2020-05-01T15:32:10-05:00 2019-06-30 951777440 GREEN HASSON & JANKS LLP 10990 WILSHIRE BLVD 16TH FLOOR LOS ANGELES CA 900243929 990 2018-07-01 952769432 VENICE FAMILY CLINIC VENI 3103928630 604 ROSE AVENUE VENICE CA 90291 ELIZABETH B FORER CEO 3103928630 2020-04-23 1 LIZBETH G NEVAREZ P01399868 3108731600 108.233.72.19 2020-04-23 16:42:26 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1E5C2E37194314C3A47C760AEAFDC059525B6175 2018 2020-11-19 02:30:22Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 50207204 0 X HTTP://WWW.VENICEFAMILYCLINIC.ORG/ X 1970 CA TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 21 21 373 1486 0 0 15571302 17845497 30426379 31521106 -35439 310151 0 0 45962242 49676754 0 0 0 0 33825581 36790161 0 0 2238752 10629789 12552076 44455370 49342237 1506872 334517 38892913 38471906 1704633 887290 37188280 37584616 TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 0 0 41165889 31521106 VFC SERVES AS A MEDICAL HOME, PROVIDING COORDINATED AND COMPREHENSIVE PRIMARY CARE, SPECIALTY CARE, AND ENABLING SERVICES FOR LOW-INCOME, UNINSURED, AND HOMELESS FAMILIES AND INDIVIDUALS. IT SERVES EVERYONE FROM INFANTS, CHILDREN, AND TEENS TO ADULTS AND SENIORS. VFC OFFERS A VARIETY OF SERVICES INCLUDING: MEDICAL PRIMARY AND SPECIALTY CARE, DENTAL, INTEGRATIVE MEDICINE, VISION SERVICES,PHARMACY, AND BEHAVIORAL HEALTH. VFC ALSO PROVIDES TREATMENT AND COUNSELING SERVICES TO HIV PATIENTS THROUGH ITS COMMON GROUND PROGRAM. VFC PROVIDES HEALTH CARE ON SIX DAYS AND FOUR EVENINGS PER WEEK. VFC'S PRIMARY SERVICE AREA INCLUDES VENICE, SANTA MONICA, PALMS, MAR VISTA, INGLEWOOD, CULVER CITY AND WEST LOS ANGELES, ALL IN LOS ANGELES COUNTY. 41165889 1 1 0 1 0 0 0 1 0 1 1 1 0 0 0 0 0 1 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 1 0 0 0 1 102 0 1 373 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 21 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 CA X ANDREA BLACKBIRD 3106647941 604 ROSE AVENUE VENICE CA 90291 JOHN GERESI CHAIR 2.00 2.00 X X 0 0 0 JOAN HERMAN CHAIR ELECT 2.00 2.00 X X 0 0 0 JEFFREY E SINAIKO TREASURER AND IMMEDIATE PAST BOARD CHAIR 2.00 2.00 X X 0 0 0 MICHAEL ST PIERRE SECRETARY 2.00 0.00 X X 0 0 0 WILLIAM FLUMENBAUM BOARD MEMBER 2.00 2.00 X 0 0 0 MAYER B DAVIDSON MD BOARD MEMBER 2.00 2.00 X 0 0 0 JENIFER ANISMAN BOARD MEMBER 2.00 0.00 X 0 0 0 KEN BASCOM BOARD MEMBER 2.00 0.00 X 0 0 0 NEIL H PARKER MD BOARD MEMBER 2.00 2.00 X 0 0 0 PAUL SABEN BOARD MEMBER 2.00 0.00 X 0 0 0 OLGA CARRASCO BOARD MEMBER 2.00 0.00 X 0 0 0 NADIA SHAHEEN BOARD MEMBER 2.00 0.00 X 0 0 0 CARMEN THOMAS-PARIS BOARD MEMBER 2.00 0.00 X 0 0 0 LEISA WU BOARD MEMBER 2.00 2.00 X 0 0 0 DIANA CARSOLA BOARD MEMBER 2.00 0.00 X 0 0 0 LOETTE LOSHAK BOARD MEMBER 2.00 0.00 X 0 0 0 EDITH J MADRID BOARD MEMBER 2.00 0.00 X 0 0 0 ALLAN GORDON BOARD MEMBER 2.00 0.00 X 0 0 0 CAROLINA MONGE BOARD MEMBER 2.00 0.00 X 0 0 0 PATRICIA RAMIREZ BOARD MEMBER 2.00 0.00 X 0 0 0 TARYN KEANE BOARD MEMBER 2.00 0.00 X 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 40.00 1.00 X 259178 0 62598 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 40.00 1.00 X 194335 0 57250 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 248803 0 69558 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 40.00 0.00 X 222846 0 57745 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 205704 0 50113 NAVEENA PONNUSAMY CHIEF DEVELOPMENT OFFICER 40.00 0.00 X 209906 0 53829 ANITA MARIA ZAMORA CHIEF OPERATIONS OFFICER 40.00 0.00 X 222381 0 56678 SHARON NG DIRECTOR OF PHARMACY 40.00 0.00 X 170004 0 50978 JASON VU HUA CHIEF INFORMATION OFFICER 40.00 0.00 X 159430 0 47479 STACEY ANN SCARBOROUGH DIR. OF HUMAN RESOURCES & HEAD START 40.00 0.00 X 156816 0 38091 JAY W LEE MEDICAL DIRECTOR 40.00 0.00 X 152149 0 32648 COLEY MARVIN KING PHYSICIAN 40.00 0.00 X 202133 0 49213 GILMORE SEISOON CHUNG PHYSICIAN 40.00 0.00 X 195510 0 39431 CAROL R SCHWARTZ PHYSICIAN 40.00 0.00 X 179907 0 48867 MICHELLE I AGUILAR PHYSICIAN 40.00 0.00 X 176917 0 37475 NANCY MARIE PIERRE-PAUL NURSE PRACTITIONER 40.00 0.00 X 172031 0 46548 3128050 0 798501 58 0 1 0 BROTHERS MAINTENANCE SERVICES PO BOX 3283 WHITTIER CA 90605 CLEANING SERVICE 462814 RANDSTAD US LP PO BOX 894217 LOS ANGELES CA 90189 STAFFING SERVICES 389132 PEOPLE 20 GLOBAL INC PO BOX 31001-1288 PASADENA CA 91110 STAFFING SERVICES 201347 GIANT TECHNOLOGY 10366 CIRCULO DE JUAREZ FOUNTAIN VALLEY CA 92708 SQL PROGRAMMER 195600 4 3200000 10551222 4094275 80998 17845497 THIRD PARTY REIMBURSEMENT 621400 19964587 19964587 MEDI-CAL PHARMACY 900099 11556519 11556519 31521106 409836 409836 430765 530450 -99685 -99685 -99685 49676754 31521106 0 310151 2886330 2443050 299356 143924 23725874 19933097 2591463 1201314 3306625 2868855 281466 156304 4577650 3971608 389657 216385 2293682 1990018 195242 108422 39051 39051 82883 82883 63994 63994 1395978 734734 579629 81615 9067 2501 5646 920 631292 483251 127283 20758 1113755 856218 152683 104854 1708055 1403517 286033 18505 126061 96112 28242 1707 34639 26383 7752 504 8254 8254 874365 748411 89312 36642 426203 333421 54637 38145 PHARMACEUTICAL SUPPLIES 3776997 3776997 LICENSES & FEES 567324 157474 342610 67240 MED SUP & WASTE REMOVAL 444001 441448 2553 EQUIPMENT 267870 150359 107661 9850 982287 748435 202189 31663 49342237 41165889 5937596 2238752 802 802 6761366 4627624 5603524 8003069 4887037 4242588 257473 286904 139951 171418 20747123 13092202 8057856 7654921 338 182 12942350 13153830 242216 330568 38892913 38471906 1036902 887290 667731 0 1704633 887290 X 23726590 24922381 8239633 7640178 5222057 5022057 37188280 37584616 38892913 38471906 X 334517 95783 -33964 X 0 1 X 1 1 1 X 20726494 21188376 18705895 15571302 17845497 94037564 20726494 21188376 18705895 15571302 17845497 94037564 3917503 90120061 238595 53304 104279 125905 409836 931919 171552 171552 95141035 125048088 0.94720 0.92320 X SCHEDULE A, PART II VENICE FAMILY CLINIC IS EXEMPT UNDER 509(A)(1) AND 170(B)(1)(A)(III). THE ORGANIZATION HAS MADE AN ELECTION TO COMPLETE SCHEDULE A, PART II, SECTION A. PUBLIC SUPPORT. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 30985 0 0 30985 0 PART II-B, LINE 1: DURING THE 2018-2019 FISCAL YEAR, VENICE FAMILY CLINIC'S IN-HOUSE ADVOCACY TEAM AND ITS PUBLIC POLICY COMMITTEE, BOTH COMPRISED OF STAFF AND BOARD MEMBERS, ADDRESSED HEALTH CARE POLICY ISSUES AT THE LOCAL, STATE AND FEDERAL LEVELS. ON THE FEDERAL LEVEL, WE WORKED TO EDUCATE OUR ELECTED OFFICIALS ABOUT HOW PROPOSED CHANGES TO TITLE X FUNDING, THE PUBLIC CHARGE RULE AND HUD ELIGIBILITY WOULD HAVE SERIOUS NEGATIVE CONSEQUENCES FOR THE MOST ECONOMICALLY DISADVANTAGED MEMBERS OF OUR COMMUNITY AND THE PROVIDERS TREATING THEM. WE ALSO LOBBIED FOR CONTINUED COMMUNITY HEALTH CENTER FUNDING. A SMALL GROUP OF VENICE FAMILY CLINIC STAFF AND BOARD MEMBERS ATTENDED THE FAMILIES USA ANNUAL CONFERENCE IN WASHINGTON, DC IN JANUARY 2019 AND MET WITH LEGISLATORS TO DISCUSS THESE AND OTHER ISSUES IN PERSON. ON THE STATE LEVEL, VENICE FAMILY CLINIC PARTICIPATED IN MEETINGS IN SACRAMENTO WITH LEADERS FROM THE CALIFORNIA PRIMARY CARE ASSOCIATION AND THE DEPARTMENT OF HEALTH CARE SERVICES TO DISCUSS HOW PROPOSED CHANGES TO THE 340B PHARMACY PROGRAM WOULD NEGATIVELY IMPACT COMMUNITY HEALTH CENTERS AND THE PATIENTS THEY SERVE AND TO WORK ON ALTERNATE SOLUTIONS. LOCALLY, OVER THE PAST YEAR, VENICE FAMILY CLINIC WORKED CLOSELY WITH THE CITY OF LOS ANGELES MAYOR'S OFFICE, OUR CITY OF LOS ANGELES COUNCILMEMBER'S OFFICE, SEVERAL OF OUR LONGTIME COMMUNITY PARTNERS AND MEMBERS OF OUR COMMUNITY EXPERIENCING HOMELESSNESS TO ADDRESS ISSUES RELATED TO INCREASING RESOURCES FOR THE LARGE AND GROWING UNHOUSED POPULATION IN VENICE AND SURROUNDING COMMUNITIES. THE GOAL OF ALL OF VENICE FAMILY CLINIC'S ADVOCACY EFFORTS IS TO INCREASE ACCESS TO AND QUALITY OF CARE FOR THE MEDICALLY UNDERSERVED, THEREBY FURTHERING THE CLINIC'S MISSION TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 21000 0 6184965 50000 180189 -496765 5918387 5816199 50000 560879 -242113 6184965 5240862 50000 775581 -250244 5816199 5731858 50000 -262704 -278292 5240862 6560040 150000 288739 -1266921 5731858 0.84860 0.15140 0 0 1116512 1116512 7996477 5654895 2341582 8601673 5118073 3483600 3032461 2319234 713227 7654921 UCLA EIP FUND 5918387 F UCLA STIP FUND 7235443 F 13153830 PART V, LINE 4: INTEREST/DIVIDEND INCOME FROM THE CLINIC'S ENDOWMENT FUNDS ARE USED TO PAY FOR THE SALARIES & BENEFITS OF PHYSICIANS AND OTHER PROVIDERS. X X 0 0 0 0 0 0 