2016-05-02T17:45:04-05:00 2015-06-30 952302617 SINGERLEWAK LLP 10960 WILSHIRE BLVD STE 700 LOS ANGELES CA 900243783 990 2014-07-01 952769432 VENICE FAMILY CLINIC VENI 3103928630 604 ROSE AVENUE VENICE CA 90291 ELIZABETH B FORER INTERIM CEO 3103928630 2016-04-25 1 LIOR TEMKIN P00748170 3104773924 2016-04-25 2014 2016-08-17 19:52:53Z ANITA ZAMORA 604 ROSE AVENUE VENICE CA 90291 34348268 0 X HTTP://VENICEFAMILYCLINIC.ORG/ X 1970 CA THE VENICE FAMILY CLINIC IS A PRIVATE, NONPROFIT COMMUNITY HEALTH CENTER. FOUNDED IN 1970 TO MEET THE HEALTH CARE NEEDS OF THE LOW-INCOME RESIDENTS OF VENICE THE CLINIC HAS GROWN TO TEN LOCATIONS ACROSS THE WESTSIDE OF LOS ANGELES COUNTY. ITS MISSION IS TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 15 15 282 640 0 0 20472644 20726494 8923117 12830967 272647 238595 485974 171552 30154382 33967608 0 0 0 0 20873356 23228328 0 0 1481758 11183703 8871392 32057059 32099720 -1902677 1867888 19836802 22038967 2307806 2668776 17528996 19370191 X SEE SCHEDULE O 0 0 26654709 12830967 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/THROAT, GASTROENTEROLOGY, GYNECOLOGY, NEUROLOGY, OPHTHALMOLOGY, OPTOMETRY, ORTHOPEDICS AND PODIATRY, MENTAL HEALTH DIAGNOSTIC TESTS AND MEDICATIONS. HEALTH CARE IS PROVIDED SIX DAYS AND FOUR EVENINGS PER WEEK, WITH 77,256 PRIMARY HEALTH CARE VISITS, 5,548 SPECIALTY CARE VISITS, 5,510 DENTAL VISITS, 7,653 MENTAL HEALTH CARE VISITS AND 7,668 HEALTH EDUCATION VISITS PROVIDED DURING THE YEAR ENDED JUNE 30, 2015.VENICE FAMILY CLINIC'S 22,419 PATIENTS IN THE YEAR ENDED JUNE 30, 2015 ARE PRIMARILY PEOPLE WITH LOW INCOMES BELOW THE POVERTY LEVEL, OVER ONE-THIRD OF WHOM HAVE NO HEALTH INSURANCE. MANY ARE HOMELESS OR UNEMPLOYED. 26654709 1 1 0 1 0 0 0 1 0 1 1 1 0 0 0 1 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 1 106 0 1 282 1 0 0 0 0 0 1 1 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X X ANDREA BLACKBIRD 3106647941 604 ROSE AVENUE VENICE CA 90291 MAYER B DAVIDSON MD BOARD MEMBER 2.00 X 0 0 0 PAULA DAVIS BOARD MEMBER 2.00 X 0 0 0 AIME ESPINOSA BOARD MEMBER 2.00 X 0 0 0 DAVID T FEINBERG MD BOARD MEMBER (UNTIL 02/15) 2.00 X 0 0 0 LUIS GALVEZ BOARD MEMBER 2.00 X 0 0 0 RICH MARKEY BOARD MEMBER 2.00 X 0 0 0 WENDY SMITH MEYER PHD BOARD MEMBER (UNTIL 06/15) 2.00 X 0 0 0 NEAL H PARKER MD BOARD MEMBER 2.00 X 0 0 0 BILL RESNICK MD BOARD MEMBER (UNTIL 06/15) 2.00 X 0 0 0 PAUL SABEN BOARD MEMBER 2.00 X 0 0 0 FLORA M SANTACRUZ BOARD MEMBER (UNTIL 03/15) 2.00 X 0 0 0 LOURDES SERVIN BOARD MEMBER 2.00 X 0 0 0 NADIA SHAHEEN BOARD MEMBER 2.00 X 0 0 0 CARMEN THOMAS-PARIS BOARD MEMBER 2.00 X 0 0 0 KAREN WAGLE BOARD MEMBER (UNTIL 06/15) 2.00 X 0 0 0 LEISA WU BOARD