2024-04-24T17:01:18-07:00 2023-06-30 812030609 Bakulesh Patel CPA 2070 Trestle Glen Rd Walnut Creek CA 94598 990 2022-07-01 942151392 ROUND VALLEY INDIAN HEALTH CENTER INC ROUN 7079836404 PO Box 247 Covelo CA 95428 Marilyn Horne Fiscal Officer 7079836404 2024-04-30 1 Marilyn Horne 999009999 1 Bakulesh Patel P01484348 9252661245 2024-04-25 X 1 11 1 AAL2 2022 2023-04-26 12:10:37Z X Marilyn Horne P O Box 247 Covelo CA 95428 10454250 0 X RoundValleyIndianHealthCenter.com X 1967 CA Out patient Medical/Dental Facility- To Provide Low Cost Primary Health Care services to Native Americans and other medically underserves rural residents of Covelo and Round Valley, California 7 7 98 0 0 0 5564667 6751774 1937412 3110522 33081 50587 21758 541367 7556918 10454250 0 0 0 0 4014526 4205407 0 0 0 3470090 3485391 7484616 7690798 72302 2763452 11824950 13107204 7608771 6127573 4216179 6979631 PROVIDE LOW COST PRIMARY HEALTH CARE SERVICES TO NATIVE AMERICANS AND OTHER MEDICALLY UNDERSERVEDRURAL RESIDENTS OF COVELO AND ROUND VALLEY, CALIFORNIA 0 0 4012780 0 5017290 THROUGH CONTRACT WITH INDIAN HEALTH SERVICES, DHHS-USA, VARIOUS HEALTH CARE SERVICES ARE PROVIDED TO NATIVE INDIANS WHO ARE RESIDENTS OF ROUND VALLEY, CALIFORNIA. SUCH SERVICES INCLUDE PRIMARY HEALTHCARE DENTAL AND VISION. PROGRAM ALSO PROVIDE SUBSTANCE ABUSE COUNSELING CLINIC SERVICES, CONTRACT HEALTH SERVICES 607379 0 3747083 PATIENTS BILLING-THE CLINIC ALSO PROVIDES LOW COST PRIMARY HEALTH CARE SERVICES TO ALL LOCAL RESIDENTS THAT ARE AMONG THE UNDERSERVED LOW INCOME POPULATION. THE INCOME DERIVED IS PRIVATE PATIENTS FEES, MEDICARE, MEDICAL, INSURANCE BILLING CLAIMS. SELF PAY etc. 128422 0 128422 Through US Department of Health and Human Services contract funding under the Special Diabetes Program for Indians, the Clinic provides various educational programs and activities to treat and manage the diabetes among the qualifying local native Indian residents. 1388908 0 1561455 Various other Healthcare and Welfare related programs with the Primary objective of serving the local indigenous and resident Indians of the Round Valley and Covelo area 1388908 0 1561455 6137489 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 90 0 1 98 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 CA X Marilyn Horne 7079836404 PO Box 247 Covelo CA 95428 Snehal Raisoni MD Clinic Physician 40 0 X X 282550 0 0 Kevin Mack Psy.D 40 0 X X 254189 0 0 Vicki Shively PHN Clinic Nurse 40 0 X 131077 0 0 Marvin Trotter MD Medical Doctor 20.00 0 X 106263 0 0 Marilyn Horne Fiscal Manager 40 0 X X 103202 0 0 Emily Bruton Physical Therapist 20.00 0 X 94694 0 0 Linda Lohne Interim Executive Director 30.00 0 X X 79194 0 0 Virginia Scribner Deputy Executive Director 40 0 X X 71602 0 0 JoAnna Gonzales Board Vice Chair 10 0 X 0 0 0 Otus Brotherton Board Chair 10 0 X 0 0 0 Amanda Want Board Secretary 10 0 X 0 0 0 Miranda Want Board Member 10 0 X 0 0 0 Marian Azbill Board Member 40 0 X 0 0 0 Jill Hoaglen Board Member 10 0 X 0 0 0 Esther Bryant Board Treasurer 10 0 X 0 0 0 1122771 0 0 5 0 1 0 DT-Trac Consulting and Billing Service 210 North Broadway Miller SD 57362 Patients