2014-05-15T16:46:36-05:00 2013-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET 9TH FLOOR SAN FRANCISCO CA 94105 990 2012-07-01 941744108 LA CLINICA DE LA RAZA INC LACL 5105354000 1515 FRUITVALE AVENUE OAKLAND CA 946012322 PATRICIA AGUILERA 5105354000 2014-05-14 1 RENIE BURBANK P00159653 4159561500 2012 2015-11-30 17:44:51Z PATRICIA AGUILERA 1515 FRUITVALE AVENUE OAKLAND CA 946012322 82632755 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. 18 18 1054 214 0 0 28692976 28420815 52669270 53353962 403556 441569 574104 338247 82339906 82554593 0 0 0 0 56224127 62625607 0 0 348336 23119637 23302287 79343764 85927894 2996142 -3373301 66470605 63657301 23357118 24315389 43113487 39341912 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 35717489 MEDICAL - THE MEDICAL CLINIC PROVIDED BASIC HEALTH CARE FOR PEOPLE OF ALL AGES SUCH AS FAMILY MEDICINE, INTERNAL MEDICINE PEDIATRICS, AND OBSTETRICS-GYNECOLOGY. 15634518 14279980 DENTAL - THE DENTAL CLINIC PROVIDED THE FOLLOWING DENTAL SERVICE SUCH AS DENTAL HYGIENE, GENERAL DENTISTRY, ORTHODONTICS, PERIODONTICS, PEDODONTICS, ENDODONTICS, AND ORAL SURGERY. 6043544 3356493 ANCILLARY - THE ANCILLARY DEPARTMENT INCLUDES IN-PATIENT, PHARMACY, RADIOLOGY, AND LABORATORY SERVICES. 6299292 0 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. 6299292 69653319 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 1 123 0 1 1054 1 0 0 0 0 0 1 1 0 0 0 0 X 18 18 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 1.00 X X 0 0 0 PETER MANOLEAS 1.00 X X 0 0 0 AMY PREVEDEL 1.00 X X 0 0 0 ANDREW PETERSON 1.00 X X 0 0 0 FRANCIS AVALOS 1.00 X 0 0 0 MARIA ESPINOZA 1.00 X 0 0 0 NORMA GUERRERO 1.00 X 0 0 0 AISHA HAMPTON-BOWSER 1.00 X 0 0 0 YVONNE HUDSON-HARMON 1.00 X 0 0 0 JOANN INTILI 1.00 X 0 0 0 BOB KATTER 1.00 X 0 0 0 REV RODNEY LEGGETT 1.00 X 0 0 0 LUZ LIZARDO 1.00 X 0 0 0 MICHAEL MOORE 1.00 X 0 0 0 JILL NOONAN 1.00 X 0 0 0 JORGE PEREZ 1.00 X 0 0 0 ANDREW PETERSON 1.00 X 0 0 0 PAUL SWENSON 1.00 X 0 0 0 JANE C GARCIA 40.00 X 244252 0 72657 BRUCE CARP 40.00 X 146870 0 26129 PATRICIA ZAYAS 40.00 X 198257 0 23537 JORGE S SIOPACK 40.00 X 307615 0 21217 SUSAN SYKES 40.00 X 219842 0 21105 EDWARD ROTHMAN 40.00 X 206094 0 23551 THOMAS HALLIGAN 40.00 X 217181 0 17743 LISA MONTANG 40.00 X 186592 0 28133 1726703 0 234072 84 0 1 0 MTS HEALTHCARE 27943 SECO CANYON ROAD 127 SANTA CLARITA CA 91350 SOFTWARE CONSULTANT 259808 QUALITY SYSTEMS INC P O BOX 511449 LOS ANGELES CA 90051 SOFTWARE CONSULTANT 240631 TDF CONSTRUCTION 868 MADIGAN AVENUE CONCORD CA 94518 CONSTRUCTION SERVICES 154625 NOR CAL MEDICAL TEMPS P O BOX 736 TIBURON CA 94920 PHARMACY TEMP 151409 MACMAN MANAGEMENT LLC 5068 BISSETT WAY SACRAMENTO CA 95835 ADMINISTRATIVE CONSULTANT 149991 11 130000 22097050 6193765 1609670 28420815 NET PATIENT REVENUE 621400 49107606 49107606 CAPITATION REVENUE 621400 3568327 3568327 OTHER OPERATING REV 621400 678029 678029 53353962 441569 441569 78750 130000 78162 588 588 OTHER INCOME 900099 332073 332073 MEDICAL RECORDS 621400 5586 5586 337659 82554593 53353962 0 779816 728154 728154 49042599 40985888 7856723 199988 1220906 1054418 160928 