2024-09-30T16:15:02-05:00 2023-12-31 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2023-01-01 237310613 WEST COUNTY HEALTH CENTERS INC WEST 7078695977 PO BOX 1449 GUERNEVILLE CA 95446 JASON CUNNINGHAM DO CHIEF EXECUTIVE OFFICER 7078695977 2024-09-30 1 0 MICHAEL LUMSDEN P01262236 4159561500 2024-09-30 2023 2024-10-15 13:58:12Z JASON CUNNINGHAM DO PO BOX 1449 GUERNEVILLE CA 95446 25431018 0 X WWW.WCHEALTH.ORG X 1973 CA WEST COUNTY HEALTH CENTERS INC. IS A PRIVATE, NON-PROFIT FEDERALLY QUALIFIED HEALTH CENTER PROVIDING QUALITY HEALTH SERVICES TO THE WHOLE COMMUNITY REGARDLESS OF ABILITY TO PAY. 13 13 258 13 0 0 9915724 6707663 17933731 18513785 48958 136635 75854 72935 27974267 25431018 0 0 0 0 15135167 16249820 0 0 2400 10798991 11481750 25934158 27731570 2040109 -2300552 29215576 29779485 13708710 16568280 15506866 13211205 X TO PROVIDE COMPREHENSIVE, QUALITY, AND ACCESSIBLE HEALTH CARE SERVICES TO THE COMMUNITIES OF WESTERN SONOMA COUNTY. 0 0 19919765 0 18513785 WEST COUNTY HEALTH CENTER OFFERS A FULL SCOPE OF PRIMARY MEDICAL, DENTAL CARE, AND MENTAL HEALTH SERVICES WITHIN WESTERN SONOMA COUNTY. OUR HIGHLY QUALIFIED HEALTH CARE TEAM CONSISTS OF PHYSICIANS, MID-LEVEL PROVIDERS (FAMILY NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS), DENTISTS, PSYCHOTHERAPISTS, AND NURSES, AND ARE SUPPORTED BY MEDICAL AND DENTAL ASSISTANTS, OUTREACH WORKERS, AND ADMINISTRATIVE STAFF. ALL OF OUR EMPLOYEES ARE COMMITTED TO PROVIDING COMPASSIONATE AND ACCESSIBLE CARE FOR ALL MEMBERS OF OUR DIVERSE COMMUNITY. MANY OF OUR STAFF MEMBERS ARE BILINGUAL IN SEVERAL LANGUAGES, INCLUDING SPANISH AND VIETNAMESE. WEST COUNTY HEALTH CENTERS DELIVERS HEALTH CARE TO AN IMPORTANT CROSS-SECTION OF OUR COMMUNITY, INCLUDING ELEMENTARY AGE CHILDREN WHOSE PARENTS CANNOT OTHERWISE AFFORD THE MEDICAL CARE NEEDED TO KEEP THEM HEALTHY AND ACTIVE IN SCHOOLS; THOSE WHO ARE NOT ACCEPTED ELSEWHERE DUE TO HIV/AIDS, HOMELESSNESS, MENTAL ILLNESS OR ADDICTION; THOSE IN THE COMMUNITY WHO LACK THE FINANCIAL RESOURCES TO PAY FOR QUALITY HEALTH CARE; AS WELL AS MANY OTHERS. NO PATIENT IS TURNED AWAY FROM WEST COUNTY HEALTH CENTER FOR LACK OF FUNDS. 19919765 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 29 0 1 258 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ROBERT HEINEMEIER 7078695977 PO BOX 1449 GUERNEVILLE CA 95446 JASON CUNNINGHAM DO CHIEF EXECUTIVE OFFICER 40.00 X 245245 0 16941 CONSTANCE EARL DO CMO - INNOVATIONS & OPERATIONS 40.00 X 237405 0 16786 RAIN MOORE MD CMO - COMMUNITY HEALTH & ADVOCACY 40.00 X 217796 0 13793 DAVID THAI DDS DENTAL DIRECTOR 40.00 X 204332 0 14162 MICHAEL KOZART PHYSICIAN 40.00 X 209321 0 5150 ANDREA SEIFFERTT DO PHYSICIAN 40.00 X 184858 0 13604 VALERIE EBEL MD PHYSICIAN 40.00 X 182086 0 13691 BROOKE VEZINO MD PHYSICIAN 40.00 X 176974 0 15332 JARED GARRISON-JAKEL MD PHYSICIAN 40.00 X 175004 0 13613 DEETTE DEVILLE MD CMO - PROVIDER SUSTAINABILITY 40.00 X 173787 0 14822 ELLEN BAUER PHD CHIEF ADMINISTRATIVE OFFICER 40.00 X 172400 0 12848 ROBERT HEINEMEIER CHIEF FINANCIAL OFFICER 40.00 X 0 0 0 JOHN KORNFELD PHD PRESIDENT 1.00 X X 0 0 0 DEBRA JOHNSON VICE PRESIDENT 1.00 X X 0 0 0 MARY FELTON RN MSN BOARD SECRETARY 1.00 X X 0 0 0 DWIGHT CARY TREASURER 1.00 X X 0 0 0 ANGELES DAVID BOARD MEMBER 1.00 X 0 0 0 ELIOT ENRIQUEZ BOARD MEMBER 1.00 X 0 0 0 ALICE FIDDIAN-GREEN