestar.
Para construir sistemas de apoyo saludables:
C! Establezca relaciones s61idas con
sus hijos.
[:) Mant6ngase activo y comparta buenos
habitos con familiares y amigos.
CI Si es cuidadorfamiliar, pida ayuda a
los demas.
[:l Onase a un grupo enfocado en su hobby
favorito, como leer, ir de excursi6n
o pintar.
€ Tome una clase para aprender
algo nuevo.
€ Ofr6zcase como voluntario para las cosas
que le interesan en su comunidad, como
un jardin comunitario, una escuela, una
biblioteca o un lugar de culto.
[] Viaje a diferentes lugares y conozca
gente nueva.
PROPOSAL PAGE 111 of 113
1197
AltaMed
Quuim CARE WlTHOu7 EXCEPTION1. In the tast 12 months, when you made an appointment to see your counselor, how often
did you get an appointment within 30 days?
0 Never
0 Sometimes
0 Usually
0 Always
2. During your most recent visit, were clerks and
receptionists at this counselor's office as helpful
as you thought they should be?
r3 Yes, definitely
0 Yes, somewhat
[1 No
3. During your most recent visit, did you see this
counselor within 15 minutes of your
appointment time?
0 Yes
0 No
4. During your most recent visit, did this counselor
listen carefully to you?
0 Yes, definitely
0 No, somewhat
[1 No
5. During your most recent visit, did you talk with
this counselor about your concerns?
0 Yes
0 No
6. During your most recent visit, did this counselor
give you easy to understand information about
your concerns?
0 Yes, definitely
[:] Yes, somewhat
0 No
7. During your most recent visit, did this counselor
show respect for what you had to say?
0 Yes, definitely
0 Yes, somewhat
rJ No
Survey Instructions (Behavioral Health): Answer each
question by completely filling in the square to the left of your answer.
8. Overall,didyoufindyourtherapysessions
helpful?
€ Yes, definitely
€ Yes, somewhat
0 NO
9. Using any number from 0 to 10, where 0 is the
worst counselor possible and 10 is the best
counselor possible, what number would you use
to rate this counselor?
0 0 Worst counselor possible
CJI
02 03
04 05
06 07
08 09
0 10 Best counselor possible
10. Would you recommend this counselor's office
to your family and friends?
(:J Yes, definitely
(1 Yes, somewhat
0 No
11. In general, how would you rate your overall
mental or emotional health?
€ Excellent
[:] Verygood
0 Good
0 Fair
(1 Poor
Additional comments about your visit:
Patient Name: (optional):
Telephone Number: (optional):
Thank you! Please return the completed survey in the postage-paid envelope.
PROPOSAL PAGE 112 of 113
The)
1198
AltaMed
QUALITY CARE WITHOUT EXCEP-rlON"'
1. En los ultimos 12 meses, cuando hacia una cita
para ver a su consejero, 2con cuanta frecuencia
obtenra una cita en un periodo de 30 dias?
[1 Nunca
[:1 A veces
0 Usualmente
0 Siempre
2. Durante su visita mis reciente, .ilos empleados
y recepcionistas en la oficina de su consejero
fueron tan utiles como crey6 que deberian ser?
[1 St, definitivamente
€ Si en cierta medida
CJ No
3. Durante su visita mas reciente, 2vio a este
consejero en un plazo de 15 minutos despues
de la hora de su cita?
[1 Si
[1 No
4. Durante su visita mis reciente, 2este consejero
lo escuch6 con atenci6n?
[1 Si, definitivamente
[:J No, poco
[1 No
5. Durante su visita mis reciente, 6habl6 con este
consejero sobre sus inquietudes?
0 St
0 No
6. Durante su visita mis reciente, 2este consejero
le dio informaci6n facil de entender sobre sus
inquietudes?
€ Si, definitivamente
0 Si, en cierta medida
0 No
7. Durante su visita mis reciente, 2este consejero
mostr6 respeto por lo que usted tenia para
decir?
[1 Si, definitivamente
J Si, en cierta medida
0 No
Instrucciones de la encuesta (Salud del comportamiento):
Para responder cada pregunta, rellene completamente el
cuadrado que se encuentra a la izquierda de su respuesta.
8. En general, ge fueron utiles sus sesiones de
terapia?
[1 Si, definitivamente
[1 Si, en cierta medida
[1 No
9. Con un numero del 0 al 10, si 0 significa que es
el peor consejero posible y 10 que es el mejor
consejero posible, 2que nGmero usaria para
calificar a este consejero?
(J O Peor consejero posible
01 02
03 04
05 06
07 08
09 (J 10 Mejor consejero posible
10. ,:Recomendaria la oficina de este consejero a su
familia y amigos?
0 Si, definitivamente
0 Si, en cierta medida
€ No
11. Usualmente, .Jc6mo calificar(a su salud mental o
emocional en general?
0 Excelente
0 Muybuena
[1 Buena
[:J Aceptable
0 Mala
Comentarios adicionales sobre su visita:
Nombre del paciente: (opcional):
Numero de tel6fono: (opcional):
iGracias! Envfe esta encuesta completa en el sobre con franqueo pagado.
PROPOSAL PAGE 113 of 113
)0!
1199
AitaMed
QtJAllTYCAffll WffHOLff ffCFPTIONOffice of the
South Gate City Cle*
JUN 2 3 2022
FILED
@I: 5Uf Cl,,
2022 REQUEST FOR PROPOSALS:
Mental Heaith Assistance Program
Requiring Certified Counseling/Cliiiic@I Services
1200
Attachment F
gf lag
l .1
DEPARTMENT OF MENT-AL HEALT- H
I)t--t-;J;. recovery. welLbeing.
JONATHAN E. SHERIN, M.D., Ptl.D.
Dlreclor
Curley L. Bonds, M.D.
ChleJ Medical Orlk.er
C!inical Operalions
Gregory C. Polk, M.PA
Chief Deputy Director
Admlnistrative Operations
June 23, 2020 ADOPTED
The Honorable Board of Supervisors
County of Los Angeles
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 90012
Dear Supervisors:
BOARD OF SUPERVISORS
COUNTY OF LOS ANGELES
8 June 23, 2020
EXECUTIVEOFFICER
HEARING ON PUBLISED CHARGES FOR FISCAL YEAR 2020-21
FOR SPECIALTY MENT AL HEALTH SERVICES
(ALL SUPERVISORIAL DISTRICTS)
(3 VOTES)
SUBJECT
Request approval to establish Fiscal Year 2020-21 Published Charges for the provision of specialty mental health services provided by the Department of Mental Health's directly operated clinics.
IT IS RECOMMENDED THAT THE BOARD:
Approve the Department of Mental Health's (DMH) proposed FY 2020-21 Published Charges, effective July 1, 2020.
PURPOSE/JUSTIFICATION OF RECOMMENDED ACTION
Approval of the recommended action will allow DMH to make effective its proposed Published Charges, reflected in Attachment 1,for use in billing the general public and third party payers for specialty mental health services provided by DMH directly operated clinics, as permitted by law.
Implementation of Strategic Plan Goals
The recommended action is consistent with the County's Strategic Plan Goal Ill, Realize Tomorrow's Government Today, specifically Strategylll.3- Pursue Operational Effectiveness, Fiscal Responsibility, and Accountability.
)Db 1201
The Honorable Board of Supervisors
6/23/2020
FISCAL IMPACT/FINANCING
Approval of the requested action will enable DMH to establish a reasonable approximation of actual costs for specialty mental health services rendered.
There is no net County cost impact associated with the recommended action.
FACTS AND PROVISIONS/LEGAL REQUIREMENTS
The State Plan provides that Short-Doyle/Medi-Cal (SD/MC) services are to be paid at the lower of actual costs or customary charges, which is consistent with federal Medicaid rules. The State has implemented such provision in the California Code of Regulations Title 9 and in its cost reporting instructions. The term customary charges is synonymous with the term Published Charges, which is defined as the usual and customary charges prevalent in the public mental health sector that are used to bill the general public, insurers, and other non-Title XIX payers.
DMH contracts with the State Department of Health Care Services (DHCS) as the local Mental Health Plan (MHP) and provides specialty mental health services to Medi-Cal beneficiaries under a Section 191 5(b) waiver. DHCS claims federal reimbursement for Medi-Cal specialty mental health services based on public expenditures certified by the MHPs. When a MHP submits an interim claim for reimbursement it should either reflect the MHP's actual cost or a reasonable approximation of the MHP's actual cost. When the claim for reimbursement is for a specialty mental health service rendered by a county owned and operated facility, the MHP is not expected to know its actual cost.
The MHP will not know its actual cost until the fiscal year is over and it has completed its cost finding and cost allocation through the specialty mental health services cost report. Consequently, the interim claim for reimbursement of services rendered by county-owned and operated providers will be based upon a reasonable approximation of the MHP's actual cost, which are typically the lower of 1 ) Published Charges or the 2) County Interim Rates, which are set by DHCS and based on the most recent certified cost report submitted by the MHP. DHCS will settle these interim payments to actual cost when the MHP files its certified cost report.
DMH's Published Charges are determined annually based on the most recent Annual Cost Report, projected cost increases, estimated service delivery, and are adjusted by the Centers For Medicare and Medicaid Services Market Basket Index Levels.
In accordance with Government Code Section
to the approval of a change to an existing fee.
in compliance with Government Code Section
66018, a public hearing will be held as required, prior Special notice of that public hearing (Attachment II),
6062a, has been published by the Executive Office.
IMPACT ON CURRENT SERVICES (OR PROJECTS)
The recommended FY 2020-21 Published Charges will become effective on July 1, 2020. This increase is not expected to negatively impact mental health services to the public. With the application of the Uniform Method of Determining Ability to Pay, as established by State law, all uninsured DMH patients will most likely pay less than the Published Charges. Subsequently, there is no anticipated impact on current services.
'),D'l 1202
The Honorable Board of Supervisors
6/23/2020
Respectfully submitted,
,='7y(
JONATHAN E. SHERIN, M.D., Ph.D.
Director
JES:GP:SK:mm
Enclosures
c: Executive Officer, Board of Supervisors
Chief Executive Office
County Counsel
Auditor-Controller
Chairperson, Mental Health Commission
1203
Attachment I
COUNTY OF LOS ANGELES - DEPARTMENT OF MENT AL HEALTH
FISCAL YEAR 2020-21 PUBLISHED CHARGES
EFFECTIVE JULY 01 , 2020
SERVICE NON-MEDI-CAL MEDI-CAL
FUNCTION SERVICE FY2020-21 FY 20202-21
SERVICEDESCRIPTION MODE CODE UNIT RATES' RATES"
Crisis Stabilization:
Urgent Care
Day Treatment Intensive:
Half Day (3-4 hours)
Full Day (more than 4 hours)
Day Rehabilitation:
Half Day (3-4 hours)
Full Day (more than 4 hours)
Targeted Case Management
Mental Health Services
Medication Support Services
Crisis Intervention
Mental Health Promotion3
Community Client Services3
Conservatorship:
3 Investigation
3 Administration
Life Support /Board & Care3
Case Management Support3
10 25-29 Hour
81-84 Half Day
85-89 Full Day
91-94 Half Day
95-99 Full Day
01-09 Minute
10-59 Minute
60-69 Minute
70-79 Minute
10-19 Staff Hour
20-29 Staff Hour
20-29 Staff Hour
30-39 Staff Hour
40-49 Day
60-69 Staff Hour
882.51 772.93
272.2i
338.75
140.55
219.43
4. 38
5. 61
11 .24
9.03 226.19
226.19
224.09
212.27
43.40 268.89
238.41
296.69
i23.10
192.18
3. 84
4. 9i
9.84 7.91
N/A
N/A
Footnote(s)
1 Non-Medi-Cal rates include departmental administrative overhead costs. 2 Medi-Cal rates do not include administrative overhead costs since reimbursement for such costs are claimed througha separate process.
3 Services are non-Medi-Cal only.
1204
Attachment II
NOTICE OF HEARING ON PUBLISHED CHARGES FOR
PATIENT CARE SERVICES FOR FISCAL YEAR 2020-21
Notice is hereby given that a public hearing will be held by the Board of Supervisors, establishing proposed rates for Fiscal Year (FY) 2020-21. It is proposed that such rates for FY 2020-21 be effective July 1, 2020.
Said hearing will be held on June 23, 2020, at 9:30 a.m., in the Hearing Room of the Board of Supervisors, Room 381, Kenneth Hahn Hall of Administration, 500 West Temple Street (the corner or Temple Street and Grand Avenue), Los Angeles, California 90012. For current Board Meeting information, including Health Orders affecting public access to the Board Hearing Room, please visit http://bos.lacounty.qov. Any member of the public wishing to participate may do so by submitting written comments, objections, or statements to the Executive Office of the Board of Supervisors at [email protected].
To listen by telephone call (877) 873-8017 (enter the access code when prompted; for English: 141111, for Spanish: 222222). To view via web: http://bos.lacounty.qov/BoardMeetinq/Live-Broadcast.
The Board of Supervisors will consider and may adopt the Published Charges. Further, notice is given that the Board of Supervisors may continue this hearing from time to time.
The proposed Published Charges will be on file and available for review online at at https://dmh.lacounty.qov/abouUboard-correspondence/
For further information regarding this matter, please telephone the County of Los Angeles, Department of Mental Health, Office oT the Chief Deputy Director at (213) 738-4926.
Si no entiende esta noticia o si necesita mas informacion favor de llamar a este numero (213) 738-4926.
CELIA ZAV ALA
EXECUTIVE OFFICER
Board of Supervisors
7.,10
1205
ATT ACHMENT G
C@MPATIOR
COUNSEIING CENTER
CLARIFICATION
City of Soutli Oiite
City Clerk's Ofl'ice
Attn: Ana LeNoue, Interim }}ousing Manager
8650 CatliforniaAve,, Soulh Gate, CA 90280
Re: Mental I-IealtliAssistance Program
American Rescue Plait Act (ARPA)
Date: Jily 25, 2022
Tliank you for the o.pportuinty to apply for ARPA fimtling witli tlie City of Socitli Gate. Compatior is !Villi}}${ tO (:011tillue tO COllllllit ClllliCal Stffff, resourcesalld collateral !%erViCe8tO tlle ARPA proBralllaS it lias beendoiiig.for the past two years,
We would like to clarify gur overall loaded liourly rate is $75.00 per liourwliicli wilk iticlude providing direct services to clients, we will service up to 365 clients for a total of $175,000. Tliis will also minin'iize tlie amount oFre,femls provided to tli!rd party providers. Services wJ]l include direct services for Substance Use Disorder, Metttal }lealtli, Case Maiiagement, UA drug screenii'ig, prevention and intervention,
Sincerely,
Elizabeth Duran, SUDC IS
ExecutiveDirector
4363 Tweedy Blvd,, South Gate, CA 90280
Tel.323-378-2009 Fax213-395-9592
www,compatior.orq/wp
lll 1206
apChkLst
07/20/2022
€lTYMANAaEftS OFFICE
AUG02 2022
9:51:15AM
WARRANT REGISTER FOR COUNCIL MEETING 8/9/2022
Final Check List
CITY OF SOUTH GATE
PART I
Page: I
Bank : botw BANK OF THE WEST
Check# Date Vendor Invoice
97684 7/21/2022 0012107 CALIFORNIASTATE DISBURSEM(Ben302660 Voucher:
97685 7/2'1/2022 00002138 FRANCHISETAXBOARD Ben302656
Voucher:
97686 7/21/2022 0009920 0CSE CLEARINGHOUSE SDU Ben302658 Voucher:
Inv Date Description ' Amount Paid
7/21/2022 CASTATEDISB.UNITPAYMENT 299.99
7/21/2022 GARNISHMENT-FRANCHISETA 695.61
7/21/2022 GARNISHMENT-ARCHILDSUPF 324.00
Sub total for BANK OF THE WEST:
Check Total
;gg.gg
695.61
324.00
1319.60
3 checks in this report. Grand Total All Checks: 1 ,319.60 Page: 1
1207
WARRANT REGISTER FOR COUNCIL MEETING 8/9/2022 PART II
apChkLst
07/20/2022 12:17:52PM
Final Check List
CITY OF SOUTH GATE
Bank : botw BANK OF THE WEST
Check # Date Vendor Invoice Inv Date Description Amount Paid xffi) (u.irQga'go a g j - : - 0
Voucher:
,4- 7'4+j "Uu->
Voucher:
:q@2Kj) :a-p!
;454%35:1
q
Voucher:
Sub total for BANK OF THE WES T:
Page: 1
Check Total
:A-;a5'g6:=
:Ji'-o:i7gsTh
260,310.68
3 checks in this report. Grand Total All Checks: 260,310.68 Page: 1
1208
WARRANT REGISTER FOR COUNCIL MEETING 8/9/2022 PART Ill
apChkLst
07/26/2022 5:19:20PM
Bank : botw BANK OF THE WEST
Check # Date Vendor
tgjaqY5),'j7>=ei7]6g'7', @iT,4:g' .:eo,@egarz:::iNq:3
Voucher:
"l check in this report.
Final Check List
CITY OF SOUTH GATE
Page: 1
Invoice Inv Date Description Amount Paid
Sub total for BANK OF THE WE-ST:
Check Total
115,400.00
Grand Total All Checks: 115,400.00
Page: 4
1209
WARRANT REGISTER FOR COUNCIL MEETING 8/9/2022 PART IV
apChkLst
07/26/2022 5:38:37PM
Bank : botw BANK OF THE WEST
Check # Date Vendor
:'.; .:tjT3§j;gg:,i'a
Voucher:
J ';:$Q2. :Qo4,s:sg0
Voucher:
2 checks in this report.
Final Check List
CITY OF SOUTH GATE
Page: I
Invoice
J.
?4""9)
iJaea
Inv Date Description Amount Paid
Sub total for BANK OF THE WES T:
Check Total
T7ia
3,905,624.74
Grand Total All Checks: 3,905,624.74
Page: 1
1210
WARRANT REGISTER FOR COUNCIL MEETING 8/9/2022 PART V
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 1
Bank : botw BANK OF THE WEST
Check # Date Vendor
97695 8/9/2022 00003766
Voucher:
97696 8/9/2022 00004607
Voucher:
97697 8/9/2022 00004372
Voucher:
97698 8/9/2022 0011059
Voucher:
97699 8/9/2022 0011577
Voucher:
97700 8/9/2022 00001330
Voucher:
97701 8/9/2022 00000706
Voucher:
97702 8/9/2022 0013535
Voucher:
Invoice
ABEL GLASS & SCREEN 32445
ADLERHORSTINTERNATIONAL, 1107945
AIRGAS USA, LLC 9125290502
9126218670
9127758750
9127763349
9126633940
9125922273
ALESHIRE & WYNDER, LLP, SUIT168587
69162
ALL PHASE ELECTRIC SUPPLY CO946-1042957
ALLIANT INSURANCE SVC INC 1997245
ALTEC INDUSTRIES, INC.
ALVARADO, BIANCA
51019209
51019251
Ref000302451
Inv Date Description
6/13/2022 TAXABLE: REPLACE GLASS ON 1
3/18/2022 SUPPLIESFORCARLO/VARELA.
5/4/2022
6 /23/2022
7 /all/2022
7/11/2022
7/6/2022
6/1 6/2022
6 /21 /2022
7 /1 /2022
7/1 4/2022
DISTRIBUTATION OF SPECIALTY
DISTRIBUTATION OF SPECIALTY
INVENTORY Pa/ SAFETY SUPPL
INVENTORY Pa/ SAFETY SUPPL
DISTRIBUTATION OF SPECIALTY
DISTRIBUTATION OF SPECIALTY
THRU 5/31/22: SPECIALIZED LEG
THRU 6/30/22: SPECIALIZED LEG
INVENTORY/Pa LAMPS
7/12/2022 7/i/22-7/1/23:EXCESSWORKER!
6/30/2022
6 /30/2022
7 /12/2022
AERIAL TRUCK ANNUAL CERTIFI
AERIAL TRUCK ANNUAL CERT. It
UB REFUND CST #00062508 - 86i
Amount Paid
294.10
46.33 309.93
329.97
935.69
1 ,763.80
2 42.08
3 02.67
13 ,132.23
14 ,630.60
3,808.92
174,850.00
1 ,269.00
1,106.00
116.80
Check Total
294. 10
46.33 3,884.14
27,762.83
3,808.92
17 4,850.00
2,375.00
116.80
Page: 1
1211
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 2
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
97703 8/9/2022 00003399 ALVARADOSMITH
Voucher:
97704 8/9/2022 00001727 AMERICAN RED CROSS
Voucher:
Invoice
370050
370080
370081
370082
370083
370053
370054
370077
370058
370060
370059
370061
370062
370063
370065
370064
370067
370068
370070
370071
370072
370073
370074
370075
370051
370052
370078
370066
370069
370076
370056
370079
22440464
Inv Date Description
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
THRU 6/30/22: GENERAL
THRU 6/30/22: ATTEND SPECIALi
THRU 6/30/22:TUESDAYS, AGENI
THRU 6/30/22: COSG ADV. ANGE
THRU 6/30/22: COSG ADV. JAH H
THRU 6/30/22: COSG REGARDIN
THRU 6/30/22: COSG ADV. ROBLI
THRU 6/30/22: COSG AL ADV. SAI
THRU 6/30/22: COSG ADV. LUZ M
THRU 6/30/22: COSG ADV. ERICk
THRU 6/30/22: RE: COSG ADV. At
THRU 6/30/22: COSG ADV. SILVIA
THRU 6/30/22: COSG ADV. AUREI
THRU 6/30/22: RE: COSG ADV. L)
THRU 6/30/22: RE: COSG ADV. S(
THRU 6/30/22: RE: COSG, ET AL.
THRU 6/30/22: COSG ADV. GABR
THRU 6/30/22: COSG ADV. MARC
THRU 6/30/22: COSG ADV.MARIA
THRU 6/30/22: COSG, ET AL. ADI,
THRU 6/30/22: COSG, ET AL. AD\i
THRU 6/30/22: COSG, ET AL. AD!
6/30/22 COSG ADV. GLORIA ROC
THRU 6/30/22: COSG ADV. AALI Yi
THRU 6/30/22: EMPLOYMENT MA
THRU 6/30/22: COMMUNITY DEV
THRU 6/30/22: COSG, ET AL. AD!
