Form 990 for tax year 2022
Filed by WESTERN SIERRA MEDICAL CLINIC INC.
Totals
- Total revenue
- $20,122,865
- Total expenses
- $17,481,211
- Contributions and grants received
- $5,682,664
- Grants paid
- $0
- Program service revenue
- $14,032,529
- Investment income
- $81,872
- Other revenue
- $325,800
- Total assets, end of year
- $17,963,680
- Total liabilities, end of year
- $8,088,827
- Net assets or fund balances, end of year
- $9,874,853
- Program services expenses (Part IX)
- $13,073,580
- Management and general expenses
- $4,407,631
- Fundraising expenses
- $0
- Program service expenses (Part III)
- $13,073,580
Program services were 74.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.
Line items
Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.
Revenue
Part VIII, the statement of revenue.
-
1e · Government grants (contributions)
$5,557,389
-
1f · All other contributions, gifts and grants
$125,275
-
1g · Noncash contributions included above
$125,275
-
2a · Program service revenue: PATIENT SERVICE REVENUE
total $11,732,669 · related or exempt $11,732,669
-
2b · Program service revenue: PHARMACY REVENUE
total $1,599,529 · related or exempt $1,599,529
-
2c · Program service revenue: CAPITATION REVENUE
total $700,331 · related or exempt $700,331
-
3 · Investment income
total $109,327 · excluded $109,327
-
6a · Gross rents
real property $4,760
-
6b · Less rental expenses
real property $0
-
6c · Rental income or loss
real property $4,760
-
6d · Net rental income or loss
total $4,760 · related or exempt $4,760
-
7b · Less cost or other basis and sales expenses
securities $27,455
-
7c · Gain or loss
securities -$27,455
-
7d · Net gain or loss
total -$27,455 · excluded -$27,455
-
11a · Other revenue: OTHER INCOME
total $321,040 · related or exempt $321,040
-
11e · Other revenue, total
$321,040
Functional expenses
Part IX, the statement of functional expenses.
-
5 · Compensation of officers, directors and key employees
total $904,160 · program services $904,160
-
7 · Other salaries and wages
total $7,633,033 · program services $4,917,933 · management and general $2,715,100
-
8 · Pension plan contributions
total $172,276 · program services $131,012 · management and general $41,264
-
9 · Other employee benefits
total $1,971,267 · program services $1,507,854 · management and general $463,413
-
10 · Payroll taxes
total $713,789 · program services $545,989 · management and general $167,800
-
11a · Fees: management
total $136,639 · program services $136,639
-
11b · Fees: legal
total $55,822 · program services $55,822
-
11c · Fees: accounting
total $221,699 · program services $221,699
-
11g · Fees: other
total $2,394,957 · program services $1,963,865 · management and general $431,092
-
12 · Advertising and promotion
total $13,767 · program services $11,305 · management and general $2,462
-
13 · Office expenses
total $10,539 · program services $8,642 · management and general $1,897
-
16 · Occupancy
total $646,557 · program services $530,177 · management and general $116,380
-
17 · Travel
total $65,505 · program services $53,714 · management and general $11,791
-
19 · Conferences, conventions and meetings
total $104,128 · program services $85,385 · management and general $18,743
-
20 · Interest
total $305,766 · program services $250,728 · management and general $55,038
-
22 · Depreciation, depletion and amortization
total $435,050 · program services $356,741 · management and general $78,309
-
23 · Insurance
total $131,265 · program services $107,637 · management and general $23,628
-
24a · Other expenses: SUPPLIES
total $1,184,913 · program services $971,629 · management and general $213,284
-
24b · Other expenses: OTHER
total $346,254 · program services $284,912 · management and general $61,342
-
24c · Other expenses: REPAIRS AND MAINTENANCE
total $33,825 · program services $27,737 · management and general $6,088
Balance sheet
Part X, book values.