BOARD MEMBER 1.00 X 0 0 0 PAULETTE HALL BOARD MEMBER 1.00 X 0 0 0 HENRY JAKE HAMLIN BOARD MEMBER 1.00 X 0 0 0 JENNIFER NICHOLS BOARD MEMBER 1.00 X 0 0 0 WHITNEY REULING BOARD MEMBER 1.00 X 0 0 0 ALAN SIEGLE BOARD MEMBER 1.00 X 0 0 0 MERI HARDING STORINO BOARD MEMBER 1.00 X 0 0 0 2179208 0 150742 33 0 1 0 KLH CONSULTING INC 2324 BETHARDS DRIVE SANTA ROSA CA 95405 CONSULTING - IT SERVICES 675163 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 CONTRACTED MEDICAL PROVIDERS 506607 SCANSTAT TECHNOLOGIES PO BOX 201327 DALLAS TX 753201327 CONTRACTED - REFERRALS SERVICE 480212 MAXIMON VENTURES LLC 900 PACIFIC COAST HWY STE 105 HUNTINGTON BEACH CA 92648 CONSULTING-CFO/COO/CSO/IT/CASE MGMT 434770 DR CATALYST LLC PO BOX 255436 SACRAMENTO CA 95865 CONTRACTED - VIRTUAL SERVICES 240235 10 4661773 2045890 6707663 NET PATIENT SERVICE REVENUE 621400 12658197 12658197 340B PHARMACY REVENUE 456110 5175866 5175866 CAPITATION REVENUE 621400 507920 507920 OTHER REVENUE 523000 171802 171802 18513785 123545 123545 13090 13090 72935 0 72935 72935 72935 25431018 18513785 0 209570 1340318 892884 447434 12218651 9993531 2225120 194768 160086 34682 1511172 1223403 287769 984911 791670 193241 13300 677 12623 75832 75832 2637966 176955 2458611 2400 394558 95514 299044 44771 39932 4839 1182176 19436 1162740 1552540 1346845 205695 37243 6224 31019 77124 59772 17352 366301 345329 20972 1088752 986717 102035 245389 191222 54167 MEDICAL SUPPLIES/DRUGS 3674647 3557581 117066 DUES, FEES, MEMBERSHIPS 63369 8168 55201 EQUIPMENT EXPENSES 18604 17214 1390 TAXES & LICENSES 9178 6605 2573 27731570 19919765 7809405 2400 306717 52859 5569631 3630572 435375 728138 2979731 2928446 386682 504114 343895 407052 21281794 4184795 17983278 17096999 195879 255573 1014388 4175732 29215576 29779485 1886290 2251732 329473 734517 9658403 9454958 430113 406627 1404431 3720446 13708710 16568280 X 15261898 12732747 244968 478458 15506866 13211205 29215576 29779485 -2300552 4891 0 X 0 1 X 1 1 1 X 8441909 9712542 10808632 9915724 6707663 45586470 8441909 9712542 10808632 9915724 6707663 45586470 2820170 42766300 52088 27536 36305 78118 209570 403617 46694 46694 46036781 73080549 0.92900 0.96820 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INSURANCE PROCEEDS - 2022 AMOUNT: $ 46,694. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7500 7500 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: DURING 2023, THE ORGANIZATION PAID DUES TO THE CALIFORNIA PRIMARY CARE ASSOCIATION; A PORTION OF THOSE DUES ($7,500) HAVE BEEN INDICATED AS USED FOR LOBBYING ACTIVITIES PERTAINING TO THE HEALTHCARE INDUSTRY. 1095744 1095744 16546330 2467288 14079042 1433544 873760 559784 1907156 843747 1063409 299020 299020 17096999 DEPOSITS 33188 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1017958 OPERATING LEASE RIGHT-OF-USE ASSETS 3124586 4175732 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 546864 OPERATING LEASE LIABILITIES 3173582 3720446 X 25435909 4891 4891 25431018 0 25431018 27731570 0 27731570 0 27731570 PART X, LINE 2: THE CENTER IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUSES BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF DECEMBER 31, 2023, THE CENTER HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. X X 0 0 0 0 0 0 0 0 0 JASON CUNNINGHAM DO CHIEF EXECUTIVE OFFICER 245245 0 0 