2023-05-16T16:09:57-05:00 2022-06-30 330700332 VASQUEZ COMPANY LLP 655 N CENTRAL AVE STE 1550 GLENDALE CA 91203 990 2021-07-01 953137803 WILMINGTON COMMUNITY CLINIC WILM 3105495760 1009 N AVALON BLVD WILMINGTON CA 90744 DOLORES BONILLA CEO 3105495760 2023-05-16 1 DOLORES BONILLA 999009999 REGINA PRINCE CPA P00576936 2138731700 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z DOLORES BONILLA 1009 N AVALON BLVD WILMINGTON CA 90744 8542644 0 X WWW.WILMINGTONCC.ORG X 1977 CA WILMINGTON COMMUNITY CLINIC PROVIDES QUALITY, NON-DISCRIMINATORY HEALTH SERVICES TO IMPROVE THE HEALTH AND WELL-BEING OF ALL SERVED, REGARDLESS OF THEIR ABILITY TO PAY. 10 9 111 40 0 0 5603966 4175990 4747049 4342764 81 90 2038 23800 10353134 8542644 0 0 0 0 5596274 5796154 0 72470 205483 2462110 2402332 8058384 8270956 2294750 271688 6510838 7177035 1458922 1853431 5051916 5323604 X WILMINGTON COMMUNITY CLINIC'S PRIMARY PURPOSES ARE TO PROVIDE FREE MEDICAL, PSYCHOLOGICAL, LEGAL, DENTAL, SOCIAL, VOCATIONAL END RELATED SERVICES TO THOSE REQUESTING SUCH SERVICES AND TO DEVELOP METHODS FOR BETTER SERVING THOSE MEMBERS OF THE COMMUNITY WHOSE NEEDS IN THE FOREGOING AREAS ARE NOT SERVED ADEQUATELY BY EXISTING FACILITIES AND TO OFFER ITS ENCOURAGEMENT AND ASSISTANCE TO OTHER ORGANIZATIONS WITH SIMILAR PURPOSES. 0 0 6741033 4342764 WILMINGTON COMMUNITY CLINIC PROVIDES COMPREHENSIVE MEDICAL CARE TO ADULTS, SENIOR CITIZENS, AND CHILDREN IN THE UNDERSERVED COMMUNITY OF WILMINGTON AND SURROUNDING AREAS IN THE GREATER LOS ANGELES AREA. THESE SERVICES INCLUDE PRIMARY AND GENERAL MEDICAL AND DENTAL CARE, MENTAL HEALTH, PEDIATRICS, WOMEN'S SERVICES, PRENATAL AND FAMILY PLANNING, HEALTH EDUCATION, AND NUTRITIONAL COUNSELING. HEALTHCARE IS PROVIDED SIX DAYS AND FOUR EVENINGS PER WEEK.THE CLINIC, A FEDERALLY QUALIFIED HEALTH CARE CENTER, PROVIDES SERVICES TO APPROXIMATELY 7,800 PATIENTS PER YEAR. PATIENTS ARE PRIMARILY LATINO, UNINSURED, UNEMPLOYED OR WORKING POOR; THE VAST MAJORITY LIVING WITH INCOMES BELOW FEDERALLY DESIGNATED POVERTY LEVELS AND LITTLE OR NO INSURANCE. WCC PROVIDED 36,704 VISITS OF HEALTH CARE TO 7,848 INDIVIDUALS FOR THE CALENDAR YEAR 2021. 6741033 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 18 0 1 111 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CA X CHARLES RO CFO 3105495760 1009 N AVALON BLVD WILMINGTON CA 90744 GRANT REED BOARD MEMBER 1.00 X 0 0 0 DANIEL VALDEZ BOARD MEMBER 1.00 X 0 0 0 DR XYLINA BEAN BOARD MEMBER 1.00 X 0 0 0 SHERIL GARZON BOARD MEMBER 1.00 X 0 0 0 DIANE KACER-MCCASLIN BOARD TREASURER 1.00 X X 0 0 0 GRETCHEN GOLDSMITH BASKERVILLE BOARD MEMBER 1.00 X 0 0 0 SHANNON CISCH BOARD CHAIR/PRES./FUNDRAISER 1.00 X X 65888 0 0 BYRON LANE BOARD VICE CHAIR 1.00 X X 0 0 0 YAMILET MEDRANO BOARD SECRETARY 1.00 X X 0 0 0 LUISA MORALES BOARD MEMBER 1.00 X 0 0 0 DOLORES BONILLA CEO 40.00 X 173609 0 17551 CHARLES RO CFO 40.00 X 155179 0 12453 JERRY CARNEGIE CHIEF OPERATING OFFICER 40.00 X 142382 0 6541 SUSAN BALLAGH CHIEF MEDICAL