2014-05-15T13:32:31-05:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 20 E THOMAS RD STE 2300 PHOENIX AZ 85012 990 2012-07-01 953881333 CLINICA MSR OSCAR A ROMERO CLIN 3239871401 123 S ALVARADO ST LOS ANGELES CA 90057 SANDRA ROSSATO 3239871401 2014-05-15 1 KACIE MCEWEN P01599614 6022662248 2012 2015-11-30 17:44:51Z X SANDRA ROSSATO 123 S ALVARADO ST LOS ANGELES CA 90057 9134182 0 X WWW.CLINICAROMERO.COM X 1983 CA TO PROVIDE QUALITY, AFFORDABLE AND CULTURALLY SENSITIVE HEALTH CARE AND OTHER SERVICES TO THE UNINSURED, INSURED AND UNDERSERVED COMMUNITIES OF GREATER LOS ANGELES REGARDLESS OF THEIR ABILITY TO PAY BY UPHOLDING THE LEGACY AND TRADITION OF MONSENOR OSCAR ROMERO AND EDUCATING AND EMPOWERING SALVADORAN AND OTHER COMMUNITY MEMBERS THROUGH COMMUNITY ORGANIZING, HEALTH EDUCATION AND SOCIAL JUSTICE AND EXCHANGE PROGRAMS IN EL SALVADOR. 9 9 137 16 0 0 3855566 2762794 4594191 6248371 343 370 179823 112825 8629923 9124360 0 150 0 0 5782287 5934065 0 0 26257 3370377 2789525 9152664 8723740 -522741 400620 9194194 8828654 5927156 5355257 3267038 3473397 X OUR MISSION IS TO PROVIDE QUALITY, AFFORDABLE AND CULTURALLY SENSITIVE HEALTH CARE AND OTHER SERVICES TO THE UNINSURED, INSURED AND UNDERSERVED COMMUNITIES OF GREATER LOS ANGELES REGARDLESS OF THEIR ABILITY TO PAY BY UPHOLDING THE LEGACY AND TRADITION OF MONSENOR OSCAR ROMERO AND EDUCATING AND EMPOWERING SALVADORAN AND OTHER COMMUNITY MEMBERS THROUGH COMMUNITY ORGANIZING, HEALTH EDUCATION AND SOCIAL JUSTICE AND EXCHANGE PROGRAMS IN EL SALVADOR. 0 0 5631748 150 5544202 CLINICA ROMERO PROVIDES LOW-COST COMPREHENSIVE PRIMARY CARE AND DISEASE PREVENTION SERVICES FOR MEN, WOMEN AND CHILDREN OF ALL AGES. OUR DOCTORS STRIVE TO PROVIDE THE BEST LEVEL OF CARE IN ORDER TO IMPROVE THE QUALITY OF LIFE OF ALL PATIENTS. SERVICES INCLUDE: EXAMS: COMPLETE MEDICAL EXAMINATIONS.CANCER SCREENINGS: LAB TESTS, ULTRASOUNDS.CHRONIC DISEASE MANAGEMENT: MEDICATIONS AND LIFESTYLE REGIMENS FOR AVOIDING COMPLICATIONS ASSOCIATED WITH ASTHMA, HEART DISEASE, HYPERTENSION, HIGH BLOOD PRESSURE AND DIABETES.FAMILY PLANNING: PROGRAMS TO ASSIST YOUNG AND BEGINNING FAMILIES.PRENATAL CARE: PRENATAL CLASSES AND NUTRITIONAL GUIDANCE.PEDIATRICS: WELL-CHILD VISITS FOR HEALTHY GROWTH AND DEVELOPMENT.VACCINATIONS: PEDIATRIC IMMUNIZATIONS AND ADULT VACCINES. 625553 0 588034 CLINICA ROMERO PROVIDES A LOW-COST DENTAL SERVICES FOR ADULTS AND CHILDREN IN A FRIENDLY ENVIRONMENT THAT PUTS OUR PATIENTS AT EASE. GOOD ORAL HEALTH REQUIRES REGULAR DENTAL EXAMINATION AND MAINTENANCE TO HELP PREVENT AND MANAGE DISEASE. OUR TEAM SPECIALIZES IN PREVENTATIVE CARE AND PROVIDES THE FOLLOWING SERVICES:SERVICES FOR ADULTS:COMPLETE ORAL EXAMINATIONS INCLUDING X-RAYS.PREVENTATIVE SERVICES AND PERIODIC PERIODONTAL MAINTENANCE TREATMENT:PROPHYLAXIS (CLEANINGS) AND NON-SURGICAL PERIODONTAL TREATMENT (SCALING AND ROOT PLANING), ORAL HYGIENE EDUCATIONRESTORATIVE SERVICES:RESTORATION FILLINGS, CANAL TREATMENT LIMITED TO ANTERIOR TEETH, SIMPLE EXTRACTIONSSERVICES FOR CHILDREN:COMPLETE ORAL EXAMINATIONS AND X-RAYSPREVENTATIVE SERVICES:PROPHYLAXIS (CLEANINGS), FLUORIDE VARNISH APPLICATIONS, SEALANTS, ORAL HYGIENE EDUCATIONRESTORATIVE