2015-05-14T13:09:10-05:00 2014-06-30 952302617 SINGERLEWAK LLP 10960 WILSHIRE BLVD STE 700 LOS ANGELES CA 900243783 990 2013-07-01 952769432 VENICE FAMILY CLINIC VENI 3103928630 604 ROSE AVENUE VENICE CA 90291 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 3103928630 2015-05-06 1 LIOR TEMKIN P00748170 3104773924 2015-04-28 2013 2016-02-25 16:41:14Z ELIZABETH B FORER 604 ROSE AVENUE VENICE CA 90291 30453524 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 NINE LOCATIONS ACROSS THE WESTSIDE OF LOS ANGELES COUNTY. ITS MISSION IS TO PROVIDE QUALITY PRIMARY HEALTH CARE TO PEOPLE IN NEED. 21 21 264 1463 0 0 23660784 20472644 8149722 8923117 1905478 272647 98585 485974 33814569 30154382 0 0 0 0 18754602 20873356 0 0 1310424 15030384 11183703 33784986 32057059 29583 -1902677 21512049 19836802 2571627 2307806 18940422 17528996 X SEE SCHEDULE O 0 0 26664305 8923117 VENICE FAMILY CLINIC SERVES AS A PRIMARY CARE 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, PSYCHOLOGICAL SERVICES, DIAGNOSTIC TESTS AND MEDICATIONS. HEALTH CARE IS PROVIDED FIVE DAYS AND FOUR EVENINGS PER WEEK, WITH 71,078 PRIMARY HEALTH CARE VISITS, 3,670 SPECIALTY CARE VISITS, 4,453 DENTAL VISITS, 5,983 MENTAL HEALTH CARE VISITS AND 7,668 HEALTH EDUCATION VISITS PROVIDED DURING THE YEAR ENDED JUNE 30, 2014.VENICE FAMILY CLINIC'S 20,023 PATIENTS IN YEAR ENDED JUNE 30, 2014 ARE PRIMARILY THE UNINSURED WORKING POOR, UNEMPLOYED AND HOMELESS, THE VAST MAJORITY OF WHOM HAVE INCOMES BELOW THE POVERTY LEVEL AND NO HEALTH INSURANCE. A HIGH PROPORTION OF THE CLINIC'S CHILDREN AND ADULT PATIENTS ARE MINORITY GROUP MEMBERS. THE CLINIC'S PRIMARY SERVICE AREA INCLUDES VENICE, SANTA MONICA, PALMS, MAR VISTA, INGLEWOOD, CULVER CITY AND MIDTOWN, ALL IN LOS ANGELES COUNTY. 26664305 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 1 100 0 1 264 1 0 0 0 0 0 1 1 0 0 0 0 X 21 21 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 2.00 X 0 0 0 LUIS GALVEZ BOARD MEMBER 2.00 X 0 0 0 LOETTE LOSHAK BOARD MEMBER 2.00 X 0 0 0 RICH MARKEY BOARD MEMBER 2.00 X 0 0 0 WENDY SMITH MEYER PHD BOARD MEMBER 2.00 X 0 0 0 NEAL H PARKER MD BOARD MEMBER 2.00 X 0 0 0 BILL RESNICK MD BOARD MEMBER 2.00 X 0 0 0 PAUL SABEN BOARD MEMBER 2.00 X 0 0 0 FLORA M SANTACRUZ BOARD MEMBER 2.00 X 0 0 0 STEWART SERADSKY BOARD MEMBER 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 KARINA WAGLE BOARD MEMBER 2.00 X 0 0 0 LEISA WU BOARD MEMBER 2.00 X 0 0 0 WILLIAM FLUMENBAUM BOARD CHAIR 2.00 X X 0 0 0 BRIAN D KAN MD PAST BOARD CHAIR 2.00 X X 0 0 0 ASHLEY JOHNSON SECRETARY 2.00 X X 0 0 0 JEFFREY E SINAIKO TREASURER 2.00 X X 0 0 0 ANDREA BLACKBIRD FROM 3114 CHIEF FINANCE OFFICER 40.00 X 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 40.00 X 179764 0 78449 LORETO S MELO THRU 22814 CHIEF FINANCE OFFICER 40.00 X 141735 0 65064 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 38.00 X 156713 0 69285 KAREN C LAMP MEDICAL DIRECTOR 40.00 X 193988 0 78448 MARGARITA LOEZA CHIEF MEDICAL INFO. OFFICER 40.00 X 161513 0 63033 CHIQUITA R FLOWERS PHYSICIAN 36.00 X 128683 0 49331 BARBARA F GROTTS NURSE PRACTITIONER 40.00 X 150307 0 60031 JASON VU HUA CHIEF INFORMATION OFFICER 40.00 X 118000 0 53958 COLEY MARVIN KING PHYSICIAN 40.00 X 137772 0 64203 SHARON NG DIR. PHARMACY 40.00 X 159550 0 68758 1528025 0 650560 11 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 1218018 310000 6805373 12139253 6467992 20472644 MEDICARE/MEDICAID PYMT 621400 8923117 8923117 8923117 272647 272647 299142 1218018 299142 0 PHARMACY REVENUE 900099 428038 428038 MISCELLANEOUS INCOME 900099 196325 196325 LOSS FROM UCLA EIP FUN 900099 -138389 -138389 485974 30154382 8923117 0 758621 1781233 944469 836764 13329097 11235513 1228606 864978 1511908 1301668 125340 84900 3282583 2854681 240090 187812 968535 805543 113481 49511 2897 2897 88577 88577 627468 382486 225799 19183 267919 194190 72013 1716 502536 227873 270555 4108 138425 125432 7817 5176 73202 73202 832063 753238 64855 13970 221809 7122 214687 DONATED DRUGS AND PHARM 6269306 6269306 PHARMACEUTICAL AND LAB 504492 504492 REPAIRS & MAINTENANCE 489304 410506 66874 11924 MEDICAL SUP & REMOVAL 226600 226600 939105 421186 450773 67146 32057059 26664305 4082330 1310424 702 752 1851790 1272798 5143434 4356029 977393 1616371 975104 1120684 115551 96553 15047179 9554224 5466144 5492955 2534 0 6492589 5353756 486808 526904 21512049 19836802 223641 364632 2347986 1943174 2571627 2307806 X 7277763 6062188 6188602 5492751 5474057 5974057 18940422 17528996 21512049 19836802 -1902677 491251 0 X 0 1 X 1 1 1 X 26260250 29119560 26310106 23659163 20472644 125821723 9052847 9689336 9303267 8149722 8923117 45118289 35313097 38808896 35613373 31808885 29395761 170940012 369725 388782 375046 317165 297634 1748352 0 369725 388782 375046 317165 297634 1748352 169191660 123217 213493 213009 264442 272647 1086808 123217 213493 213009 264442 272647 1086808 84160 54190 64740 98585 485974 787649 35520474 39076579 35891122 32171912 30154382 172814469 0.97900 0.98280 0.00630 0.00560 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: 2009 OTHER REVENUE 84160 2010 OTHER REVENUE 54190 2011 OTHER REVENUE 64740 2012 OTHER REVENUE 98585 2013 OTHER REVENUE 485974 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 0 0 0 1 0 0 0 0 0 PART II-B, LINE 1: DURING THE 2013-2014 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 FOCUSED ON THE "FUNDING CLIFF," WHICH THREATENS TO REDUCE FUNDING UP TO 70 PERCENT FOR COMMUNITY HEALTH CENTERS. THIS WOULD RESULT IN REDUCTION OR ELIMINATION OF HEALTH CARE ACCESS IN SOME OF THE NATION'S MOST VULNERABLE COMMUNITIES. ON THE STATE LEVEL, VENICE FAMILY CLINIC JOINED A PAYMENT REFORM WORK GROUP ORGANIZED BY THE CALIFORNIA PRIMARY CARE ASSOCIATION WHICH IS WORKING 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 THE COUNTY DEPARTMENT OF HEALTH AND THE COUNTY BOARD OF SUPERVISORS TO ROLL OUT A NEW SYSTEM OF COVERAGE CALLED MY HEALTH LA FOR PATIENTS INELIGIBLE FOR COVERAGE UNDER THE AFFORDABLE CARE ACT. IN ADDITION, MEETINGS WERE HELD WITH ELECTED OFFICIALS ON THE CITY, STATE AND FEDERAL LEVELS TO EDUCATE THEM ABOUT THE NEEDS OF THE MEDICALLY UNDERSERVED AND THE PROVIDERS TREATING THEM. 0 5707178 500000 625509 272647 6560040 5178737 200000 544036 215595 5707178 4406652 1050000 -74201 203714 5178737 4030445 575967 199760 4406652 3033757 750000 372368 125680 4030445 1.00000 0 0 1116512 1116512 6253303 4898315 1354988 5338443 3050403 2288040 2338921 1605506 733415 5492955 UCLA EIP FUND 4948490 F UCLA STIP FUND 405266 F 5353756 X 34869879 491251 3396040 828206 4715497 30154382 0 30154382 36243555 3396040 790456 4186496 32057059 0 32057059 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, 2014, 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, 2013 WITH REGARD TO ALL TAX POSITIONS AND RESULTS REPORTED. PART XI, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 529,065. SPECIAL EVENTS 299,141. PART XII, LINE 2D - OTHER ADJUSTMENTS: AMOUNT REPORTED ON OTHER RETURN 491,315. SPECIAL EVENTS 299,141. SILVER CIRCLE 1285921 1073098 212823 138280 30000 44542 HOLIDAY MOVIE 115258 106425 8833 8833 1 115981 38495 77486 77487 1517160 1218018 299142 138280 30000 130862 299142 0 X X 0 0 0 0 0 0 0 0 0 ELIZABETH B FORER CHIEF EXECUTIVE OFFICER 179764 0 0 0 0 0 19801 0 58648 0 258213 0 0 0 LORETO S MELO THRU 22814 CHIEF FINANCE OFFICER 141735 0 0 0 0 0 15620 0 49444 0 206799 0 0 0 BLANCA ANDRES ASSOCIATE MEDICAL DIRECTOR 156713 0 0 0 0 0 17321 0 51964 0 225998 0 0 0 KAREN C LAMP MEDICAL DIRECTOR 193988 0 0 0 0 0 21375 0 57073 0 272436 0 0 0 MARGARITA LOEZA CHIEF MEDICAL INFO. OFFICER 161513 0 0 0 0 0 17824 0 45209 0 224546 0 0 0 CHIQUITA R FLOWERS PHYSICIAN 128683 0 0 0 0 0 14231 0 35100 0 178014 0 0 0 BARBARA F GROTTS NURSE PRACTITIONER 150307 0 0 0 0 0 16531 0 43500 0 210338 0 0 0 JASON VU HUA CHIEF INFORMATION OFFICER 118000 0 0 0 0 0 13040 0 40918 0 171958 0 0 0 COLEY MARVIN KING PHYSICIAN 137772 0 0 0 0 0 15235 0 48968 0 201975 0 0 0 SHARON NG DIR. PHARMACY 159550 0 0 0 0 0 17574 0 51184 0 228308 0 0 0 X 6 46545 FAIR MARKET VALUE X 13 6400097 FAIR MARKET VALUE X MEDICAL EQUIP 2 11000 FAIR MARKET VALUE X PATIENT CLOTH 1 10350 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 60000 CASH VENICE FAMILY CLINIC FOUNDATION C 250000 CASH