2018-02-15T11:41:56-06:00 2017-03-31 221478099 COHNREZNICK LLP 4 BECKER FARM ROAD ROSELAND NJ 07068 990 2016-04-01 742357970 Su Clinica Familiar Inc SUCL 9563656750 1706 Treasure Hills Blvd Harlingen TX 78550 Adam Saldivar Chief Financial Officer 9563656750 2018-02-15 1 THOMAS LANNING P00851654 9732283500 2018-02-12 209.3.217.20 2018-02-15 07:40:03 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A999648B7C0F94429496C189B46642AFC33E1A30 2016 2021-01-29 14:40:06Z elena marin md 1706 Treasure Hills Blvd Harlingen TX 78550 34075375 0 X WWW.SUCLINICA.ORG X 1971 TX EXCELLENCE IN HEALTH CARE DELIVERY AND CLINICAL EDUCATION, AND BE RECOGNIZED AS A LEADER IN COMMUNITY HEALTH. 13 13 468 40 0 0 10517190 10442383 20071561 23106270 1316 182 510288 526540 31100355 34075375 0 0 0 0 21072670 21916917 0 0 0 11960381 13188786 33033051 35105703 -1932696 -1030328 24607869 22539692 12675697 11391718 11932172 11147974 X TO PROMOTE A HEALTHIER COMMUNITY BY PROVIDING ACCESS TO HIGH QUALITY COMPREHENSIVE MEDICAL CARE, HEALTH EDUCATION AND SUPPORT SERVICES. 0 0 27346098 23632810 SU CLINICA'S COMMITMENT TO A HEALTHY SOCIETY INCLUDES PARTICIPATION IN A VARIETY OF DIFFERENT PROGRAMS, AS LISTED HERE.- PATIENT CENTERED MEDICAL HOME (PCMH) - SU CLINICA FAMILIAR HAS ACCOMPLISHED AND IS CURRENTLY A LEVEL 3 PATIENT CENTERED MEDICAL HOME AT ITS HARLINGEN, TEXAS; BROWNSVILLE, TEXAS; RAYMONDVILLE, TEXAS; AND SANTA ROSA, TEXAS LOCATION.- ACCOUNTABLE CARE ORGANIZATION (ACO) - SU CLINICA FAMILIAR IS ENGAGED IN AN ACO WHICH IS CHARACTERIZED BY A PAYMENT AND CARE DELIVERY MODEL THAT SEEKS TO TIE PROVIDER REIMBURSEMENTS TO QUALITY METRICS AND REDUCTIONS IN THE TOTAL COST OF CARE FOR ITS MEDICARE PATIENT POPULATION. THE ACO IS ACCOUNTABLE TO THE PATIENTS AND THE THIRD-PARTY PAYER FOR THE QUALITY, PPROPRIATENESS AND EFFICIENCY OF THE HEALTH CARE PROVIDED.- DIABETES PREVENTION PROGRAM - Through the CDC-led National Diabetes Prevention Program (National DPP), public and private organizations will work together to expand the infrastructure for the nationwide delivery of an evidence-based lifestyle change program to prevent or delay onset of type 2 diabetes among adults with pre-diabetes. - HRSA AIMS (Mental Health/ Substance Abuse Grant) - The clinic is currently involved in a two-pronged expansion of existing services: 1) expanded mental health services and addition of substance abuse services in Willacy County. This effort includes telehealth consultation with contract psychiatrists. 2) Expanded capacity for pediatric and adult mental health prevention and treatment services in Cameron County.- INTEGRATED HEALTHCARE IMPROVEMENT Su Clinica will improve diabetes and co-morbidity outcomes. We will serve a panel of 200 underserved patients, each with 2 or more co-morbidities including diabetes, hypertension, obesity, and depression, with a focus on improving health outcomes. Provide data showing the results for these patients related to the 4 co-morbidities. - DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) 1115 WAIVER THE CLINIC EXPECTS THAT THE USE OF ELECTRONIC MEDICAL RECORDS, HEALTH INFORMATION EXCHANGE, PATIENT CENTERED MEDICAL HOME AND COORDINATION WITH THE HOSPITAL WILL LEAD TO A PERCENTAGE REDUCTION IN THE NUMBER OF ADULT PATIENTS WITH TYPE 1 OR 2 DIABETES WHOSE HBA1C IS ABOVE 9.0%, OTHERWISE KNOWN AS POOR CONTROL.- Project DOC (Diabetes and Obesity Control) - The goal is to create an ecosystem in which the private sector, healthcare, and patients leverage technology and collaborate to change the healthcare model.- hRSA OUTREACH AND ENROLLMENT PROGRAM - EXPAND CURRENT OUTREACH AND ENROLLMENT ASSISTANCE ACTIVITIES AND FACILITATE ENROLLMENT OF ELIGIBLE HEALTH CENTER PATIENTS AND SERVICE AREA RESIDENTS INTO AFFORDABLE HEALTH INSURANCE COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACES, MEDICAID, OR THE CHILDREN'S HEALTH INSURANCE PROGRAM.- DIABETES COLLABORATIVE - A NATIONAL PROGRAM TO PROVIDE PERSONALIZED CASE MANAGEMENT SERVICES TO DIABETES PATIENTS.