THRU 6/30/22: COSG ADV. NALLE
THRU 6/30/22: COSG ADV. DEBR
THRU 6/30/22: COSG ADV. EVELI
6/30/22 ARGUELLO V COSG
6/30/22 COSG ADV MARIA HEREI
STAFF CERTIFICATION RECORD
Amount Paid
1,870.00
4,117.50
11,900.00
680.25
2,109.20
11 ,::o.oo
3,65al.50
722.41
9,511 .28
4 ,309.80
5 00.00
7,675.00
14,675.00
453.00
1 ,512.50
2 ,553.25
5,715.30
525.00
947.29
4,100.00
200.05
103.95
2 ,475.00
3 00.00
302.50
6 ,187.50
7 ,404.70
671.33
1 ,680.40
2 ,600.00
51.00 2,525.00
585.00
Check Total
113,249.7i
585.00
Page:2
1212
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 3
Bank : botw BANK OF THE WEST (Continued)
Check# Date Vendor Invoice InvDa'te
97705 8/9/2022 00004309 AMERIFLEX INV535003 6/30/2022
Voucher: INV543485 7/6/2022
97706 8/9/2022 0009798 ANIMALFRIENDSPETHOTEL 4ei7470 5/24/2022 Voucher: 4ei7471 5/24/2022
97707 8/9/2022 0013533 ARAIZA, MARIA Ref000302449 7/12/2022 Voucher:
97708 8/9/2022 00003529 AT&T JULY2022 7/1/2022
Voucher:
97709 8/9/2022 00003692 AT&TMOBILITY 28728833867XO617/2/2022 Description
FSA ADMIN FEE I PARTICIPANTE
FSA ADMIN FEE 35 PARTICIPANn
K-9 VETERINARY SERVICES
K-9 VETERINARY SERVICES
UB REFUND CST#00050712 -27E
BILLING PRD- JULY 2022
6/3/22-7/2/22: MDCS DATA CARDS
Voucher:
97710 8/9/2022 00000201
Voucher:
97711 8/9/2022 0010585
Voucher:
97712 8/9/2022 0011066
Voucher:
97713 8/9/2022 0010615
Voucher:
97714 8/9/2022 0012979
Voucher:
97715 8/9/2022 0006803
Voucher:
97716 8/9/2022 0012870
Voucher:
97717 8/9/2022 0013325
Voucher:
97718 8/9/2022 00002469
Voucher:
97719 8/9/2022 00000651
Voucher:
97720 8/9/2022 0005554
Voucher:
97721 8/9/2022 0012885
Voucher:
ATLANTIC LOCK & KEY
AUTOZONE STORES, INC.
BARNETT, RHONDA
BEARCOM
01077
5488801345
276210
264902
5384184
5/31/2022 SERVICE CALLTO MAKE KEYS F
6/30/2022 AUTO PARTS
7/13/2022
6/30/2022
6/1 /2022
BERNARDS OFFICE FURNITURE 44851
44850
BEST CONTRACTING SERVICES, 19411
6/23/2022
6/23/2022
4/30/2022
BIBRIESCA DE ARELLANO, MAR11MBSUMMERO622 7/18/2022
MBSUMMERO622 7/18/2022
BKF ENGINEERS 22061040 6/12/2022
FORFEIT FEE (SERGIO CASTELL
FORFEIT FEE (PRISCILLA TAFO'Y
JUN 2022: MAINTENANCE RENEI
PROPOSAL N0.49038: WORK ST
PROPOSAL #49082 POLICE DEP'
INSTALL OF NEW ROOFING AT T
06/16/22-06/30/22: TONE IT UP
06/15/22-06/29/22: STEP AREOBI(
4/25/22-5/22/22: DESIGN SERVIC
BOB BARKER COMPANY 1NV1780059
BSN SPORTS, LLC 917469560
6/17/2022 JAILSUPPLIES:TOOTHPASTE
6/29/2022 ADULTSPORTSSUPPLIES
CALIFORNIA BLDNG STANDARDEAPR2022-JUNE 21 6/30/2022
CANON FINANCIAL SERVICES, IN28838133 7/9/2022
APR2022-JUNE 2022: BLDG STAi
BILLING DATE 07/17/2022-08/16/;
Amount Paid
35.00 190.75
434.50
129.75
53.08 239.77
1 ,810.80
650.00
90.45 30.00
30.00 1 ,019.57
15,000.92
10,420.10
101,711.62
225.00
225.00
13,7 43.00
174.16
771.65
604.80
1 ,558.72
Check Total
225.75
564.25
53.08 239.77
1,810.80
650.00
90.45 60.00
1,Oi9.57
25,421.02
101,7il.62
450.00
13,7 43.00
174.16
771 .65
604.80
1 ,558.72
Page:3
1213
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 4
Bank : botw BANK OF THE WEST (Continued)
Check# Date Vendor Invoice InvDate
97722 8/9/2022 00004433 CARPENTER, ROTHANS & DUMO41355 6/15/2022 Voucher: 41356 6tl5/2022
97723 8/9/2022 00001102 CENTRALBASINWATERASSOC.5/"12/22:ANNUALl5/18/2022 Voucher:
97724 8/9/2022 0006239 CENTRALFORD 10552 6/30/2022
Voucher:
97725 8/9/2022 0005839 CHAMPION CHRYSLER JEEP 001664561 6/29/2022 Voucher:
97726 8/9/2022 0011708 CLIENTFIRSTTECHNOLOGY 13727 5/31/2022 Voucher: 43636 4/1/2022
13726 5/31/2022
97727 8/9/2022 0010904 CMR:BARRON,JOSHUA JULY2022 7/14/2022 Voucher:
97728 8/9/2022 00003341 CMR:CYPERT,JENNIFER JULY2022 7/14/2022 Voucher:
97729 8/9/2022 00004154 CMR:FLORES II,ALAND. JULY2022 7/14/2022 Voucher:
97730 8/9/2022 0011966 CMR:MONTALVO,JOHNROBER"IJULY2022 7/14/2022 Voucher:
97731 8/9/2022 0012949 CMR:RUIZ,LIZEnE JULY2022 7/14/2022 Voucher:
97732 8/9/2022 0011922 CONCENTRAMEDICALCENTERE75741055 6/22/2022 Voucher: 75816090 6/29/2022
97733 8/9/2022 00005110 COUNTY OF L.A. DEPT OF PW RE-PW-22061307i 6/13/2022 Voucher:
97734 8/9/2022 00001423 DAILY JOURNALCORPORATION B3603313 7/21/2022 Voucher: B3603502 7/21/2022
B3603319 7/21/2022
B3602849 7/21/2022
B3603506 7/2U2022
97735 8/9/2022 00000314 DAPEERROSENBLIT&LITVAKLl20460 6/30/2022 Voucher: 20458 6/30/2022
20459 6/30/2022
20461 4/30/2022
Description
THRU 5/31/22 RE: CANIZALES, D
THRU 5/31 /22: RE: MARIA RUIZ V
5/12/22: CWBA ANNUAL MEMBEF
UNIT#196 ALTERNATOR
DEALER PARTS FOR CHARGER
MAY 2022: IT PROJECT MANAGE
APR 2022: IT PROJECT MANAGE
5/13/22: IT PROJECT MANAGEME
07/14/22 - PARKS COMMISSION F
07/14/22 - PARKS COMMISSION r
07/14/22 - PARKS COMMISSION r
07/1 4/22 - PARKS COMMISSION r
07/14/22 - PARKS COMMISSION r
6/6/22-6/20/22: PROVIDE MEDICA
6/22/22-6/24/22: PROVIDE MEDIC
THRU MAY 2022: TRAFFIC SIGN)
NOTICE OF ELECTION - GPN GO
ORDINANCE PUBLICATION - OR[
NOTICE OF HEARING - CUP #86(
NOTICE OF HEARING - CUP #86C
ORDINANCE PUBLICATION - OR[
6/30/22 MUNICIPAL CODE COMPI
THRU 6/30/22: SPECIALIZED LEG
JUNE 2022 - (ANINAL CONTROUI
THRU 4/30/22: SPECIALIZED LEG
Amount Paid
2 ,180.80
3 ,033.08
50.00 450.27
190.96
525.00
3,425.00
2,388.75
75.00 75.00
75.00 75.00
75.00 695.00
378.00
9,607.11
220.00
100.00
210.00
260.00
80.00 5 ,690.09
297.50
332.50
6 8.72
Check Total
5,213.88
50.00 450.27
190.96
6 ,338.75
7 5.00
75.00 75.00
75.00 75.00
I ,073.00
g,soz.ii
870.00
6,388.81
Page:4
1214
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 5
Bank : botw BANK OF THE WEST (Continued)
Check# Date Vendor Invoice InvDate Description
97736 8/9/2022 0009748 DEPARTMENTOFWATER&POWGA431143 6/15/2022 JULY12022THROUGHJUNE30 Voucher:
97737 8/9/2022 00000696 DEPT OF CONSERVATION DMSIIAPRIL-JUNE 2022 6/30/2022 APRIL-JUNE 2022: PERMITS-S TF Voucher:
97738 8/9/2022 0006821 DIV. OF THE STATE ARCHITECT DSA QUARTER #: 6/30/2022 DSA QUARTER #2 2022 FEES Voucher:
97739 8/9/2022 00003777 DONMILLER&SONSPLUMBING364.313 6/28/2022 PLUMBINGPARTSBUILDINGMA Voucher:
97740 8/9/2022 00004013 ELITEOPTICALCO. 1755891 5/17/2022 SAFET"f"GLASSESFORLARRYC Voucher: 1779045 6/24/2022 SAFETY'GLASSESFOROMARA'
9774"1 8/9/2022 0012358 EO: GLAZE, YODIT 300001225 6/16/2022 REIMB: MEMBERSHIP - CITY CLE Voucher:
97742 8/9/2022 0013529 ESPINOZA, CRISTINIA Ref000302445 7/12/2022 UB REFUND CST#00063045 - 54- Voucher:
97743 8/9/2022 00000619 FALCONFUELS,INC. 48724 7/14/2022 REGULARUNLEADEDFUEL&S/ Voucher: 48620 7/11/2022 REGULARUNLEADEDFUEL&S)
48448 7/6/2022 REGULAR UNLEADED FUEL & S!
€37744 8/9/2022 0C113187 FAST5SOUTHGATE9,LLC 4452 6/30/2022 JUNE2022(56)CARWASHSRV.
Voucher:
97745 8/9/2022 00002026 FEDERALEXPRESSCORPORATI7-797-28732 6/23/2022 FEDEX2DAY Voucher: 7-798-21141 6/24/2022 FEDEX PRIORITY OVERNIGHT 97746 8/9/2022 0005869 FERGUSONWATERWORKS 0804480 6/22/2022 BRASSMATERIALFORWATERF Voucher:
97747 8/9/2022 00003770 FLEMINGENVIRONMENTALINC.3862 6/30/2022 FUELSTATIONIMPROVEMENTP Voucher:
97748 8/9/2022 0010237 FRONTIERCOMMUNICATIONS 209-057-1084-07/:7/U2022 BILLING-07/01/22-07/31/22ACC1 Voucher: 562-197-1130-0707/5/2022 7/5/228/4/22-ACCT#562-197-11:
97749 8/9/2022 0012210 FUNEL 2022 7/25/2022 THRU7/1/24:COMPLIANCEOFII Voucher:
97750 8/9/2022 0009215 G&MOILCOMPANY,LLC 012-041 6/30/2022 MAY2022EXPRESSCARWASHE Voucher: 012-042 6/30/2022 JUNE2022EXPRESSCARWASL
Amount Paid
9,083.00
2,318.57
826.80
115.35
230.17
244.49
200.00
25.70 5,613.7 4
13,287.99
7,180.61
352.80
6.62 i7.42
1 ,270.73
160,611.53
54.84 559.05
13,000.00
245.00
165.00
Check Total
9,083.00
2,318.57
826.80
115.35
474.66
200.00
25.70 26,082.34
352.80
24.04 i,270.73
160,611.53
613.89
13,000.00
410.00
Page: 5
1215
Check Total
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 6
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor Invoice Inv Date Description Amount Paid 97751 8/9/2022 00004934
Voucher:
97752 8/9/2022 00004869
Voucher:
97753 8/9/2022 0010639
Voucher:
977'>4 8/9/2022 0013403
Voucher:
97755 8/9/2022 0013098
Voucher:
97756 8/9/2022 0013070
Voucher:
97757 8/9/2022 0009879
Voucher:
97758 8/9/2022 00000268
Voucher:
GAS COMPANY 013 900 7300 3 07 7/18/2022
045 400 7300 6 7 /: 7 /1 8/2022
130 500 9400 5 07 7 /28/2022
i 34 700 9400 7 07 7 /1 5/2022
083 407 6536 4 06 6/24/2022
126 300 9600 1 07 7/18/2022
115 800 9600 3 07 7/18/2022
102 000 8100 7 07 7/1 5/2022
113 798 0362 7 07 7/28/2022
049 200 7902 9 07 7/19/2022
186100 7200 3 07 7/19/2022
132 eoo 9400107 7/15/2022
GOLDEN STATE WATER COMPAN33744100000 JUN 7/6/2022
537 441 00008 07 /2 7 /6/2022
637 44100007 07 /2 7 /6/2022
32809400008 07/2 7/6/2022
29007447310 07/2 7/7/2022
7374410000607/2 7/14/2022
BILLING PRD-06/1 4/22 -07/1 4/22
BILLING PRD- 06/1 4/22 -07/1 4/22
BILLING PRD-6/13/22 -07/13/22
BILLING PRD- 06/13/22 -07/13/22
BILLING PRD- 05/23/22 -06/22/22
BILLING PRD-6/1 4/22 -07/1 4/22
BILLING PRD- 06/1 4/22 -07/1 4/22
BILLING PRD- 06/13/22 -07/13/22
BILLING PRD- 06/01/22 -07/01/22
BILLING PRD- 6/15/22 -07/15/22
BILLING PRD- 06/15/22 -07/15/22
BILLING PRD-6/13/22 -07/13/22
BILLING PRD- 06/02/22 - 07/05/22
BILLING PRD- 06/02/22 - 07/05/22
BILLING PRD- 06/08/22 -07/05/22
BILLING PRD- 06/02/22 -07/05/22
BILLING PRD- 05/04/22 -06/03/22
BILLING PRD- 06/02/22 - 07/05/22
GONZALEZ GOODALE ARCHITECOO23109 5/31/2022 THRU 5/.31/22: SOUTH GATE COL GRANICUS LLC 151162 4/29/2022 GRANICUS ASSUMING CONTRAI GREEN'S DRY CLEANING & LAUTh539189 6/30/2022 JUNE 2022 JAIL CLEANING OF Bl GRIFFIN STRUCTURES, INC.
