2019-05-09T16:06:55-05:00 2018-06-30 951777440 GREEN HASSON & JANKS LLP 10990 WILSHIRE BLVD 16TH FLOOR LOS ANGELES CA 900243929 990 2017-07-01 273484548 VENICE FAMILY CLINIC FOUNDATION VENI 3103928630 604 ROSE AVENUE VENICE CA 90291 ELIZABETH B FORER CEO 3103928630 2019-04-29 1 LIZBETH G NEVAREZ P01399868 3108731600 38.186.35.254 2019-04-29 14:47:55 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1E5C2E37194314C3A47C760AEAFDC059525B6175 2017 2019-02-21 02:37:17Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 2629929 0 X HTTP://WWW.VENICEFAMILYCLINIC.ORG/ X 2010 CA TO SUPPORT THE MISSION OF THE CLINIC, TO PROVIDE QUALITY PRIMARY HEALTHCARE TO PEOPLE IN NEED. 37 37 0 437 0 0 329403 1857144 0 0 0 0 17430 -1719 346833 1855425 0 0 0 0 0 0 0 0 0 11595 38778 11595 38778 335238 1816647 756625 2626143 11741 64612 744884 2561531 THE FOUNDATION'S SPECIFIC PURPOSE IS TO SUPPORT THE MISSION OF THE CLINIC, TO PROVIDE QUALITY PRIMARY HEALTHCARE TO PEOPLE IN NEED. 0 0 SUPPORTING THE EFFORTS OF THE VENICE FAMILY CLINIC. 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 37 37 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 CA X ANDREA BLACKBIRD 3106647941 604 ROSE AVENUE VENICE CA 90291 JOHN R GERESI CHAIR 2.00 2.00 X X 0 0 0 JEFFREY E SINAIKO IMMEDIATE PAST CHAIR 2.00 2.00 X X 0 0 0 FRANK MATRICARDI DR PH TREASURER 2.00 0.00 X X 0 0 0 FERN SEIZER SECRETARY 2.00 0.00 X X 0 0 0 WILLIAM FLUMENBAUM BOARD MEMBER 2.00 2.00 X 0 0 0 SUSAN ADELMAN BOARD MEMBER 2.00 0.00 X 0 0 0 CAROL L ARCHIE MD BOARD MEMBER 2.00 0.00 X 0 0 0 NEAL BAER MD BOARD MEMBER 2.00 0.00 X 0 0 0 RICK BRADLEY BOARD MEMBER 2.00 0.00 X 0 0 0 LOWELL C BROWN ESQ BOARD MEMBER 2.00 0.00 X 0 0 0 DAVID M CARLISLE MD PHD BOARD MEMBER 2.00 0.00 X 0 0 0 MAYER B DAVIDSON MD BOARD MEMBER 2.00 2.00 X 0 0 0 SUSAN FLEISCHMAN MD BOARD MEMBER 2.00 0.00 X 0 0 0 MARK R GAVENS BOARD MEMBER 2.00 0.00 X 0 0 0 CHESTER F GRIFFITHS MD BOARD MEMBER 2.00 0.00 X 0 0 0 JIMMY H HARA MD BOARD MEMBER 2.00 0.00 X 0 0 0 JOAN E HERMAN BOARD MEMBER 2.00 0.00 X 0 0 0 BARSAM KASRAVI MD MBA MPH BOARD MEMBER 2.00 0.00 X 0 0 0 DEBORAH LAUB BOARD MEMBER 2.00 0.00 X 0 0 0 HARLEY LIKER MD MBA BOARD MEMBER 2.00 0.00 X 0 0 0 TRACEY LOEB BOARD MEMBER 2.00 0.00 X 0 0 0 VIREN MEHTA BOARD MEMBER 2.00 0.00 X 0 0 0 WENDY SMITH MEYER PHD LCSW BOARD MEMBER 2.00 0.00 X 0 0 0 ETAN CHAIM MILGROM MD MS BOARD MEMBER 2.00 0.00 X 0 0 0 JEFF NATHANSON BOARD MEMBER 2.00 0.00 X 0 0 0 WILLIAM D PARENTE BOARD MEMBER 2.00 0.00 X 0 0 0 HUTCH PARKER BOARD MEMBER 2.00 0.00 X 0 0 0 NEIL H PARKER MD BOARD MEMBER 2.00 2.00 X 0 0 0 THOMAS C PAULSEN MD BOARD MEMBER 2.00 0.00 X 0 0 0 ANDREW J RITTER BOARD MEMBER 2.00 0.00 X 0 0 0 ALAN SIEROTY BOARD MEMBER 2.00 0.00 X 0 0 0 RUSSEL TYNER AIA BOARD MEMBER 2.00 0.00 X 0 0 0 MICHAEL S WILKES MD PHD BOARD MEMBER 2.00 0.00 X 0 0 0 LEISA WU BOARD MEMBER 2.00 2.00 X 0 0 0 SUSAN