OFFICER 28.00 X 142032 0 7223 CHYNARA TOBAY MD PHYSICIAN 40.00 X 245597 0 7470 DR WAYMAN MERRILL PHYSICIAN 40.00 X 234251 0 0 DR MARCO GARCIA PHYSICIAN 40.00 X 165408 0 13482 CRYSTAL MACIEL ASSOCIATE MEDICAL DIRECTOR 40.00 X 164669 0 11840 DR THERESA LIN DENTAL DIRECTOR 40.00 X 163734 0 13470 1652749 0 90030 12 0 1 0 PRINCIPAL LIFE INSURANCE PO BOX 14526 DES MOINES IA 50392 403B ADMINISTRATOR 336360 CALIFORNIA CHOICE PO BOX 7088 ORANGE CA 92863 HEALTH PLAN ADMINISTRATOR 272955 OCHIN INC PO BOX 5426 PORTLAND OR 97228 HEALTH RECORDER SERVICE 260258 ROBERT HALF PO BOX 743295 LOS ANGELES CA 90074 TEMPORARY STAFFING SERVICE 253374 AMI HEALTHCARE STAFFING 401 WILSHIRE BVLD SU 1200 SANTA MONICA CA 90401 PROVIDER STAFFING SERVICE 193733 9 3752990 423000 4175990 CAPITATION REVENUES 621400 2292570 2292570 NET PATIENT SERVICES 621400 1995604 1995604 340B PROGRAM REVENUES 621400 54590 54590 4342764 90 90 OTHER INCOME 621400 23800 23800 23800 8542644 4342764 0 23890 X 656970 538145 104046 14779 4420267 3622409 698424 99434 330393 268933 54028 7432 388524 328751 51033 8740 26373 26373 39670 35653 4017 72470 72470 787266 707541 79725 157605 144619 10400 2586 178340 160280 18060 240168 236264 3904 2191 1355 794 42 2292 2292 158350 158350 66005 8688 57317 MEDICAL AND DENTAL SUPP 184460 184460 LABORATORY 172140 154708 17432 SECURITY 100060 89927 10133 PHARMACEUTICALS 90133 90133 197279 166875 30404 8270956 6741033 1324440 205483 3237749 4298330 160127 214470 239572 166000 922954 667260 95045 89830 3546243 1813670 1838765 1732573 16626 8572 6510838 7177035 886350 784793 40376 10580 532196 1058058 1458922 1853431 X 5051916 5323604 5051916 5323604 6510838 7177035 271688 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 300000 300000 2045071 809780 1235291 1201172 1003890 197282 1732573 SETTLEMENT TO THIRD PARTY 1058058 1058058 X 8578644 36000 36000 8542644 0 8542644 8306956 36000 36000 8270956 0 8270956 PART X, LINE 2: THE CLINIC IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SECTION 23701(D) OF THE CALIFORNIA REVENUE AND TAXATION CODE AND IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, THE CLINIC IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS, IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. GAAP REQUIRES THAT AN ORGANIZATION RECOGNIZE IN THE FINANCIAL STATEMENTS THE IMPACT OF A TAX POSITION IF THAT POSITION WILL MORE LIKELY THAN NOT BE SUSTAINED ON AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. AS OF AND FOR THE YEAR ENDED JUNE 30, 2022, THE CLINIC HAD NO MATERIAL UNRECOGNIZED TAX BENEFITS, TAX PENALTIES OR INTEREST. AS OF JUNE 30, 2022, INFORMATION RETURNS SUBSEQUENT TO 2018 FILED BY THE CLINIC ARE SUBJECT TO EXAMINATION BY THE TAXING AUTHORITIES. 0 SHANNON CISCH 1009 N AVALON BLVD WILMINGTON CA 90744 FUNDRAISING 0 0 72470 -72470 72470 -72470 X X 0 0 0 0 0 0 0 0 0 CHYNARA TOBAY MD PHYSICIAN 242164 0 3433 0 0 0 0 0 7470 0 253067 0 0 0 DR WAYMAN MERRILL PHYSICIAN 231080 0 3171 0 0 0 0 0 0 0 234251 0 0 0 DOLORES BONILLA CEO 170964 0 2645 0 0 0 8567 0 8984 0 191160 0 0 0 DR MARCO GARCIA PHYSICIAN 163431 0 1977 0 0 0 8164 0 5318 0 178890 0 0 0 DR THERESA LIN DENTAL DIRECTOR 160254 0 3480 0 0 0 7927 0 5543 0 177204 0 0 0 CRYSTAL MACIEL ASSOCIATE MEDICAL DIRECTOR 161617 0 3052 0 0 0 7811 0 4029 0 176509 0 0 0 CHARLES RO CFO 152603 0 2576 0 0 0 7611 0 4842 0 167632 0 0 0 SUSAN BALLAGH CHIEF MEDICAL OFFICER 140111 0 1921 0 0 0 6947 0 276 0 149255 0 0 0 JERRY CARNEGIE CHIEF OPERATING OFFICER 139979 0 2403 0 0 0 2400 0 4141 0 148923 0 0 0 SHANNON CISCH BOARD CHAIR 72471 FUNDRAISING SERVICES AT A DISCOUNTED RATE OF $75 PER HOUR. 0 FORM 990, PART VI, SECTION B, LINE 11B WILMINGTON COMMUNITY CLINIC'S CHIEF EXECUTIVE OFFICER AND CFO REVIEW THE FORM 990 FOR ACCURACY. SUBSEQUENTLY FORM 990, COMPLETE WITH ALL SCHEDULES, IS THEN PROVIDED TO THE FULL BOARD BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE PURPOSE OF THE ORGANIZATION'S CONFLICT OF INTEREST (COI) POLICY IS TO PREVENT THE INSTITUTIONAL OR PERSONAL INTERESTS OF WILMINGTON COMMUNITY CLINIC BOARD MEMBERS, EMPLOYEES, AGENTS, CONSULTANTS AND THOSE WHO FURNISH GOODS OR SERVICES TO THE ORGANIZATION ("INTERESTED PERSONS") FROM INTERFERING WITH THE PERFORMANCE OF THEIR DUTIES TO WILMINGTON COMMUNITY CLINIC, AND TO ENSURE THAT THERE IS NO PERSONAL, PROFESSIONAL, OR POLITICAL GAIN AT THE EXPENSE OF WILMINGTON COMMUNITY CLINIC. A CONFLICT OF INTEREST MAY EXIST WHEN THE INTERESTS OR POTENTIAL INTERESTS OF ANY INTERESTED PERSON OR THAT PERSON'S CLOSE RELATIVE, OR ANY INDIVIDUAL, GROUP, OR ORGANIZATION TO WHICH THE INTERESTED PERSON ASSOCIATED WITH WILMINGTON COMMUNITY CLINIC HAS ALLEGIANCE, MAY BE SEEN AS COMPETING WITH THE INTERESTS OF WILMINGTON COMMUNITY CLINIC, OR MAY IMPAIR SUCH INTERESTED PERSON'S INDEPENDENCE OR LOYALTY TO WILMINGTON COMMUNITY CLINIC. A CONFLICT OF INTEREST IS DEFINED AS AN INTEREST THAT MIGHT AFFECT, OR MIGHT REASONABLY APPEAR TO AFFECT, THE JUDGMENT OR CONDUCT OF ANY INTERESTED PERSON IN A MANNER THAT IS ADVERSE TO THE INTERESTS OF WILMINGTON COMMUNITY CLINIC. WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS ARE PROHIBITED FROM PARTICIPATING IN THE SELECTION, AWARD, OR ADMINISTRATION OF CONTRACTS, INCLUDING BUT NOT LIMITED TO, THOSE SUPPORTED BY FEDERAL FUNDS, IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE WILMINGTON COMMUNITY CLINIC INTERESTED PERSON OR THAT PERSON'S CLOSE RELATIVE, OR ANY INDIVIDUAL, GROUP, OR ORGANIZATION TO WHICH THE PERSON ASSOCIATED WITH WILMINGTON COMMUNITY CLINIC HAS ALLEGIANCE, HAS A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR AN AWARD. THE PROHIBITION DOES NOT APPLY TO SITUATIONS IN WHICH THE FINANCIAL INTEREST IS NOT SUBSTANTIAL (FOR EXAMPLE, AN OWNERSHIP INTEREST OF LESS THAN 5 PERCENT OF OUTSTANDING SECURITIES OF PUBLIC CORPORATIONS). WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS ARE PROHIBITED FROM SOLICITING OR ACCEPTING FOR THEIR OWN PERSONAL BENEFIT GRATUITIES, FAVORS, OR ANYTHING OF MONETARY