0 0 0 5137 0 11804 0 262186 0 0 0 CONSTANCE EARL DO CMO - INNOVATIONS & OPERATIONS 207165 0 30240 0 0 0 4982 0 11804 0 254191 0 0 0 RAIN MOORE MD CMO - COMMUNITY HEALTH & ADVOCACY 194563 0 23233 0 0 0 4356 0 9437 0 231589 0 0 0 DAVID THAI DDS DENTAL DIRECTOR 187683 0 16649 0 0 0 4087 0 10075 0 218494 0 0 0 MICHAEL KOZART PHYSICIAN 208321 0 1000 0 0 0 4186 0 964 0 214471 0 0 0 ANDREA SEIFFERTT DO PHYSICIAN 163048 0 21810 0 0 0 3682 0 9922 0 198462 0 0 0 VALERIE EBEL MD PHYSICIAN 146401 0 35685 0 0 0 3642 0 10049 0 195777 0 0 0 BROOKE VEZINO MD PHYSICIAN 157371 0 19603 0 0 0 3770 0 11562 0 192306 0 0 0 JARED GARRISON-JAKEL MD PHYSICIAN 158912 0 16092 0 0 0 3500 0 10113 0 188617 0 0 0 DEETTE DEVILLE MD CMO - PROVIDER SUSTAINABILITY 161703 0 12084 0 0 0 3746 0 11076 0 188609 0 0 0 ELLEN BAUER PHD CHIEF ADMINISTRATIVE OFFICER 172400 0 0 0 0 0 3448 0 9400 0 185248 0 0 0 A CALIFORNIA MUNICIPAL FINANCE AUTHORITY 201563466 13048VQH4 2020-10-14 10519473 CONSTRUCTION OF NEW HEALTH CENTER BUILDING 0 0 0 A 185000 10519473 279202 210389 519600 9351646 158636 2022 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S CHIEF FINANCIAL OFFICER AND CHIEF OPERATIONS & STRATEGY OFFICER ARE CONSULTANTS EMPLOYED BY MAXIMON VENTURES, LLC. TOTAL COMPENSATION PAID TO MAXIMON VENTURES, LLC DURING THE 2023 TAX YEAR WAS $434,770 AND INCLUDED $280,000 FOR THE SERVICES OF THE CHIEF FINANCIAL OFFICER AND $41,000 FOR THE SERVICES OF THE CHIEF OPERATIONS & STRATEGY OFFICER; THE REMAINDER WAS PAID TO MAXIMON VENTURES, LLC IN EXCHANGE FOR VARIOUS IT AND CASE MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT TAX ACCOUNTANT IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING STAFF. A DRAFT FORM 990 IS PREPARED AND REVIEWED BY THE CFO; ADJUSTMENTS ARE MADE (AS NECESSARY). A COMPLETE COPY OF THE FORM 990 IS THEN MADE AVAILABLE TO THE ENTIRE BOARD FOR REVIEW AND COMMENT PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY WHICH COVERS ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. UNDER THE POLICY, EACH BOARD MEMBERS IS REQUIRED TO COMPLETE AN ANNUAL CONFLICT-OF-INTEREST DISCLOSURE STATEMENT; ADDITIONAL, EACH OFFICER AND KEY EMPLOYEE IS REQUIRED TO PROVIDE A WRITTEN DISCLOSURE OF REAL OR APPARENT CONFLICTS WHEN THEY ARISE. THE COMPLETED STATEMENTS ARE PROVIDED TO THE CHIEF EXECUTIVE OFFICER AND BOARD CHAIR FOR THEIR REVIEW AND ARE MAINTAINED IN THE BOARD RECORDS. SHOULD AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST BE IDENTIFIED, THE CEO (IN THE CASE OF AN EMPLOYEE) OR THE BOARD CHAIR (IN THE CASE OF BOARD MEMBERS AND/OR THE CEO) SHALL VOTE ON WHETHER TO PROCEED WITH THE POTENTIAL TRANSACTION OR ARRANGEMENT. CONFLICTED INDIVIDUALS ARE NOT ALLOWED TO PARTICIPATE IN THE DELIBERATION OR DECISION IN REGARDS TO THE POTENTIAL OR ACTUAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEWS THE CEO'S COMPENSATION ANNUALLY, UTILIZING PUBLICLY AVAILABLE COMPENSATION INFORMATION OF SIMILARLY SITUATED EMPLOYEES IN SIMILAR ORGANIZATIONS TO SUBSTANTIATE ITS DECISION. SALARIES FOR ALL REMAINING OFFICERS AND KEY EMPLOYEES ARE DETERMINED BY THE CEO, WHO UTILIZES PUBLICLY AVAILABLE COMPENSATION INFORMATION OF SIMILARLY SITUATED EMPLOYEES. IN ADDITION, THE BOARD APPROVES ANNUAL SALARY INCREASES FOR ALL STAFF DURING THE BUDGETING PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.