2020-11-16T18:16:03-06:00 2019-12-31 910189318 MOSS ADAMS LLP 2882 PROSPECT PARK DR STE 300 RANCHO CORDOVA CA 95670 990 2019-01-01 680162903 CARES COMMUNITY HEALTH CARE 9164433299 1500 21ST STREET SACRAMENTO CA 958115216 MICHELLE MONROE CEO 9164433299 2020-11-16 1 TRACY S PAGLIA P00366884 9165038100 2020-11-16 172.9.161.112 2020-11-16 15:32:48 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AB62784BFBBCE89412A377BC0839915E4371C5BE 2019 2021-01-29 14:40:06Z ONE COMMUNITY HEALTH MICHELLE MONROE 1500 21ST STREET SACRAMENTO CA 958115216 74319220 0 X WWW.ONECOMMUNITYHEALTH.COM X 1988 CA ONE COMMUNITY HEALTH IS A PRIMARY HEALTHCARE AND SPECIALTY CARE PROVIDER DEDICATED TO IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITY. 10 10 344 13 0 0 6612195 6245315 11026545 12544490 4682438 816821 16851533 16711306 39172711 36317932 1812819 1237150 0 0 19357305 22593022 0 0 0 14791731 15450525 35961855 39280697 3210856 -2962765 63652947 64133564 14059859 12846053 49593088 51287511 X ONE COMMUNITY HEALTH TRANSFORMS LIVES THROUGH CARE, RESEARCH AND COMMUNITY AWARENESS. 0 0 17674384 517019 9102905 MEDICAL CARE - ONE COMMUNITY HEALTH PROVIDES PRIMARY CARE SERVICES AND SPECIALTY CARE FOR PATIENTS THAT INCLUDES PREVENTATIVE CARE, ROUTINE CHECKUPS, IMMUNIZATION AND MANAGEMENT OF ACUTE AND CHRONIC ILLNESSES. MEDICAL VISITS - 49,162.DENTAL CARE - ONE COMMUNITY HEALTH PROVIDES PREVENTIVE DENTAL CARE, ROUTINE CHECKUPS AND DENTAL PROCEDURES. DENTAL VISITS - 9,356. 4841505 0 16568023 PHARMACY (RETAIL) - ONE COMMUNITY HEALTH PROVIDES PHARMACY SERVICES FOR PATIENTS' PRESCRIPTIONS. THE PHARMACY FILLED 169,288 SCRIPTS IN 2019. 3075805 532887 1149975 ENABLING VISITS - COUNSELORS WORK WITH PATIENTS TO PROVIDE HEALTH INFORMATION, SECURE INSURANCE, SEEK SUPPLEMENTS FOR RENT AND UTILITIES, SECURE TRANSPORTATION AND OTHER SERVICES THAT ALLOW PATIENTS TO BE ABLE TO SECURE MEDICAL AND MENTAL HEALTH SERVICES AND ALLOW THEM TO STAY IN CARE. VISITS - 6,802. 2102059 187243 2291610 BEHAVIORAL HEALTH (PSYCHIATRY, PSYCHOLOGICAL COUNSELING AND SUBSTANCE ABUSE COUNSELING) - ONE COMMUNITY HEALTH PROVIDES COUNSELING, PSYCHIATRIC EVALUATION AND MEDICATION MANAGEMENT TO PATIENTS THROUGH SCREENING, ASSESSMENT, GROUP AND INDIVIDUAL TREATMENT. PSYCHIATRIST VISITS - 2,708; OTHER - 20,256.OPTOMETRY - 4,415 VISITS AND EXPENSES TOTALING TO $192,168, REVENUE $561,657. 2102059 187243 2291610 27693753 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 107 0 1 344 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X TALIA PETERSON 9164433299 1500 21ST STREET SACRAMENTO CA 958115216 TASNIM AAMIR KHAN CHIEF MEDICAL OFFICER 40.00 X 334929 0 36570 DAVID WAYNE SMITH PSYCHIATRIST 30.00 X 281257 0 11200 ANTON SISANTE PHYSICIAN 36.00 X 251009 0 23900 JOHN PALMER LOVEJOY PHYSICIAN 40.00 X 254018 0 15399 CORINA LYNN MD GONZALEZ PEDIATRICIAN 40.00 X 236990 0 20724 JEFFREY GERSTEIN PSYCHIATRIST 27.00 X 238932 0 9557 HEATHER MARTHA NEWHARD ASSIST SITE MEDICAL DIRECTOR 40.00 X 193749 0 6972 CHRISTY ELLEN WARD CHIEF EXECUTIVE OFFICER (THRU 08/19) 40.00 X 179239 0 