2017-05-15T12:32:20-05:00 2016-06-30 951777440 GREEN HASSON & JANKS LLP 10990 WILSHIRE BLVD 16TH FLOOR LOS ANGELES CA 900243929 990 2015-07-01 952769432 VENICE FAMILY CLINIC VENI 3103928630 604 ROSE AVENUE VENICE CA 90291 ELIZABETH B FORER CEO 3103928630 2017-04-26 1 LAUREN A HAVERLOCK P00545829 3108731600 2015 2021-01-29 14:40:06Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 44390425 0 X HTTP://WWW.VENICEFAMILYCLINIC.ORG/ X 1970 CA TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 14 14 310 950 0 0 20726494 21188376 12830967 22401482 238595 68032 171552 -16380 33967608 43641510 0 0 0 0 23228328 25747841 0 0 1650100 8871392 10144563 32099720 35892404 1867888 7749106 22038967 28243419 2668776 1185629 19370191 27057790 X TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 0 0 29730458 22401482 VFC SERVES AS A MEDICAL HOME, PROVIDING COORDINATED AND COMPREHENSIVE MEDICAL, DENTAL AND MENTAL HEALTH SERVICES THAT INCLUDE PEDIATRICS, GENERAL ADULT MEDICINE, WOMEN'S, SENIOR, HOMELESS AND CHRONIC CARE SERVICES, PRENATAL CARE, SPECIALTY CLINICS IN CARDIOLOGY, DERMATOLOGY, EAR, NOSE AND THROAT, GASTROENTEROLOGY, GYNECOLOGY, NEUROLOGY, OPHTHALMOLOGY, OPTOMETRY, ORTHOPEDICS AND PODIATRY, MENTAL HEALTH DIAGNOSTIC TESTS AND MEDICATIONS. VFC PROVIDES HEALTH CARE ON SIX DAYS AND FOUR EVENINGS PER WEEK. VFC PROVIDES SERVICES PRIMARILY TO PEOPLE OF LOW INCOME, UNEMPLOYED AND HOMELESS. VFC'S PRIMARY SERVICE AREA INCLUDES 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 1,468 PEOPLE VOLUNTEERED IN FISCAL YEAR 2016, INCLUDING APPROXIMATELY 343 PHYSICIANS. THE CLINIC ESTIMATES THAT IT RECEIVED 67,245 TOTAL VOLUNTEER HOURS, INCLUDING 6,791 GENERAL AND ADMINISTRATIVE VOLUNTEER HOURS; SUCH GENERAL AND ADMINISTRATIVE HOURS ARE NOT REPRESENTED IN THE FINANCIAL STATEMENTS IN ACCORDANCE WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. 29730458 1 1 0 1 0 0 0 1 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 94 0 1 310 1 0 0 0 0 0 1 1 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ANDREA BLACKBIRD 3106647941 604 ROSE AVENUE VENICE CA 90291 JEFFREY E SINAIKO CHAIR 2.00 2.00 X X 0 0 0 WILLIAM FLUMENBAUM IMMEDIATE PAST CHAIR 2.00 2.00 X X 0 0 0 STEWART SERADSKY TREASURER 2.00 0.00 X X 0 0 0 LOETTE LOSHAK SECRETARY 2.00 0.00 X 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 AIME ESPINOSA BOARD MEMBER 2.00 0.00 X 0 0 0 RICH MARKEY 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 LOURDES SERVIN 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 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 40.00 1.00 X 209227 0 46437 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 40.00 1.00 X 177625 0 44119 ANITA M ZAMORA COO & INTERIM CEO (03/16-05/16) 40.00 0.00 X 139090 0 19592 DESPINA G KAYICHIAN MEDICAL DIRECTOR 40.00 0.00 X 220225 0 30883 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 40.00 0.00 X 183178 0 36355 SHARON NG DIRECTOR OF PHARMACY 40.00 0.00 X 169267 0 42948 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 40.00 0.00 X 207650 0 48322 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 36.00 0.00 X 174159 0 43633 COLEY M KING PHYSICIAN 40.00 0.00 X 163822 0 43364 BARBARA F GROTTS NURSE PRACTITIONER 36.00 0.00 X 163622 0 35319 JACQUELINE N MARSTON FAMILY PHYSICIAN 40.00 0.00 X 162069 0 39935 BARBARA M TCHENG PEDIATRICIANS 40.00 0.00 X 157310 0 36409 DIANA E HOFFMAN FAMILY PHYSICIAN 40.00 0.00 X 156310 0 29263 2283554 0 496579 36 0 1 0 BROTHERS MAINTENANCE SERVICES PO BOX 3283 WHITTIER CA 90605 CLEANING SERVICE 295624 RANDSTAD US LP PO BOX 894217 LOS ANGELES CA 90189 STAFFING SERVICES 269778 ALL'S WELL PO BOX 29048 GLENDALE CA 91209 STAFFING SERVICES 161023 JENSEN ZIGMAN CONSTRUCTION CO INC 10020 NATIONAL BLVD LOS ANGELES CA 90034 CONSTRUCTION 130067 QUICKSILVER PRINTING AND GRAPHICS 9155 ALABAMA AVE STE F CHATSWORTH CA 91311 PRINTING & GRAPHICS 124429 5 1435493 8701823 11051060 1857140 21188376 THIRD PARTY REIMBURSEMENT 621400 17017524 17017524 MEDI-CAL PHARMACY 900099 5383958 5383958 22401482 53304 53304 404789 390061 14728 14728 14728 331224 1435493 342474 -11250 -11250 11250 16380 -5130 -5130 43641510 22401482 0 51652 1640494 1353267 196523 90704 16607957 13696589 1971875 939493 2166928 1789720 270468 106740 4117997 3401156 513993 202848 