WILMINGTON COMMUNITY CLINIC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- WILMINGTON COMMUNITY CLINIC (EIN 95-3137803)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-16
- IRS object ID
- 202341369349302244
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-16T16:09:57-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 330700332 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VASQUEZ COMPANY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 655 N CENTRAL AVE STE 1550 | AddressLine1Txt |
| City | GLENDALE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91203 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 953137803 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILMINGTON COMMUNITY CLINIC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WILM | BusinessNameControlTxt |
| Phone | 3105495760 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1009 N AVALON BLVD | AddressLine1Txt |
| City | WILMINGTON | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90744 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DOLORES BONILLA | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3105495760 | PhoneNum |
| Signature | 2023-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DOLORES | PersonFirstNm |
| Person Last | BONILLA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | REGINA PRINCE CPA | PreparerPersonNm |
| PTIN | P00576936 | PTIN |
| Phone | 2138731700 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DOLORES BONILLA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1009 N AVALON BLVD | AddressLine1Txt |
| City | WILMINGTON | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,542,644 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WILMINGTONCC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | WILMINGTON COMMUNITY CLINIC PROVIDES QUALITY, NON-DISCRIMINATORY HEALTH SERVICES TO IMPROVE THE HEALTH AND WELL-BEING OF ALL SERVED, REGARDLESS OF THEIR ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 111 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,603,966 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,175,990 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,747,049 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,342,764 | CYProgramServiceRevenueAmt |
| PY Investment Income | $81 | PYInvestmentIncomeAmt |
| CY Investment Income | $90 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,038 | PYOtherRevenueAmt |
| CY Other Revenue | $23,800 | CYOtherRevenueAmt |
| PY Total Revenue | $10,353,134 | PYTotalRevenueAmt |
| CY Total Revenue | $8,542,644 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,596,274 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,796,154 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $72,470 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $205,483 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,462,110 | PYOtherExpensesAmt |
| CY Other Expenses | $2,402,332 | CYOtherExpensesAmt |
| PY Total Expenses | $8,058,384 | PYTotalExpensesAmt |
| CY Total Expenses | $8,270,956 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,294,750 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $271,688 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,510,838 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,177,035 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,458,922 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,853,431 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,051,916 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,323,604 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WILMINGTON COMMUNITY CLINIC'S PRIMARY PURPOSES ARE TO PROVIDE FREE MEDICAL, PSYCHOLOGICAL, LEGAL, DENTAL, SOCIAL, VOCATIONAL END RELATED SERVICES TO THOSE REQUESTING SUCH SERVICES AND TO DEVELOP METHODS FOR BETTER SERVING THOSE MEMBERS OF THE COMMUNITY WHOSE NEEDS IN THE FOREGOING AREAS ARE NOT SERVED ADEQUATELY BY EXISTING FACILITIES AND TO OFFER ITS ENCOURAGEMENT AND ASSISTANCE TO OTHER ORGANIZATIONS WITH SIMILAR PURPOSES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,741,033 | ExpenseAmt |