17598 PAMELA CAVINESS DENTAL DIRECTOR 40.00 X 170122 0 16036 KARYNSUE ROSE-THOMAS CHIEF INFORMATION/QUALITY OFFICER 40.00 X 169844 0 13519 ALONDRA LITICE THOMPSON BEHAVIOR HEALTH DIRECTOR 40.00 X 152869 0 17795 ROSEMARIE BAUTISTA MACISAAC CHIEF FIN OFFICER (THRU 10/19) 40.00 X 151808 0 15972 ALEXANDRA AKAKA VP OF HUMAN RESOURCES 40.00 X 160668 0 6003 DONA MARIA WEISSENFELS INTERIM CEO/CHIEF OPERATIONS OFF 40.00 X 87129 0 4452 KATHLEEN ANN MARSHALL CHIEF OPERATING OFFICER (THRU 04/19) 40.00 X 69199 0 6988 RICHARD SOOHOO CHAIRPERSON 1.00 X X 0 0 0 MICHAEL MARTINEZ VICE CHAIR 1.00 X X 0 0 0 GAYLENE HUNTSMAN SECRETARY 1.00 X X 0 0 0 BOB PASCUZZI TREASURER 1.00 X X 0 0 0 SUSAN BERGIN BOARD MEMBER 1.00 X 0 0 0 ARTURO DURAZO BOARD MEMBER 1.00 X 0 0 0 ROBERT JIMENEZ BOARD MEMBER 1.00 X 0 0 0 SHELLY MCGRIFF BOARD MEMBER 1.00 X 0 0 0 DOUGLAS SMITH BOARD MEMBER 1.00 X 0 0 0 JASON VEGA BOARD MEMBER 1.00 X 0 0 0 2931762 0 222685 39 0 1 0 UCDMC-PHARMACY PO BOX 989062 WEST SACRAMENTO CA 95798 UC DAVIS PHARMACY CONTRACTORS 3030372 BENEFIT & RISK MANAGEMENT SERVICE 80 IRON POINT CIRCLE SUITE 200 FOLSOM CA 95630 EMPLOYEE BENEFITS MANAGEMENT 2568532 OCHIN 1881 SW NAITO PARKWAY PORTLAND OR 97201 ELECTRONIC HEALTH RECORDS 1222516 UNIVERSITY OF CALIFORNIA PO BOX 989062 WEST SACRAMENTO CA 95798 CONTRACTED PHYSICIANS 1179087 PROVIDER HEALTHCARE LLC 2455 E PARLEYS WAY SUITE 310 SALT LAKE CITY UT 84109 STAFFING SERVICES 525858 26 5759018 486297 6245315 ANCILLARY OUTPATIENT REVENUE 621400 12544490 12544490 12544490 755380 755380 3523 0 3523 3523 3523 3743587 3663602 18544 79985 -18544 61441 61441 50887165 34319142 16568023 16568023 MISCELLANEOUS 900099 139760 139760 139760 36317932 29112513 0 960104 X 381859 381859 855291 855291 1811460 711132 1100328 16398509 11540812 4857697 510578 358707 151871 2499278 1714488 784790 1373197 926451 446746 385833 158498 227335 104149 104149 153970 153970 6752947 5686833 1066114 144960 144960 1133545 573889 559656 1730695 773765 956930 1636511 1184315 452196 137916 58902 79014 35055 23745 11310 270470 218513 51957 1482804 1138746 344058 165482 71619 93863 MEDICAL CLINIC SUPPLIES 1316188 1316188 39280697 27693753 11586944 0 991443 1566952 498601 894356 1762384 1398458 7289432 3652452 1289046 1307397 603696 692563 28212134 8208810 21314494 20003324 25529175 31839885 4374676 2778177 63652947 64133564 4901076 4020907 25744 72624 9071798 8471798 61241 280724 14059859 12846053 X 49593088 51287511 49593088 51287511 63652947 64133564 -2962765 4657188 0 X 0 1 X 1 1 1 X 5630170 6627961 7017885 6612195 6245315 32133526 5630170 6627961 7017885 6612195 6245315 32133526 1101027 31032499 743314 575700 722738 747668 758903 3548323 58835 42948 39887 122203 139760 403633 36085482 245661976 0.86000 0.86130 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2015 AMOUNT: $ 58,835. 2016 AMOUNT: $ 42,948. 2017 AMOUNT: $ 39,887. 2018 AMOUNT: $ 122,203. 2019 AMOUNT: $ 139,760. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2609000 2609000 19739318 5172150 14567168 1053982 289412 764570 4809834 2747248 2062586 20003324 DEFERRED LEASE LIABILITY 280724 280724 X 40821150 4657188 4657188 36163962 153970 153970 36317932 39126727 0 39126727 153970 153970 39280697 PART X, LINE 2: OCH HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE PURSUANT TO CODE SECTION 501(C)(3) AND ALSO BY THE CALIFORNIA REVENUE AND TAX CODE SECTION 23701D. OCH HAS NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. HOWEVER, OCH FILES INFORMATIONAL RETURNS ANNUALLY WITH FEDERAL AND STATE TAXING AUTHORITIES. 1 SIERRA FOOTHILLS AIDS FOUNDATION 12183 LOCKSLEY LANE SUITE 208 AUBURN CA 95602 680179770 501(C)(3) 63948 HIV PREVENTION HARM REDUCTION SERVICES 2800 STOCKTON BLVD SACRAMENTO CA 95817 680300656 501(C)(3) 15000 HIV PREVENTION 2 0 IN-HOUSE SUBSTANCE ABUSE TREATEMENT 17 135050 0 CLIENT HOUSING 188 306893 0 CLIENT UTILITIES 118 43259 0 CLIENT TRANSPORTATION 420 36271 0 INSURANCE ASSISTANCE 15 8021 0 CLIENT PHARMACY ASSISTANCE 125 36522 0 DENTAL CLIENT REFERRALS 57 82428 0 DENTAL LABS 323 47414 0 MEDICAL LABS 411 77864 0 CLIENT FOOD VOUCHERS 514 71610 0 CLIENT FOOD 567 0 9959 FMV FOOD PROVIDED FOR PATIENTS PART I, LINE 2: ONE COMMUNITY HEALTH HAS SUB-GRANTEES FOR FEDERAL GRANTS. ONE COMMUNITY HEALTH MONITORS EACH GRANTEE TO ASSURE THAT THEY FOLLOW THE SAME A-133 REQUIREMENTS THAT EACH GRANT CONTRACT REQUIRES OF ONE COMMUNITY HEALTH PLUS ANY SPECIFIC REQUIREMENTS OF THE SUBGRANTEE CONTRACT. PART III, COLUMN (A): ONE COMMUNITY HEALTH RECEIVES GRANT FUNDS THAT ARE USED TO PAY FOR SERVICES NOT COVERED BY INSURANCE FOR CLIENTS. ADDITIONALLY, THERE ARE GRANT FUNDS USED TO PAY INSURANCE PREMIUMS, SUPPLEMENT RENT, UTILITY AND FOOD FOR CERTAIN PATIENTS. X X X X X 0 0 0 0 0 0 0 0 0 TASNIM AAMIR KHAN CHIEF MEDICAL OFFICER 308659 0 23770 0 2500 0 11200 0 25370 0 371499 0 0 0 DAVID WAYNE SMITH PSYCHIATRIST 258284 0 17848 0 5125 0 11200 0 0 0 292457 0 0 0 ANTON SISANTE PHYSICIAN 233500 0 15038 0 2471 0 8967 0 14933 0 274909 0 0 0 JOHN PALMER LOVEJOY PHYSICIAN 242158 0 9360 0 2500 0 9227 0 6172 0 269417 0 0 0 CORINA LYNN MD GONZALEZ PEDIATRICIAN 218240 0 15058 0 3692 0 8042 0 12682 0 257714 0 0 0 JEFFREY GERSTEIN PSYCHIATRIST 228522 0 8723 0 1687 0 9557 0 0 0 248489 0 0 0 HEATHER MARTHA NEWHARD ASSIST SITE MEDICAL DIRECTOR 166950 0 19513 0 7286 0 6666 0 306 0 200721 0 0 0 CHRISTY ELLEN WARD CHIEF EXECUTIVE OFFICER (THRU 08/19) 162931 0 15000 0 1308 0 7169 0 10429 0 196837 0 0 0 PAMELA CAVINESS DENTAL DIRECTOR 161408 0 6214 0 2500 0 6556 0 9480 0 186158 0 0 0 KARYNSUE ROSE-THOMAS CHIEF INFORMATION/QUALITY OFFICER 157846 0 9998 0 2000 0 6637 0 6882 0 183363 0 0 0 ALONDRA LITICE THOMPSON BEHAVIOR HEALTH DIRECTOR 145665 0 4704 0 2500 0 5927 0 11868 0 170664 0 0 0 ROSEMARIE BAUTISTA MACISAAC CHIEF FIN OFFICER (THRU 10/19) 151808 0 0 0 0 0 2794 0 13178 0 167780 0 0 0 ALEXANDRA AKAKA VP OF HUMAN RESOURCES 146818 0 10600 0 3250 0 6003 0 0 0 166671 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED FORM IS SENT FOR REVIEW AND COMMENTS TO THE CFO AND THE AUDIT COMMITTEE, WHOSE MEMBERSHIP INCLUDES TWO INDIVIDUALS OUTSIDE OF THE BOARD OF DIRECTORS OF ONE COMMUNITY HEALTH. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERED ALL MEMBERS OF THE BOARD OF DIRECTORS. EACH NEW RESPONSIBLE PERSON SHALL BE REQUIRED TO REVIEW A COPY OF THE POLICY AND TO ACKNOWLEDGE IN WRITING THAT HE OR SHE HAS DONE SO AND AGREES TO COMPLY WITH THE POLICY. UPON ELECTION OR RE-ELECTION TO THE BOARD OF DIRECTORS, AND ANNUALLY THEREAFTER, EACH RESPONSIBLE PERSON SHALL COMPLETE A DISCLOSURE FORM IDENTIFYING ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH THE RESPONSIBLE PERSON IS INVOLVED THAT HE OR SHE BELIEVES COULD CONTRIBUTE TO THE ARISING OF A CONFLICT OF INTEREST. THIS POLICY SHALL BE REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. BEFORE BOARD OR COMMITTEE ACTION ON A CONTRACT OR TRANSACTION INVOLVING A CONFLICT OF INTEREST, A RESPONSIBLE PERSON WHO HAS, OR MAY HAVE, A CONFLICT OF INTEREST SHALL DISCLOSE THE EXISTENCE OF THE ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST TO THE CHAIRPERSON OF THE BOARD OF DIRECTORS, OR THE CHAIR OF THE APPLICABLE COMMITTEE IN WRITING AS SOON AS THE RESPONSIBLE PERSON HAS REASON TO BELIEVE THAT HE/SHE MAY HAVE A CONFLICT. THE CHAIR OF THE BOARD OR COMMITTEE MEETING AT WHICH BOARD OR COMMITTEE ACTION RELATED TO THE CONTRACT OR TRANSACTION MAY OCCUR SHALL REPORT THE DISCLOSURE AT THE MEETING, AND THE DISCLOSURE SHALL BE REFLECTED IN THE MINUTES OF THE MEETING. A RESPONSIBLE PERSON WHO HAS A CONFLICT OF INTEREST SHALL NOT PARTICIPATE IN OR BE PERMITTED TO HEAR THE BOARD'S DISCUSSION OF THE MATTER EXCEPT TO DISCLOSE MATERIAL FACTS AND TO RESPOND TO QUESTIONS AND SHALL NOT BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM FOR PURPOSES OF THE VOTE. ANY ACTUAL OR PERCEIVED VIOLATION BY A RESPONSIBLE PERSON OF THIS CONFLICT OF INTEREST POLICY SHOULD BE BROUGHT TO THE ATTENTION OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15A THE CHIEF EXECUTIVE OFFICER'S SALARY IS DETERMINED AND APPROVED BY THE BOARD OF THE ORGANIZATION. A FIRM SPECIALIZING IN EXECUTIVE LEVEL COMPENSATION WAS ENGAGED TO REVIEW AND BENCHMARK TO LOCAL INDUSTRY STANDARDS AND TRENDS. WHEN COMPARING AND ANALYZING DATA, THE FIRM MAY MAKE RECOMMENDATIONS TO THE COMPENSATION COMMITTEE REGARDING THE SALARY GRADES AND RANGES. THE COMPENSATION COMMITTEE REVIEWS THE SALARY GRADES AND RANGES AND HAS THE RESPONSIBILITY OF APPROVING THEM. THE DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 ONE COMMUNITY HEALTH'S ANNUAL REPORT IS PLACED ON OUR WEBSITE, WWW.ONECOMMUNITYHEALTH.COM. ONE COMMUNITY HEALTH'S AUDITED FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE AVAILABLE FOR INSPECTION AT OUR OFFICES LOCATED AT 1500 21ST STREET, SACRAMENTO CA 95811. FORM 990, PART IX, LINE 11G DOCTORS: PROGRAM SERVICE EXPENSES 2,110,110. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,110,110. PHARMACY: PROGRAM SERVICE EXPENSES 3,053,180. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,053,180. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 523,543. MANAGEMENT AND GENERAL EXPENSES 1,066,114. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,589,657.