2020-07-10T07:59:33-05:00 2019-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2018-07-01 421533531 EL DORADO COMMUNITY HEALTH CENTER ELDO 5306217700 4327 GOLDEN CENTER DRIVE PLACERVILLE CA 95667 JUDY STEIN FINANCE DIRECTOR 5303508201 2020-07-09 1 TERRI REXRODE CPA MST P00096513 9206620016 2020-07-09 184.97.211.65 2020-07-09 15:05:45 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7D2FE2EA17AC540A2D29D4112E82844D375299C1 2018 2020-09-22 18:59:49Z TERRI STRATTON 4327 GOLDEN CENTER DRIVE PLACERVILLE CA 95667 15883064 0 X WWW.EDCCHC.ORG X 2002 CA TO PROVIDE HEALTH & SOCIAL SERVICES TO PEOPLE IN THE EL DORADO COUNTY AREA. 15 15 167 15 0 0 3516798 3831220 13715779 11911704 0 200 145825 125240 17378402 15868364 0 0 0 0 9529090 11462181 0 0 4000 5220384 4872961 14749474 16335142 2628928 -466778 8147934 8728152 1590576 2637572 6557358 6090580 TO PROVIDE HEALTH & SOCIAL SERVICES TO PEOPLE IN THE EL DORADO COUNTY AREA TARGETED PRIMARILY TO THE MEDI-CAL AND UNINSURED POPULATION. 0 0 13458084 12035684 THE CENTER PROVIDED PRIMARY MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES TO OVER 11,832 PATIENTS AND PERFORMED OVER 65,871 MEDICAL, DENTAL AND BEHAVIORAL HEALTH VISITS. IN ADDITION, THE CENTER HAS A MAT (MEDICALLY ASSISTED TREATMENT) PROGRAM TO HELP PATIENTS WITH OPIOID USE DISORDER). 13458084 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 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 39 0 167 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JUDY STEIN 5303508201 3108 PONTE MORINO DRIVE SUITE 130 CAMERON PARK CA 95682 MICHAEL UNGEHEUER BOARD CHAIR 1.00 X X 0 0 0 DAVID HERYET BOARD MEMBER 1.00 X 0 0 0 KATHY KREJCI VICE CHAIR 1.00 X X 0 0 0 STAN STAILEY BOARD TREASURER 1.00 X X 0 0 0 DORIS BLUMENTHAL BOARD MEMBER 1.00 X 0 0 0 JOHN MCCOY - TERMED BOARD MEMBER 1.00 X 0 0 0 MARK HICKS BOARD MEMBER 1.00 X 0 0 0 JIM ZEEK BOARD MEMBER 1.00 X 0 0 0 JUNE STAILEY BOARD MEMBER 1.00 X 0 0 0 NANCY CAMPBELL - TERMED BOARD MEMBER 1.00 X 0 0 0 PATRICIA ROSE PEREZ BOARD MEMBER 1.00 X 0 0 0 JONAS KRIKSSCIUNAS BOARD MEMBER 1.00 X 0 0 0 CAROL HERRLIE MEMBER AT LARGE 1.00 X 0 0 0 FRANK VERDIN BOARD MEMBER 1.00 X 0 0 0 BRUCE CUNHA BOARD MEMBER 1.00 X 0 0 0 KEVIN MONSMA SECRETARY 1.00 X X 0 0 0 BEN YOUNG BOARD MEMBER 1.00 X 0 0 0 JUDY STEIN FINANCE DIRECTOR 40.00 X 134961 0 22511 TERRI STRATTON CEO 40.00 X 195723 0 5600 VERONICA VELASQUEZ-MORFIN MEDICAL DIRECTOR 40.00 X 272337 0 13860 CLINT COLLINS PHYSICIAN 40.00 X 238893 0 22323 MICHAEL NGO PHYSICIAN 40.00 X 226761 0 11062 ANDREA CASILLAS-CHAVEZ PHYSICIAN 40.00 X 215526 0 21631 DIANE BASS CLINICAL DIRECTOR 30.00 X 157557 0 11028 GENE GOWDEY DENTIST 40.00 X 179899 0 21731 1621657 0 129746 29 0 1 0 340 BASICS INC 309 FELLOWSHIP ROAD STE 200 MT LAUREL NJ 08054 ADMINISTRATION OF 340B PROGRAM 299182 PANOPTIC SERVICES INC PO BOX 526 PLACERVILLE CA 95667 NETWORK SUPPORT 196967 STAFF CARE INC PO BOX 281923 ATLANTA GA 30384 LOCUM SERVICE 153990 CENTURY BUILDING MAINTENANCE 2869 COLD SPRINGS ROAD PLACERVILLE CA 95667 JANITORIAL 126065 4 3456578 374642 3831220 MEDICARE/MEDI-CAL PAYMENTS 621400 8657671 8657671 PATIENT SERVICES 621400 2983481 2983481 PATIENT FEES 621400 270552 270552 11911704 15960 14700 1260 1260 1260 200 0 200 200 200 E.H.R. INCENTIVE 621110 123980 123980 123980 15868364 12035684 0 1460 662361 295981 366380 8914958 8148632 766326 84894 7824 77070 1119366 713281 406085 680602 415386 265216 20868 5000 15868 62900 62900 489801 276466 209335 4000 23739 5644 18095 581294 390755 190539 909689 754015 155674 54968 23212 31756 34852 16667 18185 188707 188707 155788 110003 45785 CLINIC EXPENSES 2064362 2054478 9884 BAD DEBT EXPENSE 170656 170656 RECRUITING EXPENSES 71206 44065 27141 44131 26019 18112 16335142 13458084 2873058 4000 3239750 