| Revenue | $4,342,764 | RevenueAmt |
| Desc | WILMINGTON COMMUNITY CLINIC PROVIDES COMPREHENSIVE MEDICAL CARE TO ADULTS, SENIOR CITIZENS, AND CHILDREN IN THE UNDERSERVED COMMUNITY OF WILMINGTON AND SURROUNDING AREAS IN THE GREATER LOS ANGELES AREA. THESE SERVICES INCLUDE PRIMARY AND GENERAL MEDICAL AND DENTAL CARE, MENTAL HEALTH, PEDIATRICS, WOMEN'S SERVICES, PRENATAL AND FAMILY PLANNING, HEALTH EDUCATION, AND NUTRITIONAL COUNSELING. HEALTHCARE IS PROVIDED SIX DAYS AND FOUR EVENINGS PER WEEK.THE CLINIC, A FEDERALLY QUALIFIED HEALTH CARE CENTER, PROVIDES SERVICES TO APPROXIMATELY 7,800 PATIENTS PER YEAR. PATIENTS ARE PRIMARILY LATINO, UNINSURED, UNEMPLOYED OR WORKING POOR; THE VAST MAJORITY LIVING WITH INCOMES BELOW FEDERALLY DESIGNATED POVERTY LEVELS AND LITTLE OR NO INSURANCE. WCC PROVIDED 36,704 VISITS OF HEALTH CARE TO 7,848 INDIVIDUALS FOR THE CALENDAR YEAR 2021. | Desc |
| Total Program Service Expenses | $6,741,033 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 18 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 111 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLES RO CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3105495760 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1009 N AVALON BLVD | AddressLine1Txt |
| City | WILMINGTON | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90744 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| GRANT REED | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DANIEL VALDEZ | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DR XYLINA BEAN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SHERIL GARZON | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DIANE KACER-MCCASLIN | ||||||||
| BOARD TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GRETCHEN GOLDSMITH BASKERVILLE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SHANNON CISCH | ||||||||
| BOARD CHAIR/PRES./FUNDRAISER | 1.00 | Yes (X) | $65,888 | $0 | $0 | Yes (X) | ||
| BYRON LANE | ||||||||
| BOARD VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| YAMILET MEDRANO | ||||||||
| BOARD SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| LUISA MORALES | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DOLORES BONILLA | ||||||||
| CEO | 40.00 | $173,609 | $0 | $17,551 | Yes (X) | |||
| CHARLES RO | ||||||||
| CFO | 40.00 | $155,179 | $0 | $12,453 | Yes (X) | |||
| JERRY CARNEGIE | ||||||||
| CHIEF OPERATING OFFICER | 40.00 | $142,382 | $0 | $6,541 | Yes (X) | |||
| SUSAN BALLAGH | ||||||||
| CHIEF MEDICAL OFFICER | 28.00 | $142,032 | $0 | $7,223 | Yes (X) | |||
| CHYNARA TOBAY MD | ||||||||
| PHYSICIAN | 40.00 | $245,597 | $0 | $7,470 | Yes (X) | |||
| DR WAYMAN MERRILL | ||||||||
| PHYSICIAN | 40.00 | $234,251 | $0 | $0 | Yes (X) | |||
| DR MARCO GARCIA | ||||||||
| PHYSICIAN | 40.00 | $165,408 | $0 | $13,482 | Yes (X) | |||
| CRYSTAL MACIEL | ||||||||
| ASSOCIATE MEDICAL DIRECTOR | 40.00 | $164,669 | $0 | $11,840 | Yes (X) | |||
| DR THERESA LIN | ||||||||
| DENTAL DIRECTOR | 40.00 | $163,734 | $0 | $13,470 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,652,749 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $90,030 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PRINCIPAL LIFE INSURANCE | |||||
| PO BOX 14526 | DES MOINES | IA | 50392 | 403B ADMINISTRATOR | $336,360 |
| CALIFORNIA CHOICE | |||||