MEMBER 2.00 X 0 0 0 WILLIAM FLUMENBAUM IMMEDIATE PAST BOARD CHAIR 2.00 2.00 X X 0 0 0 ASHLEY JOHNSON SECRETARY (UNTIL 06/15) 2.00 2.00 X X 0 0 0 BRIAN D KAN MD PAST BOARD CHAIR (UNTIL 06/15) 2.00 2.00 X X 0 0 0 LOETTE LOSHAK SECRETARY 2.00 2.00 X X 0 0 0 STEWART SERADSKY TREASURER 2.00 2.00 X X 0 0 0 JEFFREY E SINAIKO BOARD CHAIR 2.00 2.00 X X 0 0 0 ANDREA BLACKBIRD CHIEF FINANCE OFFICER 40.00 1.00 X 145833 0 64019 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 40.00 1.00 X 194278 0 78429 ELENA REBECCA KAPGAN CHIEF DEVELOPMENT OFFICER 40.00 X 137119 0 52134 DESPINA GHABY KAYICHIAN MEDICAL DIRECTOR 40.00 X 155549 0 52525 ANITA MARIA ZAMORA CHIEF OPERATING OFFICER 40.00 X 128754 0 54987 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 36.00 X 168714 0 77090 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 40.00 X 200631 0 82146 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 40.00 X 174250 0 68102 SHARON NG DIRECTOR OF PHARMACY 40.00 X 164337 0 71162 BARBARA F GROTTS NURSE PRACTITIONER 36.00 X 157086 0 66181 COLEY MARVIN KING PHYSICIAN 40.00 X 154215 0 71887 TARIN MOLLY KOEHLER FAMILY PRACTITIONER 40.00 X 154712 0 70144 ANALIZA SANCHEZ FAMILY PRACTITIONER 40.00 X 147700 0 66653 BARBARA MARIA TCHENG PEDIATRICIAN 40.00 X 147000 0 52991 2230178 0 928450 23 0 1 0 RANSTAD US LP PO BOX 894217 LOS ANGELES CA 90189 EMPLOYMENT AGENCY 303250 HOUSTONTYNER ASSOCIATES 2630 SEPULVEDA BLVD TORRANCE CA 90505 CONSTRUCTION 165642 2 1438017 1218125 7841791 10228561 3112230 20726494 3RD PARTY REIMBURSE. 621400 11199902 11199902 MEDI-CAL PHARMACY 900099 1631065 1631065 12830967 238595 238595 380660 1438017 380660 0 MISCELLANEOUS INCOME 900099 95551 95551 GAIN FROM UCLA EIP FUN 900099 76001 76001 171552 33967608 12830967 0 410147 2210899 1501324 543719 165856 14559282 12364493 1462513 732276 1931899 1654915 197106 79878 3406862 2898440 331876 176546 1119386 937264 130065 52057 3926 3926 177896 177896 516772 424736 56841 35195 238618 53822 179916 4880 809793 725169 81134 3490 117970 99768 14671 3531 55571 55571 798943 701374 86601 10968 234955 139015 59725 36215 DONATED DRUGS AND PHARM 3447066 3447066 REPAIRS & MAINTENANCE 692716 583089 92700 16927 PHARMACEUTICAL AND LAB 439092 439092 MEDICAL SUP & REMOVAL 247324 247324 1090750 437818 488993 163939 32099720 26654709 3963253 1481758 752 802 1272798 1982443 4356029 4326844 1616371 1940341 1120684 768800 96553 159115 17224563 10353169 5492955 6871394 5353756 5628116 526904 361112 19836802 22038967 364632 655770 1943174 2013006 2307806 2668776 X 6062188 7590461 5492751 6683999 5974057 5095731 17528996 19370191 19836802 22038967 1867888 -26693 0 X 0 1 X 1 1 1 X 29119560 