HDL COREN & CONE
GSI-SGUO-12
GSI-SGUO-11
SINO20069
5/31/2022 CONSTRUCTION MANAGEMENT
4/30/2022 CONSTRUCTION MANAGEMENT
7/18/2022 JUL-SEP2022:DLCOREN&COh
HOME DEPOT CREDIT SERV1CEE8350927 5/9/2022 WATER DEPARTMENT SUPPLIEE 3361135
0371562
4361058
4/14/2022 GENERALMAINTENANCE-MISC
4/7 /2022 GENERAL MAINTENANCE - MISC
3/14/2022 STREETLIGHTSYSTEMREPAIR
1 ,028.67
2 5.39
135.26
63.47 21 .20
2122
6,335.26
i7.02
9,370.81
29.68 999.01
90.66 400.50
238.04
2,090.58
44.59 69.70
176.85
17,902.00
36,667.00
1,141.90
58,070.61
65,825.11
3,375.00
13.99 132.29
299.43
52.27 18,137.65
3,020.26
17,902.00
36,667.00
1,141.90
123,895.72
3,375.00
497.98
97759 8/9/2022 0013385 INTEGRATED LEADERSHIP, SOLLSGPD 2022-001 6/28/2022 ORGANIZATIONAL ASSESSMEN1 25,800.00 25,800.00 Voucher:
Page:6
1216
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 7
Bank : botw BANK OF THE WEST (Continued)
Check# Date Vendor Invoice InvDate Description
97760 8/9/2022 00004578 INTERWESTCONSULTINGGROU78141 5/9/2022 APR2022:AS-NEEDEDCIPSER\ Voucher:
97761 8/9/2022 0008222 JCLTRAFFICSERVICES 115086 6/29/2022 19GALVANlZEDPOST Voucher: 115087 6/29/2022 SAFETYEQUIPMENTFOREMER
97762 8/9/2022 0013280 JEFFERS,CHRIS 7/16/22 7/16/2022 JULY162022REIMBURSEMENT Voucher:
97763 8/9/2022 0007026 JOHNDEERECOMPANY 117358851 7/U2022 JOHNDEEREMOWERTOREPU Voucher:
97764 8/9/2022 00000430 JOHNL.HUNTERANDASSOCIATSG1UOR12205 6/29/2022 MAY22MANAGEMENTOFTHEl Voucher: SG11W12205 6/30/2022 MAY22PROFESSIONALSERVIC
SG11W12206 7/12/2022 JUNE22PROFESSIONALSERVl(
97765 8/9/2022 0011555 KCREFRIGERATION 220623-007 6/30/2022 REPAIROFJAILFREEZER-STAR Voucher:
97766 8/9/2022 00003387 KNORRSYSTEMS,INC. S1239927 6/30/2022 50LBPULSARBRIQUETTES Voucher: S1239939 6/30/2022 50LB PULSAR BRIQUETTES
S1237169 6/29/2022 POOLSUPPLIES
S1235250 1U30/2021 POOL&SPACHEMICALS,CHOLI
S1239260 5/26/2022 KNORRSYSTEMSFY21/22ANNI
PWSVI-7644 6/30/2022 LABOR: LOW GPM TROUBLESH(
97767 8/9/2022 00003540 LACOUNTYDEPT.OFPUBLICW(IN220001015 6/30/2022 11/1/21-4/30/22:T.S.lMPERIALH'i Voucher:
97768 8/9/2022 00003540 LACOUNTYDEPT.OFPUBLICW(lNV220000998 6/30/2022 5/1/2018-4/30/2022:T.S.5681/CEF Voucher:
97769 8/9/2022 0006905 LACOUNTYSHERIFF'SDEPARTA223421BL 6/30/2022 JUNE2022FOODFORTHEJAIL Voucher:
97770 8/9/2022 00005062 LAC1YPOLICECHIEF'SASSOC.8/31/22ARAKAW7/26/2022 8/31/22-9/2/22:REGISTRATIONFI Voucher:
97771 8/9/2022 00002870 LAWOFFICESOFJONES&MAYE110321 6/30/2022 THRU6/30/22-RE:SOUTHGATE:
Voucher:
97772 8/9/2022 00003754 LIEBERTCASSIDYWHITMORE 219113 6/6/2022 7/1/22-6/30/23:ERCMEMBERSHI Voucher:
97773 8/9/2022 00003754 LIEBERTCASSIDYWHITMORE 220635 5/31/2022 5/31/2022 REGENERAL Voucher: 220636 5/3al/2022 THRU5/31/22:READVICEREDl5
220638 5/31/2022 THRU 5/31/22: RE ADVICE RE DIE
Amount Paid
65.00 1,486.85
15,621.05
392.37
24,525.19
2,495.25
i5,7 45.00
5,992.50
266.56
1 ,977.29
1 ,627.29
157.70
2 ,008.10
2,094.71
915.00
2,413.71
108.86
782.56
200.00
1 ,938.00
4,120.00
2,094.50
112.00
2,188.00
Check Total
65.00 17,107.90
392.37
24,525.19
24,232.75
266.56
8,780.09
2,413.71
108.86
782.56
200.00
1 ,938.00
4,120.00
4,394.50
Page:7
1217
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 8
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
97774 8/9/2022 00004384 LIENONME,INC.
Voucher:
97775 8/9/2022 00001161
Voucher:
9777B 8/9/2022 00003773
Voucher:
97777 8/9/2022 00000488
Voucher:
97778 8/9/2022 0013536
Voucher:
97779 8/9/2022 0013343
Voucher:
97780 8/9/2022 0013534
Voucher:
97781 8/9/2022 0C113532
Voucher:
97782 8/9/2022 0013530
Voucher:
97783 8/9/2022 00000447
Voucher:
97784 8/9/2022 00000447
Voucher:
97785 8/9/2022 00000170
Voucher:
97786 8/9/2022 00000al70
Voucher:
97787 8/9/2022 00000al70
Voucher:
97788 8/9/2022 00000170
Voucher:
LIFE ASSIST INC
LINCOLN AQUATICS
Invoice
0333289
0333253
0333252
0333250
0333290
0333288
0333287
218786
D8780800
LINDEGAS&EQUIPMENTINC. 11132132
LlnLE, IVETTE Refl)00302452
LI1TLEJOHN COMMUNICATIONS,06302022
MADULA, MARITES Ref000302450
MAGALLON, RICHARD Ref000302448
MEJIA, RICHARD Ref000302446
MISC - BLDG PERMITS 200001050
MISC - BLDG PERMITS 22000931
MISC - PKS & REC REFUND 270073
MISC - PKS & REC REFUND 277019
MISC - PKS & REC REFUND 232976
MISC - PKS & REC REFUND 276965
Inv Date Description
7/6/2022
6/30/2022
6/1 5/2022
6 /1 4/2022
7 /6/2022
7/7/2022
7/6/2022
6/1 4/2022
6/9/2022
MEDICAL REVIEW FOR M. VALDE
MEDICAL REVIEW: CLA1M#05262
MEDICAL REVIEW: CLA1M#06042
MEDICAL REVIEW: CLA1M#05212
MEDICAL REVIEW FOR S. THIES
MEDICAL REVIEW FOR C. MEZA
MEDICAL REVIEW FOR B. ORTE(
FIRST AID SUPPLIES
AQUATIC EQUIPMENT
6/22/2022 WELDING CYLINDER RENTAL
7/12/2022 UB REFUND CST#00063716 - 43:
6/30/2022 JUN 2022: SERVICES FOR INMA1
7/12/2022 UB REFUND CST#00064509-10-
7/12/2022 UBREFUNDCST#00061761-89'
7/12/2022 UBREFUNDCST#0006i174-10!
6/22/2022 REFUND 2533 ILLINOIS AVE WAE
6/30/2022 REFUND 9920 STANFORD AVE P
7/5/2022 REFUND OF DEPOSIT (AFTER E!
7/12/2022 PATRON CAN'T ATTEND CLASSE
7/all/2022 REFUND CLASSES
7/11/2022 MEX FOLK
Amount Paid
46.97 302.44
20.48 22.57
1 , 20.85
2 6.50
22.57 97.68
138.64
115.41
137.80
100.00
68.41 50.75
37.48 4,520.49
189.80
165.00
135.00
110.00
90.00 Check Total
1,962.38
197.68
138.64
115.41
137.80
100.00
68.41 50.75
37.48 4,520.49
189.80
i65.00
135.00
110.00
90.00 Page: 8
1218
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 9
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
97789 8/9/2022 00000170
Voucher:
97790 8/9/2022 00000170
Voucher:
97791 8/9/2022 00000170
Voucher:
97792 8/9/2022 00000170
Voucher:
97793 8/9/2022 00003664
Voucher:
97794 8/9/2022 0007720
Voucher:
97795 8/9/2022 00004620
Voucher:
97796 8/9/2022 0009426
Voucher:
97797 8/9/2022 00004969
Voucher:
97798 8/9/2022 0012286
Voucher:
97799 8/9/2022 0010683
Voucher:
97800 8/9/2022 00003962
Voucher:
97801 8/9/2022 0013096
Voucher:
97802 8/9/2022 0009654
Voucher:
Invoice Inv Date Description
MISC - PKS & REC REFUND 27 4077 & 278983 6/29/2022 REFUND MEMBERSHIP OVERCk MISC - PKS & REC REFUND 277271 7/1U2022 DOG OB-CANT ATTEND CLASS MISC - PKS & REC REFUND 277277 7/11/2022 MEX-FOLKCANT ATTEND MISC - PKS & REC REFUND 280426 6/22/2022 REFUND MEMBERSHIP OVER(JMISC - SETTLEMENTS CASTRO 2022 7/14/2022 PAYMENTOFSETTLEMENTAMC MRI SOFTI/VARE, LLC.
MUTUAL PROPANE
MRIUS1136288
MRIUS1155854
589311
MV CHENG & ASSOCIATES, INC. 6/30/2022C
6/30/2022D
6/30/2022B
6/30/2022F
6/30/2022A
NATIONAL READY MIXED CONCR826010
792756-A
NATIONWIDE ENVIRONMENTAL, .32456
NEW CHEF FASHION, INC.