VALUE FROM CONTRACTORS, OR PARTIES TO SUB-AGREEMENTS. THE PROHIBITION DOES NOT APPLY TO SITUATIONS IN WHICH THE GIFT IS AN UNSOLICITED ITEM OF NOMINAL VALUE (NOT > THAN $50). WILMINGTON COMMUNITY CLINIC INTERESTED PERSONS SHALL NOT USE INFORMATION RECEIVED FROM PARTICIPATION IN WILMINGTON COMMUNITY CLINIC AFFAIRS, WHETHER EXPRESSLY DENOMINATED AS CONFIDENTIAL OR NOT, FOR PERSONAL GAIN OR TO THE DETRIMENT OF WILMINGTON COMMUNITY CLINIC. WHENEVER THE CHIEF EXECUTIVE OFFICER OR ANY BOARD MEMBER HAS A CONFLICT OF INTEREST OR A PERCEIVED CONFLICT OF INTEREST WITH WILMINGTON COMMUNITY CLINIC, HE OR SHE SHALL NOTIFY THE FULL BOARD OF SUCH CONFLICT IN WRITING USING THE ANNUAL COI DISCLOSURE FORM. WHEN ANY CONFLICT OF INTEREST IS RELEVANT TO A MATTER THAT COMES UNDER CONSIDERATION OR REQUIRES ACTION BY THE BOARD, OR A BOARD COMMITTEE, THE INTERESTED PERSON SHALL CALL IT TO THE ATTENTION OF THE BOARD CHAIR AND SHALL NOT BE PRESENT DURING BOARD OR COMMITTEE DISCUSSION OR DECISION ON THE MATTER. HOWEVER, THAT PERSON SHALL PROVIDE THE BOARD OR APPLICABLE COMMITTEE WITH ANY AND ALL RELEVANT INFORMATION ON THE PARTICULAR MATTER. THE MINUTES OF THE MEETING OF THE BOARD OR ITS COMMITTEE SHALL REFLECT THAT THE CONFLICT OF INTEREST WAS DISCLOSED, THAT THE INTERESTED PERSON WAS NOT PRESENT DURING DISCUSSION OR DECISION ON THE MATTER, AND DID NOT VOTE. WHENEVER ANY INTERESTED PERSON, WHO IS NOT ALSO A BOARD MEMBER OR THE CHIEF EXECUTIVE OFFICER (FOR EXAMPLE, EMPLOYEES, CONTRACTORS AND CONSULTANTS), HAS A CONFLICT OF INTEREST OR A PERCEIVED CONFLICT OF INTEREST WITH WILMINGTON COMMUNITY CLINIC, HE OR SHE SHALL NOTIFY THE CHIEF EXECUTIVE OFFICER OF SUCH CONFLICT IN WRITING. INTERESTED PERSONS, EXCLUDING BOARD MEMBERS, WHO VIOLATE THE CONFLICT OF INTEREST POLICY INCLUDING THE STANDARDS OF CONDUCT MAY, DEPENDING ON THE SEVERITY OF THE VIOLATION, BE SUBJECT TO ORAL ADMONISHMENT, WRITTEN REPRIMAND, REASSIGNMENT, DEMOTION, SUSPENSION OR SEPARATION. INTERESTED PERSONS, WHO ARE ALSO BOARD MEMBERS, WHO VIOLATE THE CONFLICT OF INTEREST POLICY INCLUDING THE STANDARDS OF CONDUCT MAY, DEPENDING ON THE SEVERITY OF THE VIOLATION, BE SUBJECT TO ORAL ADMONISHMENT OR REMOVAL FROM THEIR POSITION. AS ADMINISTERED BY THE CHIEF EXECUTIVE OFFICER, EACH BOARD MEMBER WILL BE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND COMPLETE AN ANNUAL COI DISCLOSURE FORM TO DISCLOSE ANY KNOWN CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST UPON HIS OR HER ELECTION OR RE-ELECTION TO THE BOARD AND ANNUALLY THEREAFTER. THE BOARD AS APPROPRIATE SHALL REVIEW ALL BOARD MEMBER CERTIFICATIONS. AS ADMINISTERED BY THE EMPLOYEE IN CHARGE OF HUMAN RESOURCES, ALL INTERESTED PERSONS THAT ARE NOT BOARD MEMBERS WILL BE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND USE A COI DISCLOSURE FORM TO DISCLOSE ANY KNOWN CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST UPON HIS OR HER EMPLOYMENT OR ENGAGEMENT WITH WILMINGTON COMMUNITY CLINIC. FORM 990, PART VI, SECTION