2017-09-29T11:37:58-07:00 2016-12-31 472251777 CHW LLP 7797 N First Street Suite 15 Fresno CA 93720 990 2016-01-01 942279011 Western Sierra Medical Clinic WEST 5302739339 PO Box 286 209 Nevada Street Downieville CA 95936 Tom Morrissey CFO 5302739339 2017-09-12 1 Jeremy Ware P00642659 5595495400 2017-09-07 67.181.18.107 2016 2021-01-29 14:40:06Z Scott McFarland 844 Old Tunnel Road Grass Valley CA 95945 11421417 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. During the year, the Clinic provided over 53,278 visits to 13,703 patients. 11 11 150 0 0 0 1500795 2166196 7598162 8805838 29 1625 39857 447758 9138843 11421417 0 0 0 0 5678441 6744293 0 0 0 3161992 4361449 8840433 11105742 298410 315675 7615083 8712476 5673274 6454992 1941809 2257484 X 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. 1 1 8085451 0 8805838 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. During the year, the Clinic provided over 53,278 visits to 13,703 patients. 0 0 0 8085451 1 1 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 81 0 1 150 1 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 Tom Morrissey Western Sierra Medical Clinic 5302734984 844 Old Tunnel Road Grass Valley CA 95945 Larry Allen Board President 1 0 X 0 0 0 Robert Oldham Director 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 Katherine Madeiros Director 1 0 X 0 0 0 Brandon Pangman 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 Tom Morrissey CFO 40 0 X 110508 0 0 Heather Lucas Ross CMO 40 0 X 227598 0 0 Scott McFarland CEO 40 0 X 202747 0 20393 Karen Higgins Psychiatrist 40 0 X 224501 0 18000 Juan Chavez Dentist 40 0 X 186531 0 2500 Monte Penner MD 40 0 X 211206 0 14680 1163091 0 55573 13 0 1 0 Freschi Construction 12461 La Barr Meadows Road Grass Valley CA 95945 Contractor 469901 Barton Associates PO Box 417844 Boston MA 02241 Locums Tenens Staffing 607111 McKesson Medical Surgical PO Box 634404 Cincinnati OH 45263 Medical Supplies 221530 Sierra Care Physicians PO Box 459001 Grass Valley CA 95945 Purchased Services 134930 Cardinal Health PO Box 742946 Los Angeles CA 90074 Pharmaceutical 103083 6 0 0 -4396 0 1952550 218042 0 2166196 Net Patient Service Revenue 621400 8805838 8805838 0 0 0 0 0 0 8805838 1625 0 0 1625 0 0 0 0 0 0 0 0 15156 0 0 0 15156 0 15156 0 0 15156 0 0 -4396 432602 432602 0 0 432602 11421417 9238440 0 16781 540853 91039 449814 4988095 3997183 990912 107093 75533 31560 673432 512635 160797 434820 314281 120539 835709 783590 52119 59581 59581 30446 30446 798785 798785 97401 14442 82959 187469 9612 177857 349508 146243 203265 128969 59503 69466 343280 19842 323438 263338 167357 95981 48267 17436 30831 Postage and Shipping 10730 1426 9304 0 Equipment 45896 23571 22325 0 Medical Supplies 1022673 1022673 0 0 139397 30300 109097 11105742 8085451 3020291 0 675493 158387 600503 289893 940978 813848 99059 102189 66953 73747 8074211 1701006 5832600 6373205 300704 7615083 8712476 516982 800011 72858 10665 4928359 5494316 150000 155075 0 5673274 6454992 X 1941809 2257484 0 0 0 0 1941809 2257484 7615083 8712476 315675 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 275721 275721 0 5296544 1003413 4293131 0 190750 28649 162101 0 1251623 668944 582679 0 1059573 0 1059573 6373205 0 X 11421417 0 0 0 0 0 11421417 0 0 0 11421417 11105742 0 0 0 0 0 11105742 0 0 0 11105742 Schedule D, Part X, Line 2 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 X 0 0 0 0 0 0 0 0 0 Juan Chavez Dentist 176334 0 10197 0 0 0 2500 0 0 0 189031 0 0 0 Karen Higgins Psychiatrist 218402 0 6099 0 0 0 18000 0 0 0 242501 0 0 0 Heather Lucas Ross CMO 226519 0 14792 0 1500 0 6250 0 8963 0 258024 0 0 0 Monte Penner MD 202323 0 8883 0 0 0 3000 0 11680 0 225886 0 0 0 Scott McFarland CEO 212942 0 4198 0 6000 0 18000 0 2393 0 243533 0 0 0 Form 990, Part III, Line 2 WSMC expanded service in Placer County by opening two satelitte clinics in Auburn at 12183 Locksley Lane and 3111 Professional Drive. Form 990, Part III, Line 3 WSMC ceased operating their mobile van in September 2016. 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.