26310106 23659163 20472644 20726494 120287967 9689336 9303267 8149722 8923117 12830967 48896409 38808896 35613373 31808885 29395761 33557461 169184376 388782 375046 317165 297634 669440 2048067 0 388782 375046 317165 297634 669440 2048067 167136309 213493 213009 264442 272647 238595 1202186 213493 213009 264442 272647 238595 1202186 54190 64740 98585 485974 171552 875041 39076579 35891122 32171912 30154382 33967608 171261603 0.97590 0.97900 0.00700 0.00630 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: 2010 OTHER REVENUE - 2010 AMOUNT: $ 54,190. 2011 OTHER REVENUE - 2011 AMOUNT: $ 64,740. 2012 OTHER REVENUE - 2012 AMOUNT: $ 98,585. 2013 OTHER REVENUE - 2013 AMOUNT: $ 485,974. 2014 OTHER REVENUE - 2014 AMOUNT: $ 171,552. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 0 0 1 1536 0 0 1536 0 PART II-B, LINE 1: DURING THE 2014-2015 FISCAL YEAR, VENICE FAMILY CLINIC'S PUBLIC AFFAIRS AND COMMUNICATIONS COMMITTEE, THE BOARD COMMITTEE OVERSEEING ADVOCACY AND PUBLIC POLICY WORK, MET ON A QUARTERLY BASIS AND ADDRESSED HEALTH CARE ISSUES AT THE LOCAL, STATE AND NATIONAL POLICY LEVELS. ON THE FEDERAL LEVEL, WE HOSTED A LUNCHEON IN HONOR OF OUTGOING CONGRESSMAN HENRY WAXMAN ATTENDED BY OUR BOARD, STAFF AND COMMUNITY PARTNERS. WE SENT A SENIOR STAFF MEMBER TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS' ANNUAL CONFERENCE IN WASHINGTON, DC ($1,536). ON THE STATE LEVEL, WE HOSTED A TOWN HALL MEETING ATTENDED BY BOARD AND STAFF WITH PETER LEE, EXECUTIVE DIRECTOR OF COVERED CALIFORNIA. WE ALSO CONTINUED TO PARTICIPATE IN A PAYMENT REFORM WORK GROUP ORGANIZED BY THE CALIFORNIA PRIMARY CARE ASSOCIATION TO IMPLEMENT A MORE TIMELY AND EQUITABLE SYSTEM OF PAYING COMMUNITY HEALTH CENTERS FOR MEDI-CAL REIMBURSEMENTS. LOCALLY, OVER THE PAST YEAR, WE WORKED CLOSELY WITH COUNCILMEMBER MIKE BONIN'S VENICE FORWARD COALITION, WHICH IS WORKING TO END HOMELESSNESS IN THE COMMUNITY OF VENICE. 0 6560040 150000 288739 1266921 5731858 5707178 500000 625509 272647 6560040 5178737 200000 544036 215595 5707178 4406652 1050000 -74201 203714 5178737 4030445 575967 199760 4406652 1.00000 0 0 1116512 1116512 6259843 5020112 1239731 7196722 3418523 3778199 2651486 1914534 736952 6871394 UCLA EIP FUND 5599624 F UCLA STIP FUND 28492 F 5628116 X 38914694 -26693 3982049 991730 4947086 33967608 0 33967608 37058985 3982049 977216 4959265 32099720 0 32099720 PART III, LINE 1A: ON OCTOBER 15, 2013, THE CLINIC ACQUIRED THE ASSETS (INCLUDED ARTWORK) AND LIABILITIES OF COMMON GROUND, A NONPROFIT ORGANIZATION. UPON COMPLETION OF THE ACQUISITION, COMMON GROUND CEASED OPERATIONS. BOTH ORGANIZATIONS HISTORICALLY SHARE A COMMON MISSION OF MEETING THE HEALTH CARE NEEDS OF THE LOW-INCOME RESIDENTS OF SOUTHERN CALIFORNIA. THROUGH THE ACQUISITION, VENICE FAMILY CLINIC SEEKS TO FURTHER ITS MISSION BY ACHIEVING GREATER ECONOMIES OF SCALE BY INTEGRATING OPERATIONAL OVERHEAD AND OTHER ORGANIZATIONAL SYNERGIES. PART V, LINE 4: INTEREST/DIVIDEND INCOME FROM THE CLINIC'S ENDOWMENT FUNDS ARE USED TO PAY FOR THE SALARIES AND BENEFITS OF PHYSICIANS, MENTAL HEALTH STAFF AND DOMESTIC VIOLENCE STAFF. PART X, LINE 2: EFFECTIVE JULY 1, 2009, THE CLINIC ADOPTED FASB ASC TOPIC NO. 740, "UNCERTAINTY IN INCOME TAXES" ("ASC 740"). IN ACCORDANCE WITH ASC 740, THE CLINIC RECOGNIZES THE IMPACT OF TAX POSITIONS IN THE FINANCIAL STATEMENTS IF THAT POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED ON AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. TO DATE, THE CLINIC HAS NOT RECORDED ANY UNCERTAIN TAX POSITIONS. THE CLINIC RECOGNIZES POTENTIAL ACCRUED INTEREST AND PENALTIES RELATED TO UNCERTAIN TAX POSITIONS IN INCOME TAX EXPENSE. DURING THE YEAR ENDED JUNE 30, 2015, THE CLINIC DID NOT RECOGNIZE ANY AMOUNT IN POTENTIAL INTEREST AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS. THE CLINIC'S INCOME TAX RETURNS REMAINS SUBJECT TO EXAMINATION FOR THE TAX YEARS ENDED ON OR AFTER JUNE 30, 2014 WITH REGARD TO ALL TAX POSITIONS AND RESULTS REPORTED. PART XI, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 611,070. SPECIAL EVENTS 380,660. PART XII, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 596,556. SPECIAL EVENTS 380,660. SILVER CIRCLE 1601687 1321685 280002 190871 17813 71318 HOLIDAY MOVIE 125603 86428 39175 39175 1 91387 29904 61483 61483 1818677 1438017 380660 190871 17813 171976 380660 0 X X 0 0 0 0 0 0 0 0 0 ANDREA BLACKBIRD CHIEF FINANCE OFFICER 145833 0 0 0 0 0 19250 0 44769 0 209852 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 194278 0 0 0 0 0 25375 0 53054 0 272707 0 0 0 ELENA REBECCA KAPGAN CHIEF DEVELOPMENT OFFICER 137119 0 0 0 0 0 17909 0 34225 0 189253 0 0 0 DESPINA GHABY KAYICHIAN MEDICAL DIRECTOR 155549 0 0 0 0 0 20816 0 31709 0 208074 0 0 0 ANITA MARIA ZAMORA CHIEF OPERATING OFFICER 128754 0 0 0 0 0 16826 0 38161 0 183741 0 0 0 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 168714 0 0 0 0 0 21944 0 55146 0 245804 0 0 0 KAREN C LAMP ASSOCIATE MEDICAL DIRECTOR 200631 0 0 0 0 0 26112 0 56034 0 282777 0 0 0 MARGARITA LOEZA CHIEF MEDICAL INFORMATION OFFICER 174250 0 0 0 0 0 22695 0 45407 0 242352 0 0 0 SHARON NG DIRECTOR OF PHARMACY 164337 0 0 0 0 0 21388 0 49774 0 235499 0 0 0 BARBARA F GROTTS NURSE PRACTITIONER 157086 0 0 0 0 0 20423 0 45758 0 223267 0 0 0 COLEY MARVIN KING PHYSICIAN 154215 0 0 0 0 0 20100 0 51787 0 226102 0 