2022-05-16T12:56:46-05:00 2021-06-30 330700332 VASQUEZ & CO LLP 655 N CENTRAL AVE STE 1550 GLENDALE CA 91203 990 2020-07-01 953137803 WILMINGTON COMMUNITY CLINIC WILM 3105491123 1009 N AVALON BLVD WILMINGTON CA 90744 DOLORES BONILLA CEO 3105495760 2022-05-13 1 DOLORES BONILLA 999009999 REGINA PRINCE CPA P00576936 2138731700 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DOLORES BONILLA 1009 N AVALON BLVD WILMINGTON CA 90744 10474977 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. 11 10 101 75 0 0 2821765 5725809 4359475 4747049 58 81 17993 2038 7199291 10474977 0 0 0 0 5057315 5596274 0 0 41069 1963767 2462110 7021082 8058384 178209 2416593 4513588 6510838 1756422 1458922 2757166 5051916 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 5326643 4625206 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 38,227 VISITS OF HEALTH CARE TO 7,858 INDIVIDUALS FOR THE FISCAL YEAR 2020-2021. 5326643 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 1 0 0 1 0 0 0 0 0 0 0 0 1 23 0 1 101 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X THE ORGANIZATION 3105491123 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/PRESIDENT 1.00 X X 50000 0 0 BYRON LANE BOARD VICE PRESIDENT 1.00 X X 0 0 0 YAMILET MEDRANO BOARD SECRETARY 1.00 X X 0 0 0 PATRICIA SISON BOARD MEMBER 1.00 X 0 0 0 ASHLEY MORRIS BOARD MEMBER 1.00 X 0 0 0 DOLORES BONILLA CEO 40.00 X 164088 0 16541 CHARLES RO CFO 40.00 X 143426 0 12445 JERRY CARNEGIE CHIEF OPERATING OFFICER 40.00 X 133433 0 6541 SUSAN BALLAGH CHIEF MEDICAL OFFICER 32.00 X 135259 0 6997 CHAYNARA TOBAY MD PHYSICIAN 40.00 X 239039 0 7023 DR WAYMAN MERRILL PHYSICIAN 40.00 X 231311 0 0 DR MARCO GARCIA PHYSICIAN 40.00 X 166211 0 12820 CRYSTAL MACIEL ASSOCIATE MEDICAL DIRECTOR 40.00 X 152900 0 11144 ANGELA LEE PA PHYSICIAN ASSISTANCE 40.00 X 150416 0 8142 DR THERESA LIN DENTAL DIRECTOR 40.00 X 141175 0 12092 1707258 0 93745 13 0 1 0 PRINCIPAL LIFE INSURANCE PO BOX 14526 DES MOINES IA 50392 403B ADMINISTRATOR 312450 CALIFORNIA CHOICE PO BOX 7088 ORANGE CA 92863 HEALTH PLAN ADMINISTRATOR 295098 BENCHMARK INFO TECH 3454 E ANAHEIM STREET LONG BEACH CA 90804 IT SERVICES 224078 QUALITY REFRIGERATION CO 3454 E ANAHEIM STREET LONG BEACH CA 90804 HVAC SERVICE 133152 QUEST PO BOX 912411 PASADENA CA 91110 COVID TESTING SERVICES 124027 5 5251639 474170 121843 5725809 CAPITATION REVENUES 621400 2564896 2564896 NET PATIENT SERVICES 621400 2060096 2060096 340B PROGRAM REVENUES 621400 122057 122057 4747049 81 81 OTHER INCOME 900099 2038 2038 2038 10474977 4747049 0 2119 X 668730 445372 223358 4179829 2783540 1396289 397183 264505 132678 350532 233438 117094 2704 1801 903 1379674 892042 447543 40089 189051 125417 62910 724 214097 123061 91036 1263 671 336 256 3317 2209 1108 143132 95319 47813 59452 39592 19860 MEDICAL AND DENTAL SUPP 214799 143046 71753 PHARMACEUTICALS 73916 49225 24691 PATIENT SERVICES 38082 25361 12721 MEMBERSHIP DUES 37377 24891 12486 105246 77153 28093 8058384 5326643 2690672 41069 1910361 3237749 160047 160127 87166 239572 741523 939580 109916 95045 3494085 1655320 1504575 1838765 4513588 6510838 853998 886350 70227 