2022-05-16T12:56:46-05:00 2021-06-30 330700332 VASQUEZ & COMPANY LLP 655 N CENTRAL AVE STE 1550 GLENDALE CA 91203 990 2020-07-01 952289916 JWCH INSTITUTE INC JWCH 3232014516 5650 JILLSON STREET COMMERCE CA 90040 JEANNE LAM CFO 3232014516 2022-05-15 1 JEANNE LAM 999009999 REGINA L PRINCE CPA P00576936 2138731700 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JEANNE LAM 5650 JILLSON STREET COMMERCE CA 90040 107915423 0 X WWW.JWCHINSTITUTE.ORG X 1960 CA TO IMPROVE THE HEALTH STATUS AND WELL BEING OF UNDERSERVED SEGMENTS OF THE POPULATION OF LOS ANGELES AREA THROUGH THE DIRECT PROVISION OR COORDINATION OF HEALTH CARE, HEALTH EDUCATION SERVICES AND RESEARCH. 11 11 1044 33 0 0 32041442 43043545 54226746 64788491 5572 14938 124450 68449 86398210 107915423 570844 194879 0 0 53688550 56237382 0 0 0 25859817 35467919 80119211 91900180 6278999 16015243 53327586 70547558 23723190 24830874 29604396 45716684 X THE SPECIFIC PURPOSES OF THIS ORGANIZATION ARE:(A) TO PROVIDE OUTPATIENT PRIMARY HEALTH SERVICE IN UNDERSERVED AREAS AND/OR FOR MEDICALLY UNDERSERVED POPULATIONS AS A COMMUNITY CLINIC. (B) TO DEVELOP, PROMOTE, AND MANAGE HEALTH CARE FACILITIES, SERVICES, AND PROGRAMS WITH AN EMPHASIS ON COMPREHENSIVE HEALTH CARE, PREVENTATIVE MEDICINE, AND HEALTH MAINTENANCE. (C) TO EDUCATE THE PUBLIC ON THE PRINCIPLES OF HEALTH PROTECTION AND PROMOTE OTHER PROJECTS IN THE INTEREST OF THE PUBLIC'S HEALTH. (D) TO ENGAGE IN ANCILLARY MEDICAL, REHABILITATION, AND RESIDENTIAL TREATMENT PROGRAMS FOR UNDERSERVED POPULATIONS.(E) TO PROMOTE MUTUALLY ACCEPTABLE AND SATISFYING RELATIONSHIPS BETWEEN THE ORGANIZATION AND OTHER PROVIDERS OF HEALTH CARE TO DEVELOP AN EFFICIENT AND EFFECTIVE DELIVERY OF HEALTH CARE. (F) TO PARTICIPATE IN AND COOPERATE WITH ANY GOVERNMENTAL AGENCY OR OTHER ORGANIZATION ENGAGED IN SIMILAR OR LIKE ACTIVITIES. (G) TO ENGAGE IN SUCH OTHER ACTIVITIES AS DIRECTED BY THE BOARD. 0 0 90703619 194879 64788491 JWCH WEINGART CLINIC AT CENTER FOR COMMUNITY HEALTH - PROVIDED 39,978 MEDICAL VISIT ASSESSMENTS TO LOW INCOME AND HOMELESS INDIVIDUALS. 6,279 PATIENTS RECEIVED HEALTH CARE SERVICES AT THE CLINIC INCLUDING PRIMARY CARE, X-RAYS, EKGS, FAMILY PLANNING, MALE WELLNESS, CASE MANAGEMENT, HIV TESTING, MENTAL HEALTH, AND DENTAL SERVICES. JWCH - OTHER CLINIC - THE BELLFLOWER HEALTH CENTER PROVIDES PRIMARY CARE SERVICES TO LOW INCOME INDIVIDUALS REGARDLESS OF ABILITY TO PAY. ALL PRIMARY CARE SERVICES FOR FAMILIES, WOMEN AND CHILDREN WILL BE AVAILABLE. CASE MANAGEMENT AND MENTAL HEALTH SERVICES WILL BE PROVIDED IN THE SITE AS WELL AS ACCESS TO ELIGIBILITY ASSISTANCE FOR PUBLIC MEDICAL BENEFITS