-
1 · Cash, non-interest-bearing
beginning of year $1,504,556 · end of year $2,159,587
-
2 · Savings and temporary cash investments
beginning of year $4,237,818 · end of year $5,377,212
-
3 · Pledges and grants receivable
beginning of year $248,156 · end of year $2,032,073
-
4 · Accounts receivable
beginning of year $1,059,387 · end of year $830,287
-
9 · Prepaid expenses and deferred charges
beginning of year $193,711 · end of year $253,316
-
10a · Land, buildings and equipment: cost or other basis
$9,483,978
-
10b · Land, buildings and equipment: accumulated depreciation
$3,459,990
-
10c · Land, buildings and equipment, net
beginning of year $6,300,543 · end of year $6,023,988
-
15 · Other assets
beginning of year $707,730 · end of year $1,287,217
-
17 · Accounts payable and accrued expenses
beginning of year $1,166,614 · end of year $1,656,733
-
19 · Deferred revenue
beginning of year $9,890 · end of year $6,904
-
23 · Secured mortgages and notes payable
beginning of year $5,418,753 · end of year $6,425,190
-
27 · Net assets without donor restrictions
beginning of year $7,656,644 · end of year $9,874,853
Mission and programs · 2022
Mission
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.
Activities or mission (Part I)
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.
-
PROVIDING ACCESSIBLE, QUALITY MEDICAL, DENTAL, AND BEHAVIORAL HEALTH SERVICES THROUGH INNOVATIVE, PATIENT-CENTERED CARE IN OUR COMMUNITIES. IN 2022, 16,304 PATIENTS WERE SERVICED WITH 85,667 UNIQUE SERVICE ENCOUNTERS.
Expenses $13,073,580 · Revenue $14,358,329
As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.
Listed in Part VII
-
Doug McDonaldDOUG MCDONALD
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Robert Oldham MDROBERT OLDHAM MD
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Brandon PagmanBRANDON PAGMAN
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Jon PeekJON PEEK
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Lupe PetersonLUPE PETERSON
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Don RussellDON RUSSELL
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Lisa WilsonLISA WILSON
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Linda GreenleeLINDA GREENLEE
DIRECTOR
- Total calculated
- $0
- Hours/week
- 1
-
Larry AllenLARRY ALLEN
CHAIR
- Total calculated
- $0
- Hours/week
- 1
-
Scott BrowneSCOTT BROWNE
VICE-CHAIR
- Total calculated
- $0
- Hours/week
- 1
-
Derek WilliamsDEREK WILLIAMS
SECRETARY
- Total calculated
- $0
- Hours/week
- 1
-
Anita DanielsANITA DANIELS
TREASURER
- Total calculated
- $0
- Hours/week
- 1
-
Jennifer MaloneJENNIFER MALONE
CHIEF EXECUTIVE OFFICER
- Total calculated
- $282,941
- From this org
- $267,727
- From related orgs
- $0
- Other
- $15,214
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $267,727
- Bonus
- $0
- Other
- $0
- Deferred
- $8,032
- Nontaxable benefits
- $7,182
- Filer's total
- $282,941
-
Joseph BrittonJOSEPH BRITTON
CHIEF MEDICAL OFFICER
- Total calculated
- $304,835
- From this org
- $297,692
- From related orgs
- $0
- Other
- $7,143
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $297,692
- Bonus
- $0
- Other
- $0
- Deferred
- $7,143
- Nontaxable benefits
- $0
- Filer's total
- $304,835
-
Dan HappsDAN HAPPS
CHIEF INFORMATION OFFICER
- Total calculated
- $160,120
- From this org
- $155,445
- From related orgs
- $0
- Other
- $4,675
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $155,445
- Bonus
- $0
- Other
- $0
- Deferred
- $4,675
- Nontaxable benefits
- $0
- Filer's total
- $160,120
-
Kathleen MarhsallKATHLEEN MARHSALL
CHIEF OPERATIONS OFFICER
- Total calculated
- $194,364
- From this org
- $183,296
- From related orgs
- $0
- Other
- $11,068
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $183,296
- Bonus
- $0
- Other
- $0
- Deferred
- $2,743
- Nontaxable benefits
- $8,325
- Filer's total
- $194,364
-
Juan A ChavezJUAN A CHAVEZ
DENTAL DIRECTOR
- Total calculated
- $260,778
- From this org
- $244,858
- From related orgs
- $0
- Other
- $15,920
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $244,858
- Bonus
- $0
- Other
- $0
- Deferred
- $7,375
- Nontaxable benefits
- $8,545
- Filer's total
- $260,778
-
Sharon McIntyreSHARON MCINTYRE
PHYSICIAN
- Total calculated
- $209,947
