2017-05-15T16:41:51-05:00 2016-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2015-07-01 941744108 LA CLINICA DE LA RAZA INC LACL 5105354000 1515 FRUITVALE AVE OAKLAND CA 94601 ALBERTO L DIAZ CFO 5105354000 2017-05-15 1 RENIE BURBANK P00159653 4159561500 2015 2021-01-29 14:40:06Z ALBERTO L DIAZ 1515 FRUITVALE AVE OAKLAND CA 94601 97542314 0 X WWW.LACLINICA.ORG X 1971 CA LA CLINICA DE LA RAZA, INC. IS A PRIVATE, NON-PROFIT CORPORATION THAT PROVIDES COMPREHENSIVE MEDICAL SERVICES TO INDIVIDUALS IN NEED THROUGHOUT THE BAY AREA, REGARDLESS OF RACE, AGE OR ABILITY TO PAY. OUR SERVICES INCLUDE MEDICAL, DENTAL, OPTICAL, WOMEN'S HEALTH, PRENATAL AND POSTNATAL CARE, PREVENTIVE MEDICINE, HEALTH AND NUTRITION EDUCATION, ADOLESCENT SERVICES, MENTAL HEALTH, BEHAVIORAL HEALTH SERVICES, CASE MANAGEMENT, REFERRAL SERVICES, PHARMACY, RADIOLOGY AND LABORATORY SERVICES. WE DELIVER OUR MEDICAL CARE IN WHATEVER LANGUAGE OUR PATIENTS SPEAK, TO ENSURE ALL OF OUR PATIENTS FEEL WELCOME AND COMFORTABLE. 14 14 1290 150 0 0 27093099 28382966 68596626 68359567 387301 347027 1434491 360212 97511517 97449772 0 0 0 0 68306861 72079038 0 0 277868 24410423 25092817 92717284 97171855 4794233 277917 69349768 71094797 27639560 28839169 41710208 42255628 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 46826430 28419868 MEDICAL- THE MEDICAL CLINIC PROVIDED BASIC HEALTH CARE FOR PEOPLE OF ALL AGES SUCH AS FAMILY MEDICINE, INTERNAL MEDICINE PEDIATRICS, AND OBSTETRICS-GYNECOLOGY. 15712246 20916177 DENTAL- THE DENTAL CLINIC PROVIDED THE FOLLOWING DENTAL SERVICE SUCH AS DENTAL HYGIENE, GENERAL DENTISTRY, ORTHODONTICS, PERIODONTICS, PEDODONTICS, ENDODONTICS, AND ORAL SURGERY. 1772529 7019479 ANCILLARY-THE ANCILLARY DEPARTMENT INCLUDES IN-PATIENT, PHARMACY, RADIOLOGY AND LABORATORY SERVICES. 14139523 12004043 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. 14139523 12004043 78450728 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 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 1 148 0 1 1290 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 0 0 CA X ALBERTO DIAZ 5105352915 1515 FRUITVALE AVENUE OAKLAND CA 946012322 JILL ELIZABETH NOONAN JD RN PRESIDENT 1.00 X X 0 0 0 DANIEL L AYALA VICE PRESIDENT 1.00 X X 0 0 0 PAUL MARRIOTT SWENSON MBA TREASURER 1.00 X X 0 0 0 NORMA GUADALUPE GUERRERO SECRETARY 1.00 X X 0 0 0 MARIA DE LOS ANGELES ESPINOZA PARLIAMENTARIAN 1.00 X 0 0 0 FRANCISCA AVALOS BOARD MEMBER 1.00 X 0 0 0 AISHA EBONY HAMPTON-BOWSER BOARD MEMBER 1.00 X 0 0 0 YVONNE SUZETTE HUDSON-HARMON BOARD MEMBER 1.00 X 0 0 0 ROBERT CALVIN KATTER BOARD MEMBER 1.00 X 0 0 0 REVEREND RODNEY J LEGGETT BOARD MEMBER 1.00 X 0 0 0 LIZ S LIZARDO BOARD MEMBER 1.00 X 0 0 0 MICHAEL C MOORE BOARD MEMBER 1.00 X 0 0 0 JORGE ALBERTO PEREZ BOARD MEMBER 1.00 X 0 0 0 ANDREW PETERSON BOARD MEMBER 1.00 X 0 0 0 AMY PREVEDEL BOARD MEMBER (THRU 12/2015) 1.00 X 0 0 0 RAMON TERRAZAS BOARD MEMBER (THRU 12/2015) 1.00 X 0 0 0 JANE C GARCIA CEO 40.00 X 507845 0 97865 PATRICIA AGUILERA CFO (THRU 05/10/16) 40.00 X 174277 0 23926 PAUL J BAYARD CHIEF MEDICAL OFFICER 40.00 X 207408 0 29167 ALBERTO LUIS DIAZ CFO 40.00 X 0 0 0 JORGE S SIOPACK PHYSICIAN-OB 40.00 X 328478 0 36996 EDWARD ROTHMAN DENTIST 40.00 X 185885 0 31533 SUSAN SYKES OB-GYN, ASSOC MEDICAL DIR 40.00 X 241540 0 34438 LISA MONTANG PHYSICIAN, ASSOC MEDICAL DIR 40.00 X 222047 0 30094 JOAN HOFFMAN PHYSICIAN, ASSOC MEDICAL DIR 40.00 X 197862 0 20004 2065342 0 304023 102 0 1 0 TAB PRODUCTS CO LLC 24923 NETWORK PLACE CHICAGO IL 94587 OUTSIDE LABOR 983026 CONSOLIDATED CLEANING SERVICE 2515 WILLOW STREET OAKLAND CA 91350 JANITORIAL 677048 QSI QUALITY SYSTEMS INC P O BOX 511449 LOS ANGELES CA 94607 SOFTWARE CONSULTANT 572769 C&C SECURITY PATROL INC 1684 DECOTO ROAD 61 UNION CITY CA 900740368 SECURITY SERVICES 468515 QUEST DIAGNOSTICS PO BOX 50368 LOS ANGELES CA 90051 LABORATORY SERVICES 408281 9 184975 23864174 4333817 1336001 28382966 NET PATIENT REVENUE 621400 59895798 59895798 CAPITATION REVENUE 621400 6555249 6555249 OTHER OPERATING REV 621400 1908520 1908520 68359567 347027 347027 7718 184975 92542 -84824 -84824 OTHER INCOME 900099 423742 423742 MEDICAL RECORDS 621400 21294 21294 445036 97449772 68359567 0 707239 1047639 40915 1006724 55752730 48096610 7552715 103405 1496727 1321084 172842 2801 9793305 8232825 1544273 16207 3988637 3464998 515916 7723 2050673 697669 1351161 1843 159857 4918 154939 84793 6493 78300 5297450 3360586 1879067 57797 255554 11266 244189 99 9433106 8531444 886716 14946 1312879 40769 1272110 3182917 2370842 802858 9217 227567 95829 130345 1393 227442 44131 155122 28189 325466 325466 1849104 1415281 433823 261728 8949 252779 EDUCATIONAL ALLOWANCE 117458 110725 6733 306823 269928 2647 34248 97171855 78450728 18443259 277868 273304 300640 17696834 14849542 5609533 8120214 4750575 6493532 249961 245804 463004 842908 47066788 18517681 29235883 28549107 10973399 11589267 97275 103783 69349768 71094797 12458087 12753526 2050365 3409722 3375000 3205000 2724296 2456201 7031812 7014720 27639560 28839169 X 40738656 41219241 971552 1036387 41710208 42255628 69349768 71094797 277917 267503 0 X X 0 1 X 1 1 1 X 28692976 28420815 28547818 26883134 28382966 140927709 28692976 28420815 28547818 26883134 28382966 140927709 140927709 403556 441569 449994 387301 347027 2029447 254270 78750 234585 49027 29012 645644 393486 337659 544915 1590860 423742 3290662 146893462 303846732 0.95940 0.95500 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 35934253 11808296 24125957 8489429 6709385 1780044 316603 316603 28549107 CONTRACT PAYABLE 2411609 PRIVATE PLACEMENT BONDS 4603111 7014720 X 98079250 267503 269433 92542 629478 97449772 0 97449772 97533830 269433 92542 361975 97171855 0 97171855 PART X, LINE 2: AS OF JUNE 30, 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: SPECIAL EVENT EXPENSES RECLASSIFIED TO REVENUE 92,542. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES RECLASSIFIED TO REVENUE 92,542. YOSHI'S EVENT 192693 184975 7718 62818 29724 192693 184975 7718 62818 29724 92542 -84824 X X 0 1 0 0 0 0 0 0 0 JANE C GARCIA CEO 249511 0 0 0 258334 0 60182 0 37683 0 605710 0 0 0 PATRICIA AGUILERA CFO (THRU 05/10/16) 174277 0 0 0 0 0 1762 0 22164 0 198203 0 0 0 PAUL J BAYARD CHIEF MEDICAL OFFICER 207408 0 0 0 0 0 3182 0 25985 0 236575 0 0 0 JORGE S SIOPACK PHYSICIAN-OB 328478 0 0 0 0 0 2333 0 34663 0 365474 0 0 0 EDWARD ROTHMAN DENTIST 185885 0 0 0 0 0 2889 0 28644 0 217418 0 0 0 SUSAN SYKES OB-GYN, ASSOC MEDICAL DIR 241540 0 0 0 0 0 2705 0 31733 0 275978 0 0 0 LISA MONTANG PHYSICIAN, ASSOC MEDICAL DIR 222047 0 0 0 0 0 3183 0 26911 0 252141 0 0 0 JOAN HOFFMAN PHYSICIAN, ASSOC MEDICAL DIR 197862 0 0 0 0 0 2080 0 17924 0 217866 0 0 0 PART I, LINE 4B LA CLINICA CREATED A NON QUALIFIED 457(F) BENEFIT PLAN FOR EXECUTIVES IN WHICH JANE GARCIA IS THE ONLY PARTICIPANT. THE AMOUNT OF THE CONTRIBUTION FOR THE 2015 CALENDAR YEAR WAS $57,000 AND CURRENT YEAR PAYMENT WAS $258,334. A ABAG FINANCE AUTHORITY FOR NONPROFIT CORP 943130123 00037CQV5 2010-12-30 3855000 FINANCING OF MONUMENT HEALTH CLINIC, CONCORD, CA 0 0 0 A 3855000 3376839 478161 2011 0 0 0 0 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 0 A 1 X 1 1336001 INVOICE STATEMENT 0 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS REVIEWED BY THE AUDIT COMMITTEE AND WAS PRESENTED AND REVIEWED BY THE BOARD OF DIRECTORS IN ELECTRONIC FORM BEFORE IT WAS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C LA CLINICA WILL BE REVIEWING AND UPDATING OUR CONFLICT OF INTEREST (COI) POLICY. TO THIS END, THE UPDATES ARE EXPECTED TO FURTHER EXPAND LA CLINICA'S PRACTICES FOR MONITORING PROPOSED AND ONGOING TRANSACTIONS FOR COI, WHICH INCLUDES DEALING WITH POTENTIAL OR ACTUAL CONFLICTS, WHETHER DISCOVERED BEFORE OR AFTER THE TRANSACTION OCCURRED. ADDITIONALLY, UPDATES WILL ADDRESS WHICH PERSONS ARE COVERED UNDER THE POLICY, THE LEVEL AT WHICH DETERMINATIONS OF WHETHER A CONFLICT EXISTS ARE MADE, AND THE LEVEL AT WHICH ACTUAL CONFLICTS ARE REVIEWED. LASTLY, UPDATE WILL OUTLINE ANY RESTRICTIONS IMPOSED ON PERSONS WITH A CONFLICT, SUCH AS RECUSE HIM/ HERSELF FROM PARTICIPATING IN A BOARD DELIBERATIONS AND DECISIONS INVOLVING THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15A CEO SALARY IS DETERMINED BY BOARD OF DIRECTORS. TOP MANAGEMENT SALARIES ARE DETERMINED BY THE CEO. THE BOARD OF DIRECTORS AND THE CEO USE COMPARABILITY DATA. THE BASIS OF SALARY TAKES INTO ACCOUNT THE SIZE OF THE ORGANIZATION; THE EMPLOYEES TENURE; THE COMPLEXITY OF THE ORGANIZATION; 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.