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 259178 0 0 0 0 0 38534 0 24064 0 321776 0 0 0 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 194335 0 0 0 0 0 28008 0 29242 0 251585 0 0 0 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 248803 0 0 0 0 0 38071 0 31487 0 318361 0 0 0 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 222846 0 0 0 0 0 35020 0 22725 0 280591 0 0 0 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 205704 0 0 0 0 0 32946 0 17167 0 255817 0 0 0 NAVEENA PONNUSAMY CHIEF DEVELOPMENT OFFICER 209906 0 0 0 0 0 32665 0 21164 0 263735 0 0 0 ANITA MARIA ZAMORA CHIEF OPERATIONS OFFICER 222381 0 0 0 0 0 35347 0 21331 0 279059 0 0 0 SHARON NG DIRECTOR OF PHARMACY 170004 0 0 0 0 0 26153 0 24825 0 220982 0 0 0 JASON VU HUA CHIEF INFORMATION OFFICER 159430 0 0 0 0 0 24436 0 23043 0 206909 0 0 0 STACEY ANN SCARBOROUGH DIR. OF HUMAN RESOURCES & HEAD START 156816 0 0 0 0 0 23811 0 14280 0 194907 0 0 0 JAY W LEE MEDICAL DIRECTOR 152149 0 0 0 0 0 21754 0 10894 0 184797 0 0 0 COLEY MARVIN KING PHYSICIAN 202133 0 0 0 0 0 26296 0 22917 0 251346 0 0 0 GILMORE SEISOON CHUNG PHYSICIAN 195510 0 0 0 0 0 25902 0 13529 0 234941 0 0 0 CAROL R SCHWARTZ PHYSICIAN 179907 0 0 0 0 0 27809 0 21058 0 228774 0 0 0 MICHELLE I AGUILAR PHYSICIAN 176917 0 0 0 0 0 23580 0 13895 0 214392 0 0 0 NANCY MARIE PIERRE-PAUL NURSE PRACTITIONER 172031 0 0 0 0 0 28629 0 17919 0 218579 0 0 0 X 1 47533 FMV X 12 33465 FMV 0 1 0 PART I, COLUMN (B): NONCASH DONATIONS ARE LISTED BY TOTAL NUMBER OF DONOR CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 8B THIS QUESTION IS NOT APPLICABLE AS THE ORGANIZATION DOES NOT HAVE A COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE INFORMATIONAL RETURN IS PREPARED BY OUTSIDE ACCOUNTANTS AND IS REVIEWED BY THE AUDIT COMMITTEE. ONCE APPROVED BY THE AUDIT COMMITTEE, THE RETURN IS THEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO ELECTRONIC FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL QUESTIONNAIRES ARE GIVEN TO BOARD MEMBERS TO DISCLOSE ANY CONFLICTS. IF A CONFLICT IS DISCLOSED IN THE ANNUAL QUESTIONNAIRE, THE INDIVIDUAL WILL BE ASKED TO RECUSE THEMSELVES FROM ANY CONVERSATIONS PERTAINING TO THIS CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD HIRES, OVERSEES, AND ANNUALLY EVALUATES THE PERFORMANCE AND COMPENSATION OF THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION INDEPENDENTLY, WITH THE CEO'S PARTICIPATION. THE CFO & OTHER KEY EMPLOYEES' COMPENSATION IS BASED UPON SKILL SET & MARKET RATE. 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 XI, LINE 9: CHANGE IN VALUE IN BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUSTS -33,964. VENICE FAMILY CLINIC FOUNDATION 604 ROSE AVENUE VENICE CA 90291 273484548 TO SUPPORT VENICE FAMILY CLINIC CA 501(C)(3) LINE 7 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0