| PO BOX 7088 | ORANGE | CA | 92863 | HEALTH PLAN ADMINISTRATOR | $272,955 |
| OCHIN INC | |||||
| PO BOX 5426 | PORTLAND | OR | 97228 | HEALTH RECORDER SERVICE | $260,258 |
| ROBERT HALF | |||||
| PO BOX 743295 | LOS ANGELES | CA | 90074 | TEMPORARY STAFFING SERVICE | $253,374 |
| AMI HEALTHCARE STAFFING | |||||
| 401 WILSHIRE BVLD SU 1200 | SANTA MONICA | CA | 90401 | PROVIDER STAFFING SERVICE | $193,733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,752,990 | GovernmentGrantsAmt |
| All Other Contributions | $423,000 | AllOtherContributionsAmt |
| Total Contributions | $4,175,990 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAPITATION REVENUES | 621400 | $2,292,570 | $2,292,570 |
| NET PATIENT SERVICES | 621400 | $1,995,604 | $1,995,604 |
| 340B PROGRAM REVENUES | 621400 | $54,590 | $54,590 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,342,764 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $90 | TotalRevenueColumnAmt |
| Exclusion | $90 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $23,800 | TotalRevenueColumnAmt |
| Exclusion | $23,800 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $23,800 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,542,644 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,342,764 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $23,890 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $656,970 | TotalAmt |
| Program Services | $538,145 | ProgramServicesAmt |
| Management And General | $104,046 | ManagementAndGeneralAmt |
| Fundraising | $14,779 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,420,267 | TotalAmt |
| Program Services | $3,622,409 | ProgramServicesAmt |
| Management And General | $698,424 | ManagementAndGeneralAmt |
| Fundraising | $99,434 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $330,393 | TotalAmt |
| Program Services | $268,933 | ProgramServicesAmt |
| Management And General | $54,028 | ManagementAndGeneralAmt |
| Fundraising | $7,432 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $388,524 | TotalAmt |
| Program Services | $328,751 | ProgramServicesAmt |
| Management And General | $51,033 | ManagementAndGeneralAmt |
| Fundraising | $8,740 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,373 | TotalAmt |
| Management And General | $26,373 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,670 | TotalAmt |
| Program Services | $35,653 | ProgramServicesAmt |
| Management And General | $4,017 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,470 | TotalAmt |
| Fundraising | $72,470 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $787,266 | TotalAmt |
| Program Services | $707,541 | ProgramServicesAmt |
| Management And General | $79,725 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,605 | TotalAmt |
| Program Services | $144,619 | ProgramServicesAmt |
| Management And General | $10,400 | ManagementAndGeneralAmt |
| Fundraising | $2,586 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,340 | TotalAmt |
| Program Services | $160,280 | ProgramServicesAmt |
| Management And General | $18,060 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $240,168 | TotalAmt |
| Program Services | $236,264 | ProgramServicesAmt |
| Management And General | $3,904 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,191 | TotalAmt |
| Program Services | $1,355 | ProgramServicesAmt |
| Management And General | $794 | ManagementAndGeneralAmt |
| Fundraising | $42 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,292 | TotalAmt |
| Program Services | $2,292 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,350 | TotalAmt |
| Management And General | $158,350 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,005 | TotalAmt |
| Program Services | $8,688 | ProgramServicesAmt |
