2018-05-14T14:03:10-05:00 2017-06-30 910189318 Moss Adams LLP 101 Second Street Suite 900 San Francisco CA 94105 990 2016-07-01 941744108 La Clinica de La Raza Inc LACL 5105354000 PO Box 22210 Oakland CA 946232210 Susan Moore CFO 5105354000 2018-05-14 1 Michael Lumsden P01262236 4159561500 2018-05-11 12.129.7.100 2018-05-14 13:44:22 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 5029E8FD9FE66385FA59B177B15FCADA276E8E0F 2016 2021-01-29 14:40:06Z X Jane C Garcia PO Box 22210 Oakland CA 946232210 101013863 0 X www.laclinica.org X 1971 CA Comprehensive medical services to individuals in need, regardless of race, age or ability to pay. 17 17 1302 204 0 0 28382966 29427380 68359567 70580875 347027 414080 360212 532874 97449772 100955209 0 0 0 0 72079038 74799767 0 0 391683 25092817 25580248 97171855 100380015 277917 575194 71094797 71400655 28839169 28891277 42255628 42509378 X TO IMPROVE THE QUALITY OF LIFE OF THE DIVERSE COMMUNITIES WE SERVE BY PROVIDING CULTURALLY APPROPRIATE, HIGH QUALITY, AND ACCESSIBLE HEALTH CARE FOR ALL. 0 0 48745330 0 49144413 Medical - The Medical Clinic provided basic health care services, such as Family Medicine, Internal Medicine, Pediatrics, and Obstetrics-Gynecology, for people of all ages. 15750461 0 18025790 Dental - The Dental clinic provided dental services, such as dental hygiene, general dentistry, orthodontics, periodontics, pedodontics, endodontics, and oral surgery, for people of all ages. 5925378 0 2160992 Ancillary - The Ancillary department includes in-patient, pharmacy, radiology, and laboratory services. 10501167 1249680 EYE - THE EYE DEPARTMENT OFFERS OPTOMETRY AND OPTHALMOLOGY SERVICES. MENTAL HEALTH - THE MENTAL HEALTH DEPARTMENT OFFERS COUNSELING SERVICES FOR CHILDREN AND ADULTS. COMMUNITY HEALTH EDUCATION - THE COMMUNITY HEALTH EDUCATION DEPARTMENT OFFERS CLASSES, SUPPORT GROUPS, AND OTHER ACTIVITIES ON VARIOUS HEALTH TOPICS. THE CLINIC PROVIDES NUTRITIONAL PROGRAMS SUCH AS THERAPEUTIC NUTRITIONAL COUNSELING, NUTRITION EDUCATION, WOMEN, INFANT, AND CHILDREN (WIC) PROGRAM. THESE SERVICES ARE PROVIDED TO COMMUNITY RESIDENTS AND PATIENTS. 10501167 1249680 80922336 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 251 0 1 1302 1 0 0 0 0 0 1 1 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Susan Moore 5105354000 1450 Fruitvale Avenue 3rd Floor Oakland CA 94601 Jill E Noonan JD RN President 1.00 0.00 X X 0 0 0 Daniel L Ayala Vice President 1.00 0.00 X X 0 0 0 Paul M Swenson MBA Treasurer 1.00 0.00 X X 0 0 0 Norma G Guerrero Secretary 1.00 0.00 X X 0 0 0 Maria D Espinoza Parliamentarian 1.00 0.00 X X 0 0 0 Francisca Avalos Board Member 1.00 0.00 X 0 0 0 Aisha E Hampton-Bowser Board Member 1.00 0.00 X 0 0 0 Yvonne S Hudson-Harmon Board Member 1.00 0.00 X 0 0 0 Rachel A Harralson Board Member 1.00 0.00 X 0 0 0 Robert C Katter Board Member 1.00 0.00 X 0 0 0 Reverend Rodney J Leggett Board Member 1.00 0.00 X 0 0 0 Andrew C Peterson Jr Board Member 1.00 0.00 X 0 0 0 Amy L Prevedel Board Member through 4/17/2017 1.00 0.00 X 0 0 0 Sophia E Bucheli Board Member 1.00 0.00 X 0 0 0 Elizabeth Diaz Board Member 1.00 0.00 X 0 0 0 Maria Tsaklanos Board Member 1.00 0.00 X 0 0 0 Dora Eckenfelder Board Member 1.00 0.00 X 0 0 0 Ramon J Terrazas Board Member 1.00 0.00 X 0 0 0 Liz S Lazardo Board Member through 7/18/2016 1.00 0.00 X 0 0 0 Jorge Alberto Perez Board Member through 7/18/2016 1.00 0.00 X 0 0 0 Jane C Garcia CEO 40.00 0.00 X 270897 0 90118 Alberto L Diaz CFO 40.00 0.00 X 138846 0 13623 Paul J Bayard Chief Medical Officer 40.00 0.00 X 204062 0 29658 Jorge S Siopack Physician - OB 40.00 0.00 X 337410 0 26835 Susan Sykes OB-GYN - Assoc Medical Director 40.00 0.00 X 248734 0 32882 Lisa Montang Physician - Assoc Medical Director 40.00 0.00 X 214565 0 29945 Joan Hoffman Physician - Assoc Medical Director 40.00 0.00 X 211118 0 20406 Charles Som Contra Costa - Reg Medical Director 40.00 0.00 X 199347 0 29086 1824979 0 272553 109 0 1 0 Security Enforcement Alliance PO Box 2279 