LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC (EIN 94-3096772)
Tax period
2012-06-01 to 2013-05-31
Filed
2014-01-15
IRS object ID
201410159349301451
Schema version
2012v2.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-01-15T13:57:49-08:00Timestamp
Tax Period End Date2013-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MICHAEL L PIELS CPAs LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1940 TOWN CENTRE DRAddressLine1
CityMEDFORDCity
StateORState
ZIP Code975046100ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN943096772EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LA CLINICA DEL VALLEBusinessNameLine1
Business Name Line2FAMILY HEALTH CARE CENTER INCBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlLACLNameControl
Phone5415356239Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13617 SOUTH PACIFIC HIGHWAYAddressLine1
CityMEDFORDCity
StateORState
ZIP Code97501ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameANGELICA RUPPEName
TitleCFOTitle
Date Signed2014-01-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSTEWART C PARMELE CPAName
PTINP00233959PTIN
Phone5417798261Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonANGELICA RUPPENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13617 S PACIFIC HWYAddressLine1
CityMEDFORDCity
StateORState
ZIP Code97501ZIPCode
FieldValueIRS element (for citing)
Gross Receipts17379256GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteWWW.LCDV.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1988YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY MEDICAL, DENTAL, AND SOCIAL SERVICES TO THE DIVERSE POPULATIONS WITHIN OUR COMMUNITIES, ESPECIALLY THOSE WHO FACE BARRIERS TO HEALTHCARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees299TotalNbrEmployees
Total Nbr Volunteers29TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year9124455ContributionsGrantsPriorYear
Contributions Grants Current Year5714260ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10385634ProgramServiceRevenuePriorYear
Program Service Revenue CY11492452ProgramServiceRevenueCY
Investment Income Prior Year-4357InvestmentIncomePriorYear
Investment Income Current Year16771InvestmentIncomeCurrentYear
Other Revenue Prior Year149653OtherRevenuePriorYear
Other Revenue Current Year155359OtherRevenueCurrentYear
Total Revenue Prior Year19655385TotalRevenuePriorYear
Total Revenue Current Year17378842TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year11796411SalariesEtcPriorYear
Salaries Etc Current Year13785037SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year79292TotalFundrsngExpCurrentYear
Other Expense Prior Year3656143OtherExpensePriorYear
Other Expenses Current Year3829572OtherExpensesCurrentYear
Total Expenses Prior Year15452554TotalExpensesPriorYear
Total Expenses Current Year17614609TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4202831RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-235767RevenuesLessExpensesCY
Total Assets BOY17678626TotalAssetsBOY
Total Assets EOY16829935TotalAssetsEOY
Total Liabilities BOY2387616TotalLiabilitiesBOY
Total Liabilities EOY1734102TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15291010NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY15095833NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE QUALITY MEDICAL, DENTAL, AND SOCIAL SERVICES TO THE DIVERSE POPULATIONS WITHIN OUR COMMUNITIES, ESPECIALLY THOSE WHO FACE BARRIERS TO HEALTHCARE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense16580747Expense
Revenue17378842Revenue
DescriptionHEALTH ENHANCEMENT FOR SEASONAL, MIGRATORY AGRICULTURAL WORKERS AND LOW INCOME PATIENTS.Description
Total Program Service Expense16580747TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109617NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees299NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonsfalseAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonANGELICA RUPPENamePerson
Telephone Number5415356239TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13617 S PACIFIC HWYAddressLine1
CityMEDFORDCity
StateORState
ZIP Code97501ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
CHRISTIE VAN AKEN
Vice President2.000.00X000
EARL SHOWERMAN MD
BOARD MEMBER2.000.00X000
BENNY SUAREZ
BOARD MEMBER2.000.00X000
MARY SINCLAIR
BOARD MEMBER2.000.00X000
JAMES ADAMS
BOARD MEMBER2.000.00X000
JERRY TAYLOR
President2.000.00X000
KEITH CASEBOLT
Treasurer2.000.00X000
LISA GREIF
BOARD MEMBER2.000.00X000
PAUL NICHOLSON
BOARD MEMBER2.000.00X000
JUNE McREYNOLDS
BOARD MEMBER2.000.00X000
MICHAEL TOWERY
BOARD MEMBER2.000.00X000
MARCIA LaFOND
Secretary2.000.00X000
PHILIP MICHAEL MD
BOARD MEMBER2.000.00X000
JOLIE JOHNSON
BOARD MEMBER2.000.00X000
IDA SAITO
COO40.000.0010099205050X
ANGELICA RUPPE
CFO40.000.009409106731X
BRENDA JOHNSON RN MBA
CEO40.000.0015911609472X
WILLIAM H PALM
MEDICAL DOCTOR40.000.00202698011316X
RICHARD L JULYAN
MEDICAL DOCTOR40.000.0019852706063X
KENNETH J RHEE
MEDICAL DOCTOR40.000.0017212305164X
MARK PHELPS
MEDICAL DOCTOR40.000.0015594903119X
LUKE BARSALOU
DENTIST40.000.0015165402786X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1235150TotalReportableCompFromOrg
Total Other Compensation49701TotalOtherCompensation
Number Individuals GT100 K18NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
S & B JAMES CONSTRUCTION
8425 AGATE ROADWHITE CITYOR97503CONSTRUCTION694201
OCHIN-OREGON COMMUNITY HEALTH INFO NETWORK
707 SW WASHINGTON ST 1200PORTLANDOR97205MEDICAL BILLING562246
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants4479568GovernmentGrants
All Other Contributions1234692AllOtherContributions
Total Contributions5714260TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PATIENT CENTERED MED HOME623000507540$507,540
NET PATIENT FEES62111010984912$10,984,912
FieldValueIRS element (for citing)
Total Program Service Revenue11492452TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8481TotalRevenueColumn
Exclusion$8,481ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Personal15870Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Personal15870Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column15870TotalRevenueColumn
Exclusion$15,870ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6804Securities
Other1900Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other414Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities6804Securities
Other1486Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column8290TotalRevenueColumn
Related Or Exempt Function Income1486RelatedOrExemptFunctionIncome
Exclusion$6,804ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events101298GrossIncomeFundraisingEvents

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column101298TotalRevenueColumn
Exclusion$101,298ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISC. INCOMEDescription
Business Code621110BusinessCode
Total Revenue Column38191TotalRevenueColumn
Exclusion$38,191ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue38191TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column17378842TotalRevenueColumn
Related Or Exempt Function Income1486RelatedOrExemptFunctionIncome
Exclusion$11,663,096ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1235150Total
Program Services884141ProgramServices
Management And General310852ManagementAndGeneral
Fundraising40157Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10137413Total
Program Services10137413ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1451962Total
Program Services1414627ProgramServices
Management And General32065ManagementAndGeneral
Fundraising5270Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total960512Total
Program Services933121ProgramServices
Management And General23767ManagementAndGeneral
Fundraising3624Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total359094Total
Program Services284584ProgramServices
Management And General74510ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total210276Total
Program Services163901ProgramServices
Management And General41699ManagementAndGeneral
Fundraising4676Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total36266Total
Program Services25386ProgramServices
Management And General10880ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total756789Total
Program Services616787ProgramServices
Management And General140002ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total44325Total
Program Services2738ProgramServices
Management And General41587ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MISCELLANEOUS183617719799605815580
REPAIRS &MAINTENANCE1871451452944181140
CONTRACTUAL82991981987210047
SUPPLIES943917926667124384812

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total278224Total
Program Services154237ProgramServices
Management And General118854ManagementAndGeneral
Fundraising5133Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total17614609Total
Program Services16580747ProgramServices
Management And General954570ManagementAndGeneral
Fundraising79292Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2757775BOY
EOY1549140EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY85080BOY
EOY224599EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1339623BOY
EOY1549325EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY39812BOY
EOY28441EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY88814BOY
EOY55196EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis16423562LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3688218LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY12727448BOY
EOY12735344EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY640074BOY
EOY687890EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY17678626BOY
EOY16829935EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1120131BOY
EOY917464EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY272485BOY
EOY5663EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY995000BOY
EOY810975EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2387616BOY
EOY1734102EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15287393BOY
EOY15095833EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3617BOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15291010BOY