SERVICES:RESTORATION FILLINGS, PULPOTOMIES, STAINLESS STEEL CROWNS, SPACE MAINTAINERS, SIMPLE EXTRACTIONS 672761 0 116135 CLINICA ROMERO'S MENTAL HEALTH DEPARTMENT WORKS WITH A PATIENT'S PRIMARY CARE PROVIDER TO ENSURE A COORDINATED PAN OF CARE. WE PROVIDE AN ARRAY OF SERVICES THAT MEETS THE PATIENT WHERE THEY ARE IN THEIR ABILITY TO MANAGE THEIR DIAGNOSIS. SERVICES INCLUDE:INDIVIDUAL COUNSELINGCHILD & ADOLESCENT COUNSELINGCOUPLE'S COUNSELINGFAMILY COUNSELINGGROUP COUNSELING:"HEALING IS A CHOICE" SUPPORT GROUP IN ENGLISH AND SPANISH 6930062 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 22 0 0 137 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 CA X X SANDRA ROSSATO 2132015745 123 S ALVARADO ST LOS ANGELES CA 90057 CARLOS VAQUERANO 1.00 X X 0 0 0 MARCELO VILLAGOMEZ 1.00 X X 0 0 0 PABLO LOPEZ 1.00 X X 0 0 0 JONATHAN CANAS 1.00 X X 0 0 0 ANA MARTINEZ 1.00 X 0 0 0 MARIA ELENA GARCIA 1.00 X 0 0 0 IVONNENANETTE MACHADO 1.00 X 0 0 0 ADALY UGALDE 1.00 X 0 0 0 RODNEY SAMAAN 1.00 X 0 0 0 JOSE ARTURO RUVALCABA 1.00 X 0 0 0 LESLIE LAMBERT 1.00 X 0 0 0 CHRISTINA BUGARIN 40.00 X 43549 0 0 SANDRA ROSSATO 40.00 X 61742 0 0 CHRISTINA RECINOS 40.00 X 122786 0 0 ALBERT PACHECO 40.00 X 30544 0 0 258621 0 0 1 0 0 0 0 2532785 230009 2762794 MEDICAL SERVICES 621110 5544202 5544202 DENTAL SERVICES 621110 588034 588034 HEALTH SERVICES 621110 116135 116135 6248371 370 370 74700 9822 64878 64878 64878 OTHER INCOME 900099 47947 47947 47947 9124360 6248371 0 113195 150 150 326497 147535 178962 4165458 3670627 479589 15242 1053306 895310 154422 3574 388804 330484 57001 1319 18000 8720 9011 269 164859 79864 82530 2465 716363 633893 82470 250 100 150 221862 104891 115487 1484 80376 38807 40249 1320 378691 199841 178266 584 27217 11485 15732 5261 922 4339 93466 40392 53074 478466 286239 192227 44730 26838 17892 MEDICAL SUPPLIES 285908 285908 HAZARDOUS WASTE DISPOSA 146300 146300 MAINTENANCE AND REPAIRS 81020 15985 65035 EDUCATION AND TRAINING 24284 24284 22472 5771 16701 8723740 6930062 1767421 26257 267824 510062 1624517 1186667 1425697 1474734 9188 10784 13582 17188 9115354 3535565 5826127 5579789 27259 49430 9194194 8828654 1750816 658046 231844 4176340 4465367 5927156 5355257 X 1915376 2069291 1351662 1404106 3267038 3473397 9194194 8828654 400620 -194261 0 X 0 1 X 0 1 1 X 5532603 5732065 4822159 3855566 2762794 22705187 5532603 5732065 4822159 3855566 2762794 22705187 22705187 5408 5017 1413 84921 75069 171828 122524 108625 122868 95245 47949 497211 23374226 22309259 0.97140 0.98850 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2008 AMOUNT: $ 122,524. 2009 AMOUNT: $ 108,625. 2010 AMOUNT: $ 122,868. 2011 AMOUNT: $ 95,245. 2012 AMOUNT: $ 47,949. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1618324 1618324 4345616 1376127 2969489 763083 558647 204436 2388331 1600791 787540 5579789 X 9134182 0 9134182 -9822 -9822 9124360 8733562 9822 9822 8723740 0 8723740 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: CLINICA IS A NONPROFIT CORPORATION EXEMPT FROM THE PAYMENT OF INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND CALIFORNIA REVENUE AND TAXATION CODE SECTION 23701(D). ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. HOWEVER, CLINICA IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS NOT IN FURTHERANCE OF THE PURPOSES FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE FINANCIAL STATEMENTS TAKEN AS A WHOLE. CLINICA FOLLOWS THE ACCOUNTING STANDARDS FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. CLINICA FILES INFORMATION RETURNS AS A TAX EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE INTERNAL REVENUE SERVICE. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: OFFSETTING EXPENSES RELATED TO RENTAL REVENUE -9,822. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES TO OFFSET RENTAL REVENUE 9,822. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL: A) CONSIST OF FOUR (4) OFFICERS AND THE IMMEDIATE PAST PRESIDENT OF THE BOARD. IF THERE IS NO IMMEDIATE PAST PRESIDENT OF THE BOARD THEN SERVING AS A DIRECTOR, THE PRESIDENT MAY, IN HIS OR HER DISCRETION, APPOINT AN ADDITIONAL MEMBER TO THE COMMITTEE FROM AMONG THE OTHER DIRECTORS THEN IN OFFICE. IN ADDITION, THE EXECUTIVE DIRECTOR AND SUCH OTHER NON-DIRECTORS AS ARE DESIGNATED FROM TIME TO TIME BY THE BOARD OF DIRECTORS, MAY BE NON- VOTING ADVISORS TO THE EXECUTIVE COMMITTEE. B) HAVE AND EXERCISE SUCH AUTHORITY AS MAY BE DELEGATED TO IT BY THE BOARD AND ACT IN ITS ABSENCE DURING AN EMERGENCY IF THE FULL BOARD IS UNABLE TO MEET. C) HAVE OVERSIGHT OVER STRATEGIC PLANNING FOR CLINICA. D) WORK WITH THE EXECUTIVE DIRECTOR AND DEVELOPMENT DEPARTMENT TO OBTAIN FUNDS FROM A BROAD RANGE OF SOURCES IN BOTH THE PUBLIC AND PRIVATE SECTORS INCLUDING: INDIVIDUALS, CORPORATIONS, FOUNDATIONS AND GOVERNMENT. E) MEET MONTHLY AT A TIME AND PLACE DETERMINED BY THE COMMITTEE. SPECIAL MEETINGS SHALL BE CALLED BY THE PRESIDENT, OR AT THE WRITTEN REQUEST OF AT LEAST TWO COMMITTEE MEMBERS. T) A MAJORITY OF THE MEMBERS SHALL CONSTITUTE A QUORUM. FORM 990, PART VI, SECTION B, LINE 11 CLINICA MSR OSCAR A ROMERO OUTSIDE AUDITORS AND FINANCIAL STAFF PREPARE THE FORM 990. THE FORM IS THEN REVIEWED AND APPROVED BY THE ORGANIZATION'S CONTROLLER OR CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER. THE FORM IS THEN SENT TO THE FULL BOARD BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CLINICA MSR OSCAR A ROMERO (CMOAR) REQUIRES ALL EMPLOYEES TO DISCLOSE, AT LEAST ANNUALLY, ALL SOURCES OF INCOME FROM COMPENSATION OR FROM OWNERSHIP OF EVERY OUTSIDE ENTITY THAT (A) SOLD, SUPPLIED OR PROVIDED SERVICES (B) OPERATED A COMPETING ENTERPRISE OR (C) PROVIDED GOODS OR SERVICES TO CMOAR IN THE LAST SIX MONTHS. CMOAR ALSO REQUIRES ALL DIRECTORS TO ANNUALLY SIGN A STATEMENT AFFIRMING (A) RECEIPT OF CMOAR CONFLICT OF INTEREST POLICY (B) UNDERSTANDING OF THE POLICY AND (C) AGREEMENT WITH THE POLICY. CMOAR CONFLICT OF INTEREST POLICY DESCRIBES HOW CMOAR WILL RESOLVE POSSIBLE CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD REVIEWED CLINICA MSR OSCAR A ROMERO CEO'S COMPENSATION. THE BOARD REVIEWED DATA OF COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED NONPROFIT EXECUTIVES. THE OCCURRENCE OF THESE DELIBERATION ARE NOTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. IN ADDITION TO BEING AVAILABLE UPON REQUEST, THE ORGANIZATION'S FORM 990 IS AVAILABLE AT WWW.GUIDESTAR.ORG.