0 0 TARIN MOLLY KOEHLER FAMILY PRACTITIONER 154712 0 0 0 0 0 20150 0 49994 0 224856 0 0 0 ANALIZA SANCHEZ FAMILY PRACTITIONER 147700 0 0 0 0 0 19278 0 47375 0 214353 0 0 0 BARBARA MARIA TCHENG PEDIATRICIAN 147000 0 0 0 0 0 19180 0 33811 0 199991 0 0 0 X 2 54737 FAIR MARKET VALUE X 8 3057493 FAIR MARKET VALUE 0 1 0 FORM 990, PART III, LINE 1 THE VENICE FAMILY CLINIC'S MISSION IS TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. IT WAS FOUNDED IN 1970 BY DR. PHILLIP ROSSMAN AND CO-FOUNDER DR. MAYER B. DAVIDSON. THEY WERE ALARMED THAT EVEN THE MOST BASIC MEDICAL SERVICES SUCH AS IMMUNIZATIONS, ANTIBIOTICS AND PRENATAL CARE WERE UNAVAILABLE FOR THE LOW-INCOME FAMILIES OF VENICE. BEGINNING IN THE EARLY 1990'S THROUGH 2011, VENICE FAMILY CLINIC WAS THE LARGEST FREE CLINIC IN THE UNITED STATES AND VIEWED AS A MODEL OF CARE. IN 2012, AS PART OF ITS RESPONSE TO THE AFFORDABLE CARE ACT, VENICE FAMILY CLINIC BECAME A SECTION 330(E) COMMUNITY HEALTH CENTER AND RECEIVED ADDITIONAL FUNDING THROUGH THE FEDERAL GOVERNMENT'S DEPARTMENT OF HEALTH AND HUMAN SERVICES, HRSA- DIVISION OF PRIMARY HEALTH CARE SERVICES. THE VENICE FAMILY CLINIC IS A BEACON OF HOPE AND HEALING FOR PEOPLE WITH LOW INCOMES AND PEOPLE AT HIGH RISK SUCH AS HOMELESS PEOPLE AND PEOPLE WHO ARE HIV+. THE VENICE FAMILY CLINIC HAS PROVEN ITSELF TO BE AN INNOVATIVE, EFFICIENT AND VIABLE RESPONSE TO THE NEED FOR PRIMARY HEALTH CARE SERVICES FOR THE WORKING POOR OF LOS ANGELES COUNTY. 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 IF ANY EMPLOYEE REASONABLY BELIEVES THAT SOME POLICY, PRACTICE, OR ACTIVITY OF VENICE FAMILY CLINIC IS IN VIOLATION OF LAW, A WRITTEN COMPLAINT MAY BE FILED BY THAT EMPLOYEE WITH THE CHIEF EXECUTIVE OFFICER AND/OR CHAIR OF THE AUDIT AND COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD HIRES, OVERSEES, AND ANNUALLY EVALUATES THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, AND CONDUCTS SUCH AN EVALUATION PRIOR TO ANY CHANGE IN THAT OFFICER'S COMPENSATION, UNLESS THERE IS A MULTI-YEAR CONTRACT IN FORCE OR THE CHANGE CONSISTS SOLELY OF ROUTINE ADJUSTMENTS FOR INFLATION OR COST OF LIVING. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. 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. UNIVERSITY OF CALIFORNIA LOS ANGELES 405 HILGARD AVE LOS ANGELES CA 90024 956006143 PUBLIC RESEARCH UNIVERSITY CA 501(C)(3) 170(B)(1) (A)(II) N/A 0 VENICE FAMILY CLINIC FOUNDATION 604 ROSE AVENUE VENICE CA 90291 273484548 FUNDRAISING ACTIVITIES CA 501(C)(3) 170(B)(1) (A)(VI) N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 UNIVERSITY OF CALIFORNIA LOS ANGELES C 868125 CASH VENICE FAMILY CLINIC FOUNDATION C 350000 CASH