PROGRAMS. BELLFLOWER HEALTH CENTER PROVIDED 25,671 MEDICAL VISITS TO 4,820 PATIENTS. THE DOWNTOWN WOMEN'S CENTER CLINIC SERVES HOMELESS WOMEN AND PROVIDES PRIMARY HEALTH CARE SERVICES, REPRODUCTIVE HEALTH SERVICES, CANCER SCREENING AND ACCESS TO SPECIALTY CARE AND MENTAL HEALTH. THE JWCH CLINIC IS EMBEDDED IN THIS HOMELESS RESIDENTIAL FACILITY AND PROVIDED 149 PATIENTS 907 MEDICAL VISITS. BPHC-HEALTH CARE CENTER CLUSTER - THE FEDERAL SECTION 330 GRANT ALLOWS FOR JWCH'S PARTICIPATION AS A FEDERALLY QUALIFIED HEALTH CENTER. THIS PROGRAM PROVIDES A BASE GRANT FOR INDIGENT CARE VISITS TO UNINSURED PERSONS IN JWCH'S HOMELESS AND COMMUNITY HEALTH CENTERS. PROVIDED UNDER THIS PROGRAM ARE PRIMARY CARE, DIAGNOSTICS, REPRODUCTIVE HEALTH SERVICES, PREVENTION AND EDUCATION AND ACCESS TO MEDICAL SPECIALISTS. ALL AGES ARE SERVED WITH THIS FUNDING. AIDS PREVENTION & EDUCATION - PROVIDES PREVENTION, EDUCATION, AND REFERRALS TO TREATMENT AMONG HIGH RISK POPULATIONS. JWCH CLINIC AT BELL GARDENS - PROVIDED 23,913 VISITS TO 4,239 PATIENTS FOR MEDICAL SERVICES IN THE MOST INDIGENT AREA IN LA COUNTY. THE FOLLOWING SERVICES ARE OFFERED: FAMILY MEDICINE, FAMILY PLANNING, COMPREHENSIVE PRENATAL CARE, PEDIATRICS, OBSTETRICS, X-RAYS, EKGS, MALE WELLNESS SERVICES, HIV TESTING AND LABORATORY SERVICES.RECUPERATIVE CARE - PROVIDES 24-HOUR CARE FOR HOMELESS PERSONS WHO ARE RECOVERING FROM AN ILLNESS OR INJURY AND DISCHARGED FROM LOCAL HOSPITALS. A TOTAL OF 186 BEDS ARE AVAILABLE DAILY, INCLUDING THREE MEALS AND ASSISTANCE WITH WOUND CARE, BENEFITS ACCESS AND CASE MANAGEMENT SERVICES. IN TOTAL, 67,890 BED DAYS ARE AVAILABLE FOR HOMELESS PERSONS WHO WOULD OTHERWISE SPEND TIME RECOVERING ON THE STREETS. POST DISCHARGE FROM RECUPERATIVE CARE, THE PROGRAM SEEKS TO FIND MORE PERMANENT SOLUTIONS FOR PATIENTS INCLUDING PLACEMENT IN TRANSITIONAL AND PERMANENT HOUSING LOCATIONS.JWCH LYNWOOD PRIMARY CARE CLINIC - PROVIDED 29,037 VISITS TO 6,977 PATIENTS RESIDING IN LYNWOOD AND THE SURROUNDING AREA OF COMPTON. BECAUSE THE MAJORITY OF THE CLINIC'S CLIENTELE ARE PEOPLE OF CHILDBEARING AGE, THEIR PRIMARY NEEDS INCLUDE FAMILY PLANNING SERVICES AND ACCESS TO ADEQUATE PRENATAL CARE. IN ADDITION, THE WOMEN ARE AT HIGH RISK OF CERVICAL CANCER, MAKING SCREENING AND TREATMENT OF SEXUALLY TRANSMITTED INFECTIONS AN IMPORTANT SERVICE AT THE CLINIC. THE FOLLOWING SERVICES ARE OFFERED: PHYSICAL/GYNECOLOGICAL EXAMINATIONS, SCREENING FOR CERVICAL AND BREAST CANCER, DIAGNOSIS AND TREATMENT OF SEXUALLY TRANSMITTED DISEASES, PREGNANCY TESTING AND REFERRALS FOR PRENATAL SERVICES, BIRTH CONTROL METHODS, DIAGNOSIS AND TREATMENT OF COMMON GYNECOLOGICAL