1214465 1003057 151585 59823 4993 4993 105606 105606 57611 57611 776197 658845 78074 39278 4569 1309 1790 1470 887754 322084 456997 108673 476771 267954 198743 10074 1243137 1054665 170633 17839 154051 114440 36186 3425 61004 61004 964554 872386 76426 15742 275032 172930 68117 33985 PHARMACEUTICAL SUPPLIES 4335943 4335943 MED SUP & WASTE REMOVAL 286170 286170 OTHER PROGRAM EXPENSES 194054 194054 PARTICIPANT SUP/ACT/INC 100881 98347 2534 216236 107542 88688 20006 35892404 29730458 4511846 1650100 802 802 1982443 3081610 4326844 6414040 1940341 6412451 768800 303912 159115 103231 17718864 11317366 6871394 6401498 5628116 5271213 361112 254662 22038967 28243419 655770 239472 2013006 837639 53976 0 54542 2668776 1185629 X 7590461 13573609 6683999 8362124 5095731 5122057 19370191 27057790 22038967 28243419 X 7749106 -268141 349663 -143029 X 0 1 X 1 1 1 X 26310106 23659163 20472644 20726494 21188376 112356783 26310106 23659163 20472644 20726494 21188376 112356783 11509392 100847391 213009 264442 9351155 238595 53304 10120505 64740 98585 196325 95551 455201 122932489 61608555 0.82030 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 414 0 0 414 0 PART II-B, LINE 1: DURING THE 2015-2016 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 HAS DRAMATICALLY IMPROVED ACCESS TO AND QUALITY OF CARE FOR THE NATION'S MOST VULNERABLE COMMUNITIES. ON THE STATE LEVEL, VENICE FAMILY CLINIC PARTICIPATED IN THE CALIFORNIA PRIMARY CARE ASSOCIATION'S ANNUAL "DAY AT THE CAPITOL 2016" EVENT, A DAY OF MEETINGS WITH STATE ELECTED OFFICIALS IN SACRAMENTO, CA. 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 ANGLEES COUNTY ON POLICY ISSUES IMPACTING COMMUNITY HEALTH CENTER PATIENTS. IN ADDITION, VENICE FAMILY CLINIC PARTICIPATED IN LOS ANGELES CITY COUNCILMAN MIKE BONIN'S "VENICE FORWARD" COALITION, WHICH IS WORKING TO ALLEVIATE HOMELESSNESS IN OUR COMMUNITY. 21000 0 5731858 50000 -262704 278292 5240862 6560040 150000 288739 1266921 5731858 5707178 500000 625509 272647 6560040 5178737 200000 544036 215595 5707178 4406652 1050000 -74201 203714 5178737 0.97730 0.02270 0 0 1116512 1116512 6259843 5232829 1027014 7565836 3823715 3742121 2776673 2260822 515851 6401498 UCLA EIP FUND 5240862 F UCLA STIP FUND 30351 F 5271213 DUE TO AFFILIATE VFCF 54542 54542 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. SILVER CIRCLE 1607331 1291218 316113 58650 61106 136736 1588 69283 HOLIDAY MOVIE 159386 144275 15111 859 14252 1766717 1435493 331224 58650 61106 137595 1588 83535 342474 -11250 X X 0 0 0 0 0 0 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 209227 0 0 0 0 0 29292 0 17145 0 255664 0 0 0 ANDREA B BLACKBIRD CHIEF FINANCIAL OFFICER 177625 0 0 0 0 0 24868 0 19251 0 221744 0 0 0 ANITA M ZAMORA COO & INTERIM CEO (03/16-05/16) 139090 0 0 0 0 0 19540 0 52 0 158682 0 0 0 DESPINA G KAYICHIAN MEDICAL DIRECTOR 220225 0 0 0 0 0 30831 0 52 0 251108 0 0 0 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 183178 0 0 0 0 0 25645 0 10710 0 219533 0 0 0 SHARON NG DIRECTOR OF PHARMACY 169267 0 0 0 0 0 23697 0 19251 0 212215 0 0 0 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 207650 0 0 0 0 0 29071 0 19251 0 255972 0 0 0 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 174159 0 0 0 0 0 24382 0 19251 0 217792 0 0 0 COLEY M KING PHYSICIAN 163822 0 0 0 0 0 22935 0 20429 0 207186 0 0 0 BARBARA F GROTTS NURSE PRACTITIONER 163622 0 0 0 0 0 22907 0 12412 0 198941 0 0 0 JACQUELINE N MARSTON FAMILY PHYSICIAN 162069 0 0 0 0 0 22690 0 17245 0 202004 0 0 0 BARBARA M TCHENG PEDIATRICIANS 157310 0 0 0 0 0 22023 0 14386 0 193719 0 0 0 DIANA E HOFFMAN FAMILY PHYSICIAN 156310 0 0 0 0 0 21883 0 7380 0 185573 0 0 0 X 9 61151 FMV X 5 1720959 FMV X AUCTION ITEMS 53 58650 SALES PRICE X RAFFLE ITEMS 2 16380 FMV 0 1 1 PART I, COLUMN (B): NON CASH DONATIONS ARE LISTED BY TOTAL NUMBER OF DONOR CONTRIBUTIONS. PART I, LINE 32B: VENICE FAMILY CLINIC 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 B, LINE 11 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. IT IS THEN REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE. 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 ON BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUSTS -143,029. 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 0 0 1 1 0 0 0