465105 10771 87464 1184766 1580243 37298 165050 116519 5205505 1720109 1234796 3485396 2275503 2993425 8147934 8728152 1089881 1279381 65866 92670 434829 1265521 1590576 2637572 X 6557358 6090580 6557358 6090580 8147934 8728152 -466778 0 X X 0 1 X 1 1 1 X PART I, LINE 3 EL DORADO COMMUNITY HEALTH CENTER IS A NOT-FOR-PROFIT CORPORATION THAT PROVIDES HEALTHCARE SERVICES THROUGH MEDICAL, BEHAVIORAL HEALTH AND DENTAL CLINICS. ITS EXEMPT STATUS WAS APPROVED UNDER IRC 509(A) AND 170(B)(1)(A)(III). IT IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL AND THEREFORE IS NOT REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2001755 2001755 1638575 741269 897306 1141178 930746 210432 423997 48094 375903 3485396 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2993425 2993425 13999152 -1883912 -1883912 15883064 -14700 -14700 15868364 14465930 14700 14700 14451230 1883912 1883912 16335142 PART XI, LINE 2D - OTHER ADJUSTMENTS: 340B EXPENSES -1,713,256. PROVISION FOR BAD DEBT -170,656. PART XI, LINE 4B - OTHER ADJUSTMENTS: CELL TOWER EXPENSES -14,700. PART XII, LINE 2D - OTHER ADJUSTMENTS: CELL TOWER EXPENSES 14,700. PART XII, LINE 4B - OTHER ADJUSTMENTS: 340B EXPENSES 1,713,256. PROVISION FOR BAD DEBT 170,656. X X X X 0 0 0 0 0 0 0 0 0 JUDY STEIN FINANCE DIRECTOR 134429 0 325 0 207 0 3647 0 18864 0 157472 0 0 0 TERRI STRATTON CEO 188004 0 5325 0 2394 0 3647 0 1953 0 201323 0 0 0 VERONICA VELASQUEZ-MORFIN MEDICAL DIRECTOR 251587 0 17900 0 2850 0 5104 0 8756 0 286197 0 0 0 CLINT COLLINS PHYSICIAN 227529 0 5670 0 5694 0 4391 0 17932 0 261216 0 0 0 MICHAEL NGO PHYSICIAN 217035 0 5154 0 4572 0 4047 0 7015 0 237823 0 0 0 ANDREA CASILLAS-CHAVEZ PHYSICIAN 207046 0 5000 0 3480 0 3761 0 17870 0 237157 0 0 0 DIANE BASS CLINICAL DIRECTOR 140083 0 13400 0 4074 0 1910 0 9118 0 168585 0 0 0 GENE GOWDEY DENTIST 172905 0 6400 0 594 0 3329 0 18402 0 201630 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS STAN STAILEY AND JUNE STAILEY HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CFO BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF EL DORADO COUNTY COMMUNITY HEALTH CENTER (THE CENTER) THAT ALL DIRECTORS, OFFICERS, EMPLOYEES AND AGENTS SHALL DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST REGARDLESS OF WHETHER THE INDIVIDUAL THINKS A CONFLICT OF INTEREST ACTUALLY EXISTS. THE BOARD OF DIRECTORS AND THE LEADERSHIP TEAM AT THE CENTER REGULARLY DISCUSS WHETHER THERE IS A CONFLICT OF INTEREST IN DIFFERENT SITUATIONS IN THE CASE OF A POTENTIALLY CONFLICTED PERSON WHO IS A DIRECTOR OR THE CEO. THAT PERSON MAY MAKE A PRESENTATION TO THE BOARD REGARDING WHETHER HE OR SHE HAS A CONFLICT. THE BOARD WILL THEN DISCUSS AND VOTE ON WHETHER A CONFLICT OF INTEREST EXISTS. IN THE CASE OF AN EMPLOYEE, THE CEO WILL DECIDE WHETHER A CONFLICT EXISTS. IF THERE IS REASONABLE CAUSE TO BELIEVE THAT A DIRECTOR, OFFICER, EMPLOYEE OR AGENT HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE INDIVIDUAL SHALL BE INFORMED OF THE BASIS FOR SUCH BELIEF AND AFFORDED AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF AFTER HEARING THE RESPONSE OF THE INDIVIDUAL, THE BOARD OR CEO DETERMINES THE INDIVIDUAL HAS IN FACT FAILED TO DISCLOSE AN INTEREST, AN APPROPRIATE CORRECTIVE AND/OR DISCIPLINARY ACTION SHALL BE TAKEN. FORM 990, PART VI, SECTION B, LINE 15 ANNUAL SALARY SURVERY'S ARE CONDUCTED AND COMPILED BY CPCA WHICH ARE USED TO DETERMINE THE SALARY RANGE FOR EACH POSITION IN THE HEALTH CENTER. THE BOARD OF DIRECTORS APPROVED THE COMPENSATION PHILOSOPHY WHICH IS USING THE CPCA SALARY SURVEY TO COMBINE 2 CATEGORIES AND USING THE AVERAGE OF THEM. OUR SALARY RANGES ARE 105% OF THIS COMBINATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE OVERSIGHT PROCESS AND SELECTION PROCESS FOR THE AUDIT HAS NOT CHANGED