PROBLEMS, HEALTH EDUCATION, REFERRALS FOR OTHER HEALTH AND SOCIAL SERVICES AS NEEDED.JWCH NORWALK CLINIC - PROVIDED 48,868 VISITS TO 6,848 PATIENTS FOR MEDICAL SERVICES IN THE MOST INDIGENT AREA IN LA COUNTY. THE FOLLOWING SERVICES ARE OFFERED: FAMILY MEDICINE, FAMILY PLANNING, COMPREHENSIVE PRENATAL CARE, PEDIATRICS, OBSTETRICS, X-RAYS, EKGS, MALE WELLNESS SERVICES, HIV TESTING AND LABORATORY SERVICES.SUBSTANCE ABUSE TREATMENT - THE MINI 12 STEP HOUSE OFFERS RESIDENTIAL AND OUTPATIENT SUBSTANCE ABUSE TREATMENT FOR WOMEN AND WOMEN WITH CHILDREN FOR ALCOHOL AND DRUG ABUSE. THE PROGRAM OFFERS AN INTENSIVE RESIDENTIAL PROGRAM FOR WOMEN WHICH INVOLVES SUBSTANCE ABUSE TREATMENT IN INDIVIDUAL AND GROUP CLASSES, CASE MANAGEMENT, MENTAL HEALTH AND REFERRAL TO MEDICAL CARE AND COMMUNITY SUPPORT SERVICES. THE RESIDENTIAL PROGRAM CAN ACCOMODATE UP TO 31 WOMEN DAILY IN THIS 24-HOUR FACILITY. THE OUTPATIENT PROGRAM OFFERS A LONGER TERM PROGRAM FOR MEN AND WOMEN BASED ON THE 12 STEP PROGRAM OF ALCOHOL AND DRUG ABSTENTION. THE PROGRAM IS SUPPORTED BY NUMEROUS LOCAL AND STATE GRANTS SPECIFICALLY FOR ALCOHOL AND DRUG TREATMENT.INFORMATION & EDUCATION - TARGETS YOUTH THAT ARE PREGNANT OR PARENTING AND PROVIDES THEM WITH SUPPORT NEEDED TO STAY IN SCHOOL, WHILE TAKING CARE OF THEMSELVES AND THEIR CHILDREN AND AT THE SAME TIME AVOIDING ANY FURTHER UNINTENDED PREGNANCY. THE PROGRAM CONNECTS YOUTH TO REPRODUCTIVE HEALTH CARE AND OTHER MEDICAL SERVICES IN A JWCH CLINIC. YOUTH IN PROBATION AND ALTERNATIVE SCHOOLS ARE THE PRIMARY FOCUS OF THE PROGRAM AS WELL AS ANY OTHER HIGH RISK YOUTH THAT SEEK SERVICES FROM THE INFORMATION & EDUCATION PROGRAM.OTHER PROGRAM SERVICES - PROVIDES EMERGENCY AND TRANSITIONAL HOUSING SERVICES TO PEOPLE LIVING WITH HIV/AIDS WITH 18 BEDS NIGHTLY LOCATED AT SRO HOUSING TRUST. THE SERVICES INCLUDE: COMPLETE PSYCHOSOCIAL ASSESSMENT, INDIVIDUAL CARE PLAN DEVELOPMENT, APPROPRIATE REFERRALS TO HOUSING, MENTAL HEALTH AND DRUG TREATMENT, MEALS AND NUTRITIONAL SUPPLEMENTATION, AND HYGIENE ITEMS AND CLOTHING. JWCH ALSO OPERATES A STREET MEDICINE TEAM AND TWO MOBILE MEDICAL UNITS WHICH PROVIDE CARE TO PERSONS ON THE STREETS.JWCH VERMONT CLINIC - PROVIDED 39,668 VISITS TO 7,606 HOMELESS PATIENTS. THE JWCH VERMONT CLINIC OFFERS MEDICAL SERVICES TO HOMELESS AND MEDICALLY INDIGENT PERSONS INCLUDING FAMILY MEDICINE, FAMILY PLANNING, CHILD HEALTH DISABILITY PREVENTION, PEDIATRICS, GERIATRIC PRIMARY CARE, EKGS. SPECIALTY REFERRALS, HIV TESTING, AND LABORATORY SERVICES.CHIP-CDC - JWCH'S CHIP PROGRAM OR (COMPREHENSIVE HIV PREVENTION PROJECT) PROVIDES HIV TESTING AND HEALTH EDUCATION ACTIVITIES