Billings Services 107264 Mendocino Finest Construction 2400 Townsend Lane Ukiah CA 95482 Construction 171361 2 0 0 0 0 6473920 277854 0 6751774 Patients Billings Revenues 621400 3110522 3110522 0 0 0 0 0 0 3110522 45496 45496 0 0 5091 5091 0 0 0 0 0 0 0 0 0 0 0 Various Related Services 624100 4740 4740 0 0 Fire Damage Insurance Proceeds 621400 536627 536627 0 0 0 0 0 0 541367 10454250 3702476 0 0 X 1122771 868773 253998 0 2359463 2139542 219921 0 412943 352832 60111 0 310230 267173 43057 0 17180 0 17180 0 991998 779602 212396 0 340700 0 340700 0 58263 0 58263 0 Contract Health, Substance Abuse & Emergency 701278 701278 0 0 Rent, Utilities, Telephone, Bld and Equip Maint etc 470095 314694 155401 0 Medical Waste, Laboratory etc. 101623 101623 0 0 Medical and Pharmacy Supplies and other 477394 423693 53701 326860 188279 138581 0 7690798 6137489 1553309 0 7716751 4285524 1217963 2074168 7012749 4645707 1542686 2367042 1347550 4380470 11824950 13107204 315711 731838 7123577 5265527 169483 130208 7608771 6127573 X 3486512 6325998 729667 653633 4216179 6979631 11824950 13107204 2763452 0 0 0 0 0 X 0 1 X 1 1 1 X 3535532 4215266 6059954 7502079 9862296 31175127 0 0 0 0 0 0 0 0 3535532 4215266 6059954 7502079 9862296 31175127 31175127 5091 5091 97617 71149 296142 33081 45496 543485 126419 104327 76302 21758 536627 865433 32589136 11195483 0.95661 0.96094 X Schedule A, Part II, Line 10 Insurance Claim Proceeds received - arson fire damage to the Medical Clinic building ( fully depreciated building). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 376775 0 376775 4438521 0 3084650 1353871 0 0 0 0 1631474 0 1278583 352891 565979 0 282474 283505 2367042 Mutual Funds- Equity/Bond 1431291 F US Treasury Notes 2949179 F 4380470 0 Vacation Payable 130208 130208 10454250 0 0 0 0 0 10454250 0 0 0 10454250 7690798 0 0 0 0 0 7690798 0 0 0 7690798 X 1 1 X 0 0 0 0 0 0 0 0 0 Snehal Raisoni MD Clinic Physician 282550 0 0 0 0 0 0 0 0 0 282550 0 0 0 Kevin Mack Psy.D 254189 0 0 0 0 0 0 0 0 0 254189 0 0 0 Schedule J, Part I, Line 1a Since the Clinic is in remote rural area it is necessary and a requirement that outside area physicians reside in the clinic provided residence. Schedule J, Part I, Line 3 All positions Titles, Job Descriptions and Compensation are discussed and approved by the Board Form 990, Part VI, Section A, Line 8b The Finance/Executive Board Committee did not maintain formal minutes of the meeting as these topics were further discussed in the regular board meetings for final approval Form 990, Part VI, Section B, Line 11b Before filing the Form 990 etc. Tax Returns are reviewed by the Fiscal Officer and the Executive Director and copies are made available for the Board Members Form 990, Part VI, Section C, Line 19 The Governing Documents, Conflict of Interest Policy and Financial Statements are made available to the public upon written request Form 990, Part IX, Line 11g Professional Medical Doctors, Nurses Locum Contract services $652,841. Other Health relates Services Contract Service - $284,910, Contract Labor $54,247. Requested and was granted filing extension to Mya 15, 2024