| Management And General | $57,317 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL AND DENTAL SUPP | $184,460 | $184,460 | |
| LABORATORY | $172,140 | $154,708 | $17,432 |
| SECURITY | $100,060 | $89,927 | $10,133 |
| PHARMACEUTICALS | $90,133 | $90,133 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,279 | TotalAmt |
| Program Services | $166,875 | ProgramServicesAmt |
| Management And General | $30,404 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,270,956 | TotalAmt |
| Program Services | $6,741,033 | ProgramServicesAmt |
| Management And General | $1,324,440 | ManagementAndGeneralAmt |
| Fundraising | $205,483 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,237,749 | BOYAmt |
| EOY | $4,298,330 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,127 | BOYAmt |
| EOY | $214,470 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $239,572 | BOYAmt |
| EOY | $166,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $922,954 | BOYAmt |
| EOY | $667,260 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,045 | BOYAmt |
| EOY | $89,830 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,546,243 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,813,670 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,838,765 | BOYAmt |
| EOY | $1,732,573 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,626 | BOYAmt |
| EOY | $8,572 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,510,838 | BOYAmt |
| EOY | $7,177,035 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $886,350 | BOYAmt |
| EOY | $784,793 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,376 | BOYAmt |
| EOY | $10,580 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $532,196 | BOYAmt |
| EOY | $1,058,058 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,458,922 | BOYAmt |
| EOY | $1,853,431 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,051,916 | BOYAmt |
| EOY | $5,323,604 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,051,916 | BOYAmt |
| EOY | $5,323,604 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,510,838 | BOYAmt |
| EOY | $7,177,035 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $271,688 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $300,000 | OtherCostOrOtherBasisAmt |
| Book Value | $300,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,045,071 | OtherCostOrOtherBasisAmt |
| Depreciation | $809,780 | DepreciationAmt |
| Book Value | $1,235,291 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,201,172 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,003,890 | DepreciationAmt |
| Book Value | $197,282 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,732,573 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SETTLEMENT TO THIRD PARTY | Desc |
| Amt | $1,058,058 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,058,058 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $8,578,644 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $36,000 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $36,000 | RevenueNotReportedAmt |
| Revenue Subtotal | $8,542,644 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,542,644 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,306,956 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $36,000 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $36,000 | ExpensesNotReportedAmt |
