2023-11-14T19:09:43-06:00 2022-12-31 330700332 VASQUEZ COMPANY LLP 655 N CENTRAL AVE STE 1550 GLENDALE CA 91203 990 2022-01-01 452424322 COMMUNITY MEDICAL WELLNESS CENTERS USA COMM 8448882692 1360 EAST ANAHEIM STREET 101 LONG BEACH CA 90813 SOMPIA PAIGNE CEO 8448882692 2023-11-14 1 SOMPIA PAIGNE 999009999 0 REGINA L PRINCE CPA P00576936 2138731700 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SOMPIA PAIGNE 1360 EAST ANAHEIM STREET 101 LONG BEACH CA 90813 15448064 0 X WWW.CMWCUSA.ORG X 2011 CA TO PROVIDE QUALITY HEALTH CARE AND HEALTH EDUCATION TO PERSONS & COMMUNITIES NATIONALLY RECOGNIZED AS HAVING SIGNIFICANT BARRIERS TO ACCESS TO QUALITY CARE & EDUCATION. 10 10 116 10 0 0 2506267 4596741 9874699 10835379 277 222 9555 15722 12390798 15448064 0 0 0 0 5126097 7375977 0 0 0 5513095 6064326 10639192 13440303 1751606 2007761 8179372 12808775 3988052 6609694 4191320 6199081 X THE ORGANIZATION IS ORGANIZED FOR THE PURPOSE OF PROVIDING, SUPPORTING AND ENCOURAGING HEALTH CARE AND HEALTH EDUCATION TO PERSONS AND COMMUNITIES NATIONALLY RECOGNIZED AS HAVING SIGNIFICANT BARRIERS TO ACCESS OF SUCH CARE AND EDUCATION. THE ORGANIZATION WILL DEVELOP AND OPERATE COMPREHENSIVE HEALTH CARE CLINICS AND EDUCATION CENTERS IN IMPOVERISHED URBAN COMMUNITIES WHERE AN ESTABLISHED NEED IS PRESENT. 0 0 10841973 10835379 COMMUNITY MEDICAL WELLNESS CENTER USA ("CMWC" A NON-PROFIT CORPORATION ESTABLISHED ON APRIL 16, 2011), HAS A MISSION TO PROVIDE QUALITY HEALTH CARE AND HEALTH EDUCATION IN IMPOVERISHED COMMUNITIES. CMWC OPERATES 5 COMPREHENSIVE HEALTH CARE CLINICS IN THE CITIES OF LONG BEACH, SYLMAR, AND WHITTIER. CMWC PROVIDES GENERAL AND PRIMARY CARE SERVICES, DENTAL, OPTOMETRY, AND SPECIALTY SERVICES TO LOW INCOME FAMILIES, IN UNDERSERVED COMMUNITIES. THE MAIN CLINIC IS LOCATED IN THE HEART OF CAMBODIA TOWN, WHERE CMWC'S STAFF SPECIALIZES IN UNDERSTANDING AND WORKING WITH PATIENTS SUFFERING WITH POST-TRAUMATIC STRESS SYNDROME AND OTHER MENTAL HEALTH ILLNESS. CMWC WAS APPROVED AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AS OF OCTOBER 13, 2015. AS A RESULT CMWC HAS BEEN ABLE TO PROVIDE MEDICAL SERVICES TO 9,432 PATIENTS DURING 2022. 10841973 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 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 55 0 1 116 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X PAUL RAMOS 8448882692 1360 EAST ANAHEIM STREET 101 LONG BEACH CA 90813 KENNETH HARLEY BOARD CHAIRPERSON 2.00 X X 0 0 0 NORITH SOTH BOARD SECRETARY 2.00 X X 0 0 0 CRYSTAL HOLLINSWORTH BOARD MEMBER 2.00 X 0 0 0 MICHELLE LARIOS BOARD TREASURER 2.00 X X 0 0 0 BUN SOK BOARD MEMBER 2.00 X 0 0 0 LANY SOK BOARD MEMBER 2.00 X 0 0 0 SOK SAN BOARD MEMBER 2.00 X 0 0 0 MALCOLM TRAN BOARD MEMBER 2.00 X 0 0 0 UBERTO JESUS HERNANDEZ BOARD MEMBER 2.00 X 0 0 0 VISETH VANN BOARD MEMBER 2.00 X 0 0 0 SOMPIA PAIGNE CEO 40.00 X 205980 0 18302 PAUL RAMOS CFO 20.00 X 148000 0 0 BOZA PHENG COO 40.00 X 145800 0 13627 MAURICE ZEITLIN DIRECTOR OF BEHAVIORAL HEALTH 40.00 X 550204 0 9660 PHENG BAKHENG CMO 40.00 X 398025 0 0 JOHN ADAMS VP MEDICAL OPERATION 20.00 X 116188 0 5980 NAGASAMUDRA ASHOK PROVIDER 20.00 X 200925 0 4057 JAVIER QUESADA PROVIDER 40.00 X 251200 0 23273 CEASAR VALLE PROVIDER 40.00 X 258775 0 2883 AVA GILLETT BEHAVIORAL HEALTH ASST. PGRM. DIR. 40.00 X 140000 0 12903 LYNN JASMINE OPTHALMOLOGIST 32.00 X 214460 0 14716 2629557 0 105401 10 0 1 0 ADVANCED CONTRACTORS 935 W 223RD STREET TORRANCE CA 90502 CONSTRUCTION SERVICE 806364 KITTYA PAIGNE 29870 KNOLL VIEW DRIVE RANCHO PALOS VERDES CA 90275 MEDICAL PROVIDER 337300 CALIFORNIA CHOICE