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 952769432 VENICE FAMILY CLINIC 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 14:22:03 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1E5C2E37194314C3A47C760AEAFDC059525B6175 2017 2019-02-21 02:37:17Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 46705223 0 X HTTP://WWW.VENICEFAMILYCLINIC.ORG/ X 1970 CA TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 19 19 361 934 0 21117 18705895 15571302 27868154 30426379 235414 -35439 -22850 0 46786613 45962242 0 0 0 0 29467145 33825581 0 0 2126121 9436546 10629789 38903691 44455370 7882922 1506872 36652136 38892913 1572148 1704633 35079988 37188280 X TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 0 0 37231964 30426379 VENICE FAMILY CLINIC (VFC) SERVES AS A MEDICAL HOME PROVIDING COORDINATED AND COMPREHENSIVE MEDICAL, DENTAL, MENTAL HEALTH, SUBSTANCE USE TREATMENT, HEALTH EDUCATION AND HEALTH INSURANCE ENROLLMENT SERVICES TO PEOPLE OF ALL AGES. VFC ALSO PROVIDES CARE FOR PEOPLE WHO ARE HIV+ THROUGH ITS COMMON GROUND PROGRAM AND FOCUSES ON EARLY CHILDHOOD DEVELOPMENT AND FAMILY EMPOWERMENT THROUGH ITS CHILDREN FIRST EARLY HEAD START PROGRAM. SERVICES INCLUDE PEDIATRICS, GENERAL ADULT MEDICINE, WOMEN'S HEALTH CARE, CARE FOCUSED ON PEOPLE EXPERIENCING HOMELESSNESS AND A BROAD RANGE OF SPECIALTY CARE SERVICES. VFC'S TWELVE SERVICE LOCATIONS ARE IN ITS PRIMARY SERVICE AREA INCLUDING VENICE, SANTA MONICA, PALMS, MAR VISTA, INGLEWOOD, CULVER CITY AND WEST LOS ANGELES, ALL IN LOS ANGELES COUNTY. VFC TRAINS MEDICAL RESIDENTS FROM ELEVEN RESIDENCY PROGRAMS. APPROXIMATELY 934 PEOPLE VOLUNTEERED IN FISCAL YEAR 2018, INCLUDING APPROXIMATELY 378 PHYSICIANS. THE CLINIC ESTIMATES THAT IT RECEIVED 56,126 TOTAL VOLUNTEER HOURS. 37231964 1 1 0 1 0 0 0 1 0 1 1 1 0 0 1 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 83 0 1 361 1 1 1 0 0 0 0 0 0 0 0 0 X 19 19 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 JEFFREY E SINAIKO IMMEDIATE PAST CHAIR & TREASURER 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 PAULA DAVIS BOARD MEMBER 2.00 0.00 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 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 40.00 1.00 X 223062 0 65222 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 40.00 1.00 X 188442 0 59658 JAY W LEE MEDICAL DIRECTOR 40.00 0.00 X 274050 0 39095 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 40.00 0.00 X 236442 0 54707 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 39.00 0.00 X 247319 0 65156 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 36.00 0.00 X 214673 0 49693 ANITA MARIA ZAMORA CHIEF OPERATIONS OFFICER 40.00 0.00 X 193148 0 44292 SHARON NG DIRECTOR OF PHARMACY 40.00 0.00 X 179575 0 54692 JASON VU HUA CHIEF INFORMATION OFFICER 40.00 0.00 X 153657 0 48268 COLEY MARVIN KING PHYSICIAN 40.00 0.00 X 212888 0 60842 GILMORE SEISOON CHUNG PHYSICIAN 40.00 0.00 X 201772 0 43521 ZARIN