Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 21,700,725 | 25,670,176 | 32,041,442 | 43,043,545 | 41,098,844 | 163,554,732 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | 21,700,725 | 25,670,176 | 32,041,442 | 43,043,545 | 41,098,844 | 163,554,732 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | 163,554,732 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 21,700,725 | 25,670,176 | 32,041,442 | 43,043,545 | 41,098,844 | 163,554,732 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,888 | 26,682 | 5,572 | 14,938 | 85,179 | 134,259 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 2,306,768 | 1,646,058 | 119,500 | 4,072,326 | ||
| 11 | Total support. Add lines 7 through 10 | 167,761,317 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| 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 7,057,334. MANAGEMENT AND GENERAL EXPENSES 51,249. FUNDRAISING EXPENSES 8,146. TOTAL EXPENSES 7,116,729. TRANSPORTATION: PROGRAM SERVICE EXPENSES 253,612. MANAGEMENT AND GENERAL EXPENSES 1,842. FUNDRAISING EXPENSES 293. TOTAL EXPENSES 255,747. PAYROLL SERVICES : PROGRAM SERVICE EXPENSES 211,129. MANAGEMENT AND GENERAL EXPENSES 1,533. FUNDRAISING EXPENSES 244. TOTAL EXPENSES 212,906. OUTSIDE SERVICES SECURITY: PROGRAM SERVICE EXPENSES 442,346. MANAGEMENT AND GENERAL EXPENSES 3,212. FUNDRAISING EXPENSES 511. TOTAL EXPENSES 446,069. OUTSIDE SERVICES TRANSLATION: PROGRAM SERVICE EXPENSES 73,478. MANAGEMENT AND GENERAL EXPENSES 534. FUNDRAISING EXPENSES 85. TOTAL EXPENSES 74,097. SUBCONTRACTOR: PROGRAM SERVICE EXPENSES 745,213. MANAGEMENT AND GENERAL EXPENSES 6,225. FUNDRAISING EXPENSES 989. TOTAL EXPENSES 752,427. OTHER PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 2,399,481. MANAGEMENT AND GENERAL EXPENSES 17,424. FUNDRAISING EXPENSES 2,770. TOTAL EXPENSES 2,419,675. |
| FORM 990, PART IX, LINE 24E | FEES: PROGRAM SERVICE EXPENSES 842,941. MANAGEMENT AND GENERAL EXPENSES 23,879. FUNDRAISING EXPENSES 1,345. TOTAL EXPENSES 868,165. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 706,696. MANAGEMENT AND GENERAL EXPENSES 18,051. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 724,747. RECRUITMENT: PROGRAM SERVICE EXPENSES 264,147. MANAGEMENT AND GENERAL EXPENSES 15,272. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 279,419. PROPERTY & SALES TAX: PROGRAM SERVICE EXPENSES 179,501. MANAGEMENT AND GENERAL EXPENSES 5,085. FUNDRAISING EXPENSES 286. TOTAL EXPENSES 184,872. TRAINING & MEETINGS: PROGRAM SERVICE EXPENSES 124,802. MANAGEMENT AND GENERAL EXPENSES 2,773. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,575. LAUNDRY: PROGRAM SERVICE EXPENSES 90,147. MANAGEMENT AND GENERAL EXPENSES 5,212. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,359. MEMBERSHIPS & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 86,961. MANAGEMENT AND GENERAL EXPENSES 5,028. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,989. UNIFORMS: PROGRAM SERVICE EXPENSES 84,673. MANAGEMENT AND GENERAL EXPENSES 4,895. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 89,568. EMPLOYEE ACKNOWLEDGEMENTS: PROGRAM SERVICE EXPENSES 59,046. MANAGEMENT AND GENERAL EXPENSES 3,414. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,460. OTHER EXPENSES: PROGRAM SERVICE EXPENSES 36,292. MANAGEMENT AND GENERAL EXPENSES 2,099. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,391. FEDERAL EXCISE TAX: PROGRAM SERVICE EXPENSES 1,516. MANAGEMENT AND GENERAL EXPENSES 43. FUNDRAISING EXPENSES 2. TOTAL EXPENSES 1,561. |
| Software ID: | |
| Software Version: |