PO BOX 7088 ORANGE CA 92863 EMPLOYEE BENEFIT PROVIDER 276578 INFINITY OUTREACH 7257 FARMDALE AVE NORTH HOLLYWOOD CA 91605 OUTREACH/STAFFING SERVICE 256313 ECLINICALWORKS PO BOX 847950 BOSTON MA 02284 IT SERVICESQ 200865 15 4472161 124580 4596741 NET PATIENT SERVICE REVENUES 621400 10075838 10075838 PHARMACY REVENUES 621400 759541 759541 10835379 222 222 OTHER INCOME 621400 15722 15722 15722 15448064 10835379 0 15944 X 1611766 1289412 322354 4720616 3776493 944123 107428 85942 21486 536072 428858 107214 400095 320076 80019 74112 59290 14822 113525 90820 22705 2168732 1734986 433746 15532 12424 3108 326534 261227 65307 290655 232524 58131 903898 723119 180779 127605 102084 25521 83684 66947 16737 424155 339324 84831 99772 79818 19954 MEDICAL/DENTAL SUPPLIES 448655 448655 REPAIRS & MAINTENANCE 359295 287436 71859 MINOR EQUIPMENT 321907 257526 64381 OUTREACH 218966 175173 43793 87299 69839 17460 13440303 10841973 2598330 0 243074 181959 904859 790332 379993 412750 600555 857638 11353 5926 6357999 499288 4345702 5858711 885166 1215869 808670 3485590 8179372 12808775 764023 1456646 542500 392500 2348638 2148143 700000 332891 1912405 3988052 6609694 X 4191320 6199081 4191320 6199081 8179372 12808775 2007761 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1308657 1308657 822843 301982 520861 2066852 197306 1869546 664895 664895 1494752 1494752 5858711 SECURITY DEPOSITS 124780 SETTLEMENT DUE FROM THIRD-PARTY PAYERS 1506416 RIGHT-OF-USE ASSETS, NET 1688832 OTHER RECEIVABLES 165562 3485590 ESTIMATED AMOUNTS DUE TO THIRD-PARTY PAYERS 188013 LEASE LIABILITY 1724392 1912405 X 15448064 0 15448064 0 15448064 13440303 0 13440303 0 13440303 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SECTION 23701D OF THE CALIFORNIA REVENUE AND TAXATION CODE AND IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. CONTRIBUTIONS TO THE ORGANIZATION ARE DEDUCTIBLE FOR TAX PURPOSES UNDER SECTION 170(C)(2) 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 YEARS ENDED DECEMBER 31, 2022 AND 2021, THE ORGANIZATION HAD NO MATERIAL UNRECOGNIZED TAX BENEFITS, TAX PENALTIES OR INTEREST. AS OF DECEMBER 31, 2022, INFORMATION RETURNS SUBSEQUENT TO 2018 FILED BY THE ORGANIZATION ARE SUBJECT TO EXAMINATION BY THE AUTHORITIES. X X 0 0 0 0 0 0 0 0 0 MAURICE ZEITLIN DIRECTOR OF BEHAVIORAL HEALTH 450000 0 100204 0 0 0 9037 0 623 0 559864 0 0 0 PHENG BAKHENG CMO 380000 0 18025 0 0 0 0 0 0 0 398025 0 0 0 JAVIER QUESADA PROVIDER 251200 0 0 0 0 0 8807 0 14466 0 274473 0 0 0 CEASAR VALLE PROVIDER 258775 0 0 0 0 0 2197 0 686 0 261658 0 0 0 LYNN JASMINE OPTHALMOLOGIST 214460 0 0 0 0 0 7159 0 7557 0 229176 0 0 0 SOMPIA PAIGNE CEO 205980 0 0 0 0 0 6570 0 11732 0 224282 0 0 0 NAGASAMUDRA ASHOK PROVIDER 200925 0 0 0 0 0 3434 0 623 0 204982 0 0 0 AVA GILLETT BEHAVIORAL HEALTH ASST. PGRM. DIR. 140000 0 0 0 0 0 1260 0 11643 0 152903 0 0 0 SOMPIA PAIGNE OFFICER MEDICAL PRACTICE PURCHASE. X 825000 392500 0 1 1 392500 PART II LOAN TO/FROM INTEREST PERSON ON APRIL 1, 2020, THE ORGANIZATION ENTERED INTO A PURCHASE AGREEMENT FOR A MEDICAL PRACTICE OWNED BY KITTYA PAIGNE, A FAMILY MEMBER OF THE ORGANIZATION'S CEO, SOMPIA PAIGNE. KITTYA PAIGNE IS ALSO A HIGHLY COMPENSATED EMPLOYEE OF THE ORGANIZATION. THE $825,000 PURCHASE PRICE WAS BASED ON AN INDEPENDENT VALUATION BY A THIRD PARTY. PURSUANT TO THE AGREEMENT, THE APRIL 1, 2020 LOAN BALANCE OF $692,500 WILL BE PAID IN MONTHLY INSTALLMENTS OF $12,500 UNTIL PAID IN FULL. FORM 990, PART VI, SECTION A, LINE 2 SOMPIA PAIGNE CEO, KITTYA PAIGNE PHYSICIAN, BOZA PHENG COO, AND BAKHENG PHENG CMO ARE ALL SIBLINGS. FORM 990, PART VI, SECTION B, LINE 11B ONCE THE FORM 990 IS COMPLETED, A COPY IS DELIVERED TO MEMBERS OF THE BOARD. THE BOARD REVIEWS THE RETURN AND IF ANY CHANGES ARE NEEDED, THE PREPARER IS NOTIFIED. FORM 990, PART VI, SECTION B, LINE 12C EACH EMPLOYEE OR AGENT ENGAGED IN THE SELECTION, AWARD, AND ADMINISTRATION OF CONTRACTS, AND EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ARE REQUIRED TO ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON (A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS CMWC USA IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. DUTY TO DISCLOSE. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION, ARRANGEMENT, OR CONTRACT. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE LEAVES THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE LEAVES THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION, ARRANGEMENT OR CONTRACT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE, IF APPROPRIATE, WILL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE AN ALTERNATIVE TO THE PROPOSED TRANSACTION, ARRANGEMENT OR CONTRACT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE DETERMINES WHETHER THE ORGANIZATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION, ARRANGEMENT OR CONTRACT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION, ARRANGEMENT OR CONTRACT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE DETERMINES BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION, ARRANGEMENT OR CONTRACT IS IN CMWC USA'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. VIOLATIONS OF THE CONFLICT OF INTEREST POLICY. IF THE GOVERNING BOARD OR COMMITTEE HAS A REASONABLE CAUSE TO BELIEVE AN INTERESTED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT INFORMS THE INTERESTED PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE INTERESTED PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE INTERESTED PERSON'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE INTERESTED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION UP TO AND INCLUDING IMMEDIATE TERMINATION. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION PACKAGE IS REVIEWED ON THE PERFORMANCE AND CAPABILITIES OF THE CEO, AND APPROVED IN ADVANCE BY THE GOVERNING BOARD MEMBERS WHO DO NOT RECEIVE ANY COMPENSATION. THE COMPARABILITY DATA UTILIZED IS GALLAGHER SURVEYS AND THE CALIFORNIA PRIMARY CARE ASSOCIATION (CPCA) COMPENSATION AND BENEFITS SURVEY. THE SURVEYS PROVIDE DETAILED INFORMATION ON EXECUTIVE, CLINICAL AND ADMINISTRATIVE PERSONNEL WORKING IN PRIMARY CARE COMMUNITY HEALTH CENTERS. THE ORGANIZATION CONTEMPORANEOUSLY SUBSTANTIATES THE DELIBERATION AND DECISION PROCESS OF THE GOVERNING BOARD IN THE BOARD MINUTES, INCLUDING A DESCRIPTION OF THE COMPARABLE DATA AND HOW IT WAS OBTAINED, THE DATE APPROVED, A DESCRIPTION OF THE TRANSACTION, AND WHO WAS PRESENT. THE PROCESS FOR DETERMINING THE COMPENSATION PACKAGES FOR OTHER OFFICERS AND KEY EMPLOYEES IS THE SAME PROCESS AS FOR THE CEO. FORM 990, PART VI, SECTION C, LINE 19 TAX RETURN AND FINANCIAL STATEMENT ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND ON ANOTHER WEBSITE (GUIDESTAR). FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 548,488. MANAGEMENT AND GENERAL EXPENSES 137,122. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 685,610. PROVIDER SERVICES: PROGRAM SERVICE EXPENSES 1,157,322. MANAGEMENT AND GENERAL EXPENSES 289,330. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,446,652. PAYROLL FEES: PROGRAM SERVICE EXPENSES 29,176. MANAGEMENT AND GENERAL EXPENSES 7,294. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,470.