| Expenses Subtotal | $8,270,956 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,270,956 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE CLINIC IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SECTION 23701(D) OF THE CALIFORNIA REVENUE AND TAXATION CODE AND IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, THE CLINIC IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS, IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. GAAP REQUIRES THAT AN ORGANIZATION RECOGNIZE IN THE FINANCIAL STATEMENTS THE IMPACT OF A TAX POSITION IF THAT POSITION WILL MORE LIKELY THAN NOT BE SUSTAINED ON AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. AS OF AND FOR THE YEAR ENDED JUNE 30, 2022, THE CLINIC HAD NO MATERIAL UNRECOGNIZED TAX BENEFITS, TAX PENALTIES OR INTEREST. AS OF JUNE 30, 2022, INFORMATION RETURNS SUBSEQUENT TO 2018 FILED BY THE CLINIC ARE SUBJECT TO EXAMINATION BY THE TAXING AUTHORITIES. | ExplanationTxt |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agrmt Prof Fundraising Acty | 0 | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHANNON CISCH | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1009 N AVALON BLVD | AddressLine1Txt |
| City | WILMINGTON | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 90744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | FUNDRAISING | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Retained By Contractor | $72,470 | RetainedByContractorAmt |
| Net To Organization | -$72,470 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $72,470 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$72,470 | TotalNetToOrganizationAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHYNARA TOBAY MD | ||||||||||||||
| PHYSICIAN | $242,164 | $0 | $3,433 | $0 | $0 | $0 | $0 | $0 | $7,470 | $0 | $253,067 | $0 | $0 | $0 |
| DR WAYMAN MERRILL | ||||||||||||||
| PHYSICIAN | $231,080 | $0 | $3,171 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $234,251 | $0 | $0 | $0 |
| DOLORES BONILLA | ||||||||||||||
| CEO | $170,964 | $0 | $2,645 | $0 | $0 | $0 | $8,567 | $0 | $8,984 | $0 | $191,160 | $0 | $0 | $0 |
| DR MARCO GARCIA | ||||||||||||||
| PHYSICIAN | $163,431 | $0 | $1,977 | $0 | $0 | $0 | $8,164 | $0 | $5,318 | $0 | $178,890 | $0 | $0 | $0 |
| DR THERESA LIN | ||||||||||||||
| DENTAL DIRECTOR | $160,254 | $0 | $3,480 | $0 | $0 | $0 | $7,927 | $0 | $5,543 | $0 | $177,204 | $0 | $0 | $0 |
| CRYSTAL MACIEL | ||||||||||||||
| ASSOCIATE MEDICAL DIRECTOR | $161,617 | $0 | $3,052 | $0 | $0 | $0 | $7,811 | $0 | $4,029 | $0 | $176,509 | $0 | $0 | $0 |
| CHARLES RO | ||||||||||||||
| CFO | $152,603 | $0 | $2,576 | $0 | $0 | $0 | $7,611 | $0 | $4,842 | $0 | $167,632 | $0 | $0 | $0 |
| SUSAN BALLAGH | ||||||||||||||
| CHIEF MEDICAL OFFICER | $140,111 | $0 | $1,921 | $0 | $0 | $0 | $6,947 | $0 | $276 | $0 | $149,255 | $0 | $0 | $0 |
| JERRY CARNEGIE | ||||||||||||||
| CHIEF OPERATING OFFICER | $139,979 | $0 | $2,403 | $0 | $0 | $0 | $2,400 | $0 | $4,141 | $0 | $148,923 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHANNON CISCH | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD CHAIR | RelationshipDescriptionTxt |
| Transaction | $72,471 | TransactionAmt |
| Transaction | FUNDRAISING SERVICES AT A DISCOUNTED RATE OF $75 PER HOUR. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | WILMINGTON COMMUNITY CLINIC'S CHIEF EXECUTIVE OFFICER AND CFO REVIEW THE FORM 990 FOR ACCURACY. SUBSEQUENTLY FORM 990, COMPLETE WITH ALL SCHEDULES, IS THEN PROVIDED TO THE FULL BOARD BEFORE FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE PURPOSE OF THE ORGANIZATION'S CONFLICT OF INTEREST (COI) POLICY IS TO PREVENT THE INSTITUTIONAL OR PERSONAL INTERESTS OF WILMINGTON COMMUNITY CLINIC BOARD MEMBERS, EMPLOYEES, AGENTS, CONSULTANTS AND THOSE WHO FURNISH GOODS OR SERVICES TO THE ORGANIZATION ("INTERESTED PERSONS") FROM INTERFERING WITH THE PERFORMANCE OF THEIR DUTIES TO WILMINGTON COMMUNITY CLINIC, AND TO ENSURE THAT THERE IS NO PERSONAL, PROFESSIONAL, OR POLITICAL GAIN AT THE EXPENSE OF WILMINGTON COMMUNITY CLINIC. A CONFLICT OF INTEREST MAY EXIST WHEN THE INTERESTS OR POTENTIAL