TICK BOARD MEMBER 2.00 0.00 X 0 0 0 MARCEL LOH BOARD MEMBER 2.00 0.00 X 0 0 0 JOHNESE SPISSO MPA BOARD MEMBER 2.00 0.00 X 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 1.00 40.00 X 0 223062 65222 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 1.00 40.00 X 0 188442 59658 0 411504 124880 0 0 1 0 0 1764864 92280 86160 1857144 754035 1764864 764954 -10919 -10919 18750 9550 9200 9200 1855425 0 0 -1719 2900 2900 1000 1000 15524 15524 1274 1274 LICENSES, FEES, AND DUE 17552 17552 EQUIPMENT - LEASES/RENT 528 528 38778 0 38778 0 566606 1910536 10834 5000 55991 42351 0 525 123194 667731 756625 2626143 11741 64612 11741 64612 X 744884 2561531 744884 2561531 756625 2626143 1816647 0 X 0 1 X 1 0 X 529065 611070 313200 329403 1857144 3639882 529065 611070 313200 329403 1857144 3639882 60286 3579596 85557 17430 0 102987 3742869 0.95640 0.95770 X 0 RECEIVABLE FROM VENICE FAMILY CLINIC 667731 667731 SILVER CIRCLE 1575405 1275495 299910 66610 83604 82950 5000 77006 ART WALK 786199 332074 454125 39995 14126 3178 366700 1 157295 157295 1901 573 650 22661 2518899 1764864 754035 66610 125500 97649 8828 466367 764954 -10919 18750 9550 0 18750 9550 9550 9200 CA 1 0 0 0 1.00000 ANDREA BLACKBIRD 604 ROSE AVE VENICE CA 90291 0 TIFFANY TSE MANAGED RAFFLE ACTIVITY X 1 16875 0 0 0 0 0 0 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 0 223062 0 0 0 0 0 40845 0 24377 0 288284 0 0 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 0 188442 0 0 0 0 0 29111 0 30547 0 248100 0 0 SCHEDULE J, PART II OFFICERS ELIZABETH B. FORER AND ANDREA B. BLACKBIRD ARE COMPENSATED BY THE RELATED ENTITY VENICE FAMILY CLINIC (VFC). 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. X 1 10000 FMV X AUCTION ITEMS 71 66610 FMV X RAFFLE ITEMS 2 9550 FMV 0 1 1 PART I, COLUMN (B): NONCASH DONATIONS ARE LISTED BY TOTAL NUMBER OF DONOR CONTRIBUTORS. PART I, LINE 32B: THE ORGANIZATION HAS AN AGREEMENT IN PLACE GIVESMART, A MOBILE BIDDING AND EVENT MANAGEMENT COMPANY TO HELP FACILITATE THE FUNDRAISING SIDE OF SILVER CIRCLE. FORM 990, PART VI, SECTION A, LINE 8B THIS QUESTION IS NOT APPLICABLE TO THE FILING ORGANIZATION. THERE IS NO COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. 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 FOUNDATION BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IF ANY INDIVIDUAL REASONABLY BELIEVES THAT SOME POLICY, PRACTICE, OR ACTIVITY OF THE ORGANIZATION IS IN VIOLATION OF LAW, A WRITTEN COMPLAINT MAY BE FILED BY THAT INDIVIDUAL WITH THE CHAIR OF THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 OFFICERS ELIZABETH B. FORER AND ANDREA B. BLACKBIRD ARE COMPENSATED BY THE RELATED ENTITY VENICE FAMILY CLINIC (VFC). 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. VENICE FAMILY CLINIC 604 ROSE AVENUE VENICE CA 90291 952769432 HEALTH CARE CA 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0