2013-07-23T17:39:51-07:00 2012-12-31 202707086 TCA Partners LLP 1111 E Herndon Avenue Suite 211 Fresno CA 93720 990 2012-01-01 942279011 Western Sierra Medical Clinic WEST 5302739339 PO Box 286 209 Nevada Street Downieville CA 95936 Tom Morrissey 5302739339 2013-06-24 1 Jeremy Ware P00642659 5594317708 2013-06-24 2012 2016-02-24 21:20:13Z Scott McFarlane 1345 Whispering Pines Lane Grass Valley CA 95945 5492438 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 39,770 visits to 10,175 patients. 11 11 87 1 0 0 921229 863134 4738621 4458466 963 353 45329 170485 5706142 5492438 0 0 3778168 4133547 0 0 1817935 1989825 5596103 6123372 110039 -630934 2780348 2229648 946281 1026515 1834067 1203133 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. 0 0 4737917 0 5492438 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 39,770 visits to 10,175 patients. 0 0 0 4737917 1 0 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 65 0 1 87 1 0 0 0 0 0 0 X 11 11 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X Tom Morrissey Western Sierra Medical Clinic 5302734984 135 Whispering Pines Lane Grass Valley CA 95945 Larry Allen 2 0 X 0 0 0 Florence Lyss 2 0 X 0 0 0 Dick Kuwarth 2 0 X 0 0 0 Scotte Browne 2 0 X 0 0 0 Tim Beals 2 0 X 0 0 0 Anita Daniels 2 0 X 0 0 0 Katherine Madeiros 2 0 X 0 0 0 Jeannie Medley 2 0 X 0 0 0 Brandon Pangman 2 0 X 0 0 0 Jon Peek 2 0 X 0 0 0 Lupe Peterson 2 0 X 0 0 0 Don Russell 2 0 X 0 0 0 Derek Williams 2 0 X 0 0 0 Tom Morrissey 40 0 X 115437 0 0 Scott McFarland 40 0 X 195589 0 0 Frank Lang Jr 40 0 X 215879 0 0 Leann Watson 40 0 X 162422 0 0 Heather Lucas Ross 40 0 X 185821 0 0 Allen Kellerman 24 0 X 134680 0 0 Frank Lang Sr 40 0 X 175069 0 0 Galen Martin 24 0 X 109000 0 0 1293897 0 0 8 0 1 0 Sierra Nevada Memorial Hospital 1500 Glasson Way Grass Valley CA 95945 Purchased Services 272739 Cardinal Health 7000 Cardinal Place Dublin OH 43017 Pharmaceutical Supplies 163638 Sierra Care Physicians PO Box 459001 Grass Valley CA 95945 Pediatric and OnCall Services 132197 3 0 0 0 0 817004 46130 0 863134 Net Patient Service Revenue 621400 5265712 5265712 0 0 -807246 -807246 0 0 4458466 353 353 0 0 0 0 0 0 0 0 0 0 12731 0 0 0 12731 0 12731 12731 0 0 0 0 0 Meaningful Use Revenue 621400 127500 127500 0 0 30254 30254 0 0 157754 5492438 4629304 0 0 526905 86352 440553 2879172 2618588 260584 86116 65692 20424 372841 295634 77207 268513 221659 46854 303717 239625 64092 7319 2951 4368 25062 25062 424709 424709 8118 1815 6303 147864 12010 135854 393046 231073 161973 57076 19668 37408 41687 6808 34879 115199 88660 26539 29649 17932 11717 Medical Supplies 359165 352534 6631 0 Postage and Shipping 6657 1389 5268 0 Equipment Rental and Maitenance 27490 7751 19739 0 43067 43067 6123372 4737917 1385455 0 345042 242598 0 26490 0 246222 254645 87394 84616 125221 72759 2115622 972766 896455 1142856 1053524 432174 2780348 2229648 402600 445946 60306 18435 483375 562134 946281 1026515 X 1834067 1203133 0 0 0 0 1834067 1203133 2780348 2229648 -630934 0 0 0 0 0 X 0 1 X 1 1 1 X 0 275721 275721 0 855870 221457 634413 0 0 0 0 0 889429 751309 138120 0 94602 0 94602 1142856 Third Party Settlements 432174 432174 5492438 0 0 0 0 0 5492438 0 0 0 5492438 6123372 0 0 0 0 0 6123372 0 0 0 6123372 X X X 0 0 0 0 0 0 0 0 0 Frank Lang Jr 204201 0 7603 0 4075 0 -3200 0 -10903 0 201776 0 0 0 Scott McFarland 186649 0 2940 0 6000 0 -16979 0 -2336 0 176274 0 0 0 Heather Lucas Ross 178000 0 7821 0 0 0 -6000 0 -6932 0 172889 0 0 0 Frank Lang Sr Operating advance Operating advance X 22817 2139 0 1 1 2139 F990_P06_S0A_L02 Form 990, Part VI, Section A, Line 2 Anita Daniels, Board Member, relationship with Tri-Counties Bank. Katherine Madeiros, Board Member, indirect rent for SNMH. F990_P06_S0B_L11b 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. F990_P06_S0B_L12c 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. F990_P06_S0B_L15 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. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Available upon request.