2021-09-09T09:18:28-05:00 2020-12-31 810385940 ANDERSON ZURMUEHLEN & CO PC PO BOX 748 BUTTE MT 59703 990 2020-01-01 942279011 WESTERN SIERRA MEDICAL CLINIC INC WEST 5302734984 844 OLD TUNNEL RD GRASS VALLEY CA 95945 JESSICA LANCE CFO 5302734984 2021-08-31 1 JESSICA LANCE 999009999 KIELY S THOEN CPA P01257958 4067820451 2021-08-31 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z JESSICA LANCE 844 OLD TUNNEL RD GRASS VALLEY CA 95945 16574297 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. THE PURPOSE INCLUDES MEDICAL AND PREVENTATIVE HEALTH SERVICES, LONG-TERM CARE AND EDUCATION CONCERNING HEALTH CARE NEEDS AND ISSUES. 13 13 164 23 0 0 2648951 6028317 11721237 9474915 74927 42009 152212 116330 14597327 15661571 0 0 0 0 8710937 8632749 0 0 0 6465463 5693010 15176400 14325759 -579073 1335812 11250493 12236237 7112521 6741298 4137972 5494939 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 PLACER, SIERRA AND NEVADA COUNTIES. THIS PURPOSE INCLUDES MEDICAL AND PREVENTATIVE HEALTH SERVICES, LONG-TERM CARE AND EDUCATION CONCERNING HEALTH CARE NEEDS AND ISSUES. 0 0 11457556 9597559 PROVIDING ACCESSIBLE, QUALITY MEDICAL, DENTAL, AND BEHAVIORAL HEALTH SERVICES THROUGH INNOVATIVE, PATIENT-CENTERED CARE IN OUR COMMUNITIES. IN 2020, 13,774 PATIENTS WERE SERVICES WITH 55,766 UNIQUE SERVICE ENCOUNTERS. 11457556 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 1 0 0 0 0 0 0 0 0 1 8 0 1 164 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X JESSICA LANCE WESTERN SIERRA MEDICAL CLINIC 5302734984 844 OLD TUNNEL ROAD GRASS VALLEY CA 95945 LARRY ALLEN PRESIDENT 1.00 X X 0 0 0 SCOTT BROWNE VICE PRESIDENT 1.00 X X 0 0 0 DEREK WILLIAMS TREASURER 1.00 X X 0 0 0 ANITA DANIELS SECRETARY 1.00 X X 0 0 0 DOUG MCDONALD DIRECTOR 1.00 X 0 0 0 PHYLLIS MURDOCK DIRECTOR 1.00 X 0 0 0 ROBERT OLDHAM DIRECTOR 1.00 X 0 0 0 BRANDON PAGMAN DIRECTOR 1.00 X 0 0 0 JON PEEK DIRECTOR 1.00 X 0 0 0 LUPE PETERSON DIRECTOR 1.00 X 0 0 0 DON RUSSELL DIRECTOR 1.00 X 0 0 0 JEFF ROSENBERG DIRECTOR 1.00 X 0 0 0 LINDA GREENLEE DIRECTOR 1.00 X 0 0 0 CHRISTINA LASICH CHIEF MEDICAL OFFICER 40.00 X 266471 0 8713 WILLIAM S MCFARLAND CHIEF EXECUTIVE OFFICER 40.00 X 133556 0 6968 ANDREW HARRIS CHIEF ADMINISTRATIVE OFFICER 40.00 X 193205 0 6470 JESSICA LANCE CHIEF FINANCIAL OFFICER 40.00 X 136287 0 12572 ZARKASHT FAKIRI PHYSICIAN 40.00 X 189918 0 11648 JUAN A CHAVEZ DENTIST 40.00 X 212770 0 16124 SHARON MCINTYRE PHYSICIAN 40.00 X 196139 0 13310 SUSAN E SHAPIRO PHYSICIAN 40.00 X 171636 0 5888 BAMIDELE OLATUNBOSUN ASSISTANT MEDICAL DIRECTOR 40.00 X 194759 0 5356 1694741 0 87049 22 0 1 0 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 LOCUMS TENENS STAFFING 508328 1 5738046 290271 290271 6028317 PATIENT SERVICE REVENUE 621400 6486298 6486298 PHARMACY REVENUE 621400 2287099 2287099 CAPITATION REVENUE 621400 701518 701518 9474915 35695 35695 11107 0 11107 11107 11107 919040 912492 234 6548 -234 6314 6314 OTHER INCOME 621400 105223 105223 105223 15661571 9597559 0 35695 X 6661318 5081463 1579855 137449 113095 24354 1223347 1006591 216756 610635 502440 108195 368330 368330 13376 13376 94747 94747 1779203 1458946 320257 15596 12789 2807 14161 11612 2549 739343 606262 133081 45408 37235 8173 12139 9954 2185 320590 262822 57768 313833 257343 56490 106127 87024 19103 SUPPLIES 1479384 1213095 266289 OTHER 356166 292054 64112 REPAIRS AND MAINTENANCE 34607 28378 6229 14325759 11457556 2868203 0 37606 503299 3120075 4066607 149951 309746 1245076 510763 17500 224350 9242757 2788564 6425994 6454193 254291 167279 11250493 12236237 1359232 749953 73882 428168 5679407 5563177 7112521 6741298 X 4137972 5494939 4137972 5494939 11250493 12236237 1335812 21155 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 340721 340721 7222167 1658185 5563982 210610 66561 144049 1239474 1063818 175656 229785 229785 6454193 X 15682726 21155 21155 15661571 0 15661571 14325759 0 14325759 0 14325759 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 0 0 0 0 0 0 0 0 0 CHRISTINA LASICH CHIEF MEDICAL OFFICER 266471 0 0 0 0 0 8713 0 0 0 275184 0 0 0 JUAN A CHAVEZ DENTIST 212770 0 0 0 0 0 16124 0 0 0 228894 0 0 0 SHARON MCINTYRE PHYSICIAN 196139 0 0 0 0 0 13310 0 0 0 209449 0 0 0 ZARKASHT FAKIRI PHYSICIAN 189918 0 0 0 0 0 11648 0 0 0 201566 0 0 0 BAMIDELE OLATUNBOSUN ASSISTANT MEDICAL DIRECTOR 194759 0 0 0 0 0 5356 0 0 0 200115 0 0 0 ANDREW HARRIS CHIEF ADMINISTRATIVE OFFICER 193205 0 0 0 0 0 6470 0 0 0 199675 0 0 0 SUSAN E SHAPIRO PHYSICIAN 171636 0 0 0 0 0 5888 0 0 0 177524 0 0 0 X 32 290271 COST 0 0 1 0 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 CONFLICTED NOTED, THE POLICY IS REVISITED AND CONFLICTING PARTIES ARE ASKED TO OBSTAIN FROM VOTING. 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 THE EVALUATIONS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,458,946. MANAGEMENT AND GENERAL EXPENSES 320,257. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,779,203. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR