2021-12-17T14:59:58-06:00 2021-03-31 952302617 SINGERLEWAK LLP 10960 WILSHIRE BOULEVARD 7TH FLOOR LOS ANGELES CA 900243783 990 2020-04-01 953514918 ARROYO VISTA FAMILY HEALTH FOUNDATION ARRO 3232545291 6000 N FIGUEROA STREET LOS ANGELES CA 90042 JLORRAINE ESTRADAS CEO 3232545291 2021-12-14 1 JLORRAINE ESTRADAS 999009999 LIOR TEMKIN P00748170 3104773924 2021-12-14 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JLORRAINE ESTRADAS 6000 N FIGUEROA STREET LOS ANGELES CA 90042 20443040 0 X WWW.ARROYOVISTA.ORG X 1980 CA TO MEET THE CURRENT AND FUTURE HEALTH NEEDS OF GREATER NORTHEAST LOS ANGELES BY PROVIDING HIGH QUALITY, COMPREHENSIVE AND AFFORDABLE HEALTH SERVICES IN A COMPASSIONATE AND FINANCIALLY RESPONSIBLE MANNER. 9 9 239 0 0 0 5483823 7589627 12702145 11313314 188190 48039 565428 1492060 18939586 20443040 0 0 0 0 16000285 15112111 0 0 26169 5844855 4827161 21845140 19939272 -2905554 503768 26664584 30889113 3923174 8068009 22741410 22821104 TO MEET THE CURRENT AND FUTURE HEALTH NEEDS OF GREATER NORTHEAST LOS ANGELES BY PROVIDING HIGH QUALITY, COMPREHENSIVE AND AFFORDABLE HEALTH SERVICES IN A COMPASSIONATE AND FINANCIALLY RESPONSIBLE MANNER. 0 0 16051697 12784374 SEE SCHEDULE O 16051697 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 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 38 0 1 239 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X JOHN L ANSALDO CFO 3232545291 6000 N FIGUEROA STREET LOS ANGELES CA 90042 PETER FERNANDEZ BOARD MEMBER 2.50 X 0 0 0 DANIEL GARRETT BOARD MEMBER 2.50 X 0 0 0 MARIA DEL ROSARIO MARTINEZ BOARD MEMBER 2.50 X 0 0 0 TERESITA MEZA BOARD MEMBER 2.50 X 0 0 0 NATO FLORES BOARD MEMBER 2.50 X 0 0 0 SERGIO TEJADILLA BOARD TREASURER / MEMBER 2.50 X X 0 0 0 ROGER ESTRADA BOARD PRESIDENT / MEMBER 2.50 X X 0 0 0 RACHAEL LOPEZ-KINNEY BOARD SECRETARY / MEMBER 2.50 X X 0 0 0 CARLOS ZARAGOZA ESQ BOARD VICE-PRESIDENT / MEM 2.50 X X 0 0 0 JOHN L ANSALDO CHIEF FINANCIAL OFFICER 40.00 X 177363 0 9635 J LORRAINE ESTRADAS RN CHIEF EXECUTIVE OFFICER 40.00 X 279403 0 13059 THUY Q PHAM MD CHIEF MEDICAL OFFICER 40.00 X 303579 0 13409 HASSAN HALAWI MD PHYSICIAN 40.00 X 207618 0 16951 FRANKLIN NGUYEN MD PHYSICIAN 40.00 X 235916 0 12958 AANAL DESAI PHYSICIAN 32.00 X 162678 0 144 NAJMA QAMAR PHYSICIAN 32.00 X 182014 0 72 ERIN KIMBERLY HERNDON MD PHYSICIAN 40.00 X 158032 0 9786 1706603 0 76014 31 0 1 0 LATARA ENTERPRISE INC 1716 W HOLT AVENUE POMONA CA 91768 CLINICAL LABORATORY & PATHOLOGY SERVICES 271792 HUNTINGTON EL SERENO LLC 948 THAYER AVENUE LOS ANGELES CA 90024 FACILITY RENT 228830 WELLPARTNER LLC - A CVS HEALTH COMPANY 20800 SW 115TH AVE SUITE 100 TUALATIN OR 97602 PHARMACEUTICALS SERVICES 156436 ROCHELLE CAROLYN KASTEN 4138 VICASA DRIVE CALABASAS CA 91302 CONSULTANT 119127 CHG COMPANIES INC POBOX 972651 DALLAS TX 75397 PROVIDER SERVICES 112723 5 6480858 1108769 469544 7589627 PATIENT FEES 621400 8469621 8469621 INCENTIVE-BASED REVENUE 621400 2843693 2843693 11313314 48039 48039 21000 0 21000 21000 21000 OTHER INCOME 900099 1471060 1471060 1471060 20443040 12784374 0 69039 846203 260837 584266 1100 11877399 10177625 1683910 15864 1756200 1461954 291903 2343 632309 519672 111794 843 12034 12034 86553 86553 491310 317042 168249 6019 359752 42419 317333 804771 545025 259746 5870 4584 1286 316484 212511 103973 139012 61180 77832 SUPPLIES 1731583 1716937 14646 UTILITIES 451019 343689 107330 LABORATORY 250001 250001 0 REPAIRS AND MAINTENANCE 118889 102872 16017 59883 35349 24534 19939272 16051697 3861406 26169 X 365625 1021600 13973984 17627033 264294 262213 1117067 1032539 2010203 2602841 10687729 6364036 4598460 4323693 4334951 4019194 26664584 30889113 2169679 2417313 720 0 1752775 5650696 3923174 8068009 X 18152475 18602146 4588935 4218958 22741410 22821104 26664584 30889113 503768 -3085 -315757 -105232 0 X 0 1 X 1 1 1 X 5396332 5089852 5122755 5483823 7589627 28682389 5396332 5089852 5122755 5483823 7589627 28682389 28682389 108776 167837 205213 188190 48039 718055 259925 537358 422853 544428 1471060 3235624 32636068 68623580 0.87890 0.90410 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: 2015 OTHER INCOME 266772 2016 OTHER INCOME 259925 2017 OTHER INCOME 537358 2018 OTHER INCOME 423043 2019 OTHER INCOME 544428 2020 OTHER INCOME 1471060 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 529084 529084 5081168 1984957 3096211 1387090 763889 623201 3324659 3260077 64582 365728 355113 10615 4323693 CONTRIBUTION RECEIVABLE 4019194 4019194 DUE TO THIRD PARTY PAYERS 2913316 SBA LOAN PAYABLE 2737380 5650696 X 20439955 -3085 -3085 20443040 0 20443040 20255029 315757 315757 19939272 0 19939272 PART X, LINE 2: THE FOUNDATION HAS BEEN DESIGNATED AS TAX EXEMPT UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), IS ALSO EXEMPT FROM STATE FRANCHISE TAXES UNDER SECTION 23701(D) OF THE CALIFORNIA REVENUE AND TAXATION CODE, AND IS NOT GENERALLY SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, THE FOUNDATION 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, AND IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE BASIC FINANCIAL STATEMENTS TAKEN AS A WHOLE. THE FOUNDATION RECOGNIZES THE IMPACT OF TAX POSITIONS IN THE FINANCIAL STATEMENTS IF THAT POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED ON AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE FOUNDATION HAS DETERMINED THAT THERE ARE NO UNRECOGNIZED TAX BENEFITS. X 0 0 0 0 0 0 0 0 0 THUY Q PHAM MD CHIEF MEDICAL OFFICER 303579 0 0 0 0 0 0 0 13409 0 316988 0 0 0 J LORRAINE ESTRADAS RN CHIEF EXECUTIVE OFFICER 256057 0 23346 0 0 0 0 0 13059 0 292462 0 0 0 FRANKLIN NGUYEN MD PHYSICIAN 235916 0 0 0 0 0 0 0 12958 0 248874 0 0 0 HASSAN HALAWI MD PHYSICIAN 207618 0 0 0 0 0 0 0 16951 0 224569 0 0 0 JOHN L ANSALDO CHIEF FINANCIAL OFFICER 177363 0 0 0 0 0 0 0 9635 0 186998 0 0 0 NAJMA QAMAR PHYSICIAN 182014 0 0 0 0 0 0 0 72 0 182086 0 0 0 ERIN KIMBERLY HERNDON MD PHYSICIAN 158032 0 0 0 0 0 0 0 9786 0 167818 0 0 0 AANAL DESAI PHYSICIAN 162678 0 0 0 0 0 0 0 144 0 162822 0 0 0 X 1 469544 COST 0 0 0 FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: MADE FOR THE COMMUNITY, BY THE COMMUNITY, ARROYO VISTA FAMILY HEALTH CENTER IS A NON-PROFIT COMMUNITY HEALTH CENTER GOVERNED BY A CONSUMER BOARD OF DIRECTORS WITH A TRUSTED TEAM OF HEALTHCARE PROFESSIONALS SERVING THE GREATER NORTHEAST LOS ANGELES SINCE 1981. WE ARE LICENSED BY THE STATE OF CALIFORNIA DEPARTMENT OF HEALTH SERVICES. AS A FEDERALLY QUALIFIED HEALTH CENTER, FUNDING IS PROVIDED THROUGH PUBLIC HEALTH SERVICES ACT, SECTION 330, WITH ADDITIONAL FUNDING FROM LOS ANGELES COUNTY AND PRIVATE SOURCES. WE ARE ACCREDITED BY THE JOINT COMMISSION, WHICH MEANS THAT ARROYO VISTA HAS BEEN RIGOROUSLY INSPECTED, TESTED AND EVALUATED. WE ARE NATIONALLY RECOGNIZED FOR THE HIGHEST LEVEL OF PATIENT SAFETY AND QUALITY OF CARE. AS A CERTIFIED PRIMARY CARE MEDICAL HOME BY THE JOINT COMMISSION, WE FOLLOW CARE COORDINATION AND INTERDISCIPLINARY TEAM CARE MODEL FOR THE PROVISION OF SERVICES. FROM OUR HUMBLE BEGINNING IN 1981 AS A SMALL STOREFRONT CLINIC, WE HAVE GROWN TO A NETWORK OF FOUR HEALTH CENTERS AND A MOBILE CLINIC SERVING EVERY MEMBER OF THE COMMUNITY, WITH OVER 79,000 PATIENT VISITS IN 2020. ARROYO VISTA PROVIDES A COMPREHENSIVE RANGE OF MEDICAL, DENTAL, OPTOMETRY, BEHAVIORAL HEALTH, IMAGING, AND PHARMACEUTICAL SERVICES. OUR SERVICES ARE DESIGNED FOR ALL AGES, FROM INFANTS AND CHILDREN, TO TEENS, ADULTS, AND THE ELDERLY. MANY SERVICES ARE PROVIDED AT NO COST, INCLUDING HEALTH EDUCATION, ANNUAL FLU VACCINE CLINICS, IMMUNIZATIONS FOR CHILDREN, AND ANNUAL HEALTH FAIR SCREENINGS. WE ALSO PROVIDE TRANSPORTATION ASSISTANCE AND APPLICATION SUPPORT FOR MEDI-CAL, MEDICARE, MHLA AND COVERED CA. SERVICES ARE PROVIDED TO OUR VALUED PATIENTS REGARDLESS OF ABILITY TO PAY. PATIENTS WITH OR WITHOUT INSURANCE, MEDI-CAL AND MEDICARE... EVERYONE IS WELCOME AT ARROYO VISTA. OUR SERVICES ARE PROVIDED IN A CULTURALLY SENSITIVE, LINGUISTICALLY APPROPRIATE AND COMPASSIONATE MANNER. MANY OF OUR DOCTORS, NURSES, AND ADMINISTRATIVE STAFF COME FROM THE LOCAL COMMUNITY, AND MANY OF US INCLUDING OUR BOARD MEMBERS ARE ALSO PATIENTS OF ARROYO VISTA. FORM 990, PART VI, SECTION B, LINE 11B EXPLANATION: THE INFORMATIONAL RETURN IS PREPARED BY AN OUTSIDE ACCOUNTANT. IT IS THEN REVIEWED BY THE CFO. ONCE APPROVED, THE RETURN IS PROVIDED TO THE BOARD OF DIRECTORS BEFORE IT IS E-FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EXPLANATION: ARROYO VISTA BOARD MEMBERS SHALL COMPLETE A DIRECTOR QUESTIONNAIRE ANNUALLY CONFIRMING THEIR INDEPENDENT STATUS AND COMPLIANCE WITH THE AGENCY'S CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 EXPLANATION: ARROYO VISTA'S PERSONNEL COMMITTEE HAS RESPONSIBILITY FOR THE REVIEW OF PERSONNEL POLICIES AND PROCEDURES INCLUDING COMPENSATION AND BENEFIT PROGRAMS. ARROYO VISTA EXECUTIVE COMMITTEE'S RESPONSIBILITIES INCLUDE YEARLY EVALUATION OF THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE AND COMPENSATION, WHICH IS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS FOR FINAL REVIEW AND APPROVAL. OTHER OFFICERS AND KEY EMPLOYEES UNDERGO AN ANNUAL APPRAISAL REVIEW TO DETERMINE PROMOTION TO A HIGHER PAY LEVEL OR FOR MERIT INCREASES. THE CEO WILL MAKE THE DECISION ON MERIT INCREASES BASED ON THE SUPERVISOR'S AND/OR EXECUTIVE'S RECOMMENDATION AND EMPLOYEE PERFORMANCE AT THE TIME OF THE APPRAISAL REVIEW. FORM 990, PART VI, SECTION C, LINE 19 EXPLANATION: ARROYO VISTA MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST, AND TO INDEPENDENT AUDITORS DURING THEIR ANNUAL INDEPENDENT FINANCIAL AUDIT. FORM 990, PART X, LINE 15, OTHER ASSETS AT MARCH 31, 2018, THE FOUNDATION HAD A RECEIVABLE THAT REPRESENTED UNCONDITIONAL PROMISES TO USE THE FACILITY LOCATED AT 6000 NORTH FIGUEROA STREET, LOS ANGELES, CA 90042, FROM THE CITY OF LOS ANGELES, DEPARTMENT OF GENERAL SERVICES (THE "CITY"). THE INITIAL TERM OF THE AGREEMENT WAS FOR THE RENT-FREE USE OF THE BUILDING FOR 20 YEARS STARTING IN JUNE 1987. THE AGREEMENT WAS AMENDED IN OCTOBER 2014, AND THE LEASE WAS RENEWED FOR ANOTHER 15 YEARS AT A NOMINAL RENT OF $1 PER YEAR. THE FOUNDATION USES THE PREMISES FOR THE PRIMARY OBJECTIVE OF PROVIDING HEALTH CARE SERVICES TO THE COMMUNITY. AS OF MARCH 31, 2021, THE BALANCE FOR THE RECEIVABLE IS $4,019,194.