- From this org
- $195,463
- From related orgs
- $0
- Other
- $14,484
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $195,463
- Bonus
- $0
- Other
- $0
- Deferred
- $5,939
- Nontaxable benefits
- $8,545
- Filer's total
- $209,947
-
Susan E ShapiroSUSAN E SHAPIRO
PHYSICIAN
- Total calculated
- $226,027
- From this org
- $218,785
- From related orgs
- $0
- Other
- $7,242
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $218,785
- Bonus
- $0
- Other
- $0
- Deferred
- $6,573
- Nontaxable benefits
- $669
- Filer's total
- $226,027
-
Ingrid BauerINGRID BAUER
PHYSICIAN
- Total calculated
- $254,600
- From this org
- $238,219
- From related orgs
- $0
- Other
- $16,381
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $238,219
- Bonus
- $0
- Other
- $0
- Deferred
- $7,836
- Nontaxable benefits
- $8,545
- Filer's total
- $254,600
-
Andrea GekasANDREA GEKAS
LICENSED MIDWIFE
- Total calculated
- $174,494
- From this org
- $164,735
- From related orgs
- $0
- Other
- $9,759
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $164,735
- Bonus
- $0
- Other
- $0
- Deferred
- $4,942
- Nontaxable benefits
- $4,817
- Filer's total
- $174,494
-
Carla PharrisCARLA PHARRIS
PHYSICAN
- Total calculated
- $213,123
- From this org
- $213,123
- From related orgs
- $0
- Other
- $0
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $213,123
- Bonus
- $0
- Other
- $0
- Deferred
- $0
- Nontaxable benefits
- $0
- Filer's total
- $213,123
-
Thomas JacobsTHOMAS JACOBS
PODIATRIST
- Total calculated
- $180,926
- From this org
- $166,828
- From related orgs
- $0
- Other
- $14,098
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $166,828
- Bonus
- $0
- Other
- $0
- Deferred
- $5,553
- Nontaxable benefits
- $8,545
- Filer's total
- $180,926
-
Brian EvansBRIAN EVANS
PHYSICIAN
- Total calculated
- $166,840
- From this org
- $162,047
- From related orgs
- $0
- Other
- $4,793
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $162,047
- Bonus
- $0
- Other
- $0
- Deferred
- $0
- Nontaxable benefits
- $4,793
- Filer's total
- $166,840
-
Tetsuya ShirasukaTETSUYA SHIRASUKA
DENTIST
- Total calculated
- $161,836
- From this org
- $148,769
- From related orgs
- $0
- Other
- $13,067
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $148,769
- Bonus
- $0
- Other
- $0
- Deferred
- $4,522
- Nontaxable benefits
- $8,545
- Filer's total
- $161,836
-
Kirsten GeorgeKIRSTEN GEORGE
PHYSICAN ASSISTANT
- Total calculated
- $157,000
- From this org
- $144,090
- From related orgs
- $0
- Other
- $12,910
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $144,090
- Bonus
- $0
- Other
- $0
- Deferred
- $4,365
- Nontaxable benefits
- $8,545
- Filer's total
- $157,000
-
Robert OlsonROBERT OLSON
PHYSICAN ASSISTANT
- Total calculated
- $151,443
- From this org
- $147,032
- From related orgs
- $0
- Other
- $4,411
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $147,032
- Bonus
- $0
- Other
- $0
- Deferred
- $4,411
- Nontaxable benefits
- $0
- Filer's total
- $151,443
-
Polly ConleyPOLLY CONLEY
PEDIATRIC NURSE PRACTIONER
- Total calculated
- $147,703
- From this org
- $134,523
- From related orgs
- $0
- Other
- $13,180
- Hours/week
- 40
-
Diana PetrosDIANA PETROS
DIRECTOR OF URGENT CARE
- Total calculated
- $145,304
- From this org
- $132,722
- From related orgs
- $0
- Other
- $12,582
- Hours/week
- 40
Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.
Schedule J
Answered yes
- 3 · Approval by the board or compensation committee
Answered no
- 4a · Severance or change-of-control payment
- 4b · Supplemental nonqualified retirement plan
- 4c · Equity-based compensation arrangement
- 5a · Pay contingent on this organization's revenues
- 5b · Pay contingent on a related organization's revenues
- 6a · Pay contingent on this organization's net earnings
- 6b · Pay contingent on a related organization's net earnings
- 7 · Other non-fixed payments
- 8 · Paid under the initial-contract exception
Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.
Grants on this return
No itemized grants to organizations on this return.
Provenance
- Return type
- form_990
- Tax year
- 2022
- Filed
- 17 July 2023
- IRS schema version
- 2022v5.0
- Source object
- 202302799349300440
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