- CHILD HEALTH INSURANCE PROGRAM (CHIP) OUTREACH PROGRAM - INFORMS LOW INCOME FAMILIES ON THE BENEFITS OF ENROLLING CHILDREN IN THE STATE CHIP PROGRAM. 27346098 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 1 0 0 0 1 35 0 1 468 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ADAM SALDIVAR 9563656750 1706 Treasure Hills Blvd Harlingen TX 78550 Arturo Cavazos EdD board member 1.00 X 0 0 0 Blanca M Salomon outgoing Board Member 1.00 1.00 X 0 0 0 Carlos Garza outgoing Board Member 1.00 1.00 X 0 0 0 christina garcia ed D board member 1.00 X 0 0 0 Claudia U Saenz board member 1.00 1.00 X 0 0 0 Denise Almon CPA board member 1.00 X X 0 0 0 fidel atkinson board member 1.00 1.00 X 0 0 0 Irma linda Lopez Board member 1.00 1.00 X 0 0 0 Lucia Aguilar board member 1.00 1.00 X 0 0 0 Robert D Rodriguez treasurer 1.00 X X 0 0 0 Robert L Guerra JD Vice Chairperson 1.00 X X 0 0 0 rosalee najar board member 1.00 X 0 0 0 Rosaura Aguilar secretary 1.00 1.00 X X 0 0 0 Sandra Lopez-Langley outgoing Board Member 1.00 1.00 X 0 0 0 Susana Anzaldua board member 1.00 1.00 X 0 0 0 Tina Briones EdD RN chairperson 1.00 1.00 X X 0 0 0 Adam Saldivar Chief Financial Officer 38.00 2.00 X 102903 0 12420 Elena Marin MD Chief Executive Officer 38.00 2.00 X 262670 0 22587 rita villanueva md chief medical officer 40.00 X 252493 0 18665 Chandrasekher Reddy MD physician 40.00 X 314267 0 25157 david de la llata physician 40.00 X 287903 0 20769 miguel martinez vela physician 40.00 X 246571 0 18305 Ramiro Munoz MD physician 40.00 X 426428 0 32740 Rose Gowan MD physician 40.00 X 222628 0 13358 2115863 0 164001 34 0 1 0 cohnreznick llp 1301 avenue of the americas new york NY 10019 Audit, Financial Services 261514 Alberto E Vasquez MD PA 2334 S 25th st Harlingen TX 78550 Professional Medical Services 252000 albert bernardoni md pa 2808 chinsberry park ln league city TX 77573 Professional Medical Services 244999 Harlingen Obstetrics and Gynecolgy 2230 Haine dr Harlingen TX 78550 Professional Medical Services 214988 bryan j prukop dpm 812 Lindburg ave McAllen TX 78501 Professional Medical Services 140000 5 9367076 1075307 97716 10442383 medicaid & medicare managed care 621400 12357052 12357052 self-pay 621400 5054835 5054835 other third party 621400 3008699 3008699 340b pharmacy revenue 621400 1485428 1485428 medicare 621400 1200256 1200256 23106270 182 182 incentive 900099 229611 229611 meaningful use incentive 621400 208250 208250 MCR Cost Report 2015 Settlement 900099 45653 45653 43026 43026 526540 34075375 23632810 0 182 704173 506352 197821 17933211 12926958 5006253 738767 515421 223346 1233250 860412 372838 1307516 912224 395292 28320 28320 664008 664008 1207537 1169583 37954 625894 475428 150466 517849 517849 1079494 977385 102109 164510 88405 76105 392733 322041 70692 1156854 1025006 131848 215236 186848 28388 Bad debts 3615165 3615165 Consumable supplies 1760226 1674949 85277 Laboratory 959582 959582 Repairs and maintenance 649505 561696 87809 151873 50794 101079 35105703 27346098 7759605 0 973440 1032047 947896 556686 2731841 2181460 190130 201574 354867 242984 28060386 9735445 19409695 18324941 24607869 22539692 3971826 3682329 6860679 5676000 1843192 2033389 12675697 11391718 X 11864250 11082504 67922 65470 11932172 11147974 24607869 22539692 X -1030328 246130 X X 0 1 X 1 1 1 X 9748240 9491738 10138521 10517190 10442383 50338072 9748240 9491738 10138521 10517190 10442383 50338072 50338072 22824 5441 1635 1316 182 31398 477982 497621 510288 526540 2012431 52381901 104394667 0.96100 0.97070 X Schedule A, Part II, Line 10, Explanation of Other Income: miscellaneous - 2013 Amount: $ 307,982. 2014 Amount: $ 217,121. 2015 Amount: $ 234,038. 2016 Amount: $ 318,290. meaningful use incentive - 2013 Amount: $ 170,000. 2014 Amount: $ 280,500. 2015 Amount: $ 276,250. 2016 Amount: $ 208,250. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2962027 2962027 16504310 3002442 13501868 4660207 3791254 868953 3933842 2941749 992093 18324941 INTEREST RATE SWAP LIABILITY 402618 line of credit 1175000 capital lease obligations 455771 2033389 X 30463635 -3611740 -3611740 34075375 0 34075375 31906292 415754 415754 31490538 3615165 3615165 35105703 Part X, Line 2: The Organization has no unrecognized tax benefits at March 31, 2017. The Organization's federal and state income tax returns prior to fiscal year 2014 are closed and management continually evaluates expiring statutes of limitations, audits, proposed settlements, changes in tax law and new authoritative rulings. The Organization recognizes interest and penalties associated with tax matters as operating expenses and includes accrued interest and penalties with accrued expenses in the consolidated statement of financial position. Part XI, Line 2d - Other Adjustments: related organization revenue 453,653. related organization eliminations -450,228. Bad debts -3,615,165. Part XII, Line 2d - Other Adjustments: related organization expenses 619,852. related organization eliminations -450,228. change in fair value of interest rate swap agreements 246,130. Part XII, Line 4b - Other Adjustments: bad debt 3,615,165. X X X X X 0 0 0 0 0 0 0 1 0 Elena Marin MD Chief Executive Officer 243420 0 15000 0 4250 0 16501 0 6086 0 285257 0 0 0 rita villanueva md chief medical officer 250993 0 1500 0 0 0 15270 0 3395 0 271158 0 0 0 Chandrasekher Reddy MD physician 258117 0 25000 0 31150 0 19071 0 6086 0 339424 0 0 0 david de la llata physician 168966 0 59929 0 59008 0 17374 0 3395 0 308672 0 0 0 miguel martinez vela physician 208662 0 7500 0 30409 0 15335 0 2970 0 264876 0 0 0 Ramiro Munoz MD physician 212900 0 5000 0 208528 0 26162 0 6578 0 459168 0 0 0 Rose Gowan MD physician 201850 0 5000 0 15778 0 13358 0 0 0 235986 0 0 0 Part I, Line 7 included on schedule j, part ii, column b(ii) are amounts representing bonus and other incentive payments. these amounts were included in the individuals 2016 w-2, and approved by the board. Part II, Column b(iii): amounts in column b represent other compensation such as vacation/other PTO payout, clinic/on call duty, admin leave, and family medical leave. X 1 22861 fmv X dental equipment 1 74855 fmv 0 0 0 Part I, Column (b): AMOUNTS IN COLUMN B REPRESENT THE NUMBER OF CONTRIBUTORS. Form 990, Part VI, Section B, line 11b THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE CHIEF FINANCIAL OFFICER REVIEWS THE 990 AND PRESENTS IT TO THE CHIEF EXECUTIVE OFFICER FOR SECONDARY REVIEW. A BOARD OF DIRECTORS MEETING IS THEN HELD FOR PRESENTATION AND APPROVAL OF THE RETURN PRIOR TO FILING. Form 990, Part VI, Section B, line 12c ALL DIRECTORS AND EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST REVIEW ANNUALLY. THE FORM CLEARLY STATES THAT THEY COMPLY WITH THE POLICY. THE CENTER REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. Form 990, Part VI, Section B, line 15 A SALARY RANGE IS PREPARED AND APPROVED BY THE BOARD OF DIRECTORS. THIS SALARY RANGE IS COMPRISED OF INFORMATION OBTAINED FROM OTHER COMMUNITY HEALTH CENTERS AND THE LOCAL MARKET FOR THE CHIEF EXECUTIVE OFFICER. A SURVEY OF THE MAJOR COMMUNITY HEALTH CENTERS IS COMPILED USING THE BUDGET OF THE CENTER AS A KEY INDICATOR. THIS INFORMATION IS PRESENTED TO THE CHAIRMAN OF THE BOARD. THE BOARD, VIA EXECUTIVE SESSION, USES THIS INFORMATION TO DETERMINE THE CEO'S SALARy. in addition, the board reviews the salaries of all individuals over $100K. PHYSICIANS' SALARIES ARE DETERMINED BY USING THE MGMA COMPENSATION AND PRODUCTIVITY INFORMATION. KEY PERSONNEL SALARIES ARE DETERMINED BY SURVEYING THE LOCAL MARKET AND HEALTH CENTER COMPENSATION GUIDE. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES THE CONFLICT OF INTEREST POLICY, ALL GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, line 9: Change in fair value of interest rate swap agreement 246,130. form 990 Part XII line 2c: THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR THE OVERSIgHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDET ACCOUNTANT. SU CLINICA FAMILIAR MEDICAL FOUNDATION 1706 TREASURE HILLS BLVD HARLINGEN TX 78550 742965534 support TX 501(c)(3) Line 12a, I su clinica 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0