NICKEY PETROLEUM co., INC.
I 033055
1032697
1032698
1033054
1032699
363242
OFFICE TEAM
OPENGOV, INC.
60326877
60367918
60408450
1NVOOOO7784
5 /20/2022
6 /20/2022
3/22/2022
7/11/2022
7/11/2022
7/11/2022
7/11/2022
7/23/2022
6/7 /2022
9/9/2021
6/30/2022
6/29/2022
6/23/2022
6/23/2022
6/29/2022
6 /23/2022
7 /19/2022
7/11/2022
7/16/2022
7/25/2022
7/4/2022
4 /20/22-5/19/22 IVR HOUSING WA
5/20/22-6/19/22 IVR HOUSING WA
ACCOUNT#16362 3/22/22
JUNE 2022 PROFESSIONAL SER
JUNE 2022 PROFESSIONAL SER
JUNE 2022 PROFESSIONAL SER
JUNE 2022 PROFESSIONAL SER
JUN 2022: PROFESSIONAL SERI
5767 IMPERIAL READY MIXED C(
CONCRETE, SAND AND AGGRE(
JUNE 2022 ANNUAL ST SWP Cal
UNIFORM, POLO SHIRTS FOR Rl
UNIFORM, POLO SHIRTS FOR 01
UNIFORM, POLO SHIRTS FOR 01
UNIFORM, POLO SHIRTS FOR E;
UNIFORM, POLO SHIRTS FOR A(
INVENTORY PO/ BARE BRICK
W/E 7/8/22: HOURLY WORKER -
W/E 7/15/22: HOURLY WORKER -
W/E 7/22/22: HOURLY WORKER -
OPENGOV - SOFTWARE & PROF
Amount Paid
60.00 55.00
45.00 30.00
59,999.00
6. 14
6.34 i,077.83
4 ,575.00
5 ,530.00
12,640.00
525.00
1 ,650.00
478.73
17.50 56,580.00
104.72
109.81
99.20 104.72
104.72
3,820.27
528.85
634.55
703.15
13,000.00
Check Total
60.00 55.00
45.00 30.00
59,999.00
12.48 1,077.83
24,920.00
496.23
56,580.00
523. 17
3,820.27
i,866.55
13,000.00
Page: 9
1219
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 10
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
97803 8/9/2022
Voucher:
97804 8/9/2022
Voucher:
97805 8/9/2022
Voucher:
97806 8/9/2022
Voucher:
97807 8/9/2022
Voucher:
97808 8/9/2022
Voucher:
97809 8/9/2022
Voucher:
97810 8/9/2022
Voucher:
97811 8/9/2022
Voucher:
97812 8/9/2022
Voucher:
97813 8/9/2022
Voucher:
97814 8/9/2022
Voucher:
97815 8/9/2022
Voucher:
97816 8/9/2022
Voucher:
97817 8/9/2022
Voucher:
97818 8/9/2022
Voucher:
Invoice
00003673 PD:AMADOR,ROMAN 1-3485
Inv Date Description
7/20/2022 6/20/21-6/22/22TRAININGANNUA
00004469
00004549
00005204
00001013
0008045
0011901
00003556
00003808
0011213
00004713
00004714
00002335
0011257
0010624
0005368
PD: CALIFORNIA POLICE CH1EFS22397 5/1/2022
21869 5/1/2022
PD: CAMACHO, NOEMI 1-3473 7/5/2022
PD: CANCIO, ROGER 1-3486 7/20/2022
PD:CITYOFSANTAANA 1-3472 7/5/2022
PD: CLEARS INC. 49TH - M. RODRI( 7/20/2022
PD:FRESNOCOUNTY'SHERIFF SO19575 7/12/2022
PD:MUNOZ,ARMANDO 1-3485 7/20/2022
PD: RODRIGUEZ, JUAN 05/28/22 5/28/2022
PD: ROSE, RYAN 1-3486
1-3484
PETTY CASH- PARKS & REC.DEP6/13/22-6/28/22
7/20/2022
7/20/2022
6/1 3/2022
PEm CASH- POLICE DEPT. -
PITNEY BOWES
PK: GUILMETTE, ROBERT
PK: SANCHEZ, MARIBEL
PRINTCO DIRECT
05/01/22-06/29/22 7/20/2022
3105571304 6/25/2022
RESUMMERO622 7/18/2022
MSSUMMERO622 7/18/2022
84622
84743
84619
84749
84745
5/6/2022
6 /29/2022
5/4/2022
6 /20/2022
671 6/2022
THRU 6/30/23: MEMERSHIP RENI
THRU 6/30/23: MEMERSHIP RENI
MAY 16-20, 2022 TRAINING SWA1
06/27/22-07/01/22 TRAINING TRA
JULY 11-22 2022 TRAINING DEFE
10/3/22-10/7/22: C.L.E.A.R.S TRAI
STC - TRAINING CLOTHING FOR
06/20/21 -06/22/22 TRAINING ANN
05/28/2022 & 6/1 5/22 TRAUMA SL
6/27/22-07/OU22 TRAINING: TRAF
06/06/22-06/10/22 TRAINING TRA
06/13/22 -6/28/22 PEm CASH P)
05/01 /2022-06/29/22 PETTY CASk
4/30/22-07/29/2022: POSTAGE MA
06/15/22-06/29/22: YOGA
06/18/22-06/25/22: ZUMBA
(500) BUSINESS CARDS - ALEJAI
BUSINESS CARDS & LETTERHE)
(500)BUSINESS CARDS - MARCE
PRINTS SETS FOR CAPITAL IMPI
24" X 18" BLUEPRINT PRINTS AN
Amount Paid
236.00
1 ,852.00
i45.00
2 37.9i
334.87
2 ,500.00
475.00
3 67.88
i93.66
504.57
334.87
g4.gg
217.97
148.33
1,34192
450.00
90.00 44. 10
44. 10
44. 10
209.48
223.26
Check Total
236.00
1,997.00
237.91
334.87
2 ,500.00
475.00
3 67.88
193.66
504.57
429.86
217.97
148.33
1 ,341.92
450.00
90.00 565.04
Page: 10
1220
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 1l
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor Invoice
97819 8/9/2022 0006933
Voucher:
97820 8/9/2022 0011881
Voucher:
97821 8/9/2022 00004804
Voucher:
97822 8/9/2022 0013531
PSYCHOLOGICAL CONSULTING /525691
525695
RICHARD C. SLADE & ASSOCIAT(6598
RIO HONDO COMMUNITY" COLLES22-16-ZSGT
X22-1 6-ZSGT
ROBINSON, ELIZABETH J Ref000302447
Inv Date Description
6/30/2022 6/16/22: 60 MINUTE SESSION IN[
6/30/2022 PRE-EMPLOYMENT EVALUATIOf'
6/24/2022 AS NEEDED HYDROGEOLOGIC !
5/26/2022 TRAINING: BASIC POLICE ACADI
6 /2/2022 6/24/22-10/5/22: BASIC POLICE A
7 /12/2022 UBREFUNDCST#00030421-95:
Amount Paid
275.00
400.00
2,280.90
1 ,273.00
1,189.50
40.00 Check Total
675.00
2,280.90
2,462.50
40.00 Voucher:
Page: 14
1221
Check Total
apChkLst
07/28/2022 11:34:32AM
Bank : botw BANK OF THE WEST
Check # Date Vendor
97824 8/9/2022 0007637
Voucher:
RSG, INC
Final Check List
CITY OF SOUTH GATE
Page: 12
(Continued)
Invoice Inv Date Descrmtion Amount Paid
1008778
1008484
1009042
1009034
1009033
1009043
1009044
1009038
1009040
1009036
1009037
1009039
1008881
1008483
1008633
1008634
1008879
1008880
1009041
1009035
1008489
1008508
1008494
1008485
1008919
1008492
1008639
1008798
1008799
1008795
1008635
1008636
1008679
1008486
1008487
4/30/2022 APRIL2022TOD-SIPGRANTWOI
2/28/2022 FEB 2022 SUCCESSOR AGENCY.
7/14/2022 JUNE2022CO#1:EXTENTIONO
7/14/2022 JUNE2022GENERAL-ONCALLS
7/14/2022 TOD-SIPGRANTWORKPROGR!
7/14/2022 JUNE20224909MASONSTPRO
7/14/2022 SUCCESSORAGENCY-ON-CALL
6/30/2022 JUNE 2022 7916LONG BEACH Bl
6/30/2022 JUNE 2022 HOUSING AUTHORIT
6/30/2022 JUNE 2022- LBB TENANT RELOC
6/30/2022 JUNE2022-9001-19LBBHABITA
6/30/2022 JUNE 2022 13050 PARAMOUNT I
6/13/2022 9001-19LONGBEACHBLHABIT)
2/28/2022 FEB 2022 SUCCESSOR AGENC\
3/31/2022 MARCH 2022 SUCCESSOR AGETh
3/31/2022 MARCH 2022 SUCCESSOR AGETh
6/13/2022 MARCH 2022 SUCCESSOR AGETh
6/13/2022 MARCH 2022 SUCCESSOR AGETh
6/30/2022 JUNE 2022 SB2 GRANT ADMIN &
6/30/2022 JUNE 2022 HOUSING AUTHORIT
3/31/2022 FEB2022PHLAGRANTADMIN&
3/31/2022 FEB2022SB2GRANTADMIN&F
3/31/2022 FEB2022HOUSINGPROGRAME
3/31/2022 FEB2022HOUSINGSUCESSOR
5/31/2022 MAY2022TOD-SIPGRANTWORI
2/28/2022 FEB 2022 EQUITABLE DEVELOPi
3/31/2022 MARCH2022EQUITABLEDEVEL
5/9/2022
5/9/2022
5/9/2022
APRIL 2022 2703 TWEEDY BLVD
APRIL 2022 PHLA GRANT ADMIN
APRIL 2022 9001-19 LBB TENAN1
3/31/2022 MARCH20229001-19LBBTENAr
3/31/2022 MARCH 2022 9001-19 LONG BEA
3/31/2022 MARCH2022PHLAGRANTADMI
3/31/2022 FEB20229001-19LBBTENANTF
3/31/2022 FEB 2022 9001-19 LONG BEACH
5,81 0.00
2,300.00
2 ,893.75
3 ,030.00
9,505.00
2 ,330.00
3 3.75
587.50
923.75
622.50
10,915.00
4 ,470.00
98.75 5 43.75
522.50
4,870.00
200.00
2,068.75
135.00
240.00
273.75
235.00
1 ,607.50
80.00 5,126.25
156.25
2 ,520.00
240.00
228.75
3 86.25
27.50 7,428.75
3,177.50
31.25 865.00
Page: 12
1222
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 13
Bank : botw BANK OF THE WE-ST (Continued)
Check # Date Vendor
97825 8/9/2022 00004834
Voucher:
97826 8/9/2022 00002616
Voucher:
97827 8/9/2022 00004857
Voucher:
97828 8/9/2022 00004858
Voucher:
97829 8/9/2022 0012098
Voucher:
97830 8/9/2022 00004874
Voucher:
97831 8/9/2022 00004884
Voucher:
97832 8/9/2022 00005096
Voucher:
97833 8/9/2022 00004864
Voucher:
Invoice
1008884
1008918
1008796
1008808
1008509
1008680
1008781
1008894
1008883
SECURITY SIGNAL DEVICES SYSS-01067644
S-01075976
8001279985
8001884344
8000883490
8001083941
8001688977
8001 490866
0038903
SHRED-IT US JV LLC
SMITH FASTENER COMPANY
SNAP-ON INDUSTRIAL ARV/52931750
SO CAL COMPTON PIPE SUPPLY2888
SO GATE CHAMBER OF COMMEFQT1
SOUTH COAST A.Q.M.D. 4007185
4010445
3988161-late fee
4019131
3985980
4018149
4019117
4018145
SOUTHERN CALIFORNIA EDISON7701"154517
90004138
SOUTH COAST A.Q.M.D.