INTERESTS OF ANY INTERESTED PERSON OR THAT PERSON'S CLOSE RELATIVE, OR ANY INDIVIDUAL, GROUP, OR ORGANIZATION TO WHICH THE INTERESTED PERSON ASSOCIATED WITH WILMINGTON COMMUNITY CLINIC HAS ALLEGIANCE, MAY BE SEEN AS COMPETING WITH THE INTERESTS OF WILMINGTON COMMUNITY CLINIC, OR MAY IMPAIR SUCH INTERESTED PERSON'S INDEPENDENCE OR LOYALTY TO WILMINGTON COMMUNITY CLINIC. A CONFLICT OF INTEREST IS DEFINED AS AN INTEREST THAT MIGHT AFFECT, OR MIGHT REASONABLY APPEAR TO AFFECT, THE JUDGMENT OR CONDUCT OF ANY INTERESTED PERSON IN A MANNER THAT IS ADVERSE TO THE INTERESTS OF WILMINGTON COMMUNITY CLINIC. WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS ARE PROHIBITED FROM PARTICIPATING IN THE SELECTION, AWARD, OR ADMINISTRATION OF CONTRACTS, INCLUDING BUT NOT LIMITED TO, THOSE SUPPORTED BY FEDERAL FUNDS, IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE WILMINGTON COMMUNITY CLINIC INTERESTED PERSON OR THAT PERSON'S CLOSE RELATIVE, OR ANY INDIVIDUAL, GROUP, OR ORGANIZATION TO WHICH THE PERSON ASSOCIATED WITH WILMINGTON COMMUNITY CLINIC HAS ALLEGIANCE, HAS A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR AN AWARD. THE PROHIBITION DOES NOT APPLY TO SITUATIONS IN WHICH THE FINANCIAL INTEREST IS NOT SUBSTANTIAL (FOR EXAMPLE, AN OWNERSHIP INTEREST OF LESS THAN 5 PERCENT OF OUTSTANDING SECURITIES OF PUBLIC CORPORATIONS). WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS ARE PROHIBITED FROM SOLICITING OR ACCEPTING FOR THEIR OWN PERSONAL BENEFIT GRATUITIES, FAVORS, OR ANYTHING OF MONETARY VALUE FROM CONTRACTORS, OR PARTIES TO SUB-AGREEMENTS. THE PROHIBITION DOES NOT APPLY TO SITUATIONS IN WHICH THE GIFT IS AN UNSOLICITED ITEM OF NOMINAL VALUE (NOT > THAN $50). WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS SHALL NOT USE INFORMATION RECEIVED FROM PARTICIPATION IN WILMINGTON COMMUNITY CLINIC AFFAIRS, WHETHER EXPRESSLY DENOMINATED AS CONFIDENTIAL OR NOT, FOR PERSONAL GAIN OR TO THE DETRIMENT OF WILMINGTON COMMUNITY CLINIC. WHENEVER THE CHIEF EXECUTIVE OFFICER OR ANY BOARD MEMBER HAS A CONFLICT OF INTEREST OR A PERCEIVED CONFLICT OF INTEREST WITH WILMINGTON COMMUNITY CLINIC, HE OR SHE SHALL NOTIFY THE FULL BOARD OF SUCH CONFLICT IN WRITING USING THE ANNUAL COI DISCLOSURE FORM. WHEN ANY CONFLICT OF INTEREST IS RELEVANT TO A MATTER THAT COMES UNDER CONSIDERATION OR REQUIRES ACTION BY THE BOARD, OR A BOARD COMMITTEE, THE INTERESTED PERSON SHALL CALL IT TO THE ATTENTION OF THE BOARD CHAIR AND SHALL NOT BE PRESENT DURING BOARD OR COMMITTEE DISCUSSION OR DECISION ON THE MATTER. HOWEVER, THAT PERSON SHALL PROVIDE THE BOARD OR APPLICABLE COMMITTEE WITH ANY AND ALL RELEVANT INFORMATION ON THE PARTICULAR MATTER. THE MINUTES OF THE MEETING OF THE BOARD OR ITS COMMITTEE SHALL REFLECT THAT THE CONFLICT OF INTEREST WAS DISCLOSED, THAT THE INTERESTED PERSON WAS NOT PRESENT DURING DISCUSSION OR DECISION ON THE MATTER, AND DID NOT VOTE. WHENEVER ANY INTERESTED PERSON, WHO IS NOT ALSO A BOARD MEMBER OR THE CHIEF EXECUTIVE OFFICER (FOR EXAMPLE, EMPLOYEES, CONTRACTORS AND CONSULTANTS), HAS A CONFLICT OF INTEREST OR A PERCEIVED CONFLICT OF INTEREST WITH WILMINGTON COMMUNITY CLINIC, HE OR SHE SHALL NOTIFY THE CHIEF EXECUTIVE OFFICER OF SUCH CONFLICT IN WRITING. INTERESTED PERSONS, EXCLUDING BOARD MEMBERS, WHO VIOLATE THE CONFLICT OF INTEREST POLICY INCLUDING THE STANDARDS OF CONDUCT MAY, DEPENDING ON THE SEVERITY OF THE VIOLATION, BE SUBJECT TO ORAL ADMONISHMENT, WRITTEN REPRIMAND, REASSIGNMENT, DEMOTION, SUSPENSION OR SEPARATION. INTERESTED PERSONS, WHO ARE ALSO BOARD MEMBERS, WHO VIOLATE THE CONFLICT OF INTEREST POLICY INCLUDING THE STANDARDS OF CONDUCT MAY, DEPENDING ON THE SEVERITY OF THE VIOLATION, BE SUBJECT TO ORAL ADMONISHMENT OR REMOVAL FROM THEIR POSITION. AS ADMINISTERED