40376 832197 532196 1756422 1458922 X 2757166 5051916 2757166 5051916 4513588 6510838 2416593 0 X 0 1 X 1 1 1 X 0.99820 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 300000 300000 300067 300067 0 1718348 804693 913655 1175670 550560 625110 1838765 SETTLEMENT TO THIRD PARTY 532196 532196 X 10389309 36175 36175 10353134 0 10353134 8094559 36175 36175 8058384 0 8058384 PART X, LINE 2: THE CLINIC IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SECTION 23701 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. IN ADDITION, THE CLINIC HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. 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, 2021, THE CLINIC HAD NO MATERIAL UNRECOGNIZED TAX BENEFITS, TAX PENALTIES OR INTEREST. AS OF JUNE 30, 2021, INFORMATION RETURNS SUBSEQUENT TO 2017 FILED BY THE CLINIC ARE SUBJECT TO EXAMINATION BY THE TAXING AUTHORITIES. X X X 0 0 0 0 0 0 0 0 0 CHAYNARA TOBAY MD PHYSICIAN 235429 0 3610 0 0 0 0 0 7023 0 246062 0 0 0 DR WAYMAN MERRILL PHYSICIAN 225961 0 5350 0 0 0 0 0 0 0 231311 0 0 0 DOLORES BONILLA CEO 162063 0 2025 0 0 0 8046 0 8495 0 180629 0 0 0 DR MARCO GARCIA PHYSICIAN 161978 0 4233 0 0 0 7835 0 4985 0 179031 0 0 0 CRYSTAL MACIEL ASSOCIATE MEDICAL DIRECTOR 150419 0 2481 0 0 0 7248 0 3896 0 164044 0 0 0 ANGELA LEE PA PHYSICIAN ASSISTANCE 145206 0 5210 0 0 0 0 0 8142 0 158558 0 0 0 CHARLES RO CFO 142380 0 1046 0 0 0 6804 0 5641 0 155871 0 0 0 DR THERESA LIN DENTAL DIRECTOR 139791 0 1384 0 0 0 6873 0 5219 0 153267 0 0 0 SHANNON CISCH BOARD CHAIR 50000 FUNDRAISING SERVICES 0 X 121843 COST OF SELLING PRICE 0 0 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 (NO < 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, AND VIOLATE THIS 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 15 WILMINGTON COMMUNITY CLINIC'S BOARD OF DIRECTORS HAS A PROCESS FOR REVIEWING AND APPROVING THE COMPENSATION OF OFFICERS AND KEY EMPLOYEES 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, OFFICERS, AND KEY EMPLOYEES INCLUDES THE APPROVAL OF THE COMPENSATION ARRANGEMENT IN ADVANCE, 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 & CONTRACTUAL FEES: PROGRAM SERVICE EXPENSES 892,042. MANAGEMENT AND GENERAL EXPENSES 447,543. FUNDRAISING EXPENSES 40,089. TOTAL EXPENSES 1,379,674. FORM 990, PART IX, LINE 24E TAXES & LICENSES: PROGRAM SERVICE EXPENSES 16,438. MANAGEMENT AND GENERAL EXPENSES 8,245. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,683. MEDICAL/OFFICE FURNITURE & EQUIPMENT: PROGRAM SERVICE EXPENSES 16,016. MANAGEMENT AND GENERAL EXPENSES 8,034. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,050. LAUNDRY: PROGRAM SERVICE EXPENSES 18,900. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,900. STAFF DEVELOPMENT: PROGRAM SERVICE EXPENSES 12,070. MANAGEMENT AND GENERAL EXPENSES 6,055. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,125. STORAGE: PROGRAM SERVICE EXPENSES 11,481. MANAGEMENT AND GENERAL EXPENSES 5,759. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,240. EDUCATIONAL MATERIALS: PROGRAM SERVICE EXPENSES 2,248. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,248.