Inv Date Description
6/1 3/2022
6/1 3/2022
5/9/2022
5/9/2022
2 /28/2022
3/31 /2022
4 /30/2022
5/31 /2022
6 /i 3/2022
1 /31 /2022
5/25/2022
3/31 /2022
6/30/2022
1 /31 /2022
2 /28/2022
5/31 /2022
4 /30/2022
5/2/2022
MAY 2022 PHLA GRANT ADMIN &
MAY 2022 9001-19 LBB TENANT F
APRIL 2022 9001-19 LONG BEAC
MARCH 2022 SUCCESSOR AGETh
FEB 2022 4909 MASON ST PROP
MARCH 2022 4909 MASON ST PF
APRIL 2022 4909 MASON ST PRC
MAY 2022 4909 MASON ST PROF
MAY 2022 2703 TWEEDY BLVD
12-SERVICE KEYFOBS
SERVICE-KEYFOBS (24)
MARCH 2022 SHREDDING OF D(
JUNE 2022 SHREDDING OF DOC
JANUARY 2022 SHREDDING OF
FEBRUARY 2022 SHREDDING OF
MAY 2022 SHREDDING OF DOCL
APRIL 2022 SHREDDING OF DO(
SPECIALITY HARDWARE
5/13/2022 UPDATE FOR SHOP MODIS SCAI
2/'14/2022 LINEPIPE&SERVICESLINEPAF
9/30/2021 1STQT7/1/21ADMINSITRATIVEF
6/3/2022
6/3/2022
6/i 6/2022
6/1 6/2022
6/1 6/2022
6/i 6/2022
7 /5/2022
7/5/2022
7/1/2022
i/26/2022
ICE (>500 HP) EM ELEC GEN-DIE
FLAT FEE FOR LAST FISCALYE)!
5% LATE PAYMENT PENALTY
POLICE DEPARTMENT FLAT FEE
JULY 2021-JUNE 2022 POLICE DF
GEN DIESEL $468.76 RULE 461 L
4933 SOUTHERN AVE FLAT FEE
4933 SOUTHERN AVE GENERAT(
CONTRACT#9000000003152: HC
RENTER #0392 FIBER OPTIC CAI
Amount Paid
608.75
511.25
4,495.00
2,696.25
200.00
2,292.50
1 ,841.25
120.00
338.75
110.80
2 09.34
94.48 221.56
92.91 92.91
99.97 99.57
3 3.00
1,065.71
2,243.64
9,360.00
468.76
151.85
7. 19
151.85
i51.07
745.88
151.85
607.32
4,918.36
1 ,305.48
Check Total
87,587.50
320. 14
701.40
33.00 1 ,065.71
2,243.64
9,360.00
1 ,676.60
759.17
6,223.84
Page: 43
1223
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 14
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
97834 8/9/2022 00004864
Voucher:
97835 8/9/2022 0009420
Voucher:
97836 8/9/2022 0012980
Voucher:
97837 8/9/2022 00004897
Voucher:
97838 8/9/2022 00004908
Voucher:
97839 8/9/2022 00002639
Voucher:
97840 8/9/2022 00004906
Voucher:
97841 8/9/2022 0011201
Voucher:
97842 8/9/2022 0009039
Voucher:
97843 8/9/2022 00003851
Voucher:
97844 8/9/2022 0008153
Voucher:
97845 8/9/2022 0009355
Voucher:
97846 8/9/2022 0010699
Voucher:
Invoice Inv Date Description
SOUTHERN CALIFORNIA ED1SON7701154528 7/i/2022
SPARKLETTS 15758432 062422 6/24/2022
SPECTRUM 108308401070122 7/U2022
0439993062022 6/20/2022
0490384062722 6/27/2022
16996701062122 6/21/2022
STFRANCISMEDICALCENTER 0333250 6/14/2022
0333252 6/1 5/2022
0333253 6/1 5/2022
0333290 7/6/2022
0333289 7/6/2022
0333287 7/6/2022
0333288 7/7/2022
STATUS ONE MEDICAL INC 64946 6/20/2022
CONTRACT#90000000031913: C
CITY WIDE WATER DISPENSER I
JULY 2022: FIBER OPTICS FOR F
ACCT#8448 30 017 0439993 SUBI
ACCT#8448 30 017 0490384 LUN(
6/21/22-7/20/22: CITY FIBER CIRC
CLAIM 052122PA A. PERAZA
CLAIM 060422TS S. THIESSEN
CLA1MO526220E E. OCHOA
S. THIESSEN CLAIM# 060622TS
M. VALEAZ CLAIM# 060622VM
B. ORTEGA CLAIM# 0609220B
C. MEZA CLAIM# 060122MC
FIRST AID SUPPLIES
STRADLING YOCCA CARLSON & 387331-0030 6/12/2022 05/31/2022 SOUTH GATE UTILIT
SWRCB FEES
TELECOM LAW FIRM, P.C.
TETRA TECH
THOMSON REUTERS
7/6/22-T2CERT 7/6/2022
12112
12305
51915674
846629271
TIME WARNER CABLE- 087997 4062922
0044267062722
0507757061522
9500923465
9500923466
TRANSYSTEMS CORPORATION INV-0003868292
T-MOBILE USA, INC.
2 /28/2022
3 /1 8/2022
6/30/2022
7/1/2022
6/29/2022
6/27/2022
6 /1 5/2022
7 /5/2022
7/5/2022
7/5/2022
KENNETH TANG - T2 WATER TRE
SPECIALIZED LEGAL SERVICES
SPECIALIZED LEGAL SERVICES
THRU 5/27/22: PROF ENGINEERI
JUNE 2022: WEST INFORMATIOTh
06/29/2022-07/28/2022 PD INTERt
JUNE 2022 CABLE FOR PD AND 1
SPECTRUM ENTRPRISE T\/
6/19/2022-06/26/20222 INVESTG/
6/19/2022-06/26/20222 INVESTG/
1-710 FIRESTONE BLVD SOUTHB
Amount Paid
1 ,590.34
514.90
948.68
539.96
294.04
1 ,699.00
337.42
347.86
835.86
1,870.55
191.52
337.42
347.86
117.64
3,248.50
80.00 2 ,325.00
3 41 .00
3,692.50
601.91
i27.97
296.45
25.99 100.00
100.00
14,477.83
Check Total
1 ,590.34
514.90
3,481 .68
4,268.49
117.64
3,248.50
80.00 2 ,666.00
3 ,692.50
601.91
450.41
200.00
14,477.83
Page: 14
1224
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 15
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
97847 8/9/2022 0013462
Voucher:
97848 8/9/2022 00004964
Voucher:
97849 8/9/2022 0005750
Voucher:
97850 8/9/2022 0010265
Voucher:
97851 8/9/2022 0012997
Voucher:
97852 8/9/2022 0011926
Voucher:
97853 8/9/2022 0000'l848
Voucher:
Invoice
TWINING, INC. 91519
UNDERGROUND SERVICE ALER1DSB20211600
620220192
dsb20210720
120220192
320220189
dsb20210418
UNITED INDUSTRIES 223153
UNITED PACIFIC SERVICES, INC. 22-0628-3
22-0630-1
22-0628-2
UNITED SITE SERVICES OF, CAL1114-i 3154708
114-13080259
0073296
0073295
0073294
0073293
URM TECHNOLOGIES, INC.
VERIZON WIRELESS
0073292
0073291
0080106
0080107
0080104
0080105
0080108
0080109
0080110
0073290
9909392959
9907234123
Inv Date Description
6/22/2022 5/13/22: TESTING SERVICES FOF
7/ /2022
7/ /2022
4/ /2022
2/ /2022
4/ /2022
3/ /2022
7/ 1/2022
6/28/2022
6/30/2022
6/28/2022
6/8/2022
5/9/2022
0/3 /2021
0/3 /2021
0/3 /2021
0/3 /2022
0/3 /2021
0/3 /2021
6 /30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
6/30/2022
10/31/2021
6 /21 /2022
7/26/2022
CA STATE FEE REGULATORY CC
DIG ALERTS
DIG ALERTS
DIG ALERTS
DIG ALERTS
DIG ALERTS
INVENTORY Pa/ NITRILE GLOVE
8936 CALDEN EMERGENCY TRE
2717 NEBRASKA AVE EMERGENI
EMERGENCY TREE SERVICES
12 MONTHS OF PORTA POTTY R
12 MONTHS OF PORTA POm R
OCT 202 - PERS
OCT 202 - PAYROLL
OCT 202 - MISC
OCT 202 - AR
OCT 202 - AP
OCT 202 - ACCNT
JUNE 2022 - AP
JUNE 2022 - AR
JUNE 2022 - STORAGE
JUNE 2022 - ACCNT
JUNE 2022 - MISC
JUNE 2022 - PAYROLL
JUNE 2022 - PERS
OCT 2021 - ACCNT
BILLING PRD- 05/22/22-06/21/22 l
BILLING PRD- 04/24/22-05/23/22
Amount Paid
1133.60
:oo.eg
447.25
200.69
719.50
615.55
200.69
i ,221 .76
1 ,760.00
1 ,760.00
1 ,320.00
2 06.55
206.37
45.60 17.10
59.70 18.30
45.00 3 4.20
37.44 21.96
4 5.72
38.54 71.64
20.52 5 4.72
34.20 3,783.81
7,675.01
Check Total
1 ,133.60
2,384.37
1 ,221.76
4,840.00
412.92
544.ei4
11,458.82
Page: 45
1225
apChkLst
07/28/2022 11:34:32AM
Final Check List
CITY OF SOUTH GATE
Page: 16
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
97854 8/9/2022 00002634
Voucher:
97855 8/9/2022 00004000
Voucher:
97856 8/9/2022 00000561
Voucher:
97857 8/9/2022 0011968
Voucher:
97858 8/9/2022 00001280
Voucher:
97859 8/9/2022 00003442
Voucher:
97860 8/9/2022 00001376
Voucher:
97861 8/9/2022 00000062
Voucher:
Invoice
VULCAN MATERIALS COMPANY 73330076
73332109
73332110
73328255
73326344
73324143
73312749
73265812
375168
7332j!142
73321497
WASTE MANAGEMENT 1274182-2684-2