B, LINE 15A WILMINGTON COMMUNITY CLINIC'S BOARD OF DIRECTORS HAS A PROCESS FOR REVIEWING AND APPROVING THE COMPENSATION OF CEO ON A ANNUAL BASIS TO DETERMINE IT IS FAIR AND REASONABLE WITH THE GOAL OF RETAINING EMPLOYEES AT COMPENSATION LEVELS WITHIN APPROPRIATE MARKET RANGE. THE PROCESS FOR DETERMINING THE COMPENSATION PAID TO THE CEO, BY THE BOARD OF DIRECTORS, WITH ALL PERSONS WITH A CONFLICT OF INTEREST ABSTAINING FROM THE BOARD'S DELIBERATION AND DISCUSSION. THE BOARD REVIEWS DATA OF COMPARABLE COMPENSATION BASED ON CALIFORNIA PRIMARY CARE ANNUAL COMPENSATION SURVEY FOR CEO. THE DOCUMENTATION OF THE BOARD INCLUDES THE TERMS OF THE TRANSACTION AND THE DATE OF APPROVAL, THE MEMBERS WHO WERE PRESENT DURING THE DEBATE AND VOTE ON THE TRANSACTION, A DESCRIPTION OF THE COMPARABLE DATA AND HOW IT WAS OBTAINED, AND DOCUMENTATION OF THE BASIS FOR THE DETERMINATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. HOWEVER CURRENT TAX LAW DOES NOT REQUIRE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIALS BE PROVIDED TO THE PUBLIC. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 159,081. MANAGEMENT AND GENERAL EXPENSES 17,925. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 177,006. PAYROLL SERVICES: PROGRAM SERVICE EXPENSES 17,543. MANAGEMENT AND GENERAL EXPENSES 1,977. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,520. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 100,254. MANAGEMENT AND GENERAL EXPENSES 11,296. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 111,550. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 430,663. MANAGEMENT AND GENERAL EXPENSES 48,527. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 479,190. FORM 990, PART IX, LINE 24E STAFF DEVELOPMENT: PROGRAM SERVICE EXPENSES 31,362. MANAGEMENT AND GENERAL EXPENSES 23,375. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,737. PATIENT SERVICES: PROGRAM SERVICE EXPENSES 52,787. MANAGEMENT AND GENERAL EXPENSES 1,030. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,817. MEMBERSHIP DUES: PROGRAM SERVICE EXPENSES 4,880. MANAGEMENT AND GENERAL EXPENSES 27,988. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,868. MEDICAL FURNITURE & EQUIPMENT: PROGRAM SERVICE EXPENSES 22,157. MANAGEMENT AND GENERAL EXPENSES 115. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,272. STORAGE: PROGRAM SERVICE EXPENSES 18,719. MANAGEMENT AND GENERAL EXPENSES 2,013. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,732. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 15,629. MANAGEMENT AND GENERAL EXPENSES 1,761. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,390. LAUNDRY: PROGRAM SERVICE EXPENSES 17,087. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,087. EDUCATIONAL MATERIALS: PROGRAM SERVICE EXPENSES 2,569. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,569. TAXES & LICENSES: PROGRAM SERVICE EXPENSES 1,685. MANAGEMENT AND GENERAL EXPENSES -25,878. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -24,193.