2015-05-12T10:56:19-05:00 2014-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2013-07-01 941744108 LA CLINICA DE LA RAZA INC LACL 5105354000 1515 FRUITVALE AVENUE OAKLAND CA 946012322 PATRICIA AGUILERA CFO 5105354000 2015-04-28 1 RENIE BURBANK P00159653 4159561500 2013 2016-03-07 17:11:31Z PATRICIA AGUILERA 1515 FRUITVALE AVENUE OAKLAND CA 946012322 93578783 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. 17 17 1027 214 0 0 28420815 28547818 53353962 60867307 441569 376071 338247 692307 82554593 90483503 0 0 0 0 62625607 67814380 0 0 275475 23302287 22521555 85927894 90335935 -3373301 147568 61157301 61277991 24315389 24261233 36841912 37016758 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 41675965 35476443 MEDICAL - THE MEDICAL CLINIC PROVIDED BASIC HEALTH CARE FOR PEOPLE OF ALL AGES SUCH AS FAMILY MEDICINE, INTERNAL MEDICINE PEDIATRICS, AND OBSTETRICS-GYNECOLOGY. 15634518 17311642 DENTAL - THE DENTAL CLINIC PROVIDED THE FOLLOWING DENTAL SERVICE SUCH AS DENTAL HYGIENE, GENERAL DENTISTRY, ORTHODONTICS, PERIODONTICS, PEDODONTICS, ENDODONTICS, AND ORAL SURGERY. 6043544 6023480 ANCILLARY - THE ANCILLARY DEPARTMENT INCLUDES IN-PATIENT, PHARMACY, RADIOLOGY, AND LABORATORY SERVICES. 11251249 2055742 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. 11251249 2055742 74605276 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 1 132 0 1 1027 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 0 0 CA X PATRICIA AGUILERA 5105352915 1515 FRUITVALE AVENUE OAKLAND CA 946012322 RAMON TERRAZAS MD MPH PRESIDENT 1.00 X X 0 0 0 PETER MANOLEAS VICE PRESIDENT 1.00 X X 0 0 0 AMY PREVEDEL SECRETARY 1.00 X X 0 0 0 PAUL SWENSON TREASURER 1.00 X X 0 0 0 YVONNE HUDSON - HARMON PARLIAMENTARIAN 1.00 X 0 0 0 FRANCIS AVALOS BOARD MEMBER 1.00 X 0 0 0 MARIA ESPINOZA BOARD MEMBER 1.00 X 0 0 0 NORMA GUERRERO BOARD MEMBER 1.00 X 0 0 0 AISHA HAMPTON - BOWSER BOARD MEMBER 1.00 X 0 0 0 JOANN INTILI BOARD MEMBER 1.00 X 0 0 0 BOB KATTER BOARD MEMBER 1.00 X 0 0 0 REV RODNEY LEGGETT BOARD MEMBER 1.00 X 0 0 0 LUZ LIZARDO BOARD MEMBER 1.00 X 0 0 0 MICHAEL MOORE BOARD MEMBER 1.00 X 0 0 0 JILL NOONAN BOARD MEMBER 1.00 X 0 0 0 JORGE PEREZ BOARD MEMBER 1.00 X 0 0 0 ANDREW PETERSON BOARD MEMBER 1.00 X 0 0 0 JANE C GARCIA CHIEF EXECUTIVE OFFICER 40.00 X 253165 0 75541 PATRICIA ZAYAS MEDICAL DIRECTOR OF QUALITY 40.00 X 173246 0 24299 BRUCE CARP CHIEF FIN'L OFFICER (PART-YEAR) 40.00 X 149685 0 31601 PATRICIA AGUILERA CHIEF FIN'L OFFICER (PART-YEAR) 40.00 X 38063 0 5207 THOMAS HALLIGAN CHIEF MEDICAL OFFICER 40.00 X 226999 0 21797 JORGE SIOPACK PHYSICIAN - OB 40.00 X 299148 0 24702 EDWARD ROTHMAN DENTIST 40.00 X 210219 0 26835 SUSAN SYKES OB-GYN, ASSOC. MEDICAL DIR. 40.00 X 219763 0 26028 LISA MONTANG PHYSICIAN, ASSOC. MEDICAL DIR. 40.00 X 203293 0 28129 KARBO TAM OB/GYN 40.00 X 209158 0 28044 1982739 0 292183 84 0 1 0 CONSOLIDATED CLEANING SERVICE 2515 WILLOW STREET OAKLAND CA 94607 JANITORIAL 506550 MTS HEALTHCARE 27943 SECO CANYON ROAD 127 SANTA CLARITA CA 91350 SOFTWARE CONSULTANT 289314 C & C SECURITY PATROL INC 1684 DECOTO ROAD 61 UNION CITY CA 94587 SECURITY SERVICES 277605 QUALITY SYSTEMS INC P O BOX 511449 LOS ANGELES CA 90051 SOFTWARE CONSULTANT 185193 NOR CAL MEDICAL TEMPS P O BOX 736 TIBURON CA 94920 PHARMACY TEMP 143607 11 7505 23817656 4722657 1764457 28547818 NET PATIENT REVENUE 621400 55851818 55851818 CAPITATION REVENUE 621400 4097024 4097024 OTHER OPERATING REV 621400 918465 918465 60867307 449994 449994 2934164 3008087 -73923 -73923 -73923 234585 7505 87193 147392 147392 OTHER INCOME 900099 503725 503725 MISCELLANEOUS INCOME 900099 32128 32128 MEDICAL RECORDS 621400 9062 9062 544915 90483503 60867307 0 1068378 1043374 116416 926958 52616069 44797178 7647496 171395 1412906 1185711 222674 4521 9095271 7595791 1471085 28395 3646760 3060361 574729 11670 1241223 968592 271568 1063 60669 11896 48773 78162 4300 73862 4190659 3378573 811688 398 177366 60696 116670 9133175 8275967 836898 20310 916155 125255 789854 1046 2947439 2201205 739342 6892 192930 88477 103503 950 193036 41064 123780 28192 507300 507300 1910579 1591493 319086 361501 11620 349881 MISCELLANEOUS EXPENSES 435429 417004 17782 643 EDUCATIONAL ALLOWANCE 175932 166377 9555 90335935 74605276 15455184 275475 223461 244541 4132267 7380947 3706697 4110137 8236606 7214353 479917 346492 383266 747096 44899709 14907188 31546163 29992521 12306527 11135403 142397 106501 61157301 61277991 7967309 8841935 1345916 688447 9098249 8544786 3912755 3912755 1991160 2273310 24315389 24261233 X 35232083 35823410 1609829 1193348 36841912 37016758 61157301 61277991 147568 27278 0 X X 0 1 X 1 1 1 X 24153663 26747578 28692976 28420815 28547818 136562850 24153663 26747578 28692976 28420815 28547818 136562850 136562850 352752 376592 403556 441569 449994 2024463 32778 64326 180618 588 147392 425702 126452 103314 393486 337659 544915 1505826 140518841 260344466 0.97180 0.97300 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 0 0 0 0 0 0 0 2085517 2085517 35371952 9596189 25775763 7442240 5310999 2131241 29992521 CONTRACT PAYABLE 2273310 2273310 X 90875952 27278 277978 87193 392449 90483503 0 90483503 90701106 277978 87193 365171 90335935 0 90335935 PART X, LINE 2: AS OF JUNE 30, 2013, 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 87,193. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES RECLASSIFIED TO REVENUE 87,193. YOSHI'S 2013 242090 7505 234585 58225 3567 25401 242090 7505 234585 58225 3567 25401 87193 147392 X X 0 1 0 0 0 0 0 0 0 JANE C GARCIA CHIEF EXECUTIVE OFFICER 253165 0 0 0 0 0 45182 0 30359 0 328706 0 0 0 PATRICIA ZAYAS MEDICAL DIRECTOR OF QUALITY 173246 0 0 0 0 0 3182 0 21117 0 197545 0 0 0 BRUCE CARP CHIEF FIN'L OFFICER (PART-YEAR) 149685 0 0 0 0 0 2080 0 29521 0 181286 0 0 0 THOMAS HALLIGAN CHIEF MEDICAL OFFICER 226999 0 0 0 0 0 2080 0 19717 0 248796 0 0 0 JORGE SIOPACK PHYSICIAN - OB 299148 0 0 0 0 0 2297 0 22405 0 323850 0 0 0 EDWARD ROTHMAN DENTIST 210219 0 0 0 0 0 2434 0 24401 0 237054 0 0 0 SUSAN SYKES OB-GYN, ASSOC. MEDICAL DIR. 219763 0 0 0 0 0 2705 0 23323 0 245791 0 0 0 LISA MONTANG PHYSICIAN, ASSOC. MEDICAL DIR. 203293 0 0 0 0 0 2434 0 25695 0 231422 0 0 0 KARBO TAM OB/GYN 209158 0 0 0 0 0 1574 0 26470 0 237202 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 2013 CALENDAR YEAR WAS $42,000. 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 6 1764457 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 THE CONFLICT OF INTEREST POLICY IS REVIEWED WHEN NEW MEMBERS JOIN THE BOARD OF DIRECTORS. ANNUAL MONITORING IS BEING IMPLEMENTED. 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. FORM 990, PART XII, LINE 2C AUDIT COMMITTEE AND OVERSIGHT - THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR.