2018-05-02T15:09:18-05:00 2017-06-30 410746749 CLIFTONLARSONALLEN LLP 20 E THOMAS RD STE 2300 PHOENIX AZ 85012 990 2016-07-01 953881333 CLINICA MSR OSCAR A ROMERO CLIN 3239871401 123 SOUTH ALVARADO STREET LOS ANGELES CA 90057 CARLOS A VAQUERANO PRESIDENT & CEO 3239871401 2018-05-01 1 KURT BENNION P01469618 6022662248 67.137.57.251 2018-05-01 11:18:57 PD P 81CD31B431919A6BAB86B87CF81D7AAD5B2A23A8 58F051F63F335AB1BDDE6F7A5C9B4348934A8A50 2016 2021-01-29 14:40:06Z CARLOS A VAQUERANO 123 SOUTH ALVARADO STREET LOS ANGELES CA 90057 13770038 0 X WWW.CLINICAROMERO.COM X 1983 CA PROVIDE QUALITY, AFFORDABLE AND CULTURALLY SENSITIVE HEALTH CARE AND OTHER SERVICES TO THE UNINSURED, INSURED AND UNDERSERVED COMMUNITIES OF GREATER LOS ANGELES. 10 10 164 62 0 0 3846918 4066782 8086242 8460873 783 -90576 463952 1220835 12397895 13657914 10850 44944 0 0 7900751 8656888 0 0 141588 4361271 4763528 12272872 13465360 125023 192554 8072664 7905185 5366299 5184959 2706365 2720226 X OUR MISSION IS TO PROVIDE QUALITY, AFFORDABLE AND CULTURALLY SENSITIVE HEALTH CARE AND OTHER SERVICES TO THE UNINSURED, INSURED AND UNDERSERVED COMMUNITIES OF GREATER LOS ANGELES REGARDLESS OF THEIR ABILITY TO PAY BY UPHOLDING THE LEGACY AND (CONTINUED IN SCHEDULE O) TRADITION OF MONSENOR OSCAR A. ROMERO AND EDUCATING AND EMPOWERING SALVADORAN AND OTHER COMMUNITY MEMBERS THROUGH COMMUNITY ORGANIZING, HEALTH EDUCATION AND SOCIAL JUSTICE AND EXCHANGE PROGRAMS IN EL SALVADOR. 0 0 7595391 44944 5404971 CLINICA ROMERO PROVIDES LOW-COST COMPREHENSIVE PRIMARY CARE AND DISEASE PREVENTION SERVICES FOR MEN, WOMEN AND CHILDREN OF ALL AGES. OUR DOCTORS STRIVE TO PROVIDE THE BEST LEVEL OF CARE IN ORDER TO IMPROVE THE QUALITY OF LIFE OF ALL PATIENTS. SERVICES INCLUDE: EXAMS: COMPLETE MEDICAL EXAMINATIONS.CANCER SCREENINGS: LAB TESTS, ULTRASOUNDS.CHRONIC DISEASE MANAGEMENT: MEDICATIONS AND LIFESTYLE REGIMENS FOR AVOIDING COMPLICATIONS ASSOCIATED WITH ASTHMA, HEART DISEASE, HYPERTENSION, HIGH BLOOD PRESSURE AND DIABETES.FAMILY PLANNING: PROGRAMS TO ASSIST YOUNG AND BEGINNING FAMILIES.(CONTINUED IN SCHEDULE O)PRENATAL CARE: PRENATAL CLASSES AND NUTRITIONAL GUIDANCE.PEDIATRICS: WELL-CHILD VISITS FOR HEALTHY GROWTH AND DEVELOPMENT.VACCINATIONS: PEDIATRIC IMMUNIZATIONS AND ADULT VACCINES. 1959498 0 1952463 CLINICA IS COMMITTED TO PROVIDING PRESCRIPTION MEDICATION THAT FITS WITHIN A PATIENT'S BUDGET. OUR PHARMACEUTICAL STAFF IS COMMITTED TO PROVIDING ACCURATE AND EASY TO UNDERSTAND INFORMATION REGARDING THE MEDICATION PRESCRIBED TO OUR PATIENTS. SERVICES INCLUDE:ON-SITE FILLING OF PRESCRIPTIONS.PRESCRIPTION REFILLS.MEDICATION MANAGEMENT IN COORDINATION WITH PRIMARY CARE PHYSICIAN. 1275978 0 1103439 CLINICA ROMERO PROVIDES A LOW-COST DENTAL SERVICES FOR ADULTS AND CHILDREN IN A FRIENDLY ENVIRONMENT THAT PUTS OUR PATIENTS AT EASE. GOOD ORAL HEALTH REQUIRES REGULAR DENTAL EXAMINATION AND MAINTENANCE TO HELP PREVENT AND MANAGE DISEASE. OUR TEAM SPECIALIZES IN PREVENTATIVE CARE AND PROVIDES THE FOLLOWING SERVICES:SERVICES FOR ADULTS:COMPLETE ORAL EXAMINATIONS INCLUDING X-RAYS.PREVENTATIVE SERVICES AND PERIODIC PERIODONTAL MAINTENANCE TREATMENT:PROPHYLAXIS (CLEANINGS) AND NON-SURGICAL PERIODONTAL TREATMENT (SCALING AND ROOT PLANING), ORAL HYGIENE EDUCATION(CONTINUED IN SCHEDULE O)RESTORATIVE