Napa CA 94558 Security Services 802132 Quality Systems Inc PO Box 511449 Los Angeles CA 90051 Software Maintenance 704124 Consolidated Cleaning Service 410 Pendleton Way Suite 12 Oakland CA 94621 Janitorial Services 464780 Quest Diagnostics PO Box 50368 Los Angeles CA 90074 Outstide Lab Services 403050 Township Building Services Inc 26 Pamaron Way Suite A Novato CA 94949 Janitorial Services 394228 20 53034 23025185 6349161 1173732 29427380 Net Patient Revenue 621400 59541944 59541944 Capitation Revenue 621400 6618749 6618749 Other Operating rev 621400 2259190 2259190 Pharmacy - 340b Prog Rev 621400 2160992 2160992 70580875 414080 414080 188612 53034 58654 129958 129958 Other Revenue 900099 402916 402916 402916 100955209 70580875 0 946954 843772 843772 57622282 49412208 8108061 102013 1589400 1342980 243674 2746 10660580 8711536 1928775 20269 4083733 3451150 625474 7109 2221431 1087822 1133609 263555 5896 257659 130247 7946 122301 5159998 3945520 1107624 106854 175747 39187 136200 360 8919177 7761057 1133039 25081 1536766 87434 1449332 3072889 2443782 628808 299 170677 93321 76558 798 205130 18861 79263 107006 312244 311808 436 1733030 1320146 412884 287732 8839 278893 Taxes & Fees 330013 134384 188477 7152 Equipment Lease 184173 139023 45150 Educational Allowance 142080 117048 24278 754 Organizational Dues 98652 18683 79969 636707 463705 161760 11242 100380015 80922336 19065996 391683 300640 336809 14849542 17528020 8120214 6122046 6493532 6031374 245804 195861 510225 598062 47908366 20250711 28549107 27657655 11589267 12441867 436466 488961 71094797 71400655 10080341 10271537 5821331 6852504 7808111 7421566 2456201 2159501 2673185 2186169 28839169 28891277 X 41219241 41632249 1036387 877129 42255628 42509378 71094797 71400655 X 575194 -253379 -68065 X 0 1 X 1 1 1 X 28420815 28547818 26883134 28382966 29427380 141662113 28420815 28547818 26883134 28382966 29427380 141662113 280465 141381648 441569 449994 387301 347027 414080 2039971 588 147392 0 0 129958 277938 337659 544915 1590860 423742 402916 3300092 147280114 321779631 0.96000 0.95940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 0 0 0 0 0 0 0 Part II-B, Line 1: Volunteers of the organization spent time in an attempt to influence public opinion on legislative matters. 2326503 2326503 35988456 12857771 23130685 8864330 7392940 1471390 729077 729077 27657655 Estimated Third-Party Payor Settlements 2186169 2186169 X 100930099 -253379 237680 -68065 -83764 101013863 -58654 -58654 100955209 100676349 237680 58654 296334 100380015 0 100380015 Part X, Line 2: The Organization is a nonprofit corporation under Internal Revenue Code Section 501(c)(3) and has been granted tax-exempt status by the Internal Revenue Service and the California Revenue and Taxation Code. As of June 30, 2017 and 2016, the Organization had no unrecognized tax positions or uncertain tax positions requiring accrual. Therefore, no provision for income taxes has been provided in the financial statements. Part XI, Line 2d - Other Adjustments: Reversal of Prior Year Contributions -68,065. Part XI, Line 4b - Other Adjustments: Fundraising Event Expenses -58,654. Part XII, Line 2d - Other Adjustments: Fundraising Event Expenses 58,654. YOSHI'S Event 241646 53034 188612 51684 6970 241646 53034 188612 51684 6970 58654 129958 X X 0 1 0 0 0 0 0 0 0 Jane C Garcia CEO 253767 0 0 0 17130 0 60182 0 29936 0 361015 0 0 0 Alberto L Diaz CFO 138846 0 0 0 0 0 446 0 13177 0 152469 0 0 0 Paul J Bayard Chief Medical Officer 186930 0 0 0 17132 0 3060 0 26598 0 233720 0 0 0 Jorge S Siopack Physician - OB 331108 0 0 0 6302 0 2346 0 24489 0 364245 0 0 0 Susan Sykes OB-GYN - Assoc Medical Director 227147 0 0 0 21587 0 2706 0 30176 0 281616 0 0 0 Lisa Montang Physician - Assoc Medical Director 197433 0 0 0 17132 0 3182 0 26763 0 244510 0 0 0 Joan Hoffman Physician - Assoc Medical Director 205104 0 0 0 6014 0 2080 0 18326 0 231524 0 0 0 Charles Som Contra Costa - Reg Medical Director 182204 0 0 0 17143 0 2080 0 27006 0 228433 0 0 0 Part I, Line 4b Jane C. Garcia participates in a supplemental, nonqualified 457(f) retirement plan. During the 2016 calendar year, contributions to the plan totalled $57,000, which has been reported as "Deferred Compensation" in Schedule J, Part II, Column (c); there were no distributions or amounts treated as taxable compensation due to substantial risk of forfeiture from the plan. A ABAG Finance Authority for Nonprofit Corporations 943130123 00037CQV5 2010-12-30 3855000 Financing of Monument Health Clinic in Concord, CA 0 0 0 B California Enterprise Development Authority 352273601 000000000 2013-03-20 12421875 Refund of Bonds dated 12/20/2001 and 9/28/2007 0 0 0 A 825000 3855000 3855000 2011 0 0 1 1 B 853434 5245000 248438 4996562 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 Part I, Line B, Column (e) and Part II, Column B, Line 3: The Form 8038 which was filed for Bond B indicated a total issue price of $12,421,875, which represents the total amount of funds the organization was approved to borrow, and is reflected on Part I, Line B, Column (e). The organization only borrowed $5,245,000 of the issue price, which is reflected in the "Total proceeds of issue" in Part II, Line 3. Part IV, Line 2a: The organization has not yet performed a rebate computation for either the 2010 or 2013 bond; after the filing of this return, the organization will be determining if a rebate computation is or was due for either bond, and will be remedying the situation if so. X 2 1173732 Fair Market Value 0 0 1 0 Part I, Column (b): The organization is reporting the number of contributions received in Schedule M, Part I, Column (b). Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an independent tax preparer in conjunction with the organization's finance and accounting department. Upon review and approval by the finance and accounting department, the Form 990 is then reviewed by the Audit Committee of the Board and then sent electronically to all members of the Board prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The organization has a conflict of interest policy which covers directors, officers, and employees who can influence the actions of La Clinica; all such indviduals are required to complete a "Conflict of Interest Questionnaire & Disclosure Statement" annually. In the event a conflict of interest is identified, disclosure should be made to the Compliance Officer (or if she or he is the one with the conflict, then to the board chair), who shall bring the matter to the attention of the Audit and Compliance Committee of the Board. Transactions with parties with whom conflicting interest exists may be undertaken only if all the following are observed: (i) the conflicting interest is fully disclosed; (ii) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (iii) a competitive bid or comparable calculation exists, and is accordance with La Clinica's procurement policy; and (iv) the Board or a duly constituted committee thereof, has determined that the transaction is in the best interest of the organization. The decision of the Board or committee is documented within the Board/committee meeting minutes. Form 990, Part VI, Section B, line 15 The salary for the CEO is determined by the members of the Board of Directors, which consists entirely of independent persons. Salaries for other officers and key employees of the organization is determined by the CEO. Both the Board of Directors and the CEO utilize comparability data when making compensation decisions, and also take into account the size and complexity of the comparable organizations, the employee's tenure, and other such information. Form 990, Part VI, Section C, line 19 The audited financial statements are distributed upon request. The governing/organizing documents are available on the website at www.laclinica.org. The conflict of interest policy is available on request. Form 990, Part XI, line 9: Reversal of Prior Year Contributions -68,065.