WESTERN EXTERMINATOR COM 24599683
947 4453
8779250
9471528
8776183
13348231
WEXBANK 82266034
WILLDAN 00335955
00335846
00336199
YOUNGBLOOD & ASSOCIATES, lr1792A
Z.A.P. MANUFACTURING INC 6711
ZIEGLER'S HARDWARE& SUPPL'fffl88
ffl13
11159
11265
Inv Date Description
6/30/2022
6/30/2022
6/30/2022
6/29/2022
6/29/2022
6/24/2022
6/1 3/2022
4/25/2022
6/30/2022
6/24/2022
6 /22/2022
7 /1/2022
6/8/2022
11/3/2021
8/4/2021
11/10/2021
8/31 /2021
1/5/2022
7/6/2022
3/9/2022
2/II /2022
5 /1 0/2022
6 /30/2022
ASPHALT AND ENVIRONMENTAL
ASPHALT AND ENVIRONMENTAL
ASPHALT AND ENVIRONMENTAL
ASPHALT AND ENVIRONMENTAL
ASPHALT AND ENVIRONMENTAL
ASPHALT AND ENVIRONMENTAL
ASPHALT, BASE, EMULSION PRC
ASPHALT, BASE, EMULSION PRC
ASPHALT, BASE, EMULSION PRC
ASPHALT, BASE, EMULSION PRC
ASPHALT AND ENVIRONMENTAL
40 YD ROLL OFF BINS FOR PUBI
GOPHER & FLEA ABATEMENT 41
GOPHER & FLEA ABATEMENT AT
GOPHER & FLEA ABATEMENT AT
GOPHER & FLEA ABATEMENT AT
GOPHER & FLEA ABATEMENT AT
GOPHER & FLEA ABATEMENT AT
7/6/22 CLOSING DATE: SHELL Gl
THRU 2/25/22: CIP MANAGEMEN
THRU 1/28/22: CIP MANAGEMEN
THRU 4/26/22: CIP MANAGEMEN
PRE-EMPLOYMENT POLYGRAPk
5/20/2022 TR/)iFFIC SIGNS RECYCLES AN[)
6/7/2022
5 /1 8/2022
6 /29/2022
6/29/2022
PRUNNING BLADES
MISC HARDWARE
MISC HARDWARE
MISC HARDWARE
Amount Paid
202.50
305.il
302.19
205.43
206.41
206.41
207.38
202.89
26.52 775.i2
204.46
2,785.34
375.00
1 ,950.00
1 ,950.00
375.00
375.00
1 ,950.00
1 ,477.35
20,800.00
10,920.00
24,960.00
300.00
299.61
39.65 14.97
19.81 1100
Check Total
2,844.42
2,785.34
6,975.00
1,477.35
56,680.00
300.00
299.61
85.43 Page: 16
1226
apChkLst Final Check List Page: 17
07/28/2022 11:34:32AM CITY OF SOUTH GATE
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
4634009 6/21/2022 00004266
0008153
00002756
0005476
00004804
00004804
0013471
00004854
0007003
0006526
00005063
00005063
00004195
0008153
0005293
0005294
0005368
0005293
0012659
0006537
0006537
0006537
0006209
0005480
0013489
0013490
0013396
0005296
0005293
0005293
0011549
0008906
0005293
0005293
0005486
Invoice Inv Date Description
3191
84651
0495151040722 4/7/2022
0500034042722 4/27/2022
048904
4/28/2022
4/1 3/2022
4/22/2022
4/25/2022
4/27/2022
4/26/2022
4/26/2022
4/28/2022
4/27/2022
u.s. BANK CORPORATE PAYMEi
TIME WARNER CABLENALEO INC. 3SNYDY37VY\/ 5/al8/2022
RENAISSANCE ESMERALDA RES6127 5/6/2022
RIO HONDO COMMUNITY COLLEOO2805 5/17/2022
RIO HONDO COMMUNITY COLLES22-110ZSGT
CB RANCH ENTERPRISE, FLOWEO64039
SMART & FINAL 069429
CATALINA CHANNEL EXPRESS GO329453
SWANK MOTION PICTURES, INC. RGi897880
CMTA 300002942
CMTA 200003994 4/26/2022
CCCA MSOO86568655 4/28/2022
TIME WARNER CABLEMICHAELS
WALGREENS
PRINTCO DIRECT
MICHAELS 061429 4/28/2022
SHEEPDOG GUARDIAN CONSUL-5AB95A1D-0001 4/27/2022
EXPEDIA 72297665002283 5/3/2022
EXPEDIA 5/3/22 5/3/2022
EXPEDIA 05/03/2022 5/3/2022
DELTAAIR 0067813419320 5/3/2022
AMERICAN AIRLINES 0017813424763 5/3/2022
BAHIA RESORT HOTEL 3663f1e4-3bbe 4/30/2022
LAMPLIGHTER INN & SUITES 04/24/2022-refund 4/24/2022
HOLIDAYINNEXPRESS,SANDIE43318354 5/"1/2022
BESTBUY BBYO1-806645"l9E 5/2/2022
MICHAELS 079495 5/9/2022
MICHAELS 050619 5/10/2022
TEMECULA VALLEY BALLOON, At 13970al 1 5/20/2022
DOLLARTREE 044411/021390 4/27/2022
MICHAELS 036741 5/4/2022
MICHAELS 092313 5/4/2022
STAPLES BUSINESS ADVANTAGE9907909962-CRE[ 5/5/2022
04/07/22 - 05/06/22 SPECTRUM S
JUNE 23-25,2022 REGISTRATIOS
MAY 12-15, 2022 HOTEL FOR CC
JM - TRAINING: SUPERVISORY C
JM - TRAINING: SUPERVISORY C
ADMISSIONS FOR DEPARTMEN1
PD: GOLF COURSE CONCESSIO
PD: SENIOR EXCURSION TICKa
DVD RENTAL FOR MOVIES IN TH
MEMBERSHIP TO CALIFORNIA V
REGISTRATION FOR THE 2022 A
APRIL 28, 2022 REGISTRATION F
04/27/22- 05/26/22 FOR SPECTRI
PD: GOLF COURSE SUPPLIES
PD: YOUTH PROGRAM SUPPLIE:
BANNERS FOR CONCERTS & MC
PD. YOUTH PROGRAM SUPPLIE:
JM - CANINE LEGAL UPDATES S
JM - TRAINING: ARREST & CONT
JM - TRAINING: ARREST & CONT
JM - TRAINING: ARREST & CONT
JM - TRAINING: ARREST & CONT
JM - TRAINING: ARREST & CONT
JM - TRAINING: CALIFORNIA ASE
JM - TRAINING: COMPUTER& INi
JM - TRAINING: LEADERSHIP AN
PD: SENIOR CENTER HAS PHOfS
PD: YOUTH PROGRAM SUPPLIE:
PD: YOUTH PROGRAM SUPPLIE.
PD: SENIOR EXCURSION TICKa
PD: GOLF COURSE SUPPLIES
PD: YOUTH PROGRAM SUPPLIE.
PD: YOUTH PROGRAM SUPPLIE:
PD: CREDITYOUTH PROGRAM S
Amount Paid
129.99
600.00
259.3"1
228.00
228.00
1 ,456.00
95.80 i50.00
2 ,780.00
95.00 435.00
65.00 234.70
55.81 10.72
1 ,631 .70
35.64 45.00
34.24 3.52
2 9.78
472.21
228.60
-816.40
-424.88
407.70
60.47 3 75.94
-4.40
132.50
28.74 i5.38
24.18 -168.63
Check Total
Page: 47
1227
apChkLst Final Check List Page: 18
07/28/2022 il:34:32AM CITY OF SOUTH GATE
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor Invoice Inv Date Description
0005295
00000322
0005372
0005371
00002988
0005476
0005476
0005293
0011549
0013333
0008 53
0008 53
0008 53
0008 53
0008 53
0008 53
0008 53
00003730
0009420
00ffi39
0005347
0013476
001 3477
0012787
0005347
0005347
0005347
0011698
0005623
00003963
00002871
0013494
0013506
00001414
0005677
WALMART
SAM'S CLUB
SUBWAY
3952257-184774 5/4/2022
080626
JKP-T7K
5/5/2022
5/5/2022
0586090042622 4/26/2022
0426271041422 4/14/2022
0600966042222 4/22/2022
0435603041422 4/14/2022
0490491042722 4/27/2022
MARRIOnHOTELS 6127 5/6/2022
SUSY'S FLOWERS 5/12/22 FLOWERE 5/12/2022
RENAISSANCE ESMERALDARES51104 5/15/2022
RENAISSANCE ESMERALDARES5ii05 5/15/2022
MICHAELS 042240 5/10/2022
TEMECULAVALLEYBALLOON,AI1397009 5/20/2022
CONTEMPORARY ART REVIEW L2959 5/21/2022
TIMEWARNERCABLE- 0426263041422 411412022
TIME WARNER CABLETIME WARNER CABLETIME WARNER CABLETIME WARNER CABLETIME WARNER CABLETIME WARNER CABLE- 0426604042522 4/25/2022 LEAGUEOFCALIFORNIACITIES5/11/22REFUND 5/5/2022
SPARKLETTS 16963364042822 4/28/2022
NORMREEVESSUPERSTORE 955597 5/5/2022
AMAZON.COM 112-5615598-5141 5/9/2022
HANDSOMEGROUP 5/14/2022
PARTYONLA 5/11/2022
LINEX 5/17/2022
AMAZON.COM
AMAZON.COM
AMAZON.COM ffl-3068055-2285 5/18/2022
WESTIN HOTELS & RESORTS 2153020-B 5/8/2022
ORIENTALTRADING 71666925al 5/5/2022
RESOURCE BUILDING MATERIAL16797440 5/18/2022
ICC-INTERNATIONALCODECOUllOl295277 5/16/2022
BESTCHOICE PRODUCTS 2153034 5/17/2022
MANERI SIGN C0. 40006874 4/5/2022
OFFICEDEPOT 084504 5/5/2022
DEPARTMENTOFPESTICIDEREl43391897593-B 5/12/2022
iff-6408640-2901 5/10/2022
ffl-1694409-6744 5/2/2022
19457
0002392
6 PD: GOLF COURSE SUPPLIES
RESTOCKING OF DRINKS, PAPE
05/05/22 FOOD FOR NATIONAL [
MAY 4-6, 2022 HOTEL FOR SCAG
MAY 12, 2022 FUNERAL (FLOWEI
MAY 14TH NIGHT STAY) HOTEL F
MAY 13-15, 2022 REGISTRATION
PD: YOUTH PROGRAM SUPPLIE.