BY THE CHIEF EXECUTIVE OFFICER, EACH BOARD MEMBER WILL BE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE AN ANNUAL COI DISCLOSURE FORM TO DISCLOSE ANY KNOWN CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST UPON HIS OR HER ELECTION OR RE-ELECTION TO THE BOARD AND ANNUALLY THEREAFTER. THE BOARD AS APPROPRIATE SHALL REVIEW ALL BOARD MEMBER CERTIFICATIONS. AS ADMINISTERED BY THE EMPLOYEE IN CHARGE OF HUMAN RESOURCES, ALL INTERESTED PERSONS THAT ARE NOT BOARD MEMBERS WILL BE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND USE A COI DISCLOSURE FORM TO DISCLOSE ANY KNOWN CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST UPON HIS OR HER EMPLOYMENT OR ENGAGEMENT WITH WILMINGTON COMMUNITY CLINIC. |
| FORM 990, PART VI, SECTION B, LINE 15A | WILMINGTON COMMUNITY CLINIC'S BOARD OF DIRECTORS HAS A PROCESS FOR REVIEWING AND APPROVING THE COMPENSATION OF CEO ON A ANNUAL BASIS TO DETERMINE IT IS FAIR AND REASONABLE WITH THE GOAL OF RETAINING EMPLOYEES AT COMPENSATION LEVELS WITHIN APPROPRIATE MARKET RANGE. THE PROCESS FOR DETERMINING THE COMPENSATION PAID TO THE CEO, BY THE BOARD OF DIRECTORS, WITH ALL PERSONS WITH A CONFLICT OF INTEREST ABSTAINING FROM THE BOARD'S DELIBERATION AND DISCUSSION. THE BOARD REVIEWS DATA OF COMPARABLE COMPENSATION BASED ON CALIFORNIA PRIMARY CARE ANNUAL COMPENSATION SURVEY FOR CEO. THE DOCUMENTATION OF THE BOARD INCLUDES THE TERMS OF THE TRANSACTION AND THE DATE OF APPROVAL, THE MEMBERS WHO WERE PRESENT DURING THE DEBATE AND VOTE ON THE TRANSACTION, A DESCRIPTION OF THE COMPARABLE DATA AND HOW IT WAS OBTAINED, AND DOCUMENTATION OF THE BASIS FOR THE DETERMINATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. HOWEVER CURRENT TAX LAW DOES NOT REQUIRE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIALS BE PROVIDED TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 159,081. MANAGEMENT AND GENERAL EXPENSES 17,925. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 177,006. PAYROLL SERVICES: PROGRAM SERVICE EXPENSES 17,543. MANAGEMENT AND GENERAL EXPENSES 1,977. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,520. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 100,254. MANAGEMENT AND GENERAL EXPENSES 11,296. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 111,550. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 430,663. MANAGEMENT AND GENERAL EXPENSES 48,527. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 479,190. |
| FORM 990, PART IX, LINE 24E | STAFF DEVELOPMENT: PROGRAM SERVICE EXPENSES 31,362. MANAGEMENT AND GENERAL EXPENSES 23,375. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,737. PATIENT SERVICES: PROGRAM SERVICE EXPENSES 52,787. MANAGEMENT AND GENERAL EXPENSES 1,030. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,817. MEMBERSHIP DUES: PROGRAM SERVICE EXPENSES 4,880. MANAGEMENT AND GENERAL EXPENSES 27,988. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,868. MEDICAL FURNITURE & EQUIPMENT: PROGRAM SERVICE EXPENSES 22,157. MANAGEMENT AND GENERAL EXPENSES 115. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,272. STORAGE: PROGRAM SERVICE EXPENSES 18,719. MANAGEMENT AND GENERAL EXPENSES 2,013. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,732. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 15,629. MANAGEMENT AND GENERAL EXPENSES 1,761. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,390. LAUNDRY: PROGRAM SERVICE EXPENSES 17,087. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,087. EDUCATIONAL MATERIALS: PROGRAM SERVICE EXPENSES 2,569. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,569. TAXES & LICENSES: PROGRAM SERVICE EXPENSES 1,685. MANAGEMENT AND GENERAL EXPENSES -25,878. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -24,193. |