EOY15095833EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17678626BOY
EOY16829935EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-235767ReconcilationRevenueExpenses
Reconciliation Unrealized Invest40590ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5303108CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4317021CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4180639CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8444725CurrentTaxYearMinus1Year
Current Tax Year5175848CurrentTaxYear
Total27421341Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5303108CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4317021CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4180639CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8444725CurrentTaxYearMinus1Year
Current Tax Year5175848CurrentTaxYear
Total27421341Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total17027421341PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years61027CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9583CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10829CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11292CurrentTaxYearMinus1Year
Current Tax Year8481CurrentTaxYear
Total101212Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11744CurrentTaxYearMinus4Years
Current Tax Year Minus2 Years6393CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15525CurrentTaxYearMinus1Year
Current Tax Year15870CurrentTaxYear
Total49532Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support27572085TotalSupport
Public Support Pertcentage1700.99450PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99030PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance640074BeginningOfYearBalance
Contributions47816Contributions
End Of Year Balance687890EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance604156BeginningOfYearBalance
Contributions35268Contributions
Investment Earnings Or Losses5837InvestmentEarningsOrLosses
Administrative Expenses5187AdministrativeExpenses
End Of Year Balance640074EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance196165BeginningOfYearBalance
Contributions375415Contributions
Investment Earnings Or Losses34615InvestmentEarningsOrLosses
Administrative Expenses2039AdministrativeExpenses
End Of Year Balance604156EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance148799BeginningOfYearBalance
Investment Earnings Or Losses48895InvestmentEarningsOrLosses
Administrative Expenses1529AdministrativeExpenses
End Of Year Balance196165EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Contributions-58170Contributions
Other Expenditures1578OtherExpenditures
Administrative Expenses148799AdministrativeExpenses
End Of Year Balance148799EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated OrgstrueEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1442898OtherCostOrOtherBasis
Book Value1442898BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11753461OtherCostOrOtherBasis
Depreciation2034540Depreciation
Book Value9718921BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3227203OtherCostOrOtherBasis
Depreciation1653678Depreciation
Book Value1573525BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings12735344TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt17487433TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments40590NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities68001DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F990108591RevenueNotRptdF990
Revenue Subtotal17378842RevenueSubtotal
Total Revenue Per Form99017378842TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt17682610TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities68001DonatedServicesUseOfFacilities
Expenses Not Rptd F99068001ExpensesNotRptdF990
Expenses Subtotal17614609ExpensesSubtotal
Total Expenses Per Form99017614609TotalExpensesPerForm990

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Agreement Ref FundraisingfalseAgreementRefFundraising

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1RAISE YOUR HEART FOR HEALTHNameOfEvent1
Gross Receipts Event1101298GrossReceiptsEvent1
Gross Revenue Event1101298GrossRevenueEvent1
Gross Receipts Total101298GrossReceiptsTotal
Gross Revenue Total Events101298GrossRevenueTotalEvents
Net Income Summary101298NetIncomeSummary

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
WILLIAM H PALM
MEDICAL DOCTOR199048365011316214014
RICHARD L JULYAN
MEDICAL DOCTOR1985276063204590
MARK PHELPS
MEDICAL DOCTOR1559493119159068
LUKE BARSALOU
DENTIST1516542786154440
KENNETH J RHEE
MEDICAL DOCTOR1721235164177287
BRENDA JOHNSON RN MBA
CEO15786212549472168588

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART I, LINE 1 - ORG. MISSIONTO ESTABLISH A COMPREHENSIVE FAMILY ORIENTED QUALITY HEALTH CARE CENTER WHICH PROVIDES FOR AGRICULTURAL WORKERS AND OTHER MEDICALLY UNDERSERVED IN JACKSON COUNTY. THE MISSION OF LA CLINICA IS TO PROVIDE QUALITY MEDICAL, DENTAL AND SOCIAL SERVICES TO THE DIVERSE POPULATIONS WITHIN OUR COMMUNITIES, ESPECIALLY THOSE WHO FACE BARRIERS TO HEALTHCARE.
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableLA CLINICA DEL VALLE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AS PER THE FOLLOWING POLICY GUIDELINES:THE AUDITED FINANCIAL STATEMENTS WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS, TO REGULATORY AGENCIES AND TO ORGANIZATIONS ENTITLED TO RECEIVE A COPY DUE TO CONTRACTUAL AGREEMENT. THE AUTHORITY TO DISTRIBUTE THE STATEMENTS TO OTHER INDIVIDUALS OR FIRMS REQUESTING THEM WILL BE LEFT TO THE DISCRETION OF THE EXECUTIVE DIRECTOR AND THE FINANCE DIRECTOR.Form 990, Part VI, Line 19
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesEACH YEAR A MARKET REVIEW IS PERFORMED FOR A COMPETITIVE ANALYSIS OF SALARIES IN THE LOCAL AND REGIONAL AREAS FOR ALL POSITIONS IN THE ORGANIZATION. THE HUMAN RESOURCES COORDINATOR COMPILES THE INFORMATION AND IT IS GIVEN TO THE ACCOUNTANT WHO INPUTS THE DATA INTO THE FORECASTED BUDGET FOR THE NEXT FISCAL YEAR. INCREASES IN BASE PAY MAY BE INCLUDED FOR NEW BUDGET PERIODS (BEGINNING IN JUNE) IF THE FOLLOWING IS TRUE:1. FINANCIAL FORECAST FOR THE ORGANIZATION IS HEALTHY;2. IF THE SALARY FOR THE JOB POSITION HAS FALLEN BELOW THE AVERAGE MARKET RANGE AND PAY THRESHOLD FOR THE ORGANIZATION;3. THE BOARD OF DIRECTORS HAS REVIEWED AND APPROVED THE NEW BUDGET INCLUDING THE CHANGES TO SALARIES AND WAGES.Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top ManagementTHE BOARD OF DIRECTORS ARE RESPONSIBLE TO HIRE AND REMOVE THE CHIEF EXECUTIVE OFFICER, SUPPORT AND ASSESS HIS OR HER PERFORMANCE, AND ENSURE THAT THE CHIEF EXECUTIVE HAS THE MORAL AND PROFESSIONAL SUPPORT NEEDED TO FURTHER THE GOALS OF THE ORGANIZATION.EACH YEAR A MARKET REVIEW IS PERFORMED FOR A COMPETITIVE ANALYSIS OF SALARIES IN THE LOCAL AND REGIONAL AREAS FOR THE CEO AND THE HUMAN RESOURCES COORDINATOR INFORMS THE BOARD CHAIR OF ANY RELEVANT PAY CHANGES THAT ARE DUE TO OCCUR. NEXT, THE EXECUTIVE COMMITTEE MEETS TO DISCUSS THE PAY CHANGE AND A VOTE IS HELD IN JUNE TO ADOPT THE PAY CHANGE OR NOT DEPENDING UPON THE BUDGETED FINANCIAL FORECAST OF THE ORGANIZATION.Form 990, Part VI, Line 15a
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsCONFLICT OF INTEREST PROCEDURES: PERSONS CONCERNED: THIS STATEMENT IS DIRECTED NOT ONLY TO DIRECTORS AND OFFICERS, BUT ALSO TO ALL EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF LA CLINICA DEL VALLE. FOR EXAMPLE, THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL OTHER PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL", AND ALL WHO HAVE PROPRIETARY INFORMATION CONCERNING LA CLINICA DEL VALLE.AREAS IN WHICH CONFLICT MAY ARISE: CONFLICTS OF INTEREST MAY ARISE IN THE RELATIONS OF DIRECTORS, OFFICERS, AND MANAGEMENT EMPLOYEES WITH ANY OF THE FOLLOWING THIRD PARTIES:1. PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO LA CLINICA DEL VALLE.2. PERSONS AND FIRMS FROM WHOM LA CLINICA DEL VALLE LEASES PROPERTY AND EQUIPMENT.3. PERSONS AND FIRMS WITH WHOM LA CLINICA DEL VALLE IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES, OR OTHER PROPERTY.4. COMPETING OR AFFINITY