ADMISSIONS FOR BALLON & Wll
PD: CULTURAL ART SUPPLIES
04/1 4/22 - 05/1 3/22 SPECTRUM E
04/26/22 - 05/25/22 SPECTRUM S
04/27/22 - 05/26/22 SPECTRUM S
04/1 4/22 - 05/1 3/22 SPECTRUM S
04/22/22 - 05/21 /22 SPECTRUM S
04/1 4/22 - 05/1 3/22 SPECTRUM S
04/25/22 - 05/24/22 SPECTRUM S
MAY 11-13, 2022 CREDIT REGIST
NC- DS SERVICES STANDARD C
ELECTRICAL REPAIRS VEHICLE
WC-BUILDING PLANS CLIPS lMT
JC-AUDITORIUM /W REPAIR
JC-TABLECLOTH REPLACEMEN1
JC-PROTECTION BED LINER FOI
MD-COIN COUNTER AND TUBES
DM-2.5MM AUDIO/AUX CABLE
DM-CAT6 CABLE -24 PACK
WC- 05/08/22-05/13/22 WESTIN H
AM-SUPPLIES FOR WATER SAFE
AM-CHALK FOR BALLS FIELDS
WC-INTERNATIONAL CODE COU
WC-BEST CHOICE PRODUCTS P
EP-CUSTOM SIGN SOUTH GATE
OFFICE SUPPLIES
DR - 2022 MEMBERSHIP - CONTI
Amount Paid
147.59
ffl.59
286.93
492.82
226.01
265.97
531 .94
69.41 1 ,404.00
60.00 5.33
2 53.39
234.70
15.98 119.99
i30.65
234.70
-550.00
25.42 2,848.55
55.02 842.46
821 .00
696.00
27.44 9.37
50.70 632.55
432.50
617.88
258.00
i54.34
111.06
71 .49
420.00
Check Total
Page: 18
1228
apChkLst Final Check List Page: 19
07/28/2022 11:34:32AM CITI OF SOUTH GATE
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor Invoice Inv Date Descrmtion
0009649
00 3508
00 3507
00 3446
00 3490
00 3396
00 3396
00 1351
0008451
0008511
0010352
0005347
0005347
0007200
00005173
00003941
0013488
0005347
0005347
0005347
0005419
0008456
0011988
00004313
0013446
00000415
0005295
0011351
0008423
0006209
0005293
000041 95
0013511
OOOEI153
00000268
AT&T
42641681
258996
APRIL 2022
6706
016640
1N1077949
INVi 077949
114-7266842-6645 5/9/2022
4/20/2022 SC-APRIL20221NTERNETSERVI
BIG 5 SPORTING GOODS 5/4/2022 SC - BASEBALLS FOR JAA OPEN FUEGO TACOS 5/5/2022 SC - REFRESHMENTS FOR BIGG
COMPULOCKSBRANDSINC 050361 4/13/2022 CREDITPRINTINGSERVICES LAMPLIGHTERINN&SUITES 4190 4/24/2022 JM-TRAINING:COMPUTER&IN1 HOLIDAYINNEXPRESS,SANDIE29064337 5/1/2022 JM-TRAINING:LEADERSHIPAN HOLIDAYINNEXPRESS,SANDlE48776174 5/1/2022 JM-TRAINING:LEADERSHIPAN KIMTURNER,LLC INVOICE-719 6/1/2022 JM-TRAINING:CULTURALDIVEI COSTCO.COM 017888 5/3/2022 SC - REFRESHMENTS FOR BIGC
SURVEY MONKEY 5/5/2022 SC - ANNUAL MEMBERSHIP FEE
COUNTYOFLOSANGELES IN1077949 3/31/2022 SOLIDWASTEPERMITFEE AMAZON.COM lNVi077949 5/3/2022 SERVICE FEE
AMAZON.COM BATTERYCHARGERFORLAWN
APWA 5/4/2022 PUBLIC WORKS MANUAL FOR E
MSA-LA & OA CHAPTER 075547 5/5/2022 REGISTRATION FOR TRAINING /! M.HARALAWNMOWERCENTER46184 5/10/2022 GENERATORFORLAWNMOWEI MFVSINC. 35578 5/11/2022 REPAIRPARTSFORUNIT204M(
AMAZON.COM IK-POWERBOOSTBATTERY
AMAZON.COM 04/25/2022 4/25/2022 SUPPLIES FOR WHITE BOARD AMAZON.COM 714215.31 4/27/2022 2WHlTEBOARDS
LA BARCA JALISCO RESTAURAN'27 4/25/2022 SC-LUNCH FOR INTERVIEW PAN NSCA 1002663676 5/16/2022 2022/2023 J. MARKEL FITNESS P CINDY'SJUMPERS,LLC 5/19/2022 ROCKWALL&JUMPERFORSPE
AT&T 4/16/22-5/15/22PHONELINEFOI
COMPULOCKS BRANDS INC 75849490 5/11/2022 PRINTING SERVICES NATIONALCONSTRUCTIONREN-05/06/2022 5/6/2022 04/16/22TOO5/15/22WC-NATIOh WALMART 090831 4/25/2022 REFRESHMENTS PURCHASED F
KIMTURNER,LLC INVOICE-690 6/1/2022 JM-TRAINING:CULTURALDIVEI PD:MARINCONSULTINGASSOCI12325 4/29/2022 JM-TRAINING:LEADERSHIPAN DELTAAIR 0017813424763 5/3/2022 JM-TRAINING:ARREST&CONT MICHAELS 019170 5/10/2022 PD:CREDITYOUTHPROGRAME
CCCA 4/28/2022 APRIL 28, 2022 REGISTRATION F
MARISCOS CAMPEON 5/2/2022 MAY 2, 2022 DINNER FOR COUN
TIME WARNER CABLE- 0255643644 5/2/2022 04/30/22 - 05/29/22 SPECTRUM S HOMEDEPOTCREDITSERVICEEO542786 5/17/2022 ME-HEAVYDUTYLGBOX 111-9726477-6142 5/13/2022
7BX7MYW9BO4S\ 5/6/2022
49980
035222
3450
Amount Paid
124.14
57.29 295.62
-2.40
531.10
383.70
407.70
111.00
290.82
384.00
i,149.00
25.51 844.98
356.00
905.63
209.48
523.51
-39.65
24.94 220.48
84.32 145.00
1 ,999.52
422.38
io<.ig
269.28
97.90 11100
750.00
178.60
-24.24
65.00 94.77
128.11
65.43 Check Total
Page: 49
1229
apChkLst Final Check List Page: 20
07/28/2022 11:34:32AM CITY OF SOUTH GATE
Bank : botw BANK OF THE WEST (Continued)
Check # Date Vendor
00002026
0005479
0005347
0005295
0013480
0013489
0013489
0005295
0005295
0013492
0005491
0012205
00000634
0011698
0005677
0005658
0012653
0008452
0012596
0011437
0008304
00000634
00000634
0013493
00002871
00002871
6302022 6/30/2022 00004309
Invoice
FEDERAL EXPRESS CORPORAT1102402SS71
AWINDOWBETWEENWORLDS 05/04/2022
Inv Date Descrmtion
5/11/2022 ME-POSTER BOARD IN LOBBY
5/4/2022
AMAZON.COM
WALMART
ffl-3932452-0245 5/11/2022
071432 5/3/2022
MA-ROOM A VICTIM DR22-04069
ME-MACLOCKS CL15 UNIVERSA
SC - PRIZES FOR BIGGEST LOSI
SOi0874
3663fi e4-3bbe-44 4/24/2022
4/25/2022 COFFEE PURCHASED
4/25/2022 ITEMS PURCHASED FOR DETEC
4/28/2022 PD: YOUTH PROGRAM SUPPLIE:
4/26/2022 WC-CALIFORNIA BUILDING OFFI
5/10/2022 DR-REPLACEMENTMAT-AUDITO
5/3/2022
5/8/2022
5/5/2022
WC- 05/08/22-05/13/22 WESTIN H
ALCOHOL BARS FOR AUDITORU
JM - TRAINING: CALIFORNIA AS!E
DR-AUBURN BRN BOULDERS-H(
ULTIMATE BARS
BAHIA RESORT HOTEL
BAHIA RESORT HOTEL 8F7E60A7-99F7-4 4/24/2022 JM - TRAINING: CALIFORNIA ASS WALMART 005074 4/25/2022 ITEMS PURCHASED FOR DETEC
WALMART 028694
MICHAEL'S STORE 019249
CVS 096014
SOUTH COAST SHINGLE co., IN(551565
CALBO 1651003875
WESTIN HOTELS & RESORTS 2153020-A
DEPARTMENT OF PESTICIDE RE146596
ELPESCADOR 053651
JARUWAN THAI 05/12/22
CXTEC
ZOOM.US
YOBITECH LLC
GODADDY.COM
CALBO
CALBO 15184
PALOMAR WORKFORCE & COMl'vFBO52200l
ICC-INTERNATIONAL CODE COU1101283303
ICC-INTERNATIONAL CODE COUli650993526
AMERIFLEX 06302022
JL-REPLACEMENT HARD DRIVE:
4/27/2022 JL-ClSCl35608-PORTSWITCHE:
5/1 /2022
5/12/2022 MA-FOOD FOR A. GONZALEZ'S F
5/10/2022 MA-FAMILYVIOLENCEPREVENT
5/18/2022 JL-SSLCERTIFICATERENEWAL
6/30/2022 JUNE 2022: ACH DEBITS BOW
4/26/2022 WC-INTERNATIONAL CODE COU
4/25/2022 WC-05/02/22-05/06/22 PC832 ARF
4/29/2022 WC-CALIFORNIA BUILDING OFFI
4/26/2022 WC-04/27/22CALIFORNIABUILDI
4/21/2022 JL-ZOOM RECORDING 100GB E>
4/26/2022 WC-04/27/22 CALIFORNIA BUILDI
INV1 45941895
2205794893
7141313
7142214
43355863654
Amount Paid
312.93
135.00
30.99 49.41
3 ,472.88
816.40
816.40
14. 18
24.68 39.68
i4.62
736.90
295.00
500.00
60.00 299.97
296.60
770.23
4 0.00
280.00
g4.gg
70.00 339.25
252.00
95.00 90.00
2,051.74
Voucher:
Sub total for BANK OF THE WEST:
Check Total
42,290.62
2,051.74
1511,053.26
166 checks and 2 wire transfers in this report. Grand Total All Checks and Wire Transfers: 1,511,053.26 Bank code: botw
97823 8/9/2022
Paae: 20
1230
WARRANT REGISTER FOR COUNCIL MEETING 8/9/2022 PART Vl
apChkLst
07/21/2022 8:30:23AM
Trial Check List
CITY OF SOUTH GATE
Page: 1
Bank : botw BANK OF THE WEST
Check # Date Vendor
2323 7/2 /2022
2324 7/2 /2022
2325 7/2 /2022
2326 7/2 /2022
2327 7/2 /2022
2328 7/2 /2022
2329 7/2 /2022
00000004
00002370
00004836
00000343
00001186
00004996
00004988
Invoice
NATIONWIDE RETIREMENT SOLLBen302662
INTERNAL REVENUE SERVICE Ben302664
SEIU LOCAL 721 Cn/V CLC-23900 Ben302666
PUBLIC EMPLOYEES RETlREM8Ben302668
EMPLOYMENT DEVELOPMENT DBen302670
SEIU-COPE LOCAL 721, LA/QC CI Ben302672
CHILD SUPPORT ON-LINE, STATEBen302674
Inv Date Description
7/2 /2022
7/2 /2022
7/2 /2022
7/2 /2022
7/2 /2022
7/2 /2022
7/2 /2022
DEF COMP NATIONWIDE: PAYME
MEDICARE: PAYMENT
SEIU DUES: PAYMENT
PERS RETIREMENT: PAYMENT
SDI: PAYMENT
SEIU- COPE LOCAL 721 DEDU(]
CHILD SUPPORT-ONLINE: PAYM
Amount Paid
55,187.86
134,731.82
2,984.02
215,982.45
45,622.52
39.00 1,399.51
Sub total for BANK OF THE WEST:
Check Total
55,187.86
134,731.82
2,984.02
215,982.45
45,622.52
39.00 1 ,399.51
455,947.18
7 wire transfers in this report. Grand Total All Wire Transfers: 455,947.18 Page: 1
1231
WARRANT REGISTER SUMMARY
CITY COUNCIL MEETING OF 8/9/2022
TOT AL PART I - PAYROLL-RELATED CHECKS
TOT AL PART II - PREPAID CHECKS (7/20/2022)
TOT AL PART Ill - PREPAID CHECK (7/26/2022)
TOT AL PART IV - PREPAID CHECKS (7/26/2022)
TOTAL PART V - ACCOUNTS PAYABLE CHECKS
TOT AL PART Vl - PAYROLL-RELATED WIRE TRANSFERS
SUB-TOTAL
LESS: VOIDS
LESS: EMPLOYEE PAYROLL DEDUCTIONS
GRAND TOT AL
1,319.60
260,310.68
115,400.00
3,905,624.74
1,511,053.26
455,947.18
6,249,655.46
0.00 299,917.75
6,549,573.21
1232
SOUTH GATE CITY COUNCIL
WARRANT APPROVAL AND CANCELLATION
Warrant Number UZ!)U4 to Warrant Number UZ!!!!1 inclusive, plus WlteTransfets toialing , as listed on the accompanying Accounts Payable Watrank Register of AuGuST92022 are approved as presented, with the exception of the following voided and replacement warrants:
Voided
Check Number Vendor Check Date Amount Reason for Void or Replacement 97823 N/A 819/2022 $ 0.00 RSG DESCRIPTION OVERFLOW
GRAND TOT AL OF VOIDED CHECKS $ 0.00
96336 LONG BEACH PRESS TELEGRAM 4/21/2022 $ 1,'157.75
LOST IN MAIL. ISSUED
REPL_ACEMENT CHECK #976G)3
96836 FAST 5 SOUTH GATE 9, LLC 5/24/2022 $ 340.20
LOST IN MAIL. ISSUED
REPLACEMENT CHECK #97694
" GRAND TOTAL OF REPLACEMENT
CHECKE $ 1,497.95
" Replacement :hecks reported in previous warrant registers iave no impact io the grand total.
Pursuant to action of the City Council on at a regular or atljoumed meeting, the City Treasurer was ordered to pay and{or cancel the above warrants, wlte transfers & ETFs. as approved. 1233