2020-10-01T20:42:22-07:00 2019-12-31 472251777 CHW LLP 7797 N First Street Suite 15 Fresno CA 93720 990 2019-01-01 942279011 Western Sierra Medical Clinic WEST 5302734984 844 Old Tunnel Road Grass Valley CA 95945 Jessica Lance CFO 5302739339 2020-05-08 1 Jeremy Ware P00642659 5595495400 2020-04-29 172.58.35.167 2019 2021-01-29 14:40:06Z WSMC 844 Old Tunnel Road Grass Valley CA 95945 14597327 0 X www.wsmcmed.org X 1975 CA The Clinic's specific purpose is to provide quality health care and related charitable and educational opportunities to people of all ages and incomes, living in Western Sierra and Nevada Counties. This purpose includes medical and preventive health services, long-term care and education concerning health care needs and issues. 11 11 0 0 0 0 2422577 2648951 12310006 11721237 0 74927 159491 152212 14892074 14597327 0 0 0 0 8481093 8710937 0 0 0 5084851 6465463 13565944 15176400 1326130 -579073 10818720 11250493 6137737 7112521 4680983 4137972 The Clinic's specific purpose is to provide quality health care and related charitable and educational opportunities to people of all ages and incomes, living in Placer, Sierra and Nevada Counties. This purpose includes medical and preventive health services, long-term care and education concerning health care needs and issues. 0 0 12203802 0 11721237 In 2019, 16,008 patients were served with 61,012 unique service encounters. Providing accessible, quality medical, dental and behavioral health services through innovative, patient-centered care in our communities. 0 0 0 12203802 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Jessica Lance Western Sierra Medical Clinic 5302734984 844 Old Tunnel Road Grass Valley CA 95945 Christina Lasich Chief Medical Officer 40 0 X 271948 0 8412 William S McFarland Chief Executive Officer 40 0 X 246597 0 14851 Zarkasht Fakiri Physician 40 0 X 243098 0 14751 Juan A Chavez Dentist 40 0 X 205735 0 15309 Thomas Jacobs Podiatrist 40 0 X 194768 0 8827 Susan E Shapiro Physician 40 0 X 184907 0 6141 Andrew Harris Chief Administrative Officer 32 0 X 166008 0 5605 Monte Penner Physician 40 0 X 159338 0 7471 Jessica Lance Chief Financial Officer 40 0 X 80333 0 4411 Larry Allen President 1 0 X 0 0 0 Scott Browne Vice President 1 0 X 0 0 0 Derek Williams Treasurer 1 0 X 0 0 0 Anita Daniels Secretary 1 0 X 0 0 0 Doug McDonald Director 1 0 X 0 0 0 Phyllis Murdock Director 1 0 X 0 0 0 Robert Oldham Director 1 0 X 0 0 0 Brandon Pagman Director 1 0 X 0 0 0 Jon Peek Director 1 0 X 0 0 0 Lupe Peterson Director 1 0 X 0 0 0 Don Russell Director 1 0 X 0 0 0 Jeff Rosenberg Director 1 0 X 0 0 0 Linda Greenlee Director 1 0 X 0 0 0 1752732 0 85778 16 0 1 0 Barton Associates Inc PO Box 417844 Boston MA 02241 Locums Tenens Staffing 1269781 1 0 0 0 0 2442472 206479 0 2648951 Net patient service revenue 621400 10992231 10992231 0 0 729006 729006 0 0 11721237 74927 0 0 74927 0 0 0 0 0 0 0 0 0 0 0 0 0 152212 152212 0 0 152212 14597327 11873449 0 74927 X 764886 764886 5986327 5063410 922917 154617 103983 50634 1235198 1064561 170637 569909 418007 151902 1635177 1488257 146920 47433 47433 132338 132338 1400896 1400896 0 20911 17147 3764 27691 22707 4984 0 0 0 671662 550763 120899 102240 83837 18403 688 564 124 333604 273555 60049 404638 331803 72835 94771 77712 17059 Supplies 1025029 840524 184505 0 Professional fees 871 714 157 0 567514 465362 102152 15176400 12203802 2972598 0 149626 37606 3009124 3120075 113466 149951 1237850 1245076 173982 0 42500 17500 9197364 2771370 5832979 6425994 259193 254291 10818720 11250493 961303 1359232 73882 5176434 5679407 0 0 6137737 7112521 X 4680983 4137972 0 0 4680983 4137972 10818720 11250493 -579073 36062 0 0 0 0 X 0 1 X 1 1 1 X 0 340721 340721 0 7164234 2771370 4392864 0 210610 0 210610 0 1479849 0 1479849 0 1950 0 1950 6425994 0 X 14597327 0 0 0 0 0 14597327 0 0 0 14597327 15176400 0 0 0 0 0 15176400 0 0 0 15176400 Schedule D, Part X, Line 2 Income Taxes: The Center is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal corporate income taxes on related income pursuant to Section 501(a) of the Code. The Center is also exempt from State corporate income taxes. The Center's returns are subject to examination by federal and state taxing authorities generally for three years after they are filed. X 0 0 0 0 0 0 0 0 0 William S McFarland Chief Executive Officer 246597 0 0 0 14851 0 0 0 0 0 261448 0 0 0 Christina Lasich Chief Medical Officer 259448 0 12500 0 8412 0 0 0 0 0 280360 0 0 0 Zarkasht Fakiri Physician 236462 0 6636 0 14751 0 0 0 0 0 257849 0 0 0 Juan A Chavez Dentist 205235 0 500 0 15309 0 0 0 0 0 221044 0 0 0 Form 990, Part VI, Section B, Line 11b The Finance Committee of the board of directors reviews the Form 990 for accuracy and completeness. The Chairman of the committee presents it to the board of directors and makes a copy available to all members of the full board. Typically, this is done prior to filing, but can be done after, if time does not allow prior to Form 990 being filed. Form 990, Part VI, Section B, Line 12c The conflict of interest policy is reviewed by the board with an updated conflict of interest form completed annually. Periodically throughout the year as business is conducted and conflicts noted, the Policy is revisited and conflicting parties are asked to abstain from vote. Form 990, Part VI, Section B, Line 15 The annual CPCA Salary Survey is compared to all employees compensation annually to confirm base salary ranges. All officers and key employees are evaluated annually by a supervisor and any increases are based on evaluations. Form 990, Part VI, Section C, Line 19 Available upon request. Form 990, Part IX, Line 11g Purchased and professional fees.