TO PERSONS AT HIGH RISK OF ACQUIRING HIV IN SKID ROW. THE MAJORITY OF THE PARTICIPANTS ARE HOMELESS OR FORMERLY HOMELESS PERSONS, LIVING IN SHELTERS, MISSIONS AND ON THE STREETS. PARTICIPANTS ARE PROVIDED RAPID HIV TESTING, IMMEDIATE ACCESS TO MEDICAL SPECIALISTS AND EDUCATION TO ASSIST THEM IN HEALTHY LIVING.HIV CASE MANAGEMENT - PROVIDES HIV MEDICAL CARE THROUGH CASE MANAGEMENT, COUNSELING AND TESTING, PREVENTION EDUCATION, REFERRALS TO EMERGENCY AND TRANSITIONAL HOUSING.JWCH ANTELOPE VALLEY CLINICS CONSISTED OF WESLEY HEALTH CENTERS (LANCASTER), WESLEY HEALTH CENTERS (PALMDALE CENTRAL) AND WESLEY HEALTH CENTERS (PALMDALE EAST). THEY PROVIDED A COMBINED TOTAL OF 102,433 VISITS TO A TOTAL OF 25,609 PATIENTS. THE FOLLOWING SERVICES ARE OFFERED: PRIMARY HEALTH CARE, REPRODUCTIVE HEALTH, DENTAL & ORAL HEALTH, BEHAVIORAL HEALTH, PEDIATRICS, PODIATRY, ENDOCRINOLOGY, DERMATOLOGY, DRUG, ALCOHOL AND OPIOID DETOX SERVICES, LABORATORY SERVICES, AND SPECIALTY REFERRALS. 90703619 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 80 0 1 1044 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X JEANNE LAM 3232014516 5650 JILLSON STREET COMMERCE CA 90040 KEITH TERASAKI MD CHAIRPERSON 2.00 X X 0 0 0 KATHLEEN J HOUSE VICE CHAIRPERSON 2.00 X X 0 0 0 SHEILA SHIMA EATON TREASURER 2.00 X X 0 0 0 JOE CASTEL SECRETARY 1.00 X X 0 0 0 LAWRENCE FERNANDEZ JR BOARD MEMBER 1.00 X 0 0 0 MARIA PADRON BOARD MEMBER 1.00 X 0 0 0 SILVIA L HERNANDEZ BOARD MEMBER 1.00 X 0 0 0 TOM GRODE BOARD MEMBER 1.00 X 0 0 0 EDUARDO SAUCEDO BOARD MEMBER 1.00 X 0 0 0 HERBERT TORRANCE BOARD MEMBER 1.00 X 0 0 0 ANNETTE SULLIVAN BOARD MEMBER 1.00 X 0 0 0 ALVARO BALLESTEROS CEO 40.00 X 308324 0 16579 JEANNE LAM CFO 40.00 X 211412 0 12245 ANDY IRIE SECRETARY 40.00 X 169046 0 13030 PAUL GREGERSON CMO 40.00 X 348670 0 17010 PHILIP LE ASSOCIATE MEDICAL DIRECTOR 40.00 X 265121 0 16932 HAROLD GLEN SAN AGUSTIN ASSO. MEDICAL DIRECTOR-HIV SRVC. 40.00 X 241824 0 12997 ANA ORTIZ DENTAL DIRECTOR 40.00 X 226071 0 13261 PAUL ROUND ASSO. MEDICAL DIRECTOR 40.00 X 215890 0 15224 MICHAEL JOHNSON COO 40.00 X 210087 0 12454 BENJAMIN MONROE MEDICAL DIRECTOR/OB/GYN 40.00 X 207956 0 11966 BRENDA VELASQUEZ DIRECTOR OF OPERATION 40.00 X 194717 0 13515 REBECCA CHOHLAS-WOOD PHYSICIAN SPECIALIST 40.00 X 240669 0 12483 PAWEL KASZUBOWSKI PHYSICIAN 40.00 X 237043 0 8774 LUCIEN ALEXANDRE PHYSICIAN 40.00 X 230689 0 13171 DENNIS BLEAKLEY PHYSICIAN 40.00 X 225558 0 15003 HTAR SU HLAING PHYSICIAN SPECIALIST 40.00 X 229109 0 6249 TIEN DANG CIO 40.00 X 161447 0 13096 3923633 0 223989 79 0 1 0 RUIZ BROTHERS CONSTRUCTION CO INC 2181 S ATLANTIC BLVD STE 101 COMMERCE