5560 8262713 6888936 1339693 34084 3371235 2818329 541934 10972 1408070 913151 490561 4358 77666 77666 78171 78171 4608285 3622446 985247 592 147785 49007 97881 897 9828297 8463010 1331819 33468 874442 30695 843312 435 2707746 2162896 537632 7218 232645 109352 118756 4537 232963 42800 146058 44105 548390 548390 1669146 1373791 295355 290314 11445 278869 EDUCATIONAL ALLOWANCE 245941 228239 16549 1153 PROGRAM ACTIVITY 51131 50200 931 301295 300326 969 85927894 69653319 15926239 348336 191208 223461 8766157 4132267 3189962 3706697 6133261 10736606 718849 479917 1660896 383266 44542771 12996608 31790531 31546163 13886007 12306527 133734 142397 66470605 63657301 7223861 7967309 1015071 1345916 9055000 9098249 4072026 3912755 1991160 1991160 23357118 24315389 X 41879528 37732083 1233959 1609829 43113487 39341912 66470605 63657301 -3373301 -398274 0 X X 0 1 X 1 1 1 X 22321331 24153663 26747578 28692976 28420815 130336363 22321331 24153663 26747578 28692976 28420815 130336363 130336363 449761 352752 376592 403556 441569 2024230 29167 32778 64326 180618 588 307477 330161 126452 103314 393486 337659 1291072 133959142 236646083 0.97300 0.97390 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 0 0 0 0 0 0 0 0 2085517 2085517 34254575 8371443 25883132 7264605 4625165 2639440 938074 938074 31546163 CONTRACT PAYABLE 1991160 1991160 X 82935257 302502 78162 380664 82554593 0 82554593 86308558 302502 78162 380664 85927894 0 85927894 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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: UNREALIZED GAIN ON RETIREMENT PLAN SPECIAL EVENT EXPENSES RECLASSIFIED TO REVENUE 78,162. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES RECLASSIFIED TO REVENUE 78,162. YOSHI'S 2012 208750 130000 78750 54750 2731 20681 208750 130000 78750 54750 2731 20681 78162 588 X X X 0 1 0 0 0 0 0 0 0 JANE C GARCIA 244252 0 0 0 0 0 44355 0 28302 0 316909 0 0 0 BRUCE CARP 146870 0 0 0 0 0 2080 0 24049 0 172999 0 0 0 PATRICIA ZAYAS 198257 0 0 0 0 0 3060 0 20477 0 221794 0 0 0 JORGE S SIOPACK 307615 0 0 0 0 0 2297 0 18920 0 328832 0 0 0 SUSAN SYKES 219842 0 0 0 0 0 2705 0 18400 0 240947 0 0 0 EDWARD ROTHMAN 206094 0 0 0 0 0 2434 0 21117 0 229645 0 0 0 THOMAS HALLIGAN 217181 0 0 0 0 0 2080 0 15663 0 234924 0 0 0 LISA MONTANG 186592 0 0 0 0 0 2434 0 25699 0 214725 0 0 0 PART I, LINE 4B LA CLINICA CREATED A NON QUALIFY 457(F) BENEFIT PLAN FOR EXECUTIVES IN WHICH JANE GARCIA IS THE ONLY PARTICIPANT. THE AMOUNT OF THE CONTRIBUTION FOR THE 2012 CALENDAR YEAR WAS $41,173.08. 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 0 A 0 1 0 0 0 0 0 0 0 PART III, LINE 9; PART IV, LINE 7; AND PART V: THE ORGANIZATION IMPLEMENTED WRITTEN PROCEDURES FOR PRIVATE BUSINESS USE, ARBITRAGE, AND TO UNDERTAKE CORRECTIVE ACTION IN CASE THEY IDENTIFIED INVALID USE OF BOND FUNDS. THE POLICIES AND PROCEDURES WERE IMPLEMENTED SHORTLY AFTER THE COMPLETION OF THE REPORTING PERIOD APPLICABLE TO THIS FORM. X 3 1609670 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. AUDIT COMMITTEE AND OVERSIGHT FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM PRIOR YEAR.