TEJANI PHYSICIAN 40.00 0.00 X 193626 0 42555 CAROL R SCHWARTZ PHYSICIAN 32.00 0.00 X 186760 0 51233 BARBARA MARIA TCHENG PHYSICIAN 36.00 0.00 X 179758 0 40835 2885172 0 719769 50 0 1 0 GLUCK DEVELOPMENT COMPANY INC 26901 AGOURA RD STE 100 CALABASAS CA 91301 CONSTRUCTION 790587 JENSEN ZIGMAN CONSTRUCTION CO INC 10020 NATIONAL BLVD LOS ANGELES CA 90034 CONSTRUCTION 776614 BROTHERS MAINTENANCE SERVICES PO BOX 3283 WHITTIER CA 90605 CLEANING SERVICE 348426 RANDSTAD US LP PO BOX 894217 LOS ANGELES CA 90189 STAFFING SERVICES 263572 HOUSTON TYNER ARCHITECTS 2630 SEPULVEDA BLVD TORRANCE CA 90505 CONSTRUCTION 195539 7 10160949 5410353 468123 15571302 THIRD PARTY REIMBURSEMENT 621400 20102078 20102078 MEDI-CAL PHARMACY 900099 10324301 10324301 30426379 125905 125905 581637 648276 94705 -66639 -94705 -161344 -161344 45962242 30426379 0 -35439 2475523 2106682 231780 137061 21670697 18448879 1997713 1224105 3095767 2630355 308395 157017 4541267 3858541 452394 230332 2042327 1735287 203453 103587 50976 50976 86350 86350 71230 71230 1066077 770798 237505 57774 8649 2694 5439 516 608241 345876 227736 34629 520976 352040 148862 20074 1368120 1100887 245612 21621 117733 98550 16868 2315 53600 44867 7679 1054 6569 6569 854721 629732 210700 14289 371102 310263 45991 14848 PHARMACEUTICAL SUPPLIES 3521285 3521285 MED SUP & WASTE REMOVAL 507251 506018 1233 LICENSES & FEES 495536 111731 302681 81124 OTHER PROGRAM EXPENSES 219917 219917 701456 437562 238119 25775 44455370 37231964 5097285 2126121 802 802 1392095 6761366 6834873 5603524 9715222 4887037 295685 257473 88297 139951 20302033 12244177 8512809 8057856 338 9537799 12942350 274554 242216 36652136 38892913 1198954 1036902 250000 0 123194 667731 1572148 1704633 X 21418656 23726590 8489275 8239633 5172057 5222057 35079988 37188280 36652136 38892913 X 1506872 645077 -43657 X 0 1 X 1 1 1 X 20472644 20726494 21188376 18705895 15571302 96664711 20472644 20726494 21188376 18705895 15571302 96664711 6082286 90582425 272647 238595 53304 104279 125905 794730 485974 171552 657526 98116967 102450099 0.92320 0.81760 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. 1 1 0 0 0 0 1 31781 0 0 31781 0 PART II-B, LINE 1: DURING THE 2017-2018 FISCAL YEAR, VENICE FAMILY CLINIC'S ADVOCACY TEAM, 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 THE NEEDS OF THE MEDICALLY UNDERSERVED AND THE PROVIDERS TREATING THEM, AND THE WAYS IN WHICH THE AFFORDABLE CARE ACT AND THE CHILDREN'S HEALTH INSURANCE PROGRAM HAS DRAMATICALLY IMPROVED ACCESS TO AND QUALITY OF CARE FOR THE NATION'S MOST VULNERABLE COMMUNITIES. WE ALSO EDUCATED OFFICIALS ON THE NEED FOR STABLE FUNDING FOR COMMUNITY HEALTH CENTERS. ON THE STATE LEVEL, VENICE FAMILY CLINIC PARTICIPATED IN THE CALIFORNIA PRIMARY CARE ASSOCIATION'S ANNUAL "DAY AT THE CAPITOL 2018" EVENT, A DAY OF MEETINGS WITH STATE ELECTED OFFICIALS IN SACRAMENTO, CA WHICH FOCUSED ON THE IMPORTANCE OF THE 340B PROGRAM AND THE NEED FOR FQHCS TO BE ABLE TO ACCESS ENHANCED PAYMENT PROGRAMS LIKE WHOLE PERSON CARE AND HEALTH HOMES. VENICE FAMILY CLINIC ALSO CONTINUED TO PARTICIPATE IN A PAYMENT REFORM WORK GROUP ORGANIZED BY THE CALIFORNIA PRIMARY CARE ASSOCIATION ADDRESSING THE NEED FOR IMPROVEMENTS IN THE MEDI-CAL PAYMENT SYSTEM. LOCALLY, OVER THE PAST YEAR, VENICE FAMILY CLINIC WORKED CLOSELY WITH THE COMMUNITY CLINIC ASSOCIATION OF LOS ANGELES COUNTY ON POLICY ISSUES IMPACTING COMMUNITY HEALTH CENTER PATIENTS. OUR FOCUS CENTERED AROUND HOMELESS HEALTH PROGRAMMING AND THE MY HEALTH LA PROGRAM. IT INCLUDED EDUCATING THE BOARD OF SUPERVISORS AND OTHER KEY STAKEHOLDERS. WE ALSO WORKED CLOSELY WITH THE MAYOR'S OFFICE AND OUR LOCAL COUNCILMEMBER'S OFFICE ON TWO KEY INITIATIVES CENTERED ON HELPING THE HOMELESS MEMBERS OF OUR COMMUNITY- A BRIDGE HOME, A PROGRAM LAUNCHED BY THE MAYOR TO PROVIDE TRANSITIONAL HOUSING FOR HOMELESS RESIDENTS THROUGHOUT LOS ANGELES COUNTY, AND PIT STOP, A PILOT PROGRAM WHICH PROVIDES PORTABLE RESTROOMS FOR THE HOMELESS IN VENICE. 21000 0 5816199 50000 560879 242113 6184965 5240862 50000 775581 250244 5816199 5731858 50000 -262704 278292 5240862 6560040 150000 288739 1266921 5731858 5707178 500000 625509 272647 6560040 0.00000 0.84430 0.15570 0 0 1116512 1116512 7941599 5454878 2486721 8535521 4686403 3849118 2708401 2102896 605505 8057856 UCLA EIP FUND 6134964 F UCLA STIP FUND 6807386 F 12942350 DUE TO AFFILIATE VFCF 667731 667731 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 223062 0 0 0 0 0 40845 0 24377 0 288284 0 0 0 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 188442 0 0 0 0 0 29111 0 30547 0 248100 0 0 0 JAY W LEE MEDICAL DIRECTOR 274050 0 0 0 0 0 19515 0 19580 0 313145 0 0 0 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 236442 0 0 0 0 0 36477 0 18230 0 291149 0 0 0 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 247319 0 0 0 0 0 36431 0 28725 0 312475 0 0 0 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 214673 0 0 0 0 0 33163 0 16530 0 264366 0 0 0 ANITA MARIA ZAMORA CHIEF OPERATIONS OFFICER 193148 0 0 0 0 0 32696 0 11596 0 237440 0 0 0 SHARON NG DIRECTOR OF PHARMACY 179575 0 0 0 0 0 27741 0 26951 0 234267 0 0 0 JASON VU HUA CHIEF INFORMATION OFFICER 153657 0 0 0 0 0 24850 0 23418 0 201925 0 0 0 COLEY MARVIN KING PHYSICIAN 212888 0 0 0 0 0 32848 0 27994 0 273730 0 0 0 GILMORE SEISOON CHUNG PHYSICIAN 201772 0 0 0 0 0 31317 0 12204 0 245293 0 0 0 ZARIN TEJANI PHYSICIAN 193626 0 0 0 0 0 28790 0 13765 0 236181 0 0 0 CAROL R SCHWARTZ PHYSICIAN 186760 0 0 0 0 0 28851 0 22382 0 237993 0 0 0 BARBARA MARIA TCHENG PHYSICIAN 179758 0 0 0 0 0 27519 0 13316 0 220593 0 0 0 X 6 346259 FMV X 5 121864 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 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 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 -43,657. 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 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0