CA 90040 RENOVATION 2122765 WESTWAYS STAFFING SERVICES INC PO BOX 970 SAN JOSE CA 95108 TEMPORARY STAFFING 1272016 TRIOMPH INC 6820 LA TIJERA BLVD STE 208B LOS ANGELES CA 90045 SECURITY GUARD SERVIVES 871924 COY BUILDER 11555 TELEGRAPH RD SANTA FE SPRINGS CA 90670 RENOVATION 777451 KIMCOMEDIQUEST DEPT 842023 LOS ANGELES CA 90084 TEMPORARY STAFFING 327613 21 40239393 2804152 43043545 PATIENT SERVICES, NET 621400 54523037 54523037 PHARMACY REVENUES 621400 8054475 8054475 IPA REVENUES 621400 2210979 2210979 64788491 14938 14938 68449 0 68449 68449 68449 107915423 64788491 0 83387 X 194879 194879 2936376 2889995 46381 42776392 42084910 691482 7067488 6996813 70675 3457126 3422555 34571 60121 48097 12024 90750 72600 18150 14752792 14637425 115367 1069981 1059282 10699 846403 837939 8464 317909 314730 3179 599768 593770 5998 1020294 1010091 10203 397820 393842 3978 MEDICAL AND LABORATORY 8376969 8293199 83770 LEASE 2163526 2141891 21635 OTHER PROGRAM EXPENSES 1763139 1743559 19580 FEES 1186147 1173965 12182 2822300 2794077 28223 91900180 90703619 1196561 0 4118926 9760336 1250635 6025411 7846457 8505140 16174641 17886449 86300 261059 584367 334592 28554661 7113785 17014915 21440876 6251345 6333695 53327586 70547558 3302129 2426131 23632 402151 10422883 13192791 9974546 8809801 23723190 24830874 X 28234613 45003746 1369783 712938 29604396 45716684 53327586 70547558 16015243 97045 0 X 0 1 X 1 1 1 X 19562724 21700725 25670176 32041442 43043545 142018612 19562724 21700725 25670176 32041442 43043545 142018612 142018612 615 1888 26682 5572 14938 49695 3731175 2306768 1646058 119500 7803501 149871808 209817211 0.94760 0.92270 X SCHEDULE A, PART II, LINE 10 EXPLANATION OF OTHER INCOME MISCELLANEOUS INCOME: 2016 $3,731,175 2017 $2,182,244 2018 $1,548,871 FUNDRAISING INCOME: 2016 $102,540 2017 $159,398 2018 $136,578 2019 $119,500 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4422569 4422569 18515492 2749434 15766058 5616600 4364351 1252249 21440876 DEPOSIT 271964 GOODWILL 6061731 6333695 PAYROLL & RELATED LIABILITIES 6992048 ESTIMATED AMOUNTS DUE TO THIRD PARTY PAYERS 1817753 8809801 X 108012468 97045 97045 107915423 0 107915423 91900180 0 91900180 0 91900180 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND THE CALIFORNIA REVENUE AND TAXATION CODE SECTION 23701D AND IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, THE ORGANIZATION 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. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES 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 YEARS ENDED JUNE 30, 2020, AND 2019, THE ORGANIZATION HAD NO MATERIAL UNRECOGNIZED TAX BENEFITS, TAX PENALTIES, OR INTEREST. AS OF JUNE 30, 2020, INFORMATION RETURNS SUBSEQUENT TO 2016 FILED BY THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY THE AUTHORITIES. 1 WEINGART CENTER ASSOCIATION 566 S SAN PEDRO STREET LOS ANGELES CA 90013 956054617 501(C)(3) 76568 FMV TO SUPPORT SUBSTANCE ABUSE PROGRAM BIENESTAR HUMAN SERVICES INC 5326 E BEVERLY BLVD LOS ANGELES CA 90022 954505737 501(C)(3) 113311 FMV TO SUPPORT HIV SERVICE PROGRAM COVENANT HOUSE CALIFORNIA 1325 N WESTERN AVE HOLLYWOOD CA 90027 133391210 501(C)(3) 5000 FMV TO SUPPORT HIV SERVICE PROGRAM 3 PART I, LINE 2: THE ORGANIZATION ENTERS INTO WRITTEN AGREEMENTS WITH THE GRANTEES SPECIFYING HOW THE GRANT MONIES ARE TO BE SPENT. THE GRANTEES ARE REQUIRED TO SUBMIT BUDGETS FOR THE GRANTS AND REPORTS ARE OBTAINED QUARTERLY OR SEMI-ANNUALLY TO ENSURE THAT MONIES ARE BEING CONSISTENT WITH THE GRANT TERMS AND THE BUDGET. X X X 0 0 0 0 0 0 0 0 0 ALVARO BALLESTEROS CEO 293424 0 500 0 14400 0 11400 0 5179 0 324903 0 0 0 JEANNE LAM CFO 203412 0 8000 0 0 0 9674 0 2571 0 223657 0 0 0 ANDY IRIE SECRETARY 168546 0 500 0 0 0 7420 0 5610 0 182076 0 0 0 PAUL GREGERSON CMO 344570 0 500 0 3600 0 11400 0 5610 0 365680 0 0 0 PHILIP LE ASSOCIATE MEDICAL DIRECTOR 264621 0 500 0 0 0 11352 0 5580 0 282053 0 0 0 HAROLD GLEN SAN AGUSTIN ASSO. MEDICAL DIRECTOR-HIV SRVC. 241324 0 500 0 0 0 7803 0 5194 0 254821 0 0 0 ANA ORTIZ DENTAL DIRECTOR 225571 0 500 0 0 0 7681 0 5580 0 239332 0 0 0 PAUL ROUND ASSO. MEDICAL DIRECTOR 215390 0 500 0 0 0 9644 0 5580 0 231114 0 0 0 MICHAEL JOHNSON COO 202587 0 7500 0 0 0 8125 0 4329 0 222541 0 0 0 BENJAMIN MONROE MEDICAL DIRECTOR/OB/GYN 207456 0 500 0 0 0 6356 0 5610 0 219922 0 0 0 BRENDA VELASQUEZ DIRECTOR OF OPERATION 194217 0 500 0 0 0 8034 0 5481 0 208232 0 0 0 REBECCA CHOHLAS-WOOD PHYSICIAN SPECIALIST 240169 0 500 0 0 0 7862 0 4621 0 253152 0 0 0 PAWEL KASZUBOWSKI PHYSICIAN 236543 0 500 0 0 0 7328 0 1446 0 245817 0 0 0 LUCIEN ALEXANDRE PHYSICIAN 230189 0 500 0 0 0 7591 0 5580 0 243860 0 0 0 DENNIS BLEAKLEY PHYSICIAN 225058 0 500 0 0 0 9393 0 5610 0 240561 0 0 0 HTAR SU HLAING PHYSICIAN SPECIALIST 229109 0 0 0 0 0 4085 0 2164 0 235358 0 0 0 TIEN DANG CIO 160947 0 500 0 0 0 7486 0 5610 0 174543 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND ITS ATTACHMENTS ARE REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE EXTENT OF THE REVIEW INCLUDES A LINE-BY-LINE REVIEW OF THE FORM 990. THE REVIEW IS BASED ON GUIDANCE PROVIDED BY THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. THE FINAL FORM 990 IS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS FOR FINAL REVIEW PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND EXECUTIVE MANAGEMENT OF THE ORGANIZATION ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. EACH BOARD MEMBER AND MEMBER OF THE EXECUTIVE MANAGEMENT STAFF SIGNS AN ANNUAL CONFLICT OF INTEREST STATEMENT. A CONFLICT OF INTEREST POLICY WAS REVIEWED AND HAS BEEN APPROVED BY THE BOARD OF DIRECTORS, AND IS IMPLEMENTED AT THE BOARD MANAGEMENT LEVEL. TRAINING ON THE POLICY WAS ALSO CONDUCTED. DETERMINATIONS OF POTENTIAL CONFLICT OF INTEREST ARE MADE AT THE BOARD LEVEL AND AT THE EXECUTIVE STAFF LEVEL. IF A POTENTIAL CONFLICT IS IDENTIFIED, AGENCY POLICY DICTATES THAT THE SUBJECT INDIVIDUAL SHALL REMOVE THEMSELVES FROM DISCUSSIONS REGARDING THE MATTER AT HAND. ALL CONFLICTS WILL BE DOCUMENTED IN MINUTES OF THE GOVERNING BOARD. ANNUALLY, THE JWCH CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD OF DIRECTORS AS PART OF THE ANNUAL REVIEW OF POLICIES AND PROCEDURES. FORM 990, PART VI, SECTION B, LINE 15 THE JWCH BOARD OF DIRECTORS SETS-UP A COMPENSATION COMMITTEE TO EVALUATE THE CEO'S SALARY BASED ON THE FOLLOWING: AN EXTENSIVE ANNUAL PERFORMANCE REVIEW IS UNDERTAKEN BY THE BOARD OF DIRECTORS VIA THIS COMMITTEE, WITH INPUT BY THE WHOLE BOARD. SHOULD A SALARY INCREASE BE WARRANTED, THE PERFORMANCE EVALUATION IS USED TOGETHER WITH SALARY COMPARISONS OF OTHER COMMUNITY HEALTH CENTERS PROVIDED BY THE CALIFORNIA PRIMARY CARE ASSOCIATION AND THE LOCAL COMMUNITY CLINIC ACCOSIATION TO REVIEW COMPARATIVE COMPENSATION LEVELS. A DETERMINATION IS THEN MADE BASED ON BOTH AND BROUGHT TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO IMPLEMENTATION OF ANY SALARY CHANGES. THE BOARD OF DIRECTORS ONLY SETS THE SALARY FOR THE CEO. THE BOARD OF DIRECTORS REVIEW AND APPROVE A SALARY COMPENSATION GRADE SCHEDULE FOR ALL OTHER AGENCY STAFF, INCLUDING THE CFO. THIS COMPENSATION GRADE SCHEDULE IS PERIODICALLY REVIEWED BY THE BOARD OF DIRECTORS SO THAT SALARIES OF AGENCY STAFF IS CONSISTENT WITH INDUSTRY STANDARDS. THE SETTING OF SALARIES FOR STAFF OTHER THAN THE CEO IS DELEGATED TO THE CEO AND HIS DESIGNEES TOGETHER WITH HUMAN RESOURCES ACCORDING TO THE AFOREMENTIONED SALARY SCHEDULE. THE DELIBERATION AND DECISION ON EACH OF THE COMPENSATION PACKAGES WAS PROPERLY SUBSTANTIATED. 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. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 14,342,377. MANAGEMENT AND GENERAL EXPENSES 41,605. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,383,982. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 295,048. MANAGEMENT AND GENERAL EXPENSES 73,762. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 368,810.