SERVICES:RESTORATION FILLINGS, CANAL TREATMENT LIMITED TO ANTERIOR TEETH, SIMPLE EXTRACTIONSSERVICES FOR CHILDREN:COMPLETE ORAL EXAMINATIONS AND X-RAYSPREVENTATIVE SERVICES:PROPHYLAXIS (CLEANINGS), FLUORIDE VARNISH APPLICATIONS, SEALANTS, ORAL HYGIENE EDUCATIONRESTORATIVE SERVICES:RESTORATION FILLINGS, PULPOTOMIES, STAINLESS STEEL CROWNS, SPACE MAINTAINERS, SIMPLE EXTRACTIONS 10830867 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 79 0 164 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0 0 1 1 0 CA X SANDRA ROSSATO 2132012745 123 SOUTH ALVARADO STREET LOS ANGELES CA 90057 CARLOS VAQUERANO PRESIDENT 1.00 X X 0 0 0 RAFAEL SWEET ESQ VICE PRESIDENT 1.00 X X 0 0 0 KRYSSIA CAMPOS SECRETARY 1.00 X X 0 0 0 MARCELO VILLAGOMEZ TREASURER 1.00 X X 0 0 0 GABRIEL AGUILA-NOLAZCO MEMBER (THROUGH APRIL 2017) 1.00 X 0 0 0 JOSE AMBROCIO AGUILAR MEMBER 1.00 X 0 0 0 LORENA BERNARDO MEMBER 1.00 X 0 0 0 MARIA ELENA GARCIA MEMBER (THROUGH APRIL 2017) 1.00 X 0 0 0 KEITH MARTIN MSW MEMBER 1.00 X 0 0 0 VENTURA MENDOZA MEMBER (THROUGH APRIL 2017) 1.00 X 0 0 0 YAMILET MARISOL MONCADA MEMBER 1.00 X 0 0 0 SANDRA RODRIGUEZ MEMBER 1.00 X 0 0 0 ADALY UGALDE MEMBER 1.00 X 0 0 0 SANDRA ROSSATO EXECUTIVE DIRECTOR 40.00 X 174008 0 6720 CHRISTINA BUGARIN FINANCE DIRECTOR 32.00 X 80286 0 500 DR SAMUEL PIERCE MEDICAL DIRECTOR 40.00 X 140461 0 1200 DR RODNEY SAMAAN ASSOCIATE MEDICAL DIRECTOR 32.00 X 134735 0 0 DR JOHN NGUYEN MD OBGYN 40.00 X 152010 0 0 DR FERNANDO RODRIGUEZ DDS DENTAL DIRECTOR 40.00 X 137540 0 300 JAMEY COREY PHARMACIST 40.00 X 128640 0 300 DEISY MENDOZA PHYSICIAN ASSISTANT 40.00 X 124840 0 0 DR MARIA AYALA MD PHYSICIAN 24.00 X 109680 0 0 1182200 0 9020 14 0 1 0 OCHIN 1881 SW NAITO PKWY PORTLAND OR 97201 EMR SERVICES 265144 7 LAYER IT SOLUTIONS INC 17701 CHATSWORTH ST GRANADA HILLS CA 91344 IT SERVICES 142863 2 4008331 58451 4066782 MEDICAL SERVICES 621110 5404971 5404971 PHARMACY 621110 1952463 1952463 DENTAL SERVICES 621110 1103439 1103439 8460873 959 959 4506 20589 -16083 -16083 -16083 91535 -91535 -91535 -91535 OTHER INCOME 900099 1236918 1236918 1236918 13657914 8460873 0 1130259 12450 12450 32494 32494 629000 106500 522500 6116222 5245714 834856 35652 1319614 1043706 249654 26254 592052 468265 112008 11779 13842 13842 74521 74521 791912 648378 86951 56583 47032 39781 7164 87 267992 165254 101114 1624 300179 231679 67532 968 129646 64916 63826 904 612367 489281 118144 4942 118600 59385 58388 827 PROGRAM EXPENSES 1756009 1740480 15206 323 DUES AND SUBSCRIPTIONS 376321 331912 44407 2 MISCELLANEOUS 220175 110246 108394 1535 MAINTENANCE AND REPAIRS 54932 40426 14398 108 13465360 10830867 2492905 141588 986976 688158 363462 387596 1997765 2156161 25785 25329 50989 32835 9289910 4674804 4646731 4615106 956 0 8072664 7905185 940154 1000397 266826 7527 4159319 4177035 5366299 5184959 X 2341815 2222027 364550 498199 2706365 2720226 8072664 7905185 192554 -178693 0 X 0 1 X 1 1 1 X 2762794 3060684 3619153 3846918 4066782 17356331 2762794 3060684 3619153 3846918 4066782 17356331 17356331 75069 133130 62547 74849 5465 351060 47949 180448 378315 409907 1236918 2253537 19960928 36419957 0.86950 0.91750 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME MEANINGFUL USE REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1618324 1618324 4346596 2376978 1969618 760622 340492 420130 2564368 1957334 607034 4615106 X 13678503 20589 20589 13657914 0 13657914 13485949 20589 20589 13465360 0 13465360 PART X, LINE 2: CLINICA IS A NONPROFIT CORPORATION, EXEMPT FROM THE PAYMENT OF INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3) AND CALIFORNIA REVENUE AND TAXATION CODE SECTION 23701(D). ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. HOWEVER, CLINICA IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. CLINICA FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. CLINICA'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 20,589. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 20,589. 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES SUPPORT HEALTH SERVICES TO THE PUBLIC 32494 0 0 0 0 0 0 32494 0 32494 CENTRAL AMERICA AND THE CARIBBEAN SUPPORT HEALTHCARE SERVICES AND HEALTHY CHILDREN 32494 RESPIRATORY MACHINE AND PLAYGROUND EQUIPMENT FMV 2 0 0 0 0 0 0 0 PART I, LINE 2: THE RECIPIENTS SENT PHOTOGRAPHS OF THE DONATED EQUIPMENT BEING USED FOR THE INTENDED PURPOSES. 1 PART I, LINE 2: AMOUNTS GIVEN WERE SPONSORSHIPS FOR LOCAL CHARITIES. ALL AMOUNTS GIVEN WERE INTENDED FOR GENERAL OPERATING SUPPORT AND NO MONITORING OCCURRED SUBSEQUENT TO THE EVENT. X 0 0 0 0 0 0 0 0 0 SANDRA ROSSATO EXECUTIVE DIRECTOR 174008 0 0 0 0 0 0 0 6720 0 180728 0 0 0 DR JOHN NGUYEN MD OBGYN 152010 0 0 0 0 0 0 0 0 0 152010 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS AND IMMEDIATE PAST PRESIDENT OF THE BOARD OF DIRECTORS. THE EXECUTIVE DIRECTOR AND OTHER NON-DIRECTORS MAY BE DESIGNATED AS NON-VOTING ADVISORS TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE EXERCISES SUCH AUTHORITY AS IS DELEGATED TO IT BY THE BOARD OF DIRECTORS AND CAN ACT IN THE BOARD'S ABSENCE DURING AN EMERGENCY IF THE FULL BOARD IS UNABLE TO MEET. FORM 990, PART VI, SECTION B, LINE 11B CLINICA MSR OSCAR A ROMERO'S OUTSIDE AUDITORS AND FINANCIAL STAFF PREPARED THE FORM 990. THE FORM WAS THEN REVIEWED BY THE FINANCE DIRECTOR AND THE EXECUTIVE DIRECTOR, THEN BY THE FINANCE COMMITTEE, THEN BY THE FULL BOARD OF DIRECTORS BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CLINICA MSR OSCAR A ROMERO (CMOAR) REQUIRES ALL EMPLOYEES TO DISCLOSE, AT LEAST ANNUALLY, ALL SOURCES OF INCOME FROM COMPENSATION OR FROM OWNERSHIP OF EVERY OUTSIDE ENTITY THAT (A) SOLD, SUPPLIED OR PROVIDED SERVICES (B) OPERATED A COMPETING ENTERPRISE OR (C) PROVIDED GOODS OR SERVICES TO CMOAR IN THE LAST SIX MONTHS. CMOAR ALSO REQUIRES ALL DIRECTORS TO ANNUALLY SIGN A STATEMENT AFFIRMING (A) RECEIPT OF CMOAR CONFLICT OF INTEREST POLICY (B) UNDERSTANDING OF THE POLICY AND (C) AGREEMENT WITH THE POLICY. CMOAR CONFLICT OF INTEREST POLICY DESCRIBES HOW CMOAR WILL RESOLVE POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWED ALL OF THE OFFICERS' COMPENSATION, INCLUDING THAT OF THE EXECUTIVE DIRECTOR. THE BOARD REVIEWED DATA OF COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED NONPROFIT EXECUTIVES. THE OCCURRENCE OF THESE DELIBERATION ARE NOTED IN THE BOARD MINUTES. THIS PROCESS LAST OCCURRED IN 2017. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION TO BEING AVAILABLE UPON REQUEST, THE ORGANIZATION'S FORM 990 IS AVAILABLE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.