ORGANIZATIONS.5. DONORS AND OTHERS SUPPORTING LA CLINICA DEL VALLE.6. AGENCIES, ORGANIZATIONS, AND ASSOCIATIONS, WHICH AFFECT THE OPERATIONS OF LA CLINICA DEL VALLE.7. FAMILY MEMBERS, FRIENDS, AND OTHER EMPLOYEES.DISCLOSURE PROCEDURE: DISCLOSURE SHOULD BE MADE ACCORDING TO LA CLINICA DEL VALLE'S STANDARDS. TRANSACTIONS WITH RELATED PARTIES MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED:1. A MATERIAL TRANSACTION IS FULLY DISCLOSED IN THE AUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION;2. THE RELATED PARTY IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTIONS;3. A COMPETITVE BID OR COMPARABLE VALUATION EXISTS; AND4. THE ORGANIZATION'S BOARD HAS ACTED UPON AND DEMOSTRATED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION.DISCLOSURE IN THE ORGANIZATION SHOULD BE MADE TO THE EXECUTIVE DIRECTOR ( OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IS MATERIAL, AND IF THE MATTERS ARE MATERIAL, BRING THEM TO THE ATTENTION OF THE BOARD CHAIR.DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE BOARD CHAIR, WHICH SHALL BRING THESE MATTERS, IF MATERIAL TO THE BOARD. THE BOARD SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IS MATERIAL, AND IN THE PRESENCE OF AN EXISTING MATERIAL CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO LA CLINICA DEL VALLE. THE DECISION OF THE BOARD ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION, AND THEIR CONCERN MUST BE THE WELFARE OF LA CLINICA DEL VALLE AND THE ADVANCEMENT OF ITS PURPOSE.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11b: Form 990 Review ProcessTHE FORM 990 PREPARER PROVIDES A DRAFT COPY OF THE FORM 990 TO THE FINANCE DIRECTOR AND THE INTERNAL ACCOUNTANT FOR REVIEW. A COPY OF THE FORM 990 IS ALSO PROVIDED TO THE FINANCE/AUDIT COMMITTEE FOR REVIEW. AFTER REVIEW THE FORM 990 PREPARER IS NOTIFIED TO FILE THE FORM 990. A REPORT IS THEN PROVIDED TO THE FULL BOARD OF DIRECTORS ON THE RESULTS AND/OR FINDINGS OF THE FORM 990.Form 990, Part VI, Line 11b
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersTHE BOARD OF DIRECTORS GENERAL RESPONSIBILITIES CONSIST OF GOVERNING THE BUSINESS AND AFFAIRS OF THE CORPORATION. ANY DECISIONS MADE ARE SUBJECT TO THE APPROVAL OF THE BOARD MEMBERS.Form 990, Part VI, Line 7b
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyA NOMINATING COMMITTEE SHALL NOMINATE CANDIDATES FOR BOARD APPROVAL TO FILL BOARD MEMBER VACANCIES. THE NOMINATING COMMITTEE SHALL MAINTAIN A CURRENT PROFILE OF THE BOARD'S MEMBERSHIP COMPOSITION TO GUIDE THE SELECTION PROCESS. IT SHALL REVIEW THE PERFORMANCE OF INCUMBENT BOARD MEMBERS WHO ARE ELIGIBLE FOR RE-ELECTION, AND IF APPROPRIATE, RECOMMEND THEM TO THE BOARD OF DIRECTORS FOR NOMINATION AND RE-ELECTION. THE COMMITTEE SHALL, SUBJECT TO THE REQUIREMENTS SET FORTH IN THE BY-LAWS, ALSO NOMINATE MEMBERS-AT-LARGE. CANDIDATES NOMINATED TO FILL BOARD POSITIONS WILL BE ELECTED BY A MAJORITY VOTE OF THE MEMBERS AT A BOARD MEETING AT WHICH A QUORUM IS PRESENT.Form 990, Part VI, Line 7a

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