2021-05-13T22:48:19-05:00 2020-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2019-07-01 831342199 LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER LACL 5105354000 PO BOX 22210 OAKLAND CA 946232210 SUSAN MOORE CFO 5105354000 2021-05-13 1 MICHAEL LUMSDEN P01262236 4159561500 2021-05-13 2019 2022-09-23 18:48:47Z JANE GARCIA PO BOX 22210 OAKLAND CA 946232210 1626736 0 X WWW.LACLINICA.ORG X 2018 CA TO SUPPORT LA CLINICA THROUGH FINANCING THE CONSTRUCTION OF A HEALTH CARE FACILITY IN VALLEJO, CA. 15 15 0 17 0 0 2064065 1573705 0 0 510 34488 0 18543 2064575 1626736 0 0 0 0 0 0 0 0 0 19053 49767 19053 49767 2045522 1576969 18990122 20588109 16944600 16965618 2045522 3622491 X THE CORPORATION IS ORGANIZED FOR THE PURPOSE OF SUPPORTING THE CHARITABLE ACTIVITIES OF LA CLINICA DE LA RAZA, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION, INCLUDING LA CLINICA DE LA RAZA'S PROPOSED HEALTH CLINIC IN SOLANO COUNTY, CALIFORNIA AND SERVING AS A QUALIFIED ACTIVE LOW-INCOME COMMUNITY BUSINESS, AS SUCH TERM IS DEFINED IN SECTION 45D OF THE INTERNAL REVENUE CODE. 0 0 0 0 0 THE ORGANIZATION SUPPORTS THE CHARITABLE ACTIVITIES OF LA CLINICA DE LA RAZA THROUGH FINANCING THE CONSTRUCTION OF A 26,000 SQUARE FOOT TWO-STORY MODERN, STATE-OF-THE-ART INTEGRATED HEALTH CARE FACILITY IN DOWNTOWN VALLEJO. 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X SUSAN MOORE 5105352924 1450 FRUITVALE AVENUE THIRD FLOOR OAKLAND CA 94601 JANE GARCIA CHIEF EXECUTIVE OFFICER 1.00 40.00 X 0 313010 48746 SUSAN MOORE CHIEF FINANCIAL OFFICER 1.00 40.00 X 0 188438 25420 YVONNE HUDSON-HARMON PRESIDENT 1.00 1.00 X X 0 0 0 RAMON TERRAZAS MD MPH VICE PRESIDENT 1.00 1.00 X X 0 0 0 CHRISTOPHER OHMAN SECRETARY 1.00 1.00 X X 0 0 0 PAUL MARRIOTT SWENSON MBA TREASURER 1.00 1.00 X X 0 0 0 NORMA GUADALUPE GUERRERO PARLIAMENTARIAN THROUGH 8/2019/DIR. 1.00 1.00 X X 0 0 0 ROBERT CALVIN KATTER PARLIAMENTARIAN START 8/2019 1.00 1.00 X X 0 0 0 DANIEL AYALA DIRECTOR THROUGH 12/2019 1.00 1.00 X 0 0 0 SOPHIA BUCHELI DIRECTOR 1.00 1.00 X 0 0 0 ELIZABETH DIAZ DIRECTOR 1.00 1.00 X 0 0 0 MARIA DE LOS ANGELES ESPINOZA DIRECTOR 1.00 1.00 X 0 0 0 ALVARO FUENTES INDEPENDENT DIRECTOR 1.00 0.00 X 0 0 0 AISHA HAMPTON-BOWSER DIRECTOR 1.00 1.00 X 0 0 0 RACHEL HARRALSON DIRECTOR THROUGH 12/2019 1.00 1.00 X 0 0 0 TERRELL JACKSON DIRECTOR 1.00 1.00 X 0 0 0 REVEREND RODNEY J LEGGETT DIRECTOR 1.00 1.00 X 0 0 0 DR TINA RAINE-BENNETT DIRECTOR 1.00 1.00 X 0 0 0 MARIA TSAKLANOS DIRECTOR 1.00 1.00 X 0 0 0 0 501448 74166 0 0 1 0 C OVERAA & CO 200 PARR BLVD RICHMOND CA 94801 CONSTRUCTION SERVICES 3566642 SWINERTON BUILDERS 10 CLAY STREET OAKLAND CA 94612 CONSTRUCTION SERVICES 233018 2 1573705 1573705 34488 34488 OTHER REVENUE 900099 18543 18543 18543 1626736 0 0 53031 31527 31527 BORROWER FEES 18240 18240 49767 0 49767 0 251455 241575 15453167 11435811 8910723 0 3285500 8910723 18990122 20588109 14625 14625 16929975 16950993 16944600 16965618 X -18543 -15279 2064065 3637770 2045522 3622491 18990122 20588109 1576969 0 X 0 1 X 1 0 X X 1 LA CLINICA DE LA RAZA INC 941744108 7 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART I, LINE 12G, COLUMN (VI): LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER WAS ORGANIZED FOR THE PURPOSE OF SUPPORTING THE CHARITABLE ACTIVITIES OF LA CLINICA DE LA RAZA, INC.; IN PARTICULAR, THE ORGANIZATION HOLDS TITLE TO PROPERTY BEING RENOVATED TO CREATE A 26,000 SQUARE FOOT, TWO-STORY MODERN STATE-OF-THE-ART INTEGRATED HEALTH CARE FACILITY IN DOWNTOWN VALLEJO, CA. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 819845 819845 8090878 8090878 8910723 X PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND HAS BEEN GRANTED TAX-EXEMPT STATUS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA REVENUE AND TAXATION CODE. AS OF JUNE 30, 2020 THE ORGANIZATION HAD NO UNRECOGNIZED TAX POSITIONS OR UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE FINANCIAL STATEMENTS. 0 1 0 0 0 0 0 0 0 JANE GARCIA CHIEF EXECUTIVE OFFICER 0 313010 0 0 0 0 0 23805 0 24941 0 361756 0 0 SUSAN MOORE CHIEF FINANCIAL OFFICER 0 188438 0 0 0 0 0 1836 0 23584 0 213858 0 0 PART I, LINE 3 THE ORGANIZATION'S CEO IS COMPENSATED BY LA CLINICA DA LA RAZA, INC., A RELATED ORGANIZATION. LA CLINICA DE LA RAZA, INC. UTILIZED THE FOLLOWING METHODS TO DETERMINE THE CEO'S COMPENSATION: COMPENSATION SURVEY OR STUDY; APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B JANE. C GARCIA PARTICIPATES IN A SUPPLEMENTAL, NONQUALIFIED 457(F) RETIREMENT PLAN PROVIDED THROUGH LA CLINICA DE LA RAZA, INC., A RELATED ORGANIZATION. DURING THE 2019 CALENDAR YEAR, CONTRIBUTIONS TO THE PLAN TOTALED $20,500, WHICH HAS BEEN REPORTED AS "DEFERRED COMPENSATION" ON SCHEDULE J, PART II, COLUMN (C); THERE WERE NO DISTRIBUTIONS OR AMOUNTS TREATED AS TAXABLE COMPENSATION DUE TO SUBSTANTIAL RISK OF FORFEITURE FROM THE PLAN. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION DOES NOT HAVE "MEMBERS" BY DEFINITION OF THE BYLAWS; HOWEVER, THE FORM 990 INSTRUCTIONS ALSO DEFINE A "MEMBER" AS ANY PERSON (INCLUDING A CORPORATION OR OTHER LEGAL ENTITY) WHO, PURSUANT TO A PROVISION OF THE ORGANIZATION'S GOVERNING DOCUMENTS, HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE (INCLUDING ELECTING MEMBERS OF THE GOVERNING BODY). ACCORDINGLY, THE ORGANIZATION HAS ONE SOLE MEMBER: LA CLINICA DE LA RAZA, INC., A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBERS OF THE BOARD OF DIRECTORS, EXCEPT FOR THE INDEPENDENT DIRECTOR, SHALL BE SELECTED BY LA CLINICA DE LA RAZA, INC. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF LA CLINICA DE LA RAZA, INC. HAS THE POWER TO APPOINT THE CHIEF EXECUTIVE OFFICER OF LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER. ADDITIONALLY, LA CLINICA VALLEJO GEORGIA STREET PROPERTY OWNER MAY NOT BE DISSOLVED WITHOUT THE WRITTEN APPROVAL OF LA CLINICA DE LA RAZA, INC. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT TAX PREPARER IN CONJUNCTION WITH THE ORGANIZATION'S FINANCE AND ACCOUNTING DEPARTMENT. UPON REVIEW AND APPROVAL BY THE FINANCE AND ACCOUNTING DEPARTMENT, THE FORM 990 IS THEN REVIEWED BY THE AUDIT COMMITTEE OF THE BOARD AND THEN SENT ELECTRONICALLY TO ALL MEMBERS OF THE BOARD PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, KEY EMPLOYEE, AND MEMBER OF THE BOARD OF DIRECTORS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: (I) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; (II) HAS READ AND UNDERSTANDS THE POLICY; AND (III) HAS AGREED TO COMPLY WITH THE POLICY. SHOULD A POTENTIAL CONFLICT OF INTEREST ARISE, THE BOARD OF DIRECTORS (OR A COMMITTEE OF THE BOARD OF DIRECTORS WITH DELEGATED POWERS) SHALL MEET TO DETERMINE WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. THE INTERESTED PERSON MAY APPEAR AT THE BOARD OR COMMITTEE MEETING FOR THE SOLE PURPOSE OF ANSWERING QUESTIONS. AFTER ANY SUCH QUESTIONS ARE ANSWERED, THE INTERESTED PERSON SHALL LEAVE THE MEETING WHILE THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON. TO ADDRESS ACTUAL CONFLICTS OF INTEREST, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE DETERMINES WHETHER THE CORPORATION CAN OBTAIN, WITH REASONABLE EFFORT, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. THE DELIBERATION AND DECISION-MAKING PROCESS IS RECORDED IN THE BOARD (OR COMMITTEE) MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES; RATHER, THESE INDIVIDUALS ARE COMPENSATED BY LA CLINICA DE LA RAZA, INC., A RELATED ORGANIZATION. ACCORDINGLY, FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BEEN ANSWERED "NO" AS MANDATED BY THE FORM 990 INSTRUCTIONS. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. LA CLINICA DE LA RAZA INC PO BOX 22210 OAKLAND CA 946232210 941744108 FEDERALLY QUALIFIED HEALTH CENTER CA 501(C)(3) LINE